Malignant ethmoidal neoplasms: a cranionasal endoscopy approach

Craniofacial resection has been adopted worldwide as the standard therapy for tumors of the paranasal sinuses involving the anterior skull base. Recent refinements in endoscopic techniques together with the development of related surgical instruments allow complete radical resection of complex anatomic structures through combined transcranial and endonasal approaches without compromising any oncological principles. We use a transcranial nasoendoscopic approach for ethmoid malignant tumors in stage I and II according to the Instituto Nazionale Tumori, Milano staging. With this technique, no cutaneous incisions and no approaching osteotomies of the facial skeleton were performed. This approach reduces the period of hospitalization and speeds recovery. Furthermore, intraoperative endoscopy facilitates placement of the osteotomies in the optimal position and improves the likelihood of achieving a complete en bloc resection with removal of all disease hitherto obscured from vision. It represents the choice indication to increase precocious postsurgery radiotherapy possibilities.