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Published on: July 5, 2021
An Algorithm for Surgical Approach to the Anterior Skull Base
Matthew R Naunheim1, Neerav Goyal1, Matthew M Dedmon1
1Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
Surgical management of anterior skull base malignancies can be achieved through various approaches, including endoscopic and craniofacial resection. An algorithm aids in selecting the optimal surgical strategy based on tumor assessment and complication rates.
Area of Science:
- Neurosurgery
- Otolaryngology
- Head and Neck Surgery
Background:
- Anterior skull base malignancies present complex surgical challenges.
- Multiple surgical approaches exist, each with potential benefits and drawbacks.
Purpose of the Study:
- To analyze surgical outcomes for anterior skull base malignancies.
- To develop an algorithm for guiding surgical approach selection.
Main Methods:
- Retrospective review of 67 patients undergoing resection.
- Analysis of endoscopic, cranioendoscopic, and craniofacial approaches.
- Evaluation of complications, recurrence, and survival rates.
Main Results:
- No significant difference in 5-year disease-free survival (82.1%) across approaches.
- Endoscopic approaches were less common for advanced T3/T4 tumors.
- Transfacial incisions were associated with higher rates of surgical site infection and sinocutaneous fistulae.
Conclusions:
- Sinonasal and skull base tumors can be safely managed surgically.
- An algorithmic approach, considering tumor characteristics and complication risks, optimizes surgical strategy.
