Combined Transcranial and Endoscopic Endonasal Approach for Resection of a Complex Sinonasal Squamous Cell Carcinoma:...

Area of Science:

• Otolaryngology
• Neurosurgery
• Head and Neck Oncology

Background:

• Sinonasal squamous cell carcinoma (SCC) is a rare malignancy with a high propensity for local invasion.
• Advanced SCC can involve critical structures like the orbits and brain, posing significant surgical challenges.
• Traditional treatments may be insufficient for extensive or inoperable tumors.

Purpose of the Study:

• To demonstrate a multidisciplinary surgical approach for resecting a large, complex sinonasal SCC.
• To illustrate the technical steps involved in a two-stage surgical resection including endoscopic and open craniotomy techniques.
• To showcase the feasibility of achieving near-complete gross total resection in challenging cases.

Main Methods:

• A two-step surgical strategy was employed: transcribiform endoscopic resection followed by bifrontal craniotomy.
• Skull base reconstruction utilized DuraMatrix and AlloDerm allografts.
• Preoperative and postoperative imaging were used to assess tumor extent and surgical outcomes.

Main Results:

• The multidisciplinary approach enabled near-complete gross total resection of the complex SCC lesion.
• The patient tolerated the procedure well, with no new neurological deficits postoperatively.
• Osteomyelitis was discovered intraoperatively and treated with a 6-week antibiotic regimen.

Conclusions:

• A multidisciplinary, staged surgical approach is effective for managing extensive sinonasal SCC involving the orbits and brain.
• This technique allows for complex tumor resection and reconstruction, potentially improving outcomes for challenging head-and-neck cancers.
• While the presented case had a fatal outcome due to sepsis post-discharge, the surgical technique demonstrated its capability for extensive tumor removal.