Endoscopic Craniofacial Resection, an Emerging Epitome of Anterior Skull Base Tumor Resection

Anterior skull base (ASB) malignancies have conventionally been treated with craniofacial resection (CFR), yet this approach is associated with significant morbidity and mortality rates. Recent advancements in endoscopic surgical techniques offer a promising alternative. This study aims to evaluate the morbidity, mortality, recurrence, metastasis, and survival rates of open CFR versus endoscopic CFR for ASB malignancies. A retrospective analysis was conducted on 24 patients who underwent surgery for sinonasal malignancies between January 2017 and July 2023. Patient demographics, tumor characteristics, surgical details, complications, and outcomes were assessed. Surgical procedures included endoscopic resection or open CFR. Statistical analyses were performed using Fisher's exact test and Wilcoxon rank sum test. Survival was estimated using the Kaplan-Meier method. Among 24 patients, 18 underwent CFR, with 13 receiving endoscopic CFR and 5 undergoing open CFR. Male predominance (mean age 40.8 years) and squamous cell carcinoma were common. Endoscopic CFR showed favorable outcomes in terms of visualization, bleeding, surgery duration, complications, and cosmesis compared to open CFR. All endoscopic patients underwent piecemeal resection, with 12 achieving negative margins. Postoperative radiotherapy was administered to all patients. Mean survival time was similar between endoscopic (709±5.5 days) and open (707±7 days) groups, with no significant difference in recurrence rates. Endoscopic CFR emerges as a feasible alternative to open CFR for ASB malignancies, offering comparable outcomes with reduced morbidity. Advancements in endoscopic techniques demonstrate promising results, highlighting the potential of endoscopic surgery in this complex anatomical region. Further studies are warranted to validate these findings and establish endoscopic CFR as a standard approach for ASB malignancies.