Craniofacial surgery for removing tumors in advanced stages that invade the anterior skull base

Craniofacial surgery provides optimal exposure of the sinonasal cavity, epidural space, and intracranial anterior fossa compartments, facilitating oncologically en bloc radical resection from an oncological standpoint. This study represents the largest series of patients undergoing craniofacial surgery in Latin America published to date. This study aims to characterize the clinical profiles of patients undergoing craniofacial surgery and to describe the technical nuances of the combined subfrontal-transbasal and midfacial degloving approach, which we consider the most appropriate surgical strategy for patients with anterior skull base neoplasms at our center.

Between 2013 and 2025, 228 consecutive patients underwent craniofacial surgery at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico. Data on clinical presentation, tumor histology, type of approach, and surgical outcomes were retrospectively investigated in institutional databases.

There were 128 males (56.1%), and the mean age was 50.8 years. The most frequent symptoms were nasal obstruction (60%), epistaxis/rhinorrhea (54.3%), cephalea/facial pain (41.2%), and olfactory disturbances (27.1%). The most frequent neoplasms were epidermoid carcinoma (19.2%), esthesioneuroblastoma (13.5%), and inverted papilloma (8.3%). The most frequently performed cranial approach was the transbasal subfrontal approach (67.9%). A total of 32.4% of patients experience progression/recurrence of their disease. Infection was the most frequent complication (4.8%). Neoadjuvant therapy was administered at 12.7%. Adjuvant therapy, such as radiotherapy (RT), was administered at 36.8%, chemotherapy (CMT) at 5.2%, and RT + CMT at 24.5%. The mean follow-up time was 51.2 months. The immediate postoperative survival rate was 100%; at 6 months, it was 94.7%; at 1 year, it was 84.2%; and at 3 years, it was 51.7%. There was no perioperative mortality.

The combination of a subfrontal-transbasal plus midfacial degloving approach is preferable for neoplasms located in the anterior skull base because they are generally very large at the time of diagnosis, mainly for the management of malignancies in advanced stages. Histology, localization, extension, relation with neurovascular structures, extra or intracranial, and extra or intradural invasion are factors to consider in the selection of the surgical approach. Multidisciplinary management is the key to getting successful results in the treatment of tumors in these areas.