Читать книгу Anterior Skull Base Tumors - Группа авторов - Страница 80

Malignant tumors that arise within the maxillary sinus and grow toward the nasal cavity to eventually reach the ASB are, in most cases, very advanced and rare (Fig. 14). If surgery is considered in these patients, craniofacial resection is indicated, usually with adjuvant radiotherapy (± chemotherapy) [40]. The checklist for assessing the 3D extent should include, once more, six “vectors of growth.” They will comprise the potential invasion of the anterior wall and premaxillary soft tissues (anterior vector), the orbital floor and PNS along the infraorbital nerve (cranial vector), and the extension through the floor of the maxillary sinus, alveolar process, and hard palate (inferior and medial vectors). When a maxillary malignancy invades the posterolateral maxillary sinus wall (posterior and lateral vectors) it results in a deep pattern of growth, which leads to destruction of the pterygoid laminae, invasion of the PPF, and spread into the infratemporal fossa/masticator space. Further extent leads the tumor to infiltrate the middle skull base structures via involvement of the greater wing of the sphenoid, and its foramina, or the superior orbital fissure. Once the neoplasm grows inside these spaces and structures, there is a good chance of PNS along the branches of the trigeminal nerve into Meckel’s cave or into the cavernous sinus.