Читать книгу Anterior Skull Base Tumors - Группа авторов - Страница 89

Nowadays, surgeons have a wide armamentarium of surgical approaches available to safely treat sinonasal malignancies, which includes open approaches, with the traditional craniofacial resection (CFR), and endoscopic transnasal techniques. The correct choice depends on the features of the pathology. It is well known that endoscopic approaches have a lower morbidity compared with traditional open techniques, due to a shorter hospitalization, absence of facial incisions, and avoidance of brain retraction. Moreover, endoscopic surgery presents clear technical advantages. For example, magnification of the surgical field allows the surgeon to carefully identify tumor margins, the site of origin, and the anatomical structures involved by the lesion. Nevertheless, a purely endoscopic approach cannot always provide successful resection of the tumor; the patient must be informed about the possibility of switching to a combined cranioendoscopic resection or CRF, depending on the effective extension of the disease evaluated intraoperatively. Despite these advantages, postoperative complications can occur after endoscopic endonasal surgery, as in any surgical intervention; however, complications after these procedures are less severe and less frequent compared with traditional open approaches. The most common complications observed include skull base reconstruction failure, intraoperative vascular lesions, and orbital or central nervous system complications. Thus, endoscopic endonasal resection, when properly planned and performed by experienced surgeons, is an acceptable treatment for well-selected skull base malignancies with long-term outcomes comparable to those achieved with traditional external approaches.

© 2020 S. Karger AG, Basel

Nowadays, the surgeon has a large armamentarium of surgical approaches available to safely treat sinonasal malignancies that includes open approaches, with the traditional craniofacial resection (CFR) [1], as well as endoscopic endonasal techniques. The correct choice depends on the features of the pathology.

Previously, open approaches with “en bloc resection” [2] were the only reasonable way to adequately treat sinonasal malignancies; in recent decades, however, endoscopic techniques have progressively improved, and can currently be considered as a valid and safe surgical method to accomplish a radical resection of many sinonasal neoplasms [3]. The most important concept approved by the scientific community is “tumor disassembling,” which is a surgical strategy of resection that is considered to be as safe as the traditional “en bloc resection,” with the same oncological outcomes.

Table 1. Indications and contraindications of transnasal endoscopic surgery for malignancies of the sinus and skull base

The evolution of endoscopic procedures has been possible, during recent decades, thanks to several factors, including improvements in surgical technique, especially concerning surgical instrumentation development, refined radiological and diagnostic methods to assess patients preoperatively, and additional expertise in skull base reconstruction techniques (Fig. 1). The major advantages of an endoscopic approach include limited morbidity mainly due to avoidance of any brain retraction during the surgical intervention [2–4], avoidance of facial incisions and osteotomies, and reduced hospitalization time. Moreover, the magnification of surgical field visualization allows the surgeon to carefully identify tumor margins, the site of origin, and anatomical structures involved by the lesion.