Читать книгу Anterior Skull Base Tumors - Группа авторов - Страница 90

In 2016, the indications and contraindications for endoscopic transnasal removal of sinonasal malignancies were summarized in detail (Table 1) [5]. Subsequently, we reported on a small series of patients with nasoethmoidal cancers of different histology and limited brain invasion, who had the lesion removed via a purely endoscopic approach. Local control at 3 years and complications were comparable to those in patients not receiving brain resection [6]. As mentioned earlier, a purely endoscopic approach is not always the ideal technique to achieve radical resection of a given tumor; accordingly, in borderline situations, the patient must be informed about the possibility of switching to a combined cranioendoscopic resection or CRF, depending on the extension of the disease, as assessed by the surgeon intraoperatively.

Fig. 1. Preoperative (a, b) and postoperative (c, d) contrast-enhanced MR scan of a 68-year-old patient, a woodworker, who presented with left unilateral epistaxis and nasal obstruction. Endoscopic endonasal biopsy of the lesion confirmed the suspicion of intestinal-type adenocarcinoma – G2. Neck ultrasound and CT scan of the chest and abdomen excluded other localizations of disease. The patient was submitted to ERTC that included the removal of both the ethmoidal complexes. Postoperatively, the patient underwent adjuvant irradiation of the surgical field (66 Gy on T and 54 Gy on N bilaterally, intensity modulated radiotherapy). Follow-up at 62 months showed no evidence of disease.

Cranioendoscopic resection, with frontal craniotomy, can be necessary in cases of massive involvement within the frontal sinus, infiltration of the dura far over the orbital roof, or extensive infiltration of the brain. On the other hand, CFR must be performed in cases of extensive lacrimal pathway infiltration, intraorbital invasion, hard-palate or anterolateral maxillary wall involvement, and/or erosion of the nasal bones; in these scenarios, more extensive resection with orbital exenteration or total maxillectomy is required [7–9].