Читать книгу Anterior Skull Base Tumors - Группа авторов - Страница 96

Once the posteroinferior and anterosuperior margins of the resection are exposed, subperiosteal dissection of the nasal-ethmoidal-sphenoidal complex is performed unilaterally or bilaterally (according to the extension of disease) to expose the lateral margins [10]. The lamina papyracea is included in the dissection when the tumor is in close proximity to or frankly involves it. When required by extension of disease, an endoscopic medial maxillectomy can be performed to achieve good control of the entire maxillary sinus [13]. Superiorly, the dissection is continued in the anteroposterior direction by resecting the olfactory fibers and the basal lamella of the ethmoidal turbinate(s) to mobilize the specimen. The entire nasal-ethmoidal-sphenoidal complex is then isolated and pushed toward the central part of the nasal fossa (centripetal technique) to remove it transorally or through the nasal vestibule. Surgical margins are checked by frozen sections and, if necessary, the resection is extended until free margins are obtained.