Читать книгу Anterior Skull Base Tumors - Группа авторов - Страница 98

The key point for subsequently performing an optimal skull base reconstruction is to properly dissect the epidural space over the orbital roofs laterally, the planum sphenoidale posteriorly, and the posterior wall of the frontal sinus anteriorly before starting the resection of the dura. The dura is then incised and circumferentially cut with angled scissors or a dedicated scalpel, far enough away from the suspected area of tumor spread. The falx cerebri is clipped or cauterized in the anterior portion before its resection, to avoid sagittal sinus bleeding; next, the posterior portion at the level of the sphenoethmoidal planum is resected. The arachnoid plane over the intracranial portion of the tumor is dissected and separated from the brain parenchyma. The specimen, including the residual tumor, anterior skull base, and the overlying dura, together with one or both of the olfactory bulbs, is removed transnasally. Dural margins are sent for frozen sections. With small tumors, dural resection can be performed by leaving the ethmoidal complex attached to the skull base at the level of the olfactory grooves in a monobloc fashion.

Table 2. Intraoperative and postoperative complications rate during sinonasal and skull base endoscopic surgery