The expanded endonasal approach for the treatment of anterior skull base tumors

Bhatki, Amol M.; Pant, Harshita; Snyderman, Carl H.; Carrau, Ricardo L.; Gardner, Paul; Prevedello, Daniel M.; Kassam, Amin B.

doi:10.1016/j.otot.2009.10.002

« Previous Next »Operative Techniques in Otolaryngology - Head and Neck Surgery
Volume 21, Issue 1 , Pages 66-73, March 2010

The expanded endonasal approach for the treatment of anterior skull base tumors

Amol M. Bhatki, MD
- Department of Otolaryngology—Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Harshita Pant, MD, PhD
- Department of Otolaryngology, University of Adelaide, Adelaide, Australia
Carl H. Snyderman, MD, FACS
- Department of Otolaryngology—Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Address reprint requests and correspondence: Carl H. Snyderman, MD, FACS, Department of Otolaryngology, Eye and Ear Institute, Suite 500, 200 Lothrop Street, Pittsburgh, PA 15213
Ricardo L. Carrau, MD, FACS
- Department of Otolaryngology—Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Paul Gardner, MD
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Daniel M. Prevedello, MD
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Amin B. Kassam, MD, FRCSC
- Saint John's Health Center & John Wayne Cancer Institute, Santa Monica, California

Traditional approaches for the resection of tumors that involve the anterior cranial base used facial and scalp incisions, a craniotomy, and facial osteotomies. These approaches required frontal lobe retraction and sometimes resulted in cosmetic and functional deficits. With the advances in optics, surgical instrumentation, and image-guided surgery, the expanded endonasal approach (EEA) has provided a less intrusive corridor to the anterior skull base without compromising the goals of oncological resection. Our extensive experience with this approach has enabled us to perform a “craniofacial resection” for anterior skull base tumors without resorting to external incisions or a craniotomy. This report details the operative technique for a completely endoscopic endonasal resection of the anterior skull base that may be used for the resection of both benign and malignant tumors.

Keywords: Anterior cranial base, Endoscopic skull base surgery, Olfactory neuroblastoma, Esthesioneuroblastoma