Endoscopic transnasal anterior skull base resection for the treatment of sinonasal malignancies

Since the landmark publication by Ketcham et al in the early 1960s, the resection of sinonasal tumors involving the anterior skull base combines transcranial and transfacial incisions and osteotomies. Recent technical and technologic advances have allowed the use of endoscopic approaches for the resection of these tumors. We report our technique for the endoscopic resection of tumors involving the anterior skull base. Our technique includes the extirpation of select tumors following critical premises, such as obtaining a complete resection and reestablishment of the separation of the sinonasal tract from the cranial cavity. There were 20 patients with various malignant tumors of the sinonasal tract operated on using an endoscopic technique. There are 19 patients alive and without evidence of disease at short-term follow-up (range 11-46 months) The only patient who presented with a recurrent tumor had a sinonasal undifferentiated carcinoma treated with primary chemoradiation. She died of an aggressive recurrence at 8 months postoperatively. In 20 patients, we did not encounter any intraoperative complication. However, postoperative complications included 1 episode of tension pneumocephalus, cerebrospinal fluid leak in 3 patients, and 1 episode of bacterial meningitis associated with a prior cerebrospinal fluid leak. Short-term results suggest that an endoscopic transnasal anterior skull base resection can be performed safely and effectively. Further experience and follow-up are required to ascertain the outcomes of patients treated with endoscopic techniques.