eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Craniofacial Surgery

Anterior Subfrontal Approach - Tumor Removal: Follow-up

Author: Ricardo L Carrau, MD, Professor, Departments of Otolaryngology and Neurological Surgery, University of Pittsburgh School of Medicine; Professor of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine
Coauthor(s): Amin B Kassam, MD, Professor and Chairman, Department of Neurological Surgery, University of Pittsburgh School of Medicine; Director, Minimally Invasive Endoneurosurgery Center, University of Pittsburgh Medical Center; Carl H Snyderman, MD, Professor, Departments of Otolaryngology and Neurological Surgery, University of Pittsburgh Medical Center; Amol M Bhatki, MD, Attending Physician, Department Of Otolaryngology–Head and Neck Surgery, Co-Director, Skull Base Surgery Center, Baylor University Medical Center
Contributor Information and Disclosures

Updated: Jul 8, 2009

Outcome and Prognosis

The prognosis of lesions that require a subfrontal approach for their resection mostly depends on histologic diagnosis and the completeness of the resection. On one side of the spectrum, high-grade sarcomas and melanomas have a dismal prognosis because of their propensity for early metastasis (ie, <10% of patients alive and without disease at 5 y). Conversely, adenocarcinomas have an excellent prognosis (ie, >75% of patients alive and without evidence of disease at 5 y). Patients with SCCA have a 5-year survival rate of 60%. Adenoid cystic carcinoma of the skull base is somewhat unpredictable but behaves more aggressively than adenoid cystic carcinomas in other parts of the head and neck (eg, salivary gland).

Future and Controversies

Use of endoscopic techniques to complement or replace traditional approaches is rapidly expanding. Intraoperative navigational devices (computer-assisted surgery) and high-definition monitors and cameras, customized instruments, and new endovascular neurosurgery techniques that allow intraoperative control of the intracranial vasculature will contribute to the advancement of these techniques. Adjunctive techniques, such as brachytherapy, radiosurgery, intra-arterial chemotherapy, and chemotherapy combined with radiation, may have a role in treatment of these lesions. However, the role of these treatments remains undefined. Reports are mainly anecdotal, and their use should be limited to controlled protocols, palliative cases, or poor surgical candidates for whom conventional therapy has failed.

 


More on Anterior Subfrontal Approach - Tumor Removal

Overview: Anterior Subfrontal Approach - Tumor Removal
Workup: Anterior Subfrontal Approach - Tumor Removal
Treatment: Anterior Subfrontal Approach - Tumor Removal
Follow-up: Anterior Subfrontal Approach - Tumor Removal
Multimedia: Anterior Subfrontal Approach - Tumor Removal
References
[ CLOSE WINDOW ]

References

  1. Smith RR, Klopp CT, Williams JM. Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer. 1954;7:991-994.

  2. Ketcham AS, Wilkins RH, Van Buren JM. A combined intracranial facial approach to the paranasal sinuses. Am J Surg. 1963;106:698-703.

  3. Tessier P, Guiot G, Derome P. Orbital hypertelorism. II. Definite treatment of orbital hypertelorism (OR.H.) by craniofacial or by extracranial osteotomies. Scand J Plast Reconstr Surg. 1973;7(1):39-58. [Medline].

  4. Dave SP, Bared A, Casiano RR. Surgical outcomes and safety of transnasal endoscopic resection for anterior skull tumors. Otolaryngol Head Neck Surg. Jun 2007;136(6):920-7. [Medline].

  5. Acheson ED, Pippard EC, Winter PD. Mortality of English furniture makers. Scand J Work Environ Health. Aug 1984;10(4):211-7. [Medline].

  6. Alberti PW. Applied surgical anatomy of the maxillary sinus. Otolaryngol Clin North Am. Feb 1976;9(1):3-20. [Medline].

  7. Blacklock JB, Weber RS, Lee YY, Goepfert H. Transcranial resection of tumors of the paranasal sinuses and nasal cavity. J Neurosurg. Jul 1989;71(1):10-5. [Medline].

  8. Bridger GP. Radical surgery for ethmoid cancer. Arch Otolaryngol. Oct 1980;106(10):630-4. [Medline].

  9. Bridger MW, Beale FA, Bryce DP. Carcinom of the paranasal sinuses--a review of 158 cases. J Otolaryngol. Oct 1978;7(5):379-88. [Medline].

  10. Castelnuovo P, Bignami M, Delu G, Battaglia P, Bignardi M, Dallan I. Endonasal endoscopic resection and radiotherapy in olfactory neuroblastoma: our experience. Head Neck. Sep 2007;29(9):845-50. [Medline].

  11. Cavallo LM, Messina A, Cappabianca P, et al. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus. Jul 15 2005;19(1):E2. [Medline].

  12. Cellini N, De Santis M, Mantello G, Stella C, Trodella L, Valentini V. Radiation therapy of cancer of paranasal sinuses: a report on 86 patients. Rays. May-Aug 1987;12(2):71-9, 109-10. [Medline].

  13. Cheesman AD, Lund VJ, Howard DJ. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses. Head Neck Surg. Jul-Aug 1986;8(6):429-35. [Medline].

  14. Cheng VS, Wang CC. Carcinomas of the paranasal sinuses: a study of sixty-six cases. Cancer. Dec 1977;40(6):3038-41. [Medline].

  15. Clifford P. Transcranial--facial approach for tumours of superior paranasal sinuses and orbit. J R Soc Med. Jun 1980;73(6):413-9. [Medline].

  16. Eibling DE, Janecka IP, Snyderman CH. Meta-analysis of outcome in anterior skull base resection for squamous cell and undifferentiated carcinoma. Skull Base Surg. 1993;3:123-129.

  17. Folbe A, Herzallah I, Duvvuri U, et al. Endoscopic endonasal resection of esthesioneuroblastoma: a multicenter study. Am J Rhinol Allergy. Jan-Feb 2009;23(1):91-4. [Medline].

  18. Frazell E, Lewis JS. Cancer of the nasal cavity and accessory sinuses: a report on the management of 416 patients. Cancer. 1963;16:1293.

  19. Fujii K, Chambers SM, Rhoton AL Jr. Neurovascular relationships of the sphenoid sinus. A microsurgical study. J Neurosurg. Jan 1979;50(1):31-9. [Medline].

  20. Gardner PA, Kassam AB, Thomas A, et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery. Jul 2008;63(1):36-52; discussion 52-4. [Medline].

  21. Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. Oct 2006;116(10):1882-6. [Medline].

  22. Hengerer AS. Embryologic development of the sinuses. Ear Nose Throat J. Apr 1984;63(4):134-6. [Medline].

  23. Hernberg S, Westerholm P, Schultz-Larsen K, et al. Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden. Scand J Work Environ Health. Aug 1983;9(4):315-26. [Medline].

  24. Jackson RT, Fitz-Hugh GS, Constable WC. Malignant neoplasms of the nasal cavities and paranasal sinuses: (a retrospective study). Laryngoscope. May 1977;87(5 Pt 1):726-36. [Medline].

  25. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. Jul 15 2005;19(1):E3. [Medline].

  26. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. Jul 15 2005;19(1):E3. [Medline].

  27. Kassam AB, Thomas A, Carrau RL, et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery. Jul 2008;63(1 Suppl 1):ONS44-52; discussion ONS52-3. [Medline].

  28. Ketcham AS, Van Buren JM. Tumors of the paranasal sinuses: a therapeutic challenge. Am J Surg. Oct 1985;150(4):406-13. [Medline].

  29. Klintenberg C, Olofsson J, Hellquist H, Sökjer H. Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure. Cancer. Aug 1 1984;54(3):482-8. [Medline].

  30. Lang J. The anterior and middle cranial fossae including the cavernous sinus and orbit. In: Sekhar LN, Janecka, IP, eds. Surgery of Cranial Base Tumors. 99. New York: Raven Press; 1993.

  31. Lewis JS, Castro EB. Cancer of the nasal cavity and paranasal sinuses. J Laryngol Otol. Mar 1972;86(3):255-62. [Medline].

  32. Lund VJ, Harrison DF. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses. Am J Surg. Sep 1988;156(3 Pt 1):187-90. [Medline].

  33. Morgenstein KM. Intranasal sphenoethmoidectomy and antrotomy. Otolaryngol Clin North Am. Feb 1985;18(1):69-74. [Medline].

  34. Myers EN, Carrau RL. Neoplasms of the nose and paranasal sinuses. Head and Neck Surgery-Otolaryngology. 1993;1091-1109.

  35. Panje WR, Dohrmann GJ 3rd, Pitcock JK, et al. The transfacial approach for combined anterior craniofacial tumor ablation. Arch Otolaryngol Head Neck Surg. Mar 1989;115(3):301-7. [Medline].

  36. Parsons JT, Mendenhall WM, Mancuso AA, Cassisi NJ, Million RR. Malignant tumors of the nasal cavity and ethmoid and sphenoid sinuses. Int J Radiat Oncol Biol Phys. Jan 1988;14(1):11-22. [Medline].

  37. Patel SG, Singh B, Polluri A, Bridger PG, Cantu G, Cheesman AD. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer. Sep 15 2003;98(6):1179-87. [Medline].

  38. Pederson E, Hogetviet AC, Anderson A. Cancer of respiratory organs among workers at a nickel refinery in Norway. Int J Cancer. 1973;68:925.

  39. Roush GC, Meigs JW, Kelly JA, Flannery JT, Burdo H. Sinonasal cancer and occupation: a case-control study. Am J Epidemiol. Feb 1980;111(2):183-93. [Medline].

  40. Schramm VL Jr, Myers EN, Maroon JC. Anterior skull base surgery for benign and malignant disease. Laryngoscope. Jul 1979;89(7 Pt 1):1077-91. [Medline].

  41. Shah JP, Bilsky MH, Patel SG. Malignant tumors of the skull base. Neurosurg Focus. Oct 15 2002;13(4):e6. [Medline].

  42. Shah JP, Sundaresan N, Galicich J, Strong EW. Craniofacial resections for tumors involving the base of the skull. Am J Surg. Oct 1987;154(4):352-8. [Medline].

  43. Sisson GA Sr, Toriumi DM, Atiyah RA. Paranasal sinus malignancy: a comprehensive update. Laryngoscope. Feb 1989;99(2):143-50. [Medline].

  44. Sisson GA, Bytell DE, Becker SP, Ruge D. Carcinoma of the paranasal sinuses and cranial-facial resection. J Laryngol Otol. Jan 1976;90(1):59-68. [Medline].

  45. Snyderman CH, Carrau RL, deVries I. Carotid artery resection: Update on preoperative evaluation. In: Instructional Courses. Vol 6. 1993:341-344.

  46. Snyderman CH, Carrau RL, Kassam AB, et al. Endoscopic skull base surgery: principles of endonasal oncological surgery. J Surg Oncol. Jun 15 2008;97(8):658-64. [Medline].

  47. Snyderman CH, Sekhar LN, Sen CN. Malignant skull base tumors. In: The Role of Surgery in Brain Tumor Management. Vol 1. 1990:243-249.

  48. Spiro JD, Soo KC, Spiro RH. Squamous carcinoma of the nasal cavity and paranasal sinuses. Am J Surg. Oct 1989;158(4):328-32. [Medline].

  49. Stankiewicz JA. Complications of endoscopic sinus surgery. Otolaryngol Clin North Am. Aug 1989;22(4):749-58. [Medline].

  50. Suarez C, Llorente JL, Fernandez De Leon R, Maseda E, Lopez A. Prognostic factors in sinonasal tumors involving the anterior skull base. Head Neck. Feb 2004;26(2):136-44. [Medline].

  51. Walike JW. Anatomy of the nasal cavities. Otolaryngol Clin North Am. Oct 1973;6(3):609-21. [Medline].

  52. Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM. Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope. Jan 2009;119(1):13-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

tumor removal, anterior subfrontal approach, tumor, anterior craniofacial resection, anterior cranial base surgery, anterior skull base surgery, tumor resection, anterior craniofacial resection, endoscopic anterior skull base surgery

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ricardo L Carrau, MD, Professor, Departments of Otolaryngology and Neurological Surgery, University of Pittsburgh School of Medicine; Professor of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine
Ricardo L Carrau, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, North American Skull Base Society, Pennsylvania Medical Society, and Triological Society
Disclosure: Storz Endoscopy Inc Honoraria Speaking and teaching; Stryker Navigation Honoraria Speaking and teaching

Coauthor(s)

Amin B Kassam, MD, Professor and Chairman, Department of Neurological Surgery, University of Pittsburgh School of Medicine; Director, Minimally Invasive Endoneurosurgery Center, University of Pittsburgh Medical Center
Amin B Kassam, MD is a member of the following medical societies: American Association of Neurological Surgeons and Ontario Medical Association
Disclosure: Karl Storz Endoscopy Consulting fee Consulting; Stryker Instruments Consulting fee Consulting; NICO Corporation Equity stake Board membership

Carl H Snyderman, MD, Professor, Departments of Otolaryngology and Neurological Surgery, University of Pittsburgh Medical Center
Carl H Snyderman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, North American Skull Base Society, Pennsylvania Medical Society, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Amol M Bhatki, MD, Attending Physician, Department Of Otolaryngology–Head and Neck Surgery, Co-Director, Skull Base Surgery Center, Baylor University Medical Center
Amol M Bhatki, MD is a member of the following medical societies: Alpha Omega Alpha and American Rhinologic Society
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Kelley, MD, Consulting Staff, Eastern Shore ENT and Allergy Associates and Peninsula Regional Medical Center
Daniel J Kelley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.