eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Craniofacial Surgery

Anterior Subfrontal Approach - Tumor Removal: Multimedia

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

Multimedia

CT scan coronal view demonstrating an osteosarcom...Media file 1: CT scan coronal view demonstrating an osteosarcoma of the ethmoid sinuses extending to the orbit and anterior cranial fossa.
CT scan coronal view demonstrating an osteosarcom...

CT scan coronal view demonstrating an osteosarcoma of the ethmoid sinuses extending to the orbit and anterior cranial fossa.

MRI axial view demonstrating extensive invasion o...Media file 2: MRI axial view demonstrating extensive invasion of the frontal lobes by an adenocarcinoma.
MRI axial view demonstrating extensive invasion o...

MRI axial view demonstrating extensive invasion of the frontal lobes by an adenocarcinoma.

MRI sagittal view demonstrating invasion of the f...Media file 3: MRI sagittal view demonstrating invasion of the fontal lobes by an osteosarcoma.
MRI sagittal view demonstrating invasion of the f...

MRI sagittal view demonstrating invasion of the fontal lobes by an osteosarcoma.

Markings for a bicoronal incision.Media file 4: Markings for a bicoronal incision.
Markings for a bicoronal incision.

Markings for a bicoronal incision.

Markings for a lateral rhinotomy incision.Media file 5: Markings for a lateral rhinotomy incision.
Markings for a lateral rhinotomy incision.

Markings for a lateral rhinotomy incision.

Intraoperative demonstration of a degloving appro...Media file 6: Intraoperative demonstration of a degloving approach.
Intraoperative demonstration of a degloving appro...

Intraoperative demonstration of a degloving approach.

Exposure of the superior orbital rims and glabell...Media file 7: Exposure of the superior orbital rims and glabella. The supraorbital neurovascular bundles have been freed from their canal and are being retracted to facilitate the exposure.
Exposure of the superior orbital rims and glabell...

Exposure of the superior orbital rims and glabella. The supraorbital neurovascular bundles have been freed from their canal and are being retracted to facilitate the exposure.

Craniotomy bone graft including the orbital rims ...Media file 8: Craniotomy bone graft including the orbital rims and glabella as a monobloc.
Craniotomy bone graft including the orbital rims ...

Craniotomy bone graft including the orbital rims and glabella as a monobloc.

Craniotomy and supraorbital block removed as sepa...Media file 9: Craniotomy and supraorbital block removed as separate bone grafts.
Craniotomy and supraorbital block removed as sepa...

Craniotomy and supraorbital block removed as separate bone grafts.

Surgical specimen after en bloc resection of ante...Media file 10: Surgical specimen after en bloc resection of anterior cranium, ethmoids, septum, and cribriform plate (posterior view).
Surgical specimen after en bloc resection of ante...

Surgical specimen after en bloc resection of anterior cranium, ethmoids, septum, and cribriform plate (posterior view).

Neurosurgical view after bifrontal craniotomy. Th...Media file 11: Neurosurgical view after bifrontal craniotomy. The osteotomies to remove the supraorbital block have been performed, but the rims are still in place.
Neurosurgical view after bifrontal craniotomy. Th...

Neurosurgical view after bifrontal craniotomy. The osteotomies to remove the supraorbital block have been performed, but the rims are still in place.

Neurosurgical view after the supraorbital rims an...Media file 12: Neurosurgical view after the supraorbital rims and glabella have been removed, enhancing access to the cribriform plate area.
Neurosurgical view after the supraorbital rims an...

Neurosurgical view after the supraorbital rims and glabella have been removed, enhancing access to the cribriform plate area.

Defect after resection of the cribriform plate.Media file 13: Defect after resection of the cribriform plate.
Defect after resection of the cribriform plate.

Defect after resection of the cribriform plate.

Elevation of a pericranial flap.Media file 14: Elevation of a pericranial flap.
Elevation of a pericranial flap.

Elevation of a pericranial flap.

Fixation of the cranial bone grafts with titanium...Media file 15: Fixation of the cranial bone grafts with titanium adaptation plates. Titanium mesh is used to cover bone gaps caused by the loss of bone associated with the craniotomy.
Fixation of the cranial bone grafts with titanium...

Fixation of the cranial bone grafts with titanium adaptation plates. Titanium mesh is used to cover bone gaps caused by the loss of bone associated with the craniotomy.

Reconstruction of the glabellar area using titani...Media file 16: Reconstruction of the glabellar area using titanium mesh.
Reconstruction of the glabellar area using titani...

Reconstruction of the glabellar area using titanium mesh.

CT scan axial view demonstrating a tension pneumo...Media file 17: CT scan axial view demonstrating a tension pneumocephalus. In the author's experience, this is the most common major complication after an anterior craniofacial resection.
CT scan axial view demonstrating a tension pneumo...

CT scan axial view demonstrating a tension pneumocephalus. In the author's experience, this is the most common major complication after an anterior craniofacial resection.

CT scan axial view of a frontal lobe contusion af...Media file 18: CT scan axial view of a frontal lobe contusion after an anterior craniofacial resection. A subfrontal approach was not used, resulting in the need for brain retraction with the subsequent trauma.
CT scan axial view of a frontal lobe contusion af...

CT scan axial view of a frontal lobe contusion after an anterior craniofacial resection. A subfrontal approach was not used, resulting in the need for brain retraction with the subsequent trauma.

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

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].

Further Reading

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

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

 
 
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