Transglabellar Approach for Anterior Skull Base and Sinonasal Tumors

Background The anterior skull base is site of several pathologies of neoplastic origin. Skull base surgery nowadays has several techniques for the resection of tumors.

Objective Describe surgical results obtained with the transglabellar approach in lesions of the anterior skull base with sinonasal extension, offering an alternative to achieve greater resection, closely and directly related to better disease control and overall survival.

Methods Retrospective, descriptive, and analytical study. The technical details of the transglabellar approach described involve the experience of more than 5 years. We describe outcomes of important variables such as duration of surgery, intraoperative bleeding, complications, as well as the final postoperative outcome.

Results Nine patients were treated, seven men and two women, age ranges from 38 to 74 (average: 55.6 years); five patients with diagnosis of esthesioneuroblastoma, two with squamous cell carcinoma, one with adenoid cystic carcinoma, and one with meningioma. The mean results were surgical time of 4.7 hours, bleeding 594 mL, and hospital stay 4.4 days. Gross total resection was achieved in eight patients (88%). There was only one immediate complication of pneumocephalus, and a late cerebral abscess 3 months after the surgical procedure ([Table 1]).

Conclusion The choice of technique for the resection of lesions of the anterior skull base and sinonasal cavity is complex, implies precise anatomical knowledge and adequate management of neurovascular structures, and we consider this technique achieves the fundamental requirements; the absence of important neurovascular structures along the way, low rate of complications, and an in-hospital stay constitute an adequate anatomical corridor to achieve excellent postoperative results in relation to the degree of resection of lesions involving these compartments.

Fig. 1 (A067)

Table 1 (A067)

Case	Sex	Age (y)	Diagnosis	Operative time (h)	Bleeding (mL)	Hospital stay (d)	Resection	Complications
1	Male	45	ENB Kadish C	4	300	4	Total	No
2	Male	38	ENB Kadish C	7	1,200	5	Subtotal	No
3	Male	44	ENB Kadish C	4	600	4	Total	No
4	Male	50	ENB Kadish B	5	1,000	3	Total	No
5	Male	74	ENB Kadish B	4	300	2	Total	No
6	Male	68	Nonkeratinizing Sinonasal carcinoma	4	600	6	Total	3 mo postoperative brain abscess
7	Female	63	Epidermoid carcinoma	6	900	4	Total	No
8	Female	54	Meningioma	5	50	4	Total	No
9	Male	65	Adenoid cystic carcinoma	4	400	8	Total	Pneumocephalus