Proposed Classification for the Transbasal Approach and Its Modifications

Iman Feiz-Erfan; Robert F. Spetzler; Eric M. Horn; Randall W. Porter; Stephen P. Beals; Salvatore C. Lettieri; Edward F. Joganic; Franco DeMonte

doi:10.1055/s-2007-994292

Skull Base 2008; 18(1): 029-047
DOI: 10.1055/s-2007-994292

ORIGINAL ARTICLE

Proposed Classification for the Transbasal Approach and Its Modifications

Iman Feiz-Erfan¹ ^, ² ^, ³ , Robert F. Spetzler¹ , Eric M. Horn¹ ^, ⁴ , Randall W. Porter¹ , Stephen P. Beals⁵ , Salvatore C. Lettieri⁶ , Edward F. Joganic⁵ , Franco DeMonte²

¹Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
²Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
³Department of Surgery, Division of Neurosurgery, Maricopa Medical Center, Phoenix, Arizona
⁴Department of Neurosurgery, University of Indiana, Indianapolis, Indiana
⁵Southwest Craniofacial Center, Phoenix, Arizona
⁶Department of Surgery, Division of Plastic Surgery, Maricopa Medical Center, Phoenix, Arizona, and Mayo Clinic, Rochester, Minnesota

Abstract

ABSTRACT

The transbasal approach offers extradural exposure of the anterior midline skull base transcranially. It can be used to treat a variety of conditions, including trauma, craniofacial deformity, and tumors. This approach has been modified to enhance basal access. This article reviews the principle differences among modifications to the transbasal approach and introduces a new classification scheme. The rationale is to offer a uniform nomenclature to facilitate discussion of these approaches, their indications, and related issues.

KEYWORDS

Frontal fossa - skull base - subcranial - subfrontal - transbasal

Full Text

References

REFERENCES

1 Beals S P, Joganic E. Transfacial exposure of anterior cranial fossa and clival tumors. BNI Q. 1992; 8 2-18
2 Raso J L, Gusmäo S. Transbasal approach to skull base tumors: evaluation and proposal of classification. Surg Neurol. 2006; 65(suppl 1) S1:33-S1:37 discussion 1:37-1:38
3 Dandy W E. Orbital Tumors: Results Following the Transcranial Operative Attack. New York; Oskar Piest 1941
4 Unterberger S. Care of frontobasal wounds [in German]. Arch Ohren Nasen Kehlkopfheilkd. 1958; 172 463-484
5 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 39-58
6 Tessier P, Guiot G, Rougerie J, Delbet J P, Pastoriza J. Cranio-naso-orbito-facial osteotomies: hypertelorism. [in French]. Ann Chir Plast. 1967; 12 103-118
7 Tessier P. Orbital hypertelorism: I. Successive surgical attempts. Material and methods. Causes and mechanisms. Scand J Plast Reconstr Surg. 1972; 6 135-155
8 Ketcham A S, Wilkins R H, Van Buren J M, Smith R R. A combined intracranial facial approach to the paranasal sinuses. Am J Surg. 1963; 106 698-703
9 Smith R R, Klopp C T, Williams J M. Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer. 1954; 7 991-994
10 Ketcham A S, Hoye R C, Van Buren J M, Johnson R H, Smith R R, Anderson M. Complications of intracranial facial resection for tumors of the paranasal sinuses. Am J Surg. 1966; 112 591-596
11 Van Buren J M, Ommaya A K, Ketcham A S. Ten years' experience with radical combined craniofacial resection of malignant tumors of the paranasal sinuses. J Neurosurg. 1968; 28 341-350
12 Ketcham A S, Van Buren J M. Tumors of the paranasal sinuses: a therapeutic challenge. Am J Surg. 1985; 150 406-413
13 Derome P J. The transbasal approach to tumors invading the base of the skull. In: Schmidek HH, Sweet WH Operative Neurosurgical Techniques: Indications, Methods, and Results. Boston; Grune & Stratton 1982: 357-379
14 Converse J M, Ransohoff J, Mathews E S, Smith B, Molenaar A. Ocular hypertelorism and pseudohypertelorism: advances in surgical treatment. Plast Reconstr Surg. 1970; 45 1-13
15 Spetzler R F, Herman J M, Beals S, Joganic E, Milligan J. Preservation of olfaction in anterior craniofacial approaches. J Neurosurg. 1993; 79 48-52
16 Feiz-Erfan I, Han P P, Spetzler R F et al.. Preserving olfactory function in anterior craniofacial surgery through cribriform plate osteotomy applied in selected patients. Neurosurgery. 2005; 57 86-93 discussion 86-93
17 Lang D A, Honeybul S, Neil-Dwyer G, Evans B T, Weller R O, Gill J. The extended transbasal approach: clinical applications and complications. Acta Neurochir (Wien). 1999; 141 579-585
18 Saito K, Takahashi M, Fukuta K, Tachibana E, Yoshida J. Recovery of olfactory function after an anterior craniofacial approach. Skull Base Surg. 1999; 9 201-206
19 Kawauchi M, Tomita S, Asari S, Ohmoto T. Preservation of olfaction in frontal transbasal approach. [in Japanese]. No Shinkei Geka. 1997; 25 613-619
20 Raveh J, Turk J B, Ladrach K et al.. Extended anterior subcranial approach for skull base tumors: long term results. J Neurosurg. 1995; 82 1002-1010
21 Brahma B, Gunnlaugsson C, Gala V, Marentette B L, Thompson B G. Treatment of ethmoidal and medial-anterior cranial base pathology using the subcranial approach with attempted preservation of olfaction: outcome in 17 patients [abstract]. Skull Base. 2003; 13(suppl 1) 6
22 Browne J D, Mims J W. Preservation of olfaction in anterior skull base surgery. Laryngoscope. 2000; 110 1317-1322
23 Terasaka S, Day J D, Fukushima T. Extended transbasal approach: anatomy, technique, and indications. Skull Base Surg. 1999; 9 177-184
24 Feiz-Erfan I, Han P P, Spetzler R F et al.. Experience with the radical transbasal approach in resection of extensive benign anterior skull base tumors [abstract]. Skull Base. 2003; 13(suppl 1) 6
25 Feiz-Erfan I, Han P P, Spetzler R F et al.. Exposure of midline cranial base without a facial incision through a combined craniofacial-transfacial procedure. Neurosurgery. 2005; 56 28-35
26 George B, Clemenceau S, Cophignon J et al.. Anterior skull base tumour: the choice between cranial and facial approaches, single and combined procedure-from a series of 78 cases. Acta Neurochir Suppl (Wien). 1991; 53 7-13
27 Spetzler R F, Pappas C T. Management of anterior skull base tumors. Clin Neurosurg. 1991; 37 490-501
28 Arita N, Mori S, Sano M et al.. Surgical treatment of tumors in the anterior skull base using the transbasal approach. Neurosurgery. 1989; 24 379-384
29 Osguthorpe J D, Patel S. Craniofacial approaches to sinus malignancy. Otolaryngol Clin North Am. 1995; 28 1239-1257
30 Fujitsu K, Saijoh M, Aoki F et al.. Telecanthal approach for meningiomas in the ethmoid and sphenoid sinuses. Neurosurgery. 1991; 28 714-719
31 Honeybul S, Neil-Dwyer G, Lang D A, Evans B T, Weller R O, Gill J. The extended transbasal approach: a quantitative anatomical and histological study. Acta Neurochir (Wien). 1999; 141 251-259
32 Cophignon J, George B, Marchac D, Roux F. Enlarged transbasal approach by mobilization of the medial fronto-orbital ridge. Neurochirurgie. 1983; 29 407-410
33 Feiz-Erfan I, Han P P, Spetzler R F et al.. The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg. 2005; 103 485-490
34 Pompili A, Caroli F, Iandolo B, Mazzitelli M R, Riccio A. Giant osteoma of the sphenoid sinus reached by an extradural transbasal approach: case report. Neurosurgery. 1985; 17 818-821
35 Jane J A, Park T S, Pobereskin L H, Winn H R, Butler A B. The supraorbital approach: technical note. Neurosurgery. 1982; 11 537-542
36 Morioka M, Hamada J, Yano S et al.. Frontal skull base surgery combined with endonasal endoscopic sinus surgery. Surg Neurol. 2005; 64 44-49
37 Fliss D M, Zucker G, Cohen A et al.. Early outcome and complications of the extended subcranial approach to the anterior skull base. Laryngoscope. 1999; 109 153-160
38 Kellman R M, Marentette L. The transglabellar/subcranial approach to the anterior skull base: a review of 72 cases. Arch Otolaryngol Head Neck Surg. 2001; 127 687-690
39 Samii M, Draf W. Surgery of space-occupying lesions of the anterior skull base. In: Samii M, Draf W Surgery of the Skull Base: An Interdisciplinary Approach. New York; Springer-Verlag 1989: 159-232
40 Alvarez-Garijo J A, Cavadas P, Vila M, Fabregat J, Alvarez A. Craniopharyngioma in children: surgical treatment by a transbasal anterior approach. Childs Nerv Syst. 1998; 14 709-712
41 Liu J K, Decker D, Schaefer S D et al.. Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors. Neurosurgery. 2003; 53 1126-1137
42 Sekhar L N, Nanda A, Sen C N, Snyderman C N, Janecka I P. The extended frontal approach to tumors of the anterior, middle, and posterior skull base. J Neurosurg. 1992; 76 198-206
43 Kurtsoy A, Menku A, Tucer B et al.. Transbasal approaches: surgical details, pitfalls and avoidances. Neurosurg Rev. 2004; 27 267-273
44 Tzortzidis F, Bejjani G, Papadas T et al.. Craniofacial osteotomies to facilitate resection of large tumours of the anterior skull base. J Craniomaxillofac Surg. 1996; 24 224-229
45 Sekhar L N, Wright D C. Resection of anterior, middle, and posterior cranial base tumors via the extended subfrontal approach. In: Sekhar LN, deOliveira E Cranial Microsurgery: Approaches and Techniques. New York; Thieme 1999: 82-90
46 Moore C E, Ross D A, Marentette L J. Subcranial approach to tumors of the anterior cranial base: analysis of current and traditional surgical techniques. Otolaryngol Head Neck Surg. 1999; 120 387-390
47 Obeid F, Al Mefty O. Recurrence of olfactory groove meningiomas. Neurosurgery. 2003; 53 534-542
48 Fahlbusch R, Neubauer U, Wigand M et al.. Neuro-rhinosurgical treatment of aesthesioneuroblastoma. Acta Neurochir (Wien). 1989; 100 93-100
49 Zhou L, Guo H, Li S, Ji Y, Huang F. An extensive subfrontal approach to the lesions involving the skull base. Chin Med J (Engl). 1995; 108 407-412
50 Maroon J C, Kennerdell J S. Microsurgical approach to orbital tumors. Clin Neurosurg. 1979; 26 479-489
51 Kawakami K, Yamanouchi Y, Kubota C, Kawamura Y, Matsumura H. An extensive transbasal approach to frontal skull-base tumors: technical note. J Neurosurg. 1992; 74 1011-1013
52 Shen J, Hu J, Hu B et al.. Extensive transbasal approach for removal of tumours in the nasal, sphenoid and clival regions [in Chinese]. Zhonghua Wai Ke Za Zhi. 1999; 37 35-37
53 Delfini R, Missori P, Iannetti G, Ciappetta P, Cantore G. Mucoceles of the paranasal sinuses with intracranial and intraorbital extension: report of 28 cases. Neurosurgery. 1993; 32 901-906
54 DeMonte F. The Chandler/Silva article reviewed. Oncology (Williston Park). 2005; 19 923
55 Shah J P, Kraus D H, Bilsky M H, Gutin P H, Harrison L H, Strong E W. Craniofacial resection for malignant tumors involving the anterior skull base. Arch Otolaryngol Head Neck Surg. 1997; 123 1312-1317
56 Hallacq P, Moreau J-J, Fischer G, Béziat J-L. Trans-sinusal frontal approach for olfactory groove meningiomas. Skull Base. 2001; 11 35-46
57 Persing J A, Jane J A, Levine P A, Cantrell R W. The versatile frontal sinus approach to the floor of the anterior cranial fossa: technical note. J Neurosurg. 1990; 72 513-516
58 Kaplan M J, Jane J A, Park T S, Cantrell R W. Supraorbital rim approach to the anterior skull base. Laryngoscope. 1984; 94 1137-1139
59 Lesoin F, Thomas III C E, Villette L, Pellerin P, Jomin M. The midline supra-orbital approach, using a large single free bone flap: technical note. Acta Neurochir (Wien). 1987; 87 86-89
60 Chandler J P, Pelzer H J, Bendok B B, Hunt B H, Salehi S A. Advances in surgical management of malignancies of the cranial base: the extended transbasal approach. J Neurooncol. 2005; 73 145-152
61 Chandler J P, Silva F E. Extended transbasal approach to skull base tumors: technical nuances and review of the literature. Oncology (Williston Park). 2005; 19 913-919
62 Raimondi A J, Gutierrez F A. A new surgical approach to the treatment of coronal synostosis. J Neurosurg. 1977; 46 210-214
63 Jakumeit H D. Neuroblastoma of the olfactory nerve. Acta Neurochir (Wien). 1971; 25 99-108
64 Blacklock J B, Weber R S, Lee Y Y, Goepfert H. Transcranial resection of tumors of the paranasal sinuses and nasal cavity. J Neurosurg. 1989; 71 10-15
65 McCutcheon I E, Blacklock J B, Weber R S et al.. Anterior transcranial (craniofacial) resection of tumors of the paranasal sinuses: surgical technique and results. Neurosurgery. 1996; 38 471-479
66 Ross D A, Marentette L J, Moore C E, Switz K L. Craniofacial resection: decreased complication rate with a modified subcranial approach. Skull Base Surg. 1999; 9 95-101
67 Ohnishi T, Mori S, Arita N. Primary meningioma of paranasal sinuses treated by the transbasal approach. Surg Neurol. 1987; 27 195-199
68 Pinsolle J, San-Galli F, Siberchicot F, Caix P, Emparanza A, Michelet F X. Modified approach for ethmoid and anterior skull base surgery. Arch Otolaryngol Head Neck Surg. 1991; 117 779-782
69 Fukuta K, Saito K, Takahashi M, Torii S. Surgical approach to midline skull base tumors with olfactory preservation. Plast Reconstr Surg. 1997; 100 318-325
70 Malecki J. New trends in frontal sinus surgery. Acta Otolaryngol. 1959; 50 137-140
71 Housepian E M. Surgical treatment of unilateral optic nerve gliomas. J Neurosurg. 1969; 31 604-607
72 Love J G, Bryar G E. Transcranial extirpation of orbital tumors. Trans Am Acad Ophthalmol Otolaryngol. 1966; 70 620-626
73 Johns M E, Kaplan M J. Surgical approach to the anterior skull base. Ear Nose Throat J. 1986; 65 117-124

Iman Feiz-ErfanM.D.

c/o Neuroscience Publications, Barrow Neurological Institute

350 W. Thomas Road, Phoenix, AZ 85013

Email: neuropub@chw.edu