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
|
