Simultaneous Combined Multiportal Approach Using Transcranial and Endoscope-Assisted Midfacial Degloving Routes for Tumors with Skull Base and Extensive Sinonasal Involvement.

Abstract

For many years, in cases of excessively extensive tumors affecting the sinonasal region and the skull base-where the novel technique of a combination of transciliary supraorbital keyhole craniotomy and endoscopic endonasal approach would not have yielded satisfactory outcomes due to anatomic limitations-our gold standard technique was a combination of transfacial and tailored transcranial approaches. To reduce surgical invasiveness, complications, and undesirable aesthetic outcomes during the surgical treatment of tumors with extensive sinonasal and skull base involvement, the transfacial approach was left behind in favor of a combination of simultaneously applied tailored transcranial and endoscope-assisted midfacial degloving approaches. A microscope-assisted tailored transcranial approach was combined with an endoscope-assisted midfacial degloving approach. This paper presents five cases with various histologic types of tumors affecting both the sinonasal area and the skull base. All patients were selected for surgical treatment by our clinical team. The mean operative time was three hours. All procedures were free of intraoperative or postoperative complications, and either total or near-total tumor excision was accomplished. Follow-up revealed no surgery-related issues in any of the patients. Our combined, simultaneous multiportal technique facilitates complete tumor resection with shortened operative times, low measures of intraoperative and postoperative complications, low mortality, and superb aesthetic outcomes.