Craniofacial resection for malignant nasal and paranasal sinus tumors assisted with the endoscope.

摘要

BACKGROUND: Craniofacial resection is regarded as the treatment of choice for paranasal malignant tumors invading the skull base. Even with this approach, the surgical view remains obscured when tumors in the deep nasal and paranasal sinuses are resected. Endoscopy provides a wide and clear surgical view in the deep and narrow nasal cavity. We report two patients who underwent craniofacial resection assisted with endoscope. METHODS: Two patients with malignant paranasal sinus tumor invading the anterior skull base underwent endoscope-assisted craniofacial resection. RESULTS: To avoid a limited surgical view in the sinonasal cavity, we performed craniofacial resection with endoscopic osteotomy and several procedures in the nasal cavity. The neurosurgeon performed anterior skull base osteotomy at an appropriate site from above, while the otolaryngologist provided illumination with the endoscope from below and preserved the adjacent structures. The patients recovered uneventfully and the endoscopic examinations of both patients 18 months after the surgery showed no recurrence. CONCLUSIONS: Endoscopes were useful for the craniofacial resection at osteotomy, providing illumination from below and at the several procedures in the deep part of the nasal cavity. If a lateral rhinotomy incision is made, the combined transfacial and transnasal approaches avoid the limited working angle associated with the transnasal approach alone. Although an endoscopic approach is useful for treating sinonasal tumors, we should recognize its advantages and limitations.