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Juvenile nasopharyngeal angiofibromas (JNAs) are rare, benign, but locally invasive vascular lesions that have traditionally been resected using open surgical approaches. However, with the wider availability of superselective intra-arterial embolization, the advent of improved endoscopic, transnasal techniques, and advances in instrumentation, recent years have witnessed a shift toward the use of...
Anterior skull base neoplasms require a multispecialty approach for adequate resection and reconstruction. Otolaryngologists are often consulted to help provide access to middle cranial fossa tumors or treat anterior cranial base pathology that arises from the nasal cavity or paranasal sinuses. The LeFort I osteotomy with downfracture of the maxilla is one of many well-described osteoplastic anterior...
Surgical exposure for massive tumor of the anterior skull base can be difficult. We have combined two surgical approaches, the subfrontal/subcranial approach and the Le Fort I osteotomy approach, to provide panoramic accesses to the anterior skull base. Via this combination of exposures, we have easily accessed and resected tumors extending from the cribiform plate all the way down to the level of...
Resection of skull base lesions and subsequent reconstruction is difficult due to the complex three-dimensional anatomy of this region. Rapid prototyping using stereolithographic or laser sinter techniques may help visualize the lesions, design access osteotomies, and create templates for reconstruction of the bony skeleton.
Midfacial degloving is a useful approach for sinonasal and skull base lesions. This technique provides wide exposure for a variety of pathologies without needing facial incisions. The midfacial degloving technique, described in detail, can also be combined with other approaches to manage extensive lesions.
Advances in endoscopic techniques and technology have substantially increased the scope of endonasal skull base surgery. Large dural defects after expanded endonasal approaches (EEA) present a challenge for reconstruction and have revealed the limitations of conventional reconstructive methods. Initial reconstructive attempts using nonvascularized free tissue grafts resulted in unacceptably high rates...
Traditional approaches for the resection of tumors that involve the anterior cranial base used facial and scalp incisions, a craniotomy, and facial osteotomies. These approaches required frontal lobe retraction and sometimes resulted in cosmetic and functional deficits. With the advances in optics, surgical instrumentation, and image-guided surgery, the expanded endonasal approach (EEA) has provided...
The use of surgical navigation has grown tremendously in endonasal endoscopic surgery. The technology has been used as an adjunct during endoscopic surgery of the skull base. Although not requisite, the benefits of navigation during endoscopic skull base surgery may lie in its ability to enhance a surgeon's approach to complex anatomic structures. The use of navigation during endoscopic skull base...
Advances in endoscopic techniques and technology have substantially increased the scope of expanded endonasal skull base surgery. Larger and more complex skull base defects pose a unique challenge for reconstruction. The pedicled nasoseptal flap has become the workhorse for reconstruction and, through its use, the virtues of a vascularized reconstruction are clearly apparent. When local mucosal flaps...
Endoscopic transsphenoidal approaches to the pituitary developed with advances in endoscopic technology. Historically, transsphenoidal approaches to the pituitary transitioned from transcranial to transnasal. Each transnasal approach is associated with distinct advantages, limitations, and complications. The standard endoscopic paraseptal approach is discussed. Modifications of the paraseptal approach...
The retromaxillary-infratemporal fossa dissection with preauricular incision is a versatile approach that can be used effectively for treating tumors involving the anterior and lateral skull base. This approach, which originally was described for accessing the temporomandibular joint, lateral orbit, and zygomatic arch, has been expanded for the treatment of tumors extending or originating within the...
Tumors of the sinonasal region and anterior skull base present diagnostic and surgical challenges. Access to and exposure of the tumor tends to be difficult because of the delicate neurovascular structures that occupy this area, including the brain and the orbital contents. The diagnosis and treatment of tumors in this region have improved with advances in diagnostic imaging, anesthesia, surgical...
The subfrontal approach represents a versatile technique allowing for broad exposure of the base of the anterior cranial fossa with minimal functional and aesthetic sequelae. A number of surgical manouvers will optimize the outcomes. These will be reviewed in detail in the article.
Improvements in skull base surgery techniques have allowed surgeons to expand the indications for resection and reconstruction of aggressive tumors. The increasingly complex defects following surgical extirpation are often reconstructed with microvascular free flaps. Techniques for free flap reconstruction of the anterior skull base are elaborated.
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