title: Anterior skull base tumour. The choice between cranial and facial approaches, single and combined procedure. From a series of 78 cases.
abstract: In order to define the most adequate surgical procedure to apply on anterior skull base lesions, we reviewed 78 cases of either benign (43 cases) or malignant (35 cases) tumours; they were treated either by a single surgical approach including transfacial approach (TF) in 9 cases, transbasal approach (TB) in 15 cases and fronto-orbital ridge deposition (FORD) in 16 cases or by a combined procedure: TB + TF (28 cases), TB + FORD (10 cases). In 7 cases, a pterional approach was associated to one of these combined procedures. A classification is proposed, based on the tumour extension along the anteroposterior axis: I) anterior to the crista galli; II) anterior to the anterior clinoïd process; III) posterior to the anterior clinoïd process; and along the vertical axis A: below the bone level; B: below the dura level; C: at and above the dura level. This classification appears very useful to choose among the surgical procedures which one is the more appropriate. In type A tumour (N = 8), TF is sufficient while in type B (N = 38) and C (N = 32) a cranial route is always necessary; among the latter, a combined procedure is frequently asked for posterior tumours type II (N = 29) and III (N = 24). However, others parameters such as tumour consistency, vascularization and need for en-bloc removal are also relevant in this choice.
authors.affiliation: Department of Neurosurgery, Hôpital Lariboisiere, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: George
authors.forename: S
authors.initials: S
authors.lastname: Clemenceau
authors.forename: J
authors.initials: J
authors.lastname: Cophignon
authors.forename: P
authors.initials: P
authors.lastname: Tran ba Huy
authors.forename: B
authors.initials: B
authors.lastname: Luboinski
authors.forename: K L
authors.initials: KL
authors.lastname: Mourier
authors.forename: G
authors.initials: G
authors.lastname: Lot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012888:Skull Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed