title: Multiportal combined transnasal transoral transpharyngeal endoscopic approach for selected skull base cancers.
abstract: BACKGROUND
  Minimally invasive endoscopic endonasal approaches to the ventral skull base have evolved considerably over the past several years. However, where there is a lateral extension of tumors as far as the parapharyngeal spaces with inferior extension below the level of the soft palate, limitations remain for an exclusive transnasal approach.
  
  
  METHODS
  A combined endoscopic-assisted transnasal-transoral-transpharyngeal multiportal approach was performed to resect selected skull base malignancies that could not be adequately managed using a single approach.
  
  
  RESULTS
  Three cases of skull base cancer (squamous cell carcinoma, polymorphous low-grade adenocarcinoma, and high-grade osteosarcoma) were suitable for such an approach. In all cases, a radical resection was obtained without major complications and with minimal morbidity for the patient.
  
  
  CONCLUSIONS
  The transnasal, transoral, and transpharyngeal surgical windows are complementary approaches that, when combined, provide excellent exposure for selected skull base malignancies that have extended too laterally and inferiorly to allow an exclusively transnasal approach. © 2016 Wiley Periodicals, Head Neck 38: E2440-E2445, 2016.
authors: Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.|Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy.
authors: Mario
authors: M
authors: Turri-Zanoni
authors: Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.|Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy.
authors: Paolo
authors: P
authors: Battaglia
authors: Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy.|First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors: Iacopo
authors: I
authors: Dallan
authors: Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy.|Unit of Neurosurgery, DBSV, University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors: Davide
authors: D
authors: Locatelli
authors: Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.|Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy.
authors: Paolo
authors: P
authors: Castelnuovo
keywords: endoscopic endonasal; multiportal approach; parapharyngeal space; skull base; transoral