title: Subcranial craniofacial resection for advanced sinonasal malignant tumours involving the anterior skull base.
abstract: BACKGROUND
  The subcranial approach is a modification of traditional craniofacial resection. It provides similar broad access to the anterior skull base, but with lower mortality and morbidity. It has been the surgical technique of choice at our institution since 2006 for treating advanced stage sinonasal tumours (American Joint Committee on Cancer stage III or above). This paper reports our experience and outcomes.
  
  
  RESULTS
  Eighteen patients underwent subcranial craniofacial resection over a seven-year period, this being combined with a second adjunctive procedure in 89 per cent of cases. Forty per cent of patients required reconstruction of the primary defect. No peri-operative deaths occurred. One patient had a transient cerebrospinal fluid leak. The major complication rate was 33 per cent, of which 67 per cent were directly related to soft tissue reconstruction. Tumour recurrence rate was 17 per cent and the five-year disease-free survival estimate was 40 per cent.
  
  
  CONCLUSIONS
  The subcranial approach is a safe and effective technique that may be used to successfully treat advanced sinonasal malignancies with anterior skull base extension.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery,Manchester Academic Health Sciences Centre,Manchester Royal Infirmary,UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Yong
authors.affiliation: Department of Otolaryngology,Lancashire Teaching Hospitals NHS Foundation Trust,Preston,UK.
authors.forename: A
authors.initials: A
authors.lastname: Soni-Jaiswal
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery,Manchester Academic Health Sciences Centre,Manchester Royal Infirmary,UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Homer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Craniofacial Resection; Paranasal Sinus Neoplasm; Subcranial Resection