Removal of ethmoidal malignant tumors by the isolated paralateronasal approach with resection of the cribriform plate and the dura mater

Alexis Faure, Christophe Ferron, Mansour Khalfallah, Judicaël Toquet, Olivier Hamel, Sylvie Raoul, Claude Beauvillain De Montreuil, Roger Robert, James T. Goodrich, Keith L. Black, Brian K. Pikul, Harry R. Van Loveren

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objective: A series of ethmoidal tumors was resected by an entirely extracranial approach through a lateral rhinotomy incision, with partial maxillectomy and removal of the cribriform plate and dura mater from below. Methods: Thirty-four consecutive patients (32 male, 2 female; mean age 64 years, range 45-78) with malignant tumors of the ethmoid sinus were operated by this technique between July 1998 and February 2002. All had complete tumor resection, including the cribriform plate and the dura mater. Excision was performed en bloc 23 times (68%). Although cerebral involvement was encountered in four cases (T4 IC), this technique was adequate for tumor resection, together with corticectomy when necessary. The method used for tumor resection and rebuilding of the anterior skull base is described in detail. Results: There were no immediate postoperative deaths. One patient developed pneumococcal meningitis with cerebrospinal fluid leakage as a result of a technical error and required further surgery. Four patients presented a confusion syndrome that regressed during the hospital stay, 2 complained of transient diplopia, and 4 had hematoma of the abdominal wall. Mean follow-up of 10.4 months (1-41 months) is still too short to reach definitive conclusions about oncologic results. Conclusions: This approach is particularly suitable for removal of tumors in contact with or invading the cribriform plate. Tumor resection is as extensive as with the traditional mixed approach, but does not require the frontal lobes to be drawn aside.

Original languageEnglish (US)
Pages (from-to)407-421
Number of pages15
JournalSurgical Neurology
Volume60
Issue number5
DOIs
StatePublished - Nov 2003

Keywords

  • Anterior skull base
  • Craniofacial surgery
  • Ethmoid sinus
  • Ethmoidal adenocarcinoma
  • Paranasal sinus neoplasm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Faure, A., Ferron, C., Khalfallah, M., Toquet, J., Hamel, O., Raoul, S., De Montreuil, C. B., Robert, R., Goodrich, J. T., Black, K. L., Pikul, B. K., & Van Loveren, H. R. (2003). Removal of ethmoidal malignant tumors by the isolated paralateronasal approach with resection of the cribriform plate and the dura mater. Surgical Neurology, 60(5), 407-421. https://doi.org/10.1016/S0090-3019(03)00321-5