Wednesday, 30 September 2015

The Superior Rhinotomy Approach: Resection of Bilateral Sinonasal and Skull Base Tumors- A 28 Year Experience

The Superior Rhinotomy Approach: Resection of BilateralSinonasal and Skull Base Tumors- A 28 Year Experience
Anthony G. Del Signore Pharm, Anthony Reino, Alan Weinberg and William Lawson*
Abstract: 
Objectives: Introduced almost 30 years ago there has been no published follow up on this novel external approach to a select group of bilateral ethmoid and anterior skull base lesions. We review the complications and long-term results of the superior rhinotomy approach.
Study Design: Retrospective review.
Methods: From 1985 to 2013, fifty-nine patients presenting to a tertiary care medical center with bilateral ethmoid tumors with and without intracranial extension were resected utilizing the superior rhinotomy approach. Tumors were classified by pathology and stage at presentation. Long term outcomes and complications were reviewed.
Results: Fifty-nine patients with bilateral ethmoid tumors were treated by the superior rhinotomy technique, with or without a bifrontal craniotomy. The mean age of this cohort was 55 years. The mean duration of the follow up was 91 months. Complication rates were noted primarily in patients undergoing craniotomy and adjuvant radiotherapy; and consisted of central nervous system, functional, cosmetic, wound and systemic complications. 
Conclusions: In this endoscopic age it is important to retain approaches that may assist in the treatment of large ethmoid lesions. As described, the superior rhinotomy is a safe, versatile and highly effective approach for the en-bloc resection of advanced malignancy of the ethmoid sinuses. Based on our experience the authors feel that this approach should be part of the otolaryngologist’s armamentarium for the treatment of advanced disease of the bilateral ethmoid sinuses and the anterior skull base.

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