Anterior Craniofacial Resection for Malignant Tumors of the Paranasal Sinuses: A Series of 382 Patients

Abstract

Anterior craniofacial resection is recognized as the standard treatment for paranasal sinus tumors approaching or involving the cribriform plate. Between 1987 and 2007, 382 patients underwent anterior craniofacial resection at the National Cancer Institute of Milan. Our technique was very simple and fast. We perform a small and low frontal craniotomy by an oscillating saw without burr holes. The resection may be extradural or intradural, according to the extension of the tumor. We use a small paranasal incision for the facial approach. The ethmoid bone is always totally removed. The defect is repaired with a pedicled pericranial flap. Surgery lasts about 3 hours. Five years of disease-free survival (median follow-up time, 61 months) according to AJCC 2002 classification was: 46% for T1, 40% for T2, 46% for T3, 34% for T4a, and 18% for T4b patients. Stage by stage, the results for untreated patients or relapses after previous noncraniofacial surgery and/or radiotherapy were: 55% versus 33% for T1; 48% versus 25% for T2; 54% versus 28% for T3; 41% versus 20% for T4a; and 25% versus 8% for T4b patients.