Combined Exoscopic and Endoscopic Technique for Craniofacial Resection.

Kenichiro Iwami,Tadashi Watanabe,Yasushi Fujimoto,Shigeru Miyachi,Koji Osuka,Tetsuya Ogawa

doi:10.3390/curroncol28050336

Kenichiro Iwami, Tadashi Watanabe + Show 4 more

Open Access

https://doi.org/10.3390/curroncol28050336

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Abstract

We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.

Highlights

Malignant head and neck tumors rarely arise from the nasal cavity, paranasal cavity, orbit, and hearing organs [1,2]
Paranasal cavity, orbit, and hearing organs are adjacent to the skull base, this region is often invaded by locally advanced malignant head and neck tumors
We report successful craniofacial resection (CFR) with combined exoscopic-endoscopic technique (CEE) in the transcranial approach

Summary

Introduction

Malignant head and neck tumors rarely arise from the nasal cavity, paranasal cavity, orbit, and hearing organs [1,2]. Among the many therapeutic approaches proposed for malignant head and neck tumors, complete surgical resection followed by postoperative radiotherapy reportedly provides the best outcomes [3,4,5]. Paranasal cavity, orbit, and hearing organs are adjacent to the skull base, this region is often invaded by locally advanced malignant head and neck tumors. Patients with malignant head and neck tumors, or benign aggressive lesions invading the skull base, are treated with craniofacial resection (CFR) [6,7]. CFR combines both the transcranial and transfacial approaches (Figure 1a): the transfacial approach is performed by head and neck surgeons, whereas the transcranial approach is performed by neurosurgeons. In CFR, a transcranial approach is critical in skull base osteotomy to permit the lesion to remain covered in the safety margin at the skull base (Figure 1a red arrow)

Methods

Discussion

Conclusion