The transbasal approach to the anterior skull base: surgical outcome of a single-centre case series

A Kaywan Aftahy,Bernhard Meyer,Melanie Barz,Claire Delbridge,Arthur Wagner,Julia S Bermeitinger,Jens Gempt,Chiara Negwer

doi:10.1038/s41598-020-80255-8

A Kaywan Aftahy, Bernhard Meyer + Show 6 more

Open Access

https://doi.org/10.1038/s41598-020-80255-8

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Abstract

A variety of sinonasal tumours, meningiomas or other lesions of the anterior skull base involve the paranasal sinuses and the periorbital area. The transbasal approach (TBA) has turned out to be a feasible technique to reach those lesions. A retrospective review at a neurosurgical university department between November 2007 and January 2020 with adult patients who underwent resection of oncologic pathologies through TBA. Surgical technique, extent of resection (EOR), clinical outcome and postoperative complications were analysed. 18 TBAs between November 2007 and January 2020 were performed. Median age was 62 (range 25–83), 7 female and 11 male patients. Gross total resection rate was 85.8% throughout all entities. Four (22.2%) patients suffered from WHO°I meningiomas and 14 (77.7%) from other extra-axial lesions. Preoperative Karnofsky Performance Status Scale (KPSS) was 80% (range 40–90), postoperative KPSS 80% (range 20–100). Rate of postoperative complications requiring intervention was 16.7%. Median follow-up was 9.8 (range 1.2–71.8) months. Modifications and extensions of the classic TBA are not mandatory. Complete resection can be performed under functional and cosmetic-preserving aspects. Second-step procedures such as transnasal approaches may be performed to avoid high morbidity of more aggressive TBAs, if necessary. Surgical considerations should be kept simple and straightforward.

Highlights

A variety of sinonasal tumours, meningiomas or other lesions of the anterior skull base involve the paranasal sinuses and the periorbital area
Oncologic lesions in the anterior skull base with transbasal infiltration and involvement of the paranasal sinuses and orbit have always been surgically challenging due to the anatomic relationships in this region
This study aims to highlight the sufficiency of simple transbasal approach (TBA) without further modifications and osteotomies and the reduction of perioperative morbidity

Summary

Introduction

A variety of sinonasal tumours, meningiomas or other lesions of the anterior skull base involve the paranasal sinuses and the periorbital area. The transbasal approach (TBA) has turned out to be a feasible technique to reach those lesions. Oncologic lesions in the anterior skull base with transbasal infiltration and involvement of the paranasal sinuses and orbit have always been surgically challenging due to the anatomic relationships in this region. These skull base tumours can originate from a variety of structures such as paranasal sinuses, nasal pharynx, leptomeninges and orbital or cranial nerves, as well as from the squamous cells or the glands. The transbasal approach (TBA) turned out to be an advanced but feasible approach to expose deep-lying lesions of the anterior skull base. Feiz-Erfan et al categorized and proposed a classification for the TBA to facilitate the comparison and discussion of these a pproaches

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