Surgical Management Of Large Tumors Research Articles

Combined Simultaneous Multiportal Approach via Minimally Invasive Transciliary and Endoscopic Endonasal Approaches for Tumors Invading Both the Skull Base and the Sinonasal Area

A combined transcranial and transfacial approach has long been the gold standard for surgical management of large tumors with sinonasal and skull base involvement. The extended endoscopic endonasal approach for such pathologies has its advantages, but it has flaws as well, such as anatomic limitations and more ponderous skull base reconstruction and thus higher risk of postoperative complications. Our primary technique for surgical treatment of these pathologies has been a combination of transfacial and minimally invasive transciliary supraorbital keyhole approaches. With the aim to further minimize invasiveness, potential complications, and unsatisfactory aesthetic outcomes during surgical treatment of large tumors invading both the sinonasal area and the skull base, we abandoned the transfacial approach and simultaneously combined the transciliary supraorbital keyhole approach with the endoscopic endonasal approach. The well-known microscope-assisted minimally invasive approach via a transciliary supraorbital keyhole craniotomy was combined with the endoscopic endonasal approach. Six patients with different histologic types of tumors affecting the sinonasal area and the skull base were operated on. The mean operative time was 3 hours, there were no unexpected intraoperative or postoperative complications, and total tumor removal was achieved in each patient. None of the patients experienced complications associated with the surgery during follow-up. Our combined simultaneous multiportal approach enables total tumor eradication with reduced operative time and is associated with minimal intraoperative and postoperative complications, low mortality rate, and excellent cosmetic results.

Endoscopic management of juvenile nasopharyngeal angiofibromas

The origin of juvenile angiofibroma is usually around the region of the sphenopalatine artery, and the surgical management of large tumors can be challenging. Traditional approaches to advanced tumors involved open transfacial or transcranial microscope-assisted surgery. Advances in image guidance and endonasal endoscopic techniques have made endonasal endoscopic approaches to the pterygopalatine and infratemporal possible. Endoscopes allow for greater magnification and visualization of complex anatomy, and endoscopic approaches allow the surgeon to avoid manipulation of the osseous midfacial structures that may result in craniofacial abnormalities in this adolescent population.

Surgical management of large tumors of the neck: Report of two unusual cases

Two cases of unusually large tumors of the neck are presented. The first tumor was a hyperfunctioning adenomatous goiter, which weighed 1,075 Gm. The second was an adenocarcinoma of the parotid gland of the mixed tumor type, which weighed 2,100 Gm. In the surgical management of large cervical tumors adequate exposure is essential. In removal of large goiters the trachea should be located in order to facilitate tracheotomy if that becomes necessary. If part of the goiter is intrathoracic, the superior pole of the thyroid and the superior thyroid vessels should be isolated, doubly ligated and divided before one attempts to elevate the intrathoracic portion. The dead space left by removal of the goiter should be drained with a strip of finely woven gauze. Mixed tumors of the parotid gland are almost invariably malignant histologically but rarely metastasize. In the removal of large parotid tumors avoidance of injury to the internal carotid artery is of prime importance. It is safer to ligate the common carotid artery than the internal carotid. The facial nerve should be preserved if possible. Postoperative radium therapy is advisable.