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Vol. 63. Issue 5.
Pages 339-347 (September - October 2012)
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Vol. 63. Issue 5.
Pages 339-347 (September - October 2012)
Original article
Endoscopic Endonasal Approach for the Treatment of Anterior Skull Base Tumours
Abordaje endoscópico endonasal para el tratamiento de tumores de la base del cráneo
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Fernando López, Vanessa Suárez, María Costales, Juan P. Rodrigo, Carlos Suárez, José Luis Llorente
Corresponding author
llorentependas@telefonica.net

Corresponding author.
Servicio de Otorrinolaringología, Unidad de Base de Cráneo, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Tables (5)
Table 1. Previous Treatments of Patients Intervened by EEA.
Table 2. Final Histology of Intervened Patients.
Table 3. Approaches Employed According to the Affected Region of the Skull Base.
Table 4. Patients With Persistent Disease After Surgery.
Table 5. Infiltration of Structures Contraindicating the Exclusive Performance of an Endonasal Approach.
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Abstract
Introduction

The increasing expertise of transnasal endoscopic surgery has recently expanded its indications to include the management of tumours affecting the skull base. We report our experience with endoscopic management of these tumours, emphasising the indications and surgical technique used.

Material and method

A retrospective analysis was performed of patients treated by an endoscopic endonasal approach (EEA) in our department from 2004 until 2011.

Results

Sixty-three patients were analysed. We performed an endoscopic craniofacial resection in 32 patients (51%), an expanded EEA in 22 (35%), a transclival approach in 6 (9%) and a transpterygoid approach in 3 (5%). The most frequent benign tumour was nasopharyngeal angiofibroma (24%), while adenocarcinoma (30%) was the most common among malignancies. Mean follow-up was 26months (range: 6–84months). The complication rate was 5% and resection was complete in 56 cases (89%). The 5-year overall-survival was 71% in patients with malignant tumours and the effectiveness was 100% in benign tumours.

Conclusion

Our results support that endoscopic surgery, when properly planned, represents a valid alternative to standard surgical approaches for the management of skull base tumours.

Keywords:
Endoscopic skull base surgery
Craniofacial resection
Adenocarcinoma
Angiofibroma
Skull base surgery
Sinonasal tumours
Resumen
Introducción

La progresiva ampliación de las indicaciones de la cirugía endoscópica nasal ha permitido que sea utilizada como vía de abordaje en el tratamiento de tumores que afectan la base del cráneo. Presentamos nuestra experiencia en el tratamiento endoscópico de estos tumores.

Material y método

Se presenta una serie retrospectiva de los tumores tratados en nuestro servicio entre los años 2004 y 2011 mediante un abordaje endoscópico endonasal (AEE).

Resultados

Fueron analizados 63 pacientes. En 32 pacientes (51%) se realizó una resección craneofacial endoscópica, en 22 (35%) se realizó un AEE ampliado, en 6 (9%) un abordaje transclival y en 3 (5%) un abordaje transpterigoideo. El tumour benigno más frecuentemente fue el angiofibroma nasofaríngeo (24%) y el adenocarcinoma (30%) fue el más frecuente entre los malignos. El seguimiento medio fue de 26 meses (rango: 6 a 84 meses). La tasa de complicaciones fue del 5% y la resección fue completa en 56 casos (89%). La supervivencia en los pacientes con tumores malignos fue del 71% a los 5 años y la efectividad fue del 100% en los tumores benignos.

Conclusiones

Los resultados obtenidos permiten afirmar que, la cirugía endoscópica ampliada a la base del cráneo, con indicaciones precisas, es una alternativa válida a los tradicionales abordajes abiertos.

Palabras clave:
Endoscopia de la base del cráneo
Resección craneofacial
Adenocarcinoma
Angiofibroma
Cirugía de la base del cráneo
Tumores nasosinusales

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