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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Craniofacial approach for upper clivus lesions and large paranasal tumours involving the anterior skull base assisted by navigation techniques

Navigationsgestützte kraniofaziale Zugangswege bei oberen Clivus-Läsionen und großen paranasalen Tumoren

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  • corresponding author M. Farhadi - Department of Neurosurgery, Medical University of Hannover
  • T. Stöver - Department of Otolaryngology, Medical University of Hannover
  • T. Rodt - Department of Neurosurgery, Medical University of Hannover
  • O. Majdani - Department of Otolaryngology, Medical University of Hannover
  • M. Lorenz - Department of Neurosurgery, Medical University of Hannover
  • T. Lenarz - Department of Otolaryngology, Medical University of Hannover
  • J.K. Krauss - Department of Neurosurgery, Medical University of Hannover

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 07.99

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc316.shtml

Published: May 8, 2006

© 2006 Farhadi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Tumours of the upper clivus and large paranasal tumours extending to the anterior skull base with penetration of the dura are difficult to approach both with regard to the extent of tumour resection and procedure-related morbidity. Therefore, surgical approaches should enhance exposure of the lesion and at the same time assist in precise localization of the tumour and adjacent structures. Here, we report on a series of patients operated on by craniofacial approaches guided by computer assisted surgery (CAS) techniques.

Methods: Twelve patients were included in this open label study. The surgical approach consisted of a lateral rhinotomy combined with a subfrontal craniotomy if necessary. The procedures were planned and assisted by advanced CAS techniques with image fusion of CT and MRI. Tumors included chordomas, esthesioneuroblastomas and carcinomas.

Results: Combined approaches with CAS proved to be safe and reliable both for identification of tumour borders and vital structures hidden or encased by the tumours. There was no mortality, and the rate of perioperative complications was low including local infection in one patient. There were no new permanent neurological deficits. Tumours were either removed completely, or subtotal resection was achieved allowing targeted postoperative radiotherapy.

Conclusions: Craniofacial approaches enhanced by CAS in a multidisciplinary setting allow safe resection of large tumours of the upper clivus and the paranasal sinuses involving the anterior skull base.