Skull Base 2011; 21(2): 071-074
DOI: 10.1055/s-0030-1261267
ORIGINAL ARTICLE

© Thieme Medical Publishers

Intraoperative Transillumination to Determine the Extent of Frontal Sinus in Subcranial Approach to Anterior Skull Base

Rajeev Sharan1 , Krishnakumar Thankappan2 , Subramania Iyer2 , Dilip Panicker2 , Moni Abraham Kuriakose3
  • 1Dharamshila Cancer Hospital and Research Centre, Vasundhara Enclave, Delhi, India
  • 2Amrita Institute of Medical Sciences, Elamakkara, Cochin, Kerala, India
  • 3Department of Surgical Oncology, Mazumdar Shaw Cancer Centre, Narayana Hrudayalaya, Bommasandra, Bengaluru, Karnataka, India
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
07. Juli 2010 (online)

ABSTRACT

We sought to determine the extent of the frontal sinus by intraoperative transillumination through the superomedial orbital wall in a subcranial approach to the anterior skull base. After raising a bicoronal flap, the frontal sinus was transilluminated through the superomedial orbital wall with a fiber-optic light source, delineating the extent of the frontal sinus. The frontal sinus boundary was marked with a marker pen. A frontal sinus anterior wall osteotomy was performed with a sagittal saw, staying within the confines of the frontal sinus marking. A bone flap was removed, and the posterior wall was drilled out. The remaining procedure was performed in a standard fashion. At the end of the procedure, the bone flap was fixed with a titanium plate. A total of 58 patients had undergone craniofacial resection from January 2004 to December 2007. In 13 patients, a subcranial approach was employed using the transillumination technique. Transillumination was successful in delineating the frontal sinus periphery in all 13 patients. Intraoperative transillumination of the frontal sinus through the superomedial orbital wall is a simple and effective method to delineate the frontal sinus periphery in a subcranial approach to the anterior skull base.

REFERENCES

  • 1 Raveh J, Vuillemin T. The surgical one-stage management of combined cranio-maxillo-facial and frontobasal fractures. Advantages of the subcranial approach in 374 cases.  J Craniomaxillofac Surg. 1988;  16 160-172
  • 2 Raveh J, Vuillemin T, Sutter F. Subcranial management of 395 combined frontobasal-midface fractures.  Arch Otolaryngol Head Neck Surg. 1988;  114 1115-1122
  • 3 Raveh J, Vuillemin T. Advantages of an additional subcranial approach in the correction of craniofacial deformities.  J Craniomaxillofac Surg. 1988;  16 350-358
  • 4 Raveh J, Vuillemin T. Subcranial-supraorbital and temporal approach for tumor resection.  J Craniofac Surg. 1990;  1 53-59
  • 5 Raveh J, Laedrach K, Speiser M et al.. The subcranial approach for fronto-orbital and anteroposterior skull-base tumors.  Arch Otolaryngol Head Neck Surg. 1993;  119 385-393
  • 6 Tato J M, Sibbald D W, Bergaglio O E. Surgical treatment of the frontal sinus by the external route.  Laryngoscope. 1954;  64 504-521
  • 7 Fung M K. Template for frontal osteoplastic flap.  Laryngoscope. 1986;  96 578-579
  • 8 Fewins J L, Otto P M, Otto R A. Computed tomography-generated templates: a new approach to frontal sinus osteoplastic flap surgery.  Am J Rhinol. 2004;  18 285-289 discussion 289-290
  • 9 Sekhar L N, Janecka I P, Jones N F. Subtemporal-infratemporal and basal subfrontal approach to extensive cranial base tumours.  Acta Neurochir (Wien). 1988;  92 83-92
  • 10 Spetzler R F, Herman J M, Beals S, Joganic E, Milligan J. Preservation of olfaction in anterior craniofacial approaches.  J Neurosurg. 1993;  79 48-52
  • 11 Delfini R, Iannetti G, Belli E, Santoro A, Ciappetta P, Cantore G. Cranio-facial approaches for tumours involving the anterior half of the skull base.  Acta Neurochir (Wien). 1993;  124 53-60
  • 12 Friedman M, Landsberg R, Tanyeri H. Intraoperative and postoperative assessment of frontal sinus patency by transillumination.  Laryngoscope. 2000;  110 683-684
  • 13 Yoskovitch A, Wright E D, Sobol S E, Desrosiers M. Frontal sinus transillumination approach to the osteoplastic flap.  J Otolaryngol. 2002;  31 118-119
  • 14 Melroy C T, Dubin M G, Hardy S M, Senior B A. Analysis of methods to assess frontal sinus extent in osteoplastic flap surgery: transillumination versus 6-ft Caldwell versus image guidance.  Am J Rhinol. 2006;  20 77-83

Moni Abraham KuriakoseM.D. F.D.S.R.C.S. F.F.D.R.C.S. F.R.C.S.Ed. F.R.C.S. 

Professor and Chairman, Surgical Oncology Services, Mujumdar-Shaw Cancer Institute, Narayana Hrudayalaya 258/A

Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560 099

eMail: mak12@nyu.edu; makuriakose@gmail.com