Evaluation of the Contribution of CAS in Combination with the Subcranial/Subfrontal Approach in Anterior Skull Base Surgery

ABSTRACT

In this study, 31 cases with different anterior skull base lesions mandating broad exposure, including the sphenoidal, parasellar, and clival region, were surgically treated using the frameless computer assisted surgery (CAS) system. The contribution of navigated surgery in relation to the broad exposure and direct visualization of this region rendered by the subcranial-subfrontal approach was evaluated. In group I, consisting of extensive tumors, the contribution of CAS was only given in five cases for the exposure of the tumor extensions located to the parasellar sphenoclival complex with concomitant distortion of the anatomic landmarks. No advantages were experienced in the more anterior locations along the ethmoidal compartment and frontal sinus. In the cases in group II, consisting of congenital anomaly implying fronto-orbital advancement and a meningoencephalocele as well as extensive mucoceles, the CAS was only helpful in those cases with an extremely aberrative anatomy in these regions.

KEYWORD

Anterior skull base tumors - subcranial/subfrontal approach - navigated skull base surgery

REFERENCES

• 1 Nolte L P, Zamorano L, Visarius H. Clinical evaluation of a system for precision enhancement in spine surgery.  Clin Biomech . 1995;  10 293-303
• 2 Langlotz F, Stucki M, Bächler R. Brief technical report-the first twelve cases of computer-assisted periacetabular osteotomy.  Comput Aid Surg . 1997;  2 317-326
• 3 Nolte L P, Langlotz F, Klaue K. Advancements of pelvic osteotomies by means of computer assistance.  Semin Arthroplasty . 1997;  8 108-113
• 4 Langlotz F, Bächler R, Berlemann U. Computer assistance for pelvic osteotomies.  Clin Orthop . 1998;  354 92-102
• 5 Fernandez P M, Zamorano L, Nolte L. Interactive image guidance in skull base surgery using an opto-electronic device.  Skull Base Surg . 1997;  7 15-21
• 6 Caversaccio M, Laedrach K, Haeusler R. Konzept eines rahmenlosen bildinteraktiven Navigationssystems für die Schädelbasis-, Nasen und Nasennebenhöhlenchirurgie.  Akt Probl Otorhinolaryngol . 1998;  21 139-148
• 7 Caversaccio M, Laedrach K, Baechler R. Navigation chirurgicale assistée par ordinateur avec ``cadre mobile dynamique'' pour les fosses nasales, les sinus et la base de cràne.  Ann Otolaryngol Chir Cerviofac . 1998;  115 253-258
• 8 Raveh J, Laedrach K, Speiser M. The subcranial approach for fronto-orbital and anteroposterior skull base tumors.  Arch Otolaryngol Head Neck Surg . 1993;  119 385-393
• 9 Raveh J, Turk J, Laedrach K. The extended anterior subcranial approach for skull base tumors-long-term results.  J Neurosurg . 1995;  82 1002-1010
• 10 Raveh J, Laedrach K, Iizuka T. The subcranial extended anterior approach for skull base tumors. In: Donald PJ, ed. Surgery of the Skull Base Vol 13. Philadelphia: Lippincott-Raven 1998: 239-261
• 11 Turk J B, Raveh J. The subcranial subfrontal approach for benign tumors of the ethmoid roof.  J Opin Technol Otolaryngol . 1999;  10 131-137
• 12 Laedrach K, Raveh J, Iizuka T. Reconstruction of the midface and orbit following tumor resection and trauma. In: Maniglia AJ, Stucker FJ, eds. Surgical Reconstruction of the Face and Anterior Skull Base Vol. 10. Philadelphia: WB Saunders, 1999: 113-140
• 13 Raveh J, Vuillemin T. Subcranial management of 395 combined frontobasal-midface fractures.  Arch Otolaryngol . 1989;  114 1115-1122
• 14 Raveh J, Laedrach K, Vuillemin T, Zingg M. Management of combined fronto-naso-orbital/skull base fractures and telecanthus in 355 cases.  Arch Otolaryngol Head Neck Surg . 1992;  118 605-614
• 15 Raveh J, Lädrach K, Vuillemin T. Specific procedures: the craniofacial congenital anomalies-the subcranial approach. In: Bosniak ST, ed. Principles and Practice of Ophthalmic Plastic and Reconstructive Surgery Vol. 110. Philadelphia: WB Saunders 1993: 1163-1177
• 16 Raveh J, Imola M, Laedrach K. Update on corrections of craniofacial anomalies. In: Marentette LJ, Kellman RM, eds. Facial Plastic Surgery Vol 3. Clinics of North America. Philadelphia: WB Saunders 1995: 3:17-38
• 17 Glicklich R, Lazor J B. The subcranial approach to trauma of the anterior cranial base.  J Craniomaxfac Trauma . 1995;  1 56-62
• 18 Glicklich R E, Cheney M L. Craniofacial approach. In: Cheyney ML, ed. Facial Surgery-Plastic and Reconstructive Baltimore, MD: Williams & Wilkins, 1998: 38:695-709
• 19 Li K, Weber A, Cheney M L. In: Cheyney ML, ed. Facial Surgery-Plastic and Reconstructive Baltimore, MD: Williams & Wilkins, 1998: 13:205-216
• 20 Kellman R M. Use of the subcranial approach in maxillofacial trauma. In: Thomas JR, Larrabee WF Jr, eds. Facial Plastic Surgery Vol 6. Clinics of North America, Philadelphia: WB Saunders 1998: 6:501-510
• 21 Moore C E, Ross D A, Marentette L J. Subcranial approach to tumors of the anterior cranial base: analysis of current and traditional surgical techniques.  Otolaryngol Head Neck Surg . 1999;  120 387-390
• 22 Ross D A, Marentette J M, Moore C E. Craniofacial resection: decreased complication rate with a modified subcranial approach.  Skull Base Surg . 1999;  9 95-100
• 23 Fliss D M, Zucker G, Cohen A. Early outcome and complications of the extended subcranial approach to the anterior skull base.  Laryngoscope . 1999;  109 153-160
• 24 Fliss D M, Zucker G, Amir A, Gatot A. The combined subcranial and midfacial degloving technique for tumor resection: report of three cases.  J Oral Maxillofac Surg . 2000;  58 106-110