Hybrid Surgery for Anterior Skull Base Tumors and How to Repair the Anterior Skull Base

Object: We present hybrid surgery with neurosurgeons/ and ENT physicians for anterior skull base tumors, and how to repair anterior skull base. Cases in our series are 32 nasal/paranasal tumors, 3 olfactory neuroblastoma, and 2 meningiomas. Post-operative follow-up period (mean) was 5.6 years. Male/female was 32/5. Mean age at operations was 45 years old.

Surgical Procedure: Following bifrontal craniotomy, extradural anterior skull base was widely exposed. If the tumor was extended into the intradural part, intradural tumor was removed first, then dural defect was closed using fascia. Thereafter, frontal base was drilled to the nasal/paranasal cavities, and microscopic transcranial surgery and transnasal endoscopic surgery were performed by neurosurgeons and ENT physicians simultaneously. The tumor in the blind space was removed cooperatively. After removing the tumor, frontal skull base defect was covered by abdominal fat pieces and sealed with fibrin glue with multi-layer fashion. Finally, anterior skull base was widely covered by vascularized galeal flap and sealed with fibrin glue again. Lumbar drainage was placed for three days after operation. Post-operative treatment such as radiation and/or chemotherapy depended on the pathology.

Results: Any CSF leakage or infection was encountered. Three patients with malignant nasal/paranasal cavities were dead 2.5, 3, and 4.5 years after surgery, respectively.

Conclusion: Hybrid surgery for anterior skull base tumors is beneficial for removal of anterior skull base tumor, and our repairmen method of the anterior skull base defect is justified.