Mario Turri-Zanoni1,2, Paolo Battaglia1,2, Iacopo Dallan2,3, Davide Locatelli2,4, Paolo Castelnuovo1,2. 1. Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy. 2. Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy. 3. First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 4. Unit of Neurosurgery, DBSV, University of Insubria, Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Abstract
BACKGROUND: Minimally invasive endoscopic endonasal approaches to the ventral skull base have evolved considerably over the past several years. However, where there is a lateral extension of tumors as far as the parapharyngeal spaces with inferior extension below the level of the soft palate, limitations remain for an exclusive transnasal approach. METHODS: A combined endoscopic-assisted transnasal-transoral-transpharyngeal multiportal approach was performed to resect selected skull base malignancies that could not be adequately managed using a single approach. RESULTS: Three cases of skull base cancer (squamous cell carcinoma, polymorphous low-grade adenocarcinoma, and high-grade osteosarcoma) were suitable for such an approach. In all cases, a radical resection was obtained without major complications and with minimal morbidity for the patient. CONCLUSION: The transnasal, transoral, and transpharyngeal surgical windows are complementary approaches that, when combined, provide excellent exposure for selected skull base malignancies that have extended too laterally and inferiorly to allow an exclusively transnasal approach.
BACKGROUND: Minimally invasive endoscopic endonasal approaches to the ventral skull base have evolved considerably over the past several years. However, where there is a lateral extension of tumors as far as the parapharyngeal spaces with inferior extension below the level of the soft palate, limitations remain for an exclusive transnasal approach. METHODS: A combined endoscopic-assisted transnasal-transoral-transpharyngeal multiportal approach was performed to resect selected skull base malignancies that could not be adequately managed using a single approach. RESULTS: Three cases of skull base cancer (squamous cell carcinoma, polymorphous low-grade adenocarcinoma, and high-grade osteosarcoma) were suitable for such an approach. In all cases, a radical resection was obtained without major complications and with minimal morbidity for the patient. CONCLUSION: The transnasal, transoral, and transpharyngeal surgical windows are complementary approaches that, when combined, provide excellent exposure for selected skull base malignancies that have extended too laterally and inferiorly to allow an exclusively transnasal approach.