Transcribiform approach, experience in endoscopic craniofacial surgery at Barros Luco Trudeau Hospital

Abstract

Introduction: The transcribiform endoscopic approach is a useful surgical tool that allows us to treat anterior skull base pathology. It has less morbidity and mortality, shorter hospital stay, fewer neurological sequelae, and therefore reduced health costs. Objective: To describe the experience of the transcribiform approach in patients of the otorhinolaryngology department of the Barros Luco Trudeau Hospital in the endoscopic craniofacial management of patients operated on with a diagnosis of sinonasal malig­nancy with involvement of the anterior skull base from 2018 to 2023. Material and Method: A retrospective descriptive study was carried out. A review of clinical records of patients undergoing transcribiform or hemitranscribiform approach was carried out and the studied variables were tabulated in Excel. Preoperative management, surgical techni­que and postoperative management are described. Results: 8 patients were operated on (2 female/6 male), with an average age of 59 years. Histological type: 3 adenocarcinomas, 2 squamous carcinomas, 2 esthesioneuroblastomas and 1 leiomyosarcoma. All involved anterior skull base and meninge. Surgery: Resection of bilateral cribriform plate with anterior fossa meninge and olfactory bulb. A patient had a left side hemitranscribiform approach. Complications: a CSF fistula, a unilateral visual deficit, a pneumoencephalus. Complementary therapy: 5 patients received adjuvant therapy with radiotherapy, 2 with chemo-radiotherapy and one received neoadjuvant chemo-radiotherapy. Survival: 6 pa­tients remain alive. Conclusions: The endoscopic approach in patients with malignant rhinosinusal neoplasia with involvement of the anterior skull base is a safe, feasible option with good postoperative results and survival.