Head and Neck ImagingCraniofacial resection
surgical procedure designed to resect neoplasms in the anterior skull base, including any
lesion involving or transgressing the anterior skull base. It is also considered in tumours contiguous to the skull base, making a successful
en bloc excision with adequate margins via the standard transfacial approach unlikely. It is most commonly used for tumours arising from the nasal cavity and
paranasal sinuses (see
sinonasal cavities cancer). The procedure combines a frontal craniotomy with resection of the floor of the anterior cranial fossa, with a lateral rhinotomy. After resection of the
tumour, the floor of the anterior fossa is reconstructed with a soft tissue flap.
Preoperative imaging influences the composition and approach of the surgical team treating a patient with sinonasal cancer, as surgical resection of sinonasal neoplasms involving the anterior skull base requires a combined transfacial and transcranial approach to allow an en bloc resection of the tumour. This means that a neurosurgical team and a head and neck surgical team will work in close cooperation during such a procedure.
Using this procedure, dural invasion can usually be handled safely, but cure can hardly ever be obtained if brain invasion is present. The management of orbital involvement is controversial. Many surgeons will elect for orbital exenteration when the periorbita is invaded, but the results are not good. Invasion of the orbital fat precludes complete resection of the tumour without orbital exenteration. Perineural tumour spread head and neck towards the foramen rotundum and cavernous sinus makes surgical clearance of the tumour highly unlikely; it also suggests a low probability of cure with radiation therapy.
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