AB030. Combined transcranial and endonasal endoscopic approach for sinonasal tumors with intracranial extension: a case series
Abstract

AB030. Combined transcranial and endonasal endoscopic approach for sinonasal tumors with intracranial extension: a case series

Wei Ping Ng1, King Peng Lee1, Komathi Ramachandran2, Azmi Alias1

1Department of Neurosurgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 2Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Putrajaya, Putrajaya, Malaysia

Correspondence to: Wei Ping Ng, MD. Department of Neurosurgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia. Email: weipingng@yahoo.com.

Background: Sinonasal tumors, occurring in less than 1% of the general population, represent a rare and challenging subset of pathologies. Lesions that affect the skull base present a varied range of pathological entities, posing significant therapeutic complexities for surgeons.

Case Description: This case series explores the surgical interventions performed on three patients with distinct histologic types of sinonasal tumors invading the skull base. These individuals presented with non-specific symptoms persisting for months to a year, including anosmia, nasal congestion, and epistaxis—all in the absence of neurological deficits. The management approaches were discussed on a multidisciplinary basis. Tumor excision was meticulously performed in a single session using a combination of endonasal endoscopic and transcranial approaches. The tumors were successfully excised, addressing both the intranasal and intracranial components. The pathological spectrum included olfactory neuroblastoma, neuroendocrine atypical carcinoid tumor, and paraganglioma with ectopic adrenocorticotropic hormone production. Reconstruction of the skull base involved the utilization of split calvaria bone graft, fascia, Tisseel glue, and a vascularized nasoseptal mucosa flap. Lumbar drain was not used. None of the patients experienced postoperative cerebrospinal fluid leaks or new neurological deficits, with the only noted complication being a subdural hematoma in one patient at a site distant from the surgical field. Minimal residual tumor was detected on postoperative magnetic resonance imaging. Patients remain in remission up to 12 months after completing adjuvant therapies.

Conclusions: The integration of surgical expertise from otolaryngologists and neurosurgeons in a combined approach enables the removal of tumors from two different directions simultaneously. Proper usage of this multilayer pedicled “double flap” contributes to the success of skull base surgery. This approach is safe and effective. It improves the visualization of the tumor, enhances access to critical areas, increases tumor clearance, and also contributes to optimal oncological outcomes.

Keywords: Sinonasal tumor; case series; combined transcranial and endonasal endoscopic

Acknowledgments

The authors thank all the efforts provided by the Neurosurgical Team from Hospital Kuala Lumpur, Malaysia and the Otorhinolaryngology Team from Hospital Putrajaya, Malaysia.

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab030/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient’s parents for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Cite this abstract as: Ng WP, Lee KP, Ramachandran K, Alias A. AB030. Combined transcranial and endonasal endoscopic approach for sinonasal tumors with intracranial extension: a case series. Chin Clin Oncol 2024;13(Suppl 1):AB030. doi: 10.21037/cco-24-ab030

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