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Image Code: 3671
Figure 1. A-C: Anterior skull base tumor involving the nasal cavity bilaterally;
Image published on/in: 2013 Vol.: 79 Ed.: 6 - 18º
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Description: Figure 1. A-C: Anterior skull base tumor involving the nasal cavity bilaterally; therefore, requiring a bilateral resection; D: Sequentially, a wide sphenoidotomy and nasoantral window are completed; E-F: A HBF is raised on the healthy side of the nasal septum and is stored in the nasopharynx; a bony posterior septectomy and Caicedo's reverse flap follows. This allows communicating the posterior nasal cavities into a single chamber; G: Bilateral frontal sinusotomy (Draf Type III), followed by the drilling of the crista galli, help to establish the anterior resection margin; H: The anterior and posterior ethmoid arteries are coagulated and divided; I: Anterior cranial base bone is dissected off the dura including fovea ethmoidalis, cribriform plate, and crista galli; J-L: After complete bony removal, the dura is exposed and opened in the 'inverted U', starting the incisions at the lateral margins; M-N: The cerebral falx is incised in a ventro-caudal direction; O: The olfactory nerves are resected for margins and their stumps are cauterized; P-R: This allows the infero-posterior displacement and resection of any residual tumor and cribiform plate en bloc; S: Once margins are deemed free from tumor by histological analysis, the reconstruction is performed; T: A collagen matrix graft is inlaid and the HBF is onlaid. Rt. MT: Right middle turbinate; Lt. MT: Left middle turbinate; MS: Maxillary sinus; SS: Sphenoid sinus; HBF: Hadad-Bassagaisteguy nasoseptal flap; FS: Frontal sinus; AEA: Anterior ethmoidal artery; PEA: Posterior ethmoidal artery; CG: Crista galli; ON: Olfactory nerve; CM: Collagen matrix.
Author(s) of the original article: Pornthep Kasemsiri; Daniel Monte Serrat Prevedello; Bradley Alan Otto; Matthew Old; Leo Ditzel Filho; Amin Bardai Kassam; Ricardo Luis Carrau
Title and link to the article: Endoscopic Endonasal endonasal technique: treatment of paranasal and anterior skull base malignancies
oldfiles.bjorl.org/conteudo/acervo/acervo_english.asp?id=4531
Link to the article: 
