Evaluation of combined neurosurgical and trans-facial excision of extensive rhinosinus tumors infiltrating the anterior skull base

Rhino-sinusal tumors are rare, representing approximately 0.3% of all cancers and 3% of tumors of the upper respiratory and digestive tracts. In cases in which the tumor has infiltrated the anterior cranial base, the treatment of choice is a surgical resection by combined neurosurgical and transfacial approach giving the best possible exposition for the excision. The resection is associated with various reconstruction techniques according to the extent of the defect. Sixteen patients with rhino-sinusal tumors extending to the anterior cerebral cavity were operated at the ENT clinic of the CHUV in Lausanne between 1977 and 1997. The transfacial and neurosurgical combined approach is rarely curative (30% 5 years survival rate, 80% local recurrence during follow-up), but is still justified, given that its disabling side-effects are scarce. It offers an acceptable quality of life and prevents complications inherent to the natural development of tumors. Pre- or postoperative radio- and chemotherapy, as well as skull base reconstructions using bone grafts or a micro-anastomosed flap give rise to complications which worsen significantly the overall prognosis and should therefore be avoided as much as possible. Still, this heavy surgery remains indicated, because it prevents the numerous complications of the natural course of the disease and offers an acceptable quality of life with only few side-effects.