We have achieved oncological, functional, and cosmetic goals. The transfacial procedures include incisions, osteotomies, and ostectomies. The transcranial approach involves incisions, craniotomies, and craniectomies. Our oncologic goals are local control or palliation; our functional goals are to preserve the function of the brain, the ocular system, and the cranial nerves; the cosmetic goals are to reduce scarring and loss of bone.
Dr. Carrau said that clinicians who venture into endoscopic procedures to prevent scarring and other morbidities involved in traditional surgery should gain experience slowly in developing their surgical skills with a variety of instruments. We use a bimanual technique, with two nostrils and two surgeons and four hands, he said. I advise you to have a lot of experience with both oncological principles and endoscopic techniques-and I really mean a lot of experience, because we are dealing with cancer, and the life of the patient will be at stake.
Endoscopic Surgery for Olfactory Neuroblastoma
In a series of video clips, Dr. Carrau described one such procedure-an olfactory neuroblastoma. We first debride the tumor to give us more space and better visualization. Our next step is to identify surgical landmarks. You are going to need two major landmarks for this tumor. One is the skull base, and we obtain that by performing a wide sphenoidotomy. The other is the lamina papyracea, which is identified by creating a wide nasomaxillary window. The lamina papyracea is removed on both sides to gain vascular control of the skull base. We usually will put a clip on an artery supplying the tumor and cauterize it at the same time. Septal incisions are similar as in the open approach. | ← Previous | | | Next → | Single Page