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Preservation of olfaction in frontal transbasal approach Masamitsu KAWAUCHI 1 , Susumu TOMITA 1 , Shoji ASARI 1 , Takashi OHMOTO 1 1Department of Neurological Surgery, Okayama University Medical School Keyword: olfation , surgical approach , skull base tumor , transbasal approach pp.613-619
Published Date 1997/7/10
DOI https://doi.org/10.11477/mf.1436901416
  • Abstract
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Lesions in the frontal base and clival area have con-ventionally been approached using the transbasal approach described by Derome and Guiot. However, this approach necessitates removal of the crista galli and sectioning of the olfactory rootlets with the associ-ated risk of anosmia and cerebrospinal fluid leak and, in addition, complex reconstruction of the frontal base is required.

We describe a new approach to deeply situated tumors in the frontal base, parasellar and clival area which is a modification of Spetzler's craniofacial approach with preservation of olfaction. In this approach, circumferential osteotomy cuts are made around the cribriform plate to permit en block removal with its attachment to both the dura and underlying mucosa. Opening of the dura is avoided and the cribri-form bone is used to reconstruct the frontal base.

Three patients underwent surgery using this ap-proach for treatment of recurrent pituitary adenoma in two cases and for clivus chordoma in one. In one pa-tient, olfactory function was not preserved because re-section of nasal mucosa was small. In the other two pa-tients, however, olfaction was preserved by creating a cribriform plate complex with a sufficient area of resec-tion of nasal mucosa and tumors were completely re-moved.

Olfaction can be preserved, CSF leakage can be pre-vented, and facial skin incision and complex frontal base reconstruction can be avoided when this technique for maintaining normal olfactory-cribriform anatomy is used in frontal transbasal approaches.


Copyright © 1997, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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