The Role of Transfacial Approach in Skull Base Surgery

ABSTRACT

Even though there are diverse tumors invading skull base, it is impossible to completely remove the tumor only by transcranial approach due to its anatomical complexity. Therefore we operated by transfacial approach as well which allows to have a good vision and remove the tumor from different directions. Transfacial approach is to approach tp the skull base for the tumor located on the margin of skull and face through exposing such as nasal cavity, paranasal cavity, nasopharyngeal cavity, etc. after separating facial bone. In 1990 Janecka introduced it, dividing the face into 4 groups mini, standard, expanded, and bilateral facial translocation, based on neurovascular and aesthetic line. Transfacial approach makes it possible to do three dimensional tumor resection, remove the tumor, check its margin directly, and have functionally and aesthetically satisfactory reconstruction. In such cases that tumor invades lower part of skull base, the tumor can be removed only by transcanial approach. Although tumor can be removed by transcranial approach to find the location three dimensionally, transfacial approach can be used as adjunctive means which allow to get a good vision and remove the remnant completely. For 36 months, we have executed 16 cases of tranfacial approach, removing tumors located at the skull base. We classify and suggest the role of tranfacial approach based on our documents.