RESUMO
The objective of the present work was to study peculiarities of diagnostics of bone and cartilaginous tumours in the sino-paranasal region with intracranial extension, to substantiate the choice of the strategy and methods for the surgical intervention for the treatment of these neoplasms. The study included 19 patients with various bone and cartilaginous neoplasms in the craniofacial region. Diagnostics was based on computed tomography allowing for 3D reconstruction of the structures of interest, magnetic resonance imaging (with amplification whenever necessary), and angiography. It is proposed to use the microsurgical and pneumatic techniques to ensure the maximally complete removal of the tumours with a minimal injury to the surrounding tissues. The extension of fascial approach is recommended for the management of intracranially spreading tumours. This technique was used for the treatment of 9 patients (7 undergoing anterior craniofacial resection, 1 lateral craniofacial resection, and 1 subcranial resection) in combination with Moure and Denker rhinotomy. The transcranial approach was employed in 8 patients one of whom underwent transoral surgery and another transnasal intervention. Also, the histological structure of the tumours needs to be taken into consideration when planning the approach and the extent of the surgical intervention. It is concluded that preliminary courses of chemo and radiotherapy do not significantly improve the outcome of surgical treatment; in contrast, they promote the development of complications during the postoperative period. The results of this study indicate that for the management of benign tumours characterized by the slow growth rate (osteoma, chondroma, chordoma) the traditional ENT approaches can be supplemented by transcranial surgery. Extensive interventions (anterior craniofacial reseaction, lateral craniofacial resection) are needed for the management of aggressive malignant tumours (ostesarcoma, chondrosarcoma) without serious injury the healthy tissues; moreover, such approach increases the survival rate of the patients.
