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Neurosurgery
Combined Craniofacial Resection of Anterior Skull Base Tum
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
9 sections · 64 slides
Foundations
What the operation is, and why it exists
- The problem: a tumor in a surgical no-man's-land
- The core idea of a 'combined' resection
- How the operation evolved
- Why the bone flap got bigger and lower over time
- Why endoscopy rose but open surgery stayed
- Three ways to reach the same tumor
The endoscopic corridor
Where a scope through the nose can and cannot reach
- The easy direction: front-to-back, in the midline
- The hard direction: carotids fence the sides
- Finding the natural sphenoid sinus opening
- When a pure endoscopic approach is off the table
- Why keep the scope even when opening the skull
- Deciding which approach to use
- What the traditional CFR exposes
The tumors and the team
What is being removed, and who plans it
- The cancers that live here
- Kadish staging of olfactory neuroblastoma
- The differential diagnosis
- Why a multidisciplinary tumor board is essential
Preoperative preparation
Reading the patient and the imaging before the first cut
- Early symptoms: why these tumors hide
- Advanced symptoms: the tumor announces itself
- Does brain invasion rule out surgery?
- Getting the tissue diagnosis safely
- CT versus MRI: complementary eyes
- Reading the MRI: telling mucus from tumor
- Hunting for spread: nodes and metastases
- Pulling the plan together at the tumor board
The operation: setup
Anesthesia, brain relaxation and positioning
- Anesthetic groundwork
- The lumbar drain debate
- Relaxing the brain to avoid retracting it
- Positioning for the open approach
- Positioning for the endoscopic approach
- When a tracheotomy is needed
- Protecting the eyes and prepping the skin
Building the exposure
Scalp flap, pericranial flap and the frontal craniotomy
- The bicoronal incision and scalp flap
- Harvesting the pericranial flap
- The frontal craniotomy
- Why place the lower edge of the frontal bone flap just above the orbital rims?
- The fronto-orbital variation
- Managing the frontal sinus and opening the dura
Facial exposures and the 'box'
Planning the walls and floor of the specimen
- Think of the resection as removing a box
- A small tumor: an endoscopically guided box
- Larger tumor: box expands to orbit and maxilla
- External incisions for craniofacial resection
- Bigger still: Weber-Fergusson and facial degloving
Key operative steps
High points of the open and endoscopic resections
- Open excision, part 1: freeing the medial orbit
- Open excision, part 2: the bone cuts and specimen
- Open excision, part 3: rebuilding the floor
- Endoscopic approach, part 1: inspect and raise the flap
- Endoscopic approach, part 2: open up and resect
- Endoscopic approach, part 3: multilayer reconstruction
Reconstruction and aftercare
Sealing the base and recovering the patient
- The reconstruction ladder
- Postoperative management
- Numbers worth remembering
- Key takeaways
- Neurosurgical Operative Atlas: Neuro-Oncology