Abstract
We have performed en bloc craniofacial resection containing both anterior and/or middle cranial base for the extensive nasal and paranasal sinus carcinoma invading the skull base since 1987, and we also proposed a new method of the intradural resection of the extensive cancer in 1990. En bloc resection of both anterior and/or middle cranial base with a maxillofacial segment is composed of two kinds of bone cutting lines on the skull base, one of which is a sagittal line throgh the cribriform plate and the other is a transverse line throuth the foramen ovale from the mandibular fossa to the carotid sulcus on the middle cranial base, and which access over the sphenoid body between the planum sphenoidale and the carotid sulcus. The area surrounded by these osteotomy lines contains the base of the pterygoid process, the superior orbital fissure, and the foramen rotundum where nasal and paranasal sinus carcinomas frequently invade. The en bloc resection is not considered to be indicated from such investigations as CT, MRI, 3D-CT and large sectioned specimens, in cases when such cancers invade further deep beyond the posteromedial margins of this area into 1) the sphenoid body, 2) the sphenoclival junction, 3) the cavernous sinus 4) the foramen lacerum and around the interal caratid artery and/or 5) the dura near this area with skip lesions on the skull base.
