Anterior Craniofacial Resection

Anterior CFR encompasses structures of the anterior mid-line and paramedian skull base (see Fig. 15.4). The ethmoid sinuses superiorly, the anterior wall of the sphenoid posteriorly, the frontal sinus anteriorly, and the nasopharynx inferiorly are included in the surgical perimeter of the anterior craniofacial resection.

Indications

• Resection of malignant tumors of the paranasal sinuses involving the ethmoid/ frontal sinus with proximity to or involvement of the ethmoid roof/ cribriform plate.

• Resection of benign tumors of the paranasal sinuses, meninges or skull base with involvement of, or extension through, the skull base.

Surgical Steps

The anterior CFR is performed through bicoro-nal and paranasal facial incisions. Following facial bone exposure, the medial walls of both orbits are explored, identifying and cauterising the anterior and posterior ethmoidal vessels. This establishes the lateral perimeter of the resection. Osteotomies can be performed at this point through the medial orbital wall of each orbit at the junction with the orbital floor. Anteriorly, a vertical cut can be made from the level of the lacrimal fossa to the level of the nasion, and a similar cut can be made posteriorly at the level of the posterior ethmoidal foramina.

At this point, a bifrontal craniotomy is performed. The bicoronal incision allows wide access to the frontal bone and, most importantly, preservation of pericranium [21] for use as a vascularized flap to repair the anterior fossa floor defect (it is raised in a rectangular shape with its base at the supraorbital region and receives its blood supply from supraorbital and

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