[Selection of operative approaches for rhinosinusal malignant tumor involving in the anterior skull base and exploration for reconstruction].

Objective: To investigate operative approaches and techniques of reconstruction for rhinosinusal malignant tumors involving in the anterior skull base.

Method: In a retrospective study, clinical data of 22 patients treated surgically in our department from 1988 to 2002 were analysed. Lateral rhinotomy was carried out in 8 patients and ampliative rhinotomy in 4 patients; in 10 patients craniofacial operation was performed. Multiple layer fascia flaps were used to repair lager defect in the anterior skull base.

Result: All tumors were totally resected. In lateral rhinotomy, local locoeled meningitis happened in 1 case, and 4 patients in craniofacial operation. None complication with cerebrospinal fluid leaks, encephalomeningocele and intracranial air. All patients were followed up from 6 months to 11 years after surgery. 7 patients died from intracranial infection or metastasis of tumor. 3-year survival rates was 15/19(78.9%); 5-year survival rates was 13/19(68.4%). The tumor invaded the orbital fascia in 9 patients. Vs 4/9 (44.4%) and 2/9(22.2%) for these 3 and 5-year survival rates.

Conclusion: Selection of operative approaches depends on the size of defects in the anterior skull base, extent of intracranial invasion and location of rhinosinusal malignant tumors; multiple layer fascia flaps can be used to reconstruct bigger defects of the skull base. It is safe, technically easy, effective procedure and worthy to be recommended.