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Abstract：
In traditional craniofacial resection of tumors invading the anterior skull base, the bilateral olfactory apparatus is resected. Recently, transnasal endoscopy has been used for olfactory preservation in resections of unilateral low-grade malignancies. However, for tumors that invade the orbita or for high-grade malignancies, the transnasal endoscopic skull base surgery has been controversial. This video demonstrates the surgical techniques of olfactory preservation during craniofacial resection of a high-grade malignancy invading the hemianterior skull base and orbita. We present the case of a 32-year-old woman with osteosarcoma in the right ethmoid sinus. The tumor invaded the ipsilateral cribriform plate, dura menta, and orbital periosteum; however, the nasal septum and crista galli were intact ( Fig. 1A, B ). Because the tumor was a high-grade malignancy and the orbita had been invaded, we performed craniofacial resection instead of endoscopic resection ( Fig. C2A ). We drilled into the right side of the crista galli, midline of the cribriform plate, and perpendicular plate of the ethmoid bone via craniotomy. As a result, we accessed the nasal cavity directly ( Fig. 2B ). To preserve the nasal septum, we detached the remaining right septal mucosa through the transfacial approach ( Fig. 2C ). Because of the high risk of cerebrospinal fluid leakage as a result of previous irradiation, we performed vascularized free flap reconstruction of the skull base instead of pericranial flap. Postoperative computed tomography revealed no evidence of tumor ( Fig. 1C, D ). The patient\'s sense of smell returned after 1 postoperative day, and she was discharged on the postoperative day 14. The link to the video can be found at: https://youtu.be/XzPABYwzkjs .
摘要：
在传统的颅面肿瘤侵犯前颅底切除术中，双侧嗅觉器具被切除。最近,经鼻内窥镜检查已用于单侧低度恶性肿瘤切除术中的嗅觉保存。然而,对于侵入眼眶的肿瘤或高级别恶性肿瘤，经鼻内镜颅底手术一直存在争议。该视频演示了颅面切除术中侵入半前颅底和眼眶的高级恶性肿瘤的嗅觉保留手术技术。我们介绍了一名32岁女性在右筛窦患有骨肉瘤的病例。肿瘤侵入同侧筛板,duramenta,和眼眶骨膜；然而，鼻中隔和cristagalli完好无损（图。1A,B).因为肿瘤是高度恶性的，并且轨道已经被侵入，我们进行了颅面切除术而不是内窥镜切除术（图。C2A).我们钻进了cristagalli的右侧，筛板的中线，和通过开颅手术的筛骨垂直板。因此,我们直接进入鼻腔（图。2B).为了保护鼻中隔，我们通过经面入路分离了剩余的右间隔粘膜（图。2C).由于先前的照射导致脑脊液漏的风险很高，我们进行了颅底血管化游离皮瓣重建，而不是颅周皮瓣。术后计算机断层扫描未显示肿瘤的迹象（图。1C,D).术后1天后患者的嗅觉恢复,她在术后第14天出院。视频的链接可以在：https://youtu找到。be/XzPABYwzkjs。
