An anatomical study on the applicability of direct endoscopic exclusion of the ethmoid arteries for devascularization of the anterior skull base structures

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The anterior skull base structures are the site of initial growth of histologically different tumors. The difficulties in their removal are often associated with significant vascularization, which may limit the amount of resection due to abundant intraoperative blood loss. Midline tumors are primarily fed by the ethmoid arteries that are not accessible to embolization. The aim of this work was a comparative experimental study of various direct approaches to the ethmoid arteries. Material and methods. The study was conducted on anatomical specimens of 12 cadaveric heads of deceased people without pathology of the anterior skull base structures, orbits, nasal cavity, and paranasal sinuses (24 sides). In all specimens, the internal and external carotid arteries were stained with silicone. During anatomical dissection, four surgical approaches for exclusion of the ethmoid arteries were studied: 1) transorbital approach to the arteries using a bicoronal incision; 2) endoscopic retro-caruncular approach; 3) endoscopic endonasal transethmoidal approach to the ethmoid artery canals; 4) endoscopic endonasal transethmoidal transorbital approach to the ethmoid arteries in the orbit. Results. We described a surgical technique for exclusion of the ethmoid arteries using the approaches and analyzed their advantages and disadvantages. We formulated an algorithm for choosing the method for direct endoscopic exclusion of the ethmoid arteries, depending on the surgical approach chosen for removal of the tumor and features of the tumor extracranial spread. Conclusion. The decision on tumor devascularization is based on assessment of tumor blood supply (CT angiography or MR angiography data). Our study demonstrated the advantages and disadvantages of various approaches to the ethmoid arteries for their exclusion in order to early devascularize anterior skull base tumors. All these approaches are less traumatic and characterized by a good cosmetic and functional outcome.

Keywords:

skull base tumor

anterior cranial fossa

endoscopy

ethmoid arteries

devascularization

surgical approach

Authors:

Gol'bin D.A.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Shkarubo M.A.

Burdenko Neurosurgical Institute, Moscow, Russia

Lasunin N.V.

FGBU "NII neĭrokhirurgii im. N.N. Burdenko" RAMN, Moskva

Cherekaev V.A.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Grigor'eva N.N.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Serova N.K.

NII neĭrokhirurgii im. N.N. Burdenko RAMN, Moskva

Tarkhnishvili G.S.

Khimki Forensic Medical Examination Unit of the Moscow Region Forensic Medical Examination Bureau, Moscow Region, Russia

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