Name of the Procedure:

Craniofacial Approach to Anterior Cranial Fossa; Extradural, Including Lateral Rhinotomy, Ethmoidectomy, Sphenoidectomy, Without Maxillectomy or Orbital Exenteration

Summary

This surgical procedure involves accessing the anterior cranial fossa through a craniofacial approach. It includes creating an opening through the nose, removing the ethmoid and sphenoid sinuses, but does not involve removing the upper jaw (maxillectomy) or the contents of the eye socket (orbital exenteration).

Purpose

The procedure addresses various conditions affecting the anterior cranial fossa such as tumors, infections, or traumatic injuries. The goal is to remove diseased tissue, relieve pressure, or repair injuries to improve the patient's health and neurological function.

Indications

• Tumors in the anterior cranial fossa
• Chronic sinus infections resistant to other treatments
• Traumatic injuries with damage to the skull base or brain
• Cerebrospinal fluid leaks

Preparation

• Fasting for 8-12 hours before the procedure
• Adjusting or stopping certain medications as directed by the doctor
• Preoperative imaging studies (CT or MRI scans) to plan the surgery
• Blood tests and other routine pre-surgical assessments

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A lateral rhinotomy is performed, making an incision along the side of the nose.
3. Extradural Access: The surgeon accesses the anterior cranial fossa without penetrating the dura mater (outer membrane covering the brain).
4. Ethmoidectomy: Removal of the ethmoid sinuses.
5. Sphenoidectomy: Removal of the sphenoid sinuses.
6. Closure: The incisions are closed and bandaged.

Specialized surgical instruments and imaging guidance are used throughout the procedure to ensure precision and safety.

Duration

The procedure typically takes between 4 to 6 hours, depending on the complexity and extent of the surgery.

Setting

The procedure is performed in a hospital's operating room specially equipped for neurosurgery.

Personnel

• Neurosurgeon
• Otolaryngologist (ENT Surgeon)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Cerebrospinal fluid leak
• Damage to surrounding structures such as the brain or optic nerves
• Temporary or permanent vision changes
• Anesthesia-related risks
• Postoperative pain and swelling

Benefits

• Removal or reduction of tumors or infections
• Relief from chronic pain or pressure
• Improved neurological function
• Restoration of normal sinus function

Patients may start seeing benefits within a few days to weeks post-surgery.

Recovery

• Hospital stay of 3-7 days for close monitoring
• Pain management with prescribed medications
• Avoidance of strenuous activities for several weeks
• Follow-up appointments for monitoring recovery and assessing surgical success
• Long-term follow-up may include imaging studies and other assessments

Alternatives

• Endoscopic sinus surgery for less invasive management of certain conditions
• Radiation therapy or chemotherapy for inoperable tumors
• Observation and medical management for less severe conditions

Each alternative has its own set of benefits and risks, which should be discussed with the healthcare provider.

Patient Experience

Patients may experience discomfort, swelling, and mild to moderate pain post-surgery, which can be managed with medication. Initial nasal congestion and drainage are common but typically resolve as healing progresses. Full recovery may take weeks to months, and patients are usually advised to avoid activities that may increase intracranial pressure. Regular follow-up visits ensure any complications are promptly managed.