Preservation of Olfaction in Anterior Skull Base Surgery

• Published in: The Laryngoscope 2000-08, Vol.110 (8), p.1317-1322
• Main Authors: Dale Browne, J., Mims, James W.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - surgery; Adult; Aged; Anterior skull base surgery; Biological and medical sciences; craniofacial resection; Encephalocele - surgery; Ethmoid Bone; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Melanoma - surgery; Middle Aged; Neoplasm Recurrence, Local - surgery; Neuroblastoma - surgery; olfaction; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Retrospective Studies; Skull Base Neoplasms - diagnosis; Skull Base Neoplasms - surgery; Smell; subcranial; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Tomography, X-Ray Computed; Tumors
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200008000-00017

Objectives/Hypothesis In selected unilateral tumors and defects of the anterior skull base, the preservation of contralateral olfaction is achievable through a localized subcranial approach without compromising surgical objectives of resection or repair. Study Design Description of a functional adaptation of anterior skull base surgical techniques through a retrospective patient series. Methods Nine patients underwent anterior skull base surgery for unilateral cribriform plate disease including four malignant and two benign tumors, two encephaloceles, and one iatrogenic cribriform injury with cerebrospinal rhinorrhea. All nine patients consented to a localized subcranial approach to the anterior skull base to preserve the contralateral olfactory nerves. In four patients with benign disease a portion of the ipsilateral nerves was additionally conserved. Postoperative olfaction was assessed objectively with a commercially available smell test. Indications, technique, results, and complications are reported and discussed. Results All patients had eradication of disease with preservation of functional olfaction Conclusions Conservation of olfaction is possible in selected cases of anterior skull base surgery when the lesion is unilaterally confined.