Tumors of the paranasal sinuses: a therapeutic challenge.

Cancer involving the ethmoid and sphenoid frontal sinus complex can be successfully eradicated by a combined transcranial and transfacial surgical dissection. Survival rates of 44 to 58 percent with a 3 percent hospital mortality rate in patients whose previous surgery or radiotherapy was largely unsuccessful suggest that this cosmetically acceptable surgical endeavor should be used more often by the head and neck surgeon in treating paranasal sinus cancer. Utilizing the principles of antibiotic prophylaxis, strict attention to principles of tumor removal and surgical technique, and the talents of the combined surgical and neurosurgical team, this aggressive surgical approach to the paranasal sinuses can be safely and successfully carried out. The approach described herein has the following advantages: it allows accurate evaluation of intracranial tumor extension while protecting the intracranial contents, it essentially avoids cerebrospinal fistulization, it provides adequate exposure for hemostasis, facilitates en bloc tumor resection, selectively conserves the orbital contents, and provides patient survival rates up to 58 percent for paranasal cancer that involves the ethmoid and sphenoid frontal sinus complex.