[Surgical treatment of naso-sinus tumors invading the anterior region of the base of the skull. Problems encountered during exploration, and repair of bone and dura mater].

Current limitations for surgical excision and solutions to problems of bone and dura mater repair of nasosinusal tumors invading the anterior region of the base of skull are discussed in relation to 14 cases. None of these patients had been operated upon by first intention using the upper approach Exploration of the median part of the anterior region is limited posteriorly by the posterior border of the jugum and the base of the anterior clinoid processes. Pre-operative discovery of invasion of the dura mater is a contraindication for surgery. Posterior and dural extension of the tumor is evaluated by combined CT Scan and tomography, but these examinations do not always confirm the absence of dura mater involvement before surgery. A double approach should be used when doubt as to invasion of the base exists. Dura mater repair involves suturing, a free periosteal flap, and a pediculated cranial periosteum flap anteriorly on the fronto-orbital region. Reconstruction of the base requires the use of the periosteal flap, alone or associated with bone grafts depending on the size and location of the bone breach. Short and long term postoperative complications were nor observed.