Combined ORL and neurosurgical approach in adenocarcinoma of the ethmoid. Preliminary results apropos of 15 cases

Fifteen cases of adenocarcinoma of the ethmoid sinus treated by a combined subfrontal and transfacial approach after induction chemotherapy are reported. The surgical technique is described precisely including a paralateronasal approach combined with a bifrontocoronal incision, a bilateral ethmoidectomy and reconstruction of the anterior base of the skull by one sheets taken-out from the inner surface of the frontal flap or more recently madreporic coralline grafts; the dura is hermetically sealed and it is lined with a large galea flap. Results were as following: one post-operative death, no clinical rhinorrhea, no recurrence from the anterior cerebral fossa, one orbital and one sphenoidal recurrences. Surgical indications are discussed according to the different extensions of the tumor and a frontal lobe extension is not a contraindication. This surgical procedure should be employed for the adenocarcinomas of the ethmoid invading the superior cells even in the absence of lysis of the cribriform plate in order to avoid the endocranial recurrences.