Sublabial transnasal approach combined with a partial resection of the nasal floor for midline skull base tumors

A variety of surgical approaches have been used in the treatment of midline cranial base tumors. These approaches usually involve complicated techniques, particularly when they are employed for tumors involving the entire clivus. This paper describes the feasibility, efficacy, and safety of the sublabial transnasal approach combined with a partial resection of the nasal floor in the treatment of midline skull base lesions. We performed this approach in three patients with midline cranial base lesions, including invasive pituitary adenoma involving the whole clivus, fibrous dysplasia, and adenocystic carcinoma. The rostrocaudal extent of surgical exposure with this technique was the planum sphenoidale superiorly and the lowermost level of the clivus inferiorly. The lateral extent of the exposure was limited to the distance between the bilateral extradural internal carotid arteries. The average time taken to expose the entire length of the clivus was approximately 30 minutes. There were no serious complications related to the surgical procedure. None of the patients developed cosmetic abnormalities. Experience with these three patients indicates that the sublabial transnasal approach combined with a partial resection of the nasal floor is a safe, less invasive and effective approach in certain cases of midline skull base tumors.