Multiportal combined transnasal transoral transpharyngeal endoscopic approach for selected skull base cancers

BACKGROUND: Minimally invasive endoscopic endonasal approaches to the ventral skull base have evolved considerably over the past several years. However, where there is a lateral extension of tumors as far as the parapharyngeal spaces with inferior extension below the level of the soft palate, limitations remain for an exclusive transnasal approach. METHODS: A combined endoscopic-assisted transnasal-transoral-transpharyngeal multiportal approach was performed to resect selected skull base malignancies that could not be adequately managed using a single approach. RESULTS: Three cases of skull base cancer (squamous cell carcinoma, polymorphous low-grade adenocarcinoma, and high-grade osteosarcoma) were suitable for such an approach. In all cases, a radical resection was obtained without major complications and with minimal morbidity for the patient. CONCLUSION: The transnasal, transoral, and transpharyngeal surgical windows are complementary approaches that, when combined, provide excellent exposure for selected skull base malignancies that have extended too laterally and inferiorly to allow an exclusively transnasal approach. © 2016 Wiley Periodicals, Head Neck 38: E2440-E2445, 2016.