Surgical Nuances of Managing Sinonasal Malignancy by Endoscopic Endonasal Transcribriform Approach

ABSTRACT: Sinonasal malignancies especially involving the ethmoidal sinuses, and nasal cavity can involve the cribriform plate and base of anterior cranial fossa. Endoscopic endonasal transcribriform approach gives a minimally invasive corridor to achieve a complete tumor removal with negative margins. To demonstrate the surgical techniques of endoscopic transcribriform approach to anterior cranial fossa in a case of adenoid cystic carcinoma of nose. Rapid debulking of tumor was performed on the right nasal cavity with removal of orbital portion of tumor, and complete excision of involved dura after an endoscopic craniectomy. This was followed by a multi-layered repair of the skull base defect. Transcribriform approach is a minimally invasive corridor to approach the sinonasal malignancies extending in the anterior cranial fossa and tumors of olfactory. Appropriate case selection is pertinent for considering a case of sinonasal malignancy for endoscopic endonasal transcribriform approach. Involvement of external nasal skin and periorbita is a contraindication for an endoscopic approach.