Superior Rhinotomy as Anterior approach to skull base
This procedure describes one of the most versatile approaches to the anterior skull base for large tumors of the sinonasal cavity. It may be used with or without a craniofacial resection. The benefits of this approach are: wide access around the tumor; good postoperative cosmesis; & decreased operative & postoperative morbidity. We have used this approach for many bilateral tumors of the nasal & sinus cavities that approach &/or invade the skull base & brain. This video show the resection of a large esthesioneuroblastoma.
Video Transcript
Operating-room audio from a skull-base operation performed through a superior rhinotomy approach. The recording is the surgical team's working conversation — positioning clamps and suction around the anterior ethmoidal artery, cutting bone, and describing the osteotomy cuts around the maxilla and nasal bones — rather than a prepared narration, so the transcript follows the case as it unfolds.
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So you don't get Dr. Lusson yelling at us? James, do you mind? This light needs to be turned on the light. Front death mortal sutra line with the anti-retmoidal artery coming out of it. You see that? You should see it. The suction is under the anti-retmoidal artery. Yeah, it's a great shot. Yeah, yeah. The artery is pretty well. Good. Now what we're going to do is take the bipolar cordary. Actually, we can actually photograph this. Bipolar? The pedal. It's on. You see that? Control the visual. I'm going to use this. I think through the 15th way.
I'll have the grave here. Get another clamp, somebody. Because when he cuts it, you've got to grab the proximal arm. We're going to cut, you see? Get the bone. Don't do anything. Don't do anything until I tell you. All right? Okay, now give me the clamp. Put a little clamp on the bone. You're going to go... Straight iris? Yeah. Got that, John? Oh, yeah. I'll get a straight iris. And you're going to cut straight up? Cut straight up. Closer to the up to the time close to you.
This blue. You're going to single tooth pick up. Cut some more. You're going to single tooth pick up? Okay. Stop. That terrain is going to grasp back area over here. I'm going to grab this over here. Now get the four oh... You got it. You got the four oh chroma? I mean the five oh chroma. Whatever. I'll take a mosquito. He ties his back on itself. Okay. I'll grab this. Okay. Suction, I think. Now you know, inside, right? Get the back of the rhino to chroma. Actually, you can go from here to here like that.
That'll be good to a congenital photograph. You have an account there. You have a single tooth? Transpartial. The idea is to move that triangle. I got a zoom on this. Okay. I've got the applicator yet or no? I'll be there. I've got an applicator and a half. It's great. It's a nice, nice big aperture over here. You see that? I'm putting the applicator in the room so you can see it very clearly. You see that? Come really close. You can see all the lining of the lacquerless sacchi vertebra.
You see that? Want me to take the light off? No, actually, it's a good view. Okay. That's good. You got that? Get it? Good. Let's start with the bleach. Is this one the front of the hood? Is the roll-cage of my life? Yeah. It's close to your table. It's kind of a triple-form needle-warp. That's all. The overall performance. And the claim to be now is a little bad. It's a little bad. All right. It's good. Okay. Same here. It's a little bit of work though. Can I shoot from this place?
Yeah, it's close to the top. It's going to set the indoor water. It's going to set the indoor water. Okay, Joe. You got that? Yep. Okay. Check this one. Got it. Got it. I hate this one. Got the right angle. Right angle. Okay. You see it very clearly. Action away. And he's going to do the same medium to the bundle. So first he's going to start... Get another stuff. You see the chomping over here. Yeah. I know it's a little bit. It's going to bite. Quad, the purple map is good.
Got a bigger one. If you say medium to the middle pergone, as to the bundle, you don't have to reconstruct the floor. And so we have our bone cut. We have cut here. We've got to cut up over here. Yeah. And then what you're going to do is you're going to come through here to get the edmonds, and you're going to come under this bundle butchers, and we're done. Okay. Set one out. Okay. Okay. Now we've got the camera. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay.
Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay, so this is pastry left in the cavity. Okay. In here. In here. Okay. Okay. Okay. You can have any of the way you want. Okay. Okay. The right-hand side. Okay. Okay. Okay. The left-hand side of the cavity. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. This is the mass of the alive. The last one. Has the orbital we trapped. He's got a good headlight. Little light. The infomerary which was here. That's that coming out. The entire infomerary. The orbital down here.
Bone cut coming through here. The pure bone cut we made sure was. Somebody put a bone on there. Put the single hook right on there. The sub should now go into the antrum. And the infir bone cut which is going across the pit on them under the infomer. And the posterior cuts going underneath the turbine. Back to terrible max area space and the posterior superior cut. Up a lot of scissors into the table. Opposite side. Which is not being taken in total. Again nasal bone. Posterior a centimeter and posterior to the superior portion of the lack of a boss.
The entire order. See some bones. You cannot enter the entrum on this side because we're not doing the meal max luxury portion on this side. Because the tumor does not cross the middle. We could be completed with a straight nail. All the way down. The Korean here. Down below and up above. That was a bit of a baby. I'm cutting down. Hey, hey. Okay. Nice. This is becoming a little. You see that. It's not plastic surgery.
Transcript auto-generated from the video’s audio for accessibility and study. Educational content only — not medical advice.
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