Open Surgical Approaches for Sinonasal Malignancies: Indications and Outcomes

Purpose of Review: This review summarizes techniques, access, and complications of open approaches to the sinonasal cavity and ventral skull base for sinonasal malignancies. The indications and appropriateness of various transfacial and transcranial approaches are discussed in the context of pathology and extent of disease. Recent Findings: En bloc resection with negative margins remains the gold standard in oncologic surgery. In properly selected patients, open approaches allow the ability to achieve negative margins during resection which optimizes overall survival and local control. Summary: Sinonasal malignancies can be safely and effectively treated with a variety of transfacial and transcranial approaches. The advantages to open approaches include gaining broader access to the sinonasal cavity, skull base, and adjacent structures as well as the ability to perform en bloc resections. Open techniques are also associated with increased morbidity. The choice to perform surgery must therefore be decided considering the patient’s tumor histology, stage, and overall goals of care.