Anterior skull base surgery for malignant tumors: A multivariate analysis of 27 years of experience

Bentz, Brandon G.; Bilsky, Mark H.; Shah, Jatin P.; Kraus, Dennis H.

doi:10.1002/hed.10250

Cited by 89 publications

(79 citation statements)

References 24 publications

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“…[1][2][3][4] This approach was considered the gold standard for treatment of anterior skull base tumors, and represented a major advance when described by Ketchum in 1963. 5 Recurrence rates were dramatically reduced by the resection of the cribriform plate.…”

Section: Introductionmentioning

confidence: 99%

Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base

et al. 2009

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TER of ASB malignancy is associated with a decreased hospital stay and faster recovery when compared to open CFR. Lower local recurrence rate in the TER group may reflect a discrepancy in histology and clinical stage. We found no significant differences in survival, metastatic, or complication rates in the two groups, whereas patients in the TER group had the added benefit of a desirable cosmetic outcome. Overall, TER seems to be an excellent alternative to CFR in properly selected cases.

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Section: Introductionmentioning

confidence: 99%

Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base

et al. 2009

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“…Tumor resection was avoided in this region because of the perceived biological aggressiveness of these tumors, difficulty in achieving negative histological margins, and the associated surgical morbidity and mortality. Although several articles have provided outcome data for resection of anterior cranial base tumors (1)(2)(3)(4)(5)(6)(7)10,13,14), very few authors have addressed cranial base malignancies specifically involving the infratemporal fossa (2,9).…”

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confidence: 99%

Craniofacial Resection for Cranial Base Malignancies Involving the Infratemporal Fossa

Bilsky

Bentz

Vitaz

et al. 2005

Operative Neurosurgery

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OBJECTIVE-Cranial base malignancies involving the infratemporal fossa have been considered unresectable. Advanced operative techniques have made tumor resection feasible in an en bloc fashion with negative histological margins, but there are limited data regarding outcome analysis in patients who have undergone resection of malignant tumors in this area. METHODS-AtMemorial Sloan-Kettering Cancer Center, 25 patients underwent anterolateral cranial base resections for tumors that involved the infratemporal fossa during a 7-year period. The most common tumors were sarcoma (n = 9), squamous cell carcinoma (n = 6), and adenoid cystic carcinoma (n = 3). The median size of the tumors was 6 cm, and 12 tumors involved the anterior cranial base and/or orbit. Tumor resections were divided into three types. Twelve patients underwent Type 1 dissection for tumors involving only the infratemporal fossa and maxillary sinus; 2 patients underwent Type 2 dissections involving the infratemporal fossa and anterior cranial base; and 11 patients underwent Type 3 dissection, which included the infratemporal fossa, anterior cranial base, and orbit. All patients required free flap reconstruction, 22 of which were rectus abdominis free flaps.RESULTS-Complications occurred in seven patients, including a single mortality resulting from a myocardial infarction. The 2-, 3-, and 5-year survival rates were 69, 63, and 56%, respectively. The relapse-free survival rates were 47% at 2 and 3 years and 41% at 5 years. Recurrences were local in nine patients and distant in four patients.CONCLUSION-Despite the extensive nature of many infratemporal fossa tumors, they can be resected with acceptable morbidity. Survival rates approach those of anterior cranial base malignancies without infratemporal fossa involvement.

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“…They are prone to re-hospitalization and repeated neurosurgical operations given their high risk for life-threatening complications, including [2,3] Patients with malignant tumors of the anterior skull base are prone to even higher rates of complication postresection. [17] As described by Bentz et al, [4] even in patients without confounding complications, the 5-year disease specific survival rate for patients undergoing anterior skull base resection for malignancy is 57%. Those patients with anterior skull base defects whose courses are complicated by prior surgical intervention, radiation, chronic infection, or fistula formation are at even greater risk for death and complications, and often suffer extended hospitalization and repetitive attempts at surgical correction.…”

Section: Discussionmentioning

confidence: 92%

“…Defects of the anterior skull base are intrinsically complex with an irregular serrated surface separating the dura from the sinonasal space, and are often complicated further by radiation, multiple prior surgical interventions, and repeat infections. [1][2][3][4] Patients with these defects are generally quite ill with poor nutritional status and a weakened immune system. They are at risk for multiple life-threatening conditions including meningitis, encephalitis, brain abscess, persistent cerebrospinal fluid (CSF) leak, pneumocephalus, and even herniation of brain tissue.…”

Section: Introductionmentioning

confidence: 99%

“…The sternocleidomastoid flap is additionally challenging due to its segmental blood supply. [4] The endoscopically performed pedicled nasoseptal flap is a newer method gaining popularity within the otolaryngology community. [10] Weber et al [11] described success in using a variety of free tissue transfer for both skull base defects and craniofacial reconstruction with exposed dura for anterior, middle and posterior skull defects combined.…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of the anterior skull base with radial forearm free tissue transfer: case series and literature review

Olaya¹,

Daly²,

Clark³

et al. 2016

PAR

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Aim: Reconstruction of the anterior skull base offers an especially complex challenge as the impermeable separation of the dural space and the upper aerodigestive tract must be maintained. We propose the use of the radial forearm free flaps (RFFF) as a superb method of re-establishing integrity in anterior skull base defects. Methods: Literature review and retrospective analysis of 4 single-institution cases of anterior skull base defects reconstructed with a RFFF. Data were collected on successful and unsuccessful defect repairs, complication rates, and length of hospitalization. Results: The indications for surgery were pneumocephalus, recurrent brain abscesses, recurrent frontal sinus mucoceles, and cerebrospinal fluid leak. Of the 4 cases, 1 was complicated by a small dehiscence of the craniotomy site, 1 developed infection, and 2 required further surgery. Conclusion: The use of RFFF is an excellent option for reconstruction of defects in the anterior skull base, especially those complicated by radiation, prior surgery, or infections. Patients with skull base defects are inherently at high risk for post-surgical complications. The RFFF transfers healthy, viable, well-vascularized tissue to prevent further infections and provides a reliable barrier between the dural and sinonasal spaces. This can reduce the need for repeat neurosurgical operations and hospitalizations.

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Anterior skull base surgery for malignant tumors: A multivariate analysis of 27 years of experience

Cited by 89 publications

References 24 publications

Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base

Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base

Craniofacial Resection for Cranial Base Malignancies Involving the Infratemporal Fossa

Reconstruction of the anterior skull base with radial forearm free tissue transfer: case series and literature review

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