Complications of craniofacial resection for malignant tumors of the skull base: Report of an International Collaborative Study

Ganly, Ian; Patel, Snehal G.; Singh, Bhuvanesh; Kraus, Dennis H.; Bridger, Patrick G.; Cantù, G.; Cheesman, A. D.; De, Geraldo; Donald, Paul J.; Fliss, Dan M.; Gullane, Patrick; Janecka, Ivo P.; Kamata, Shin Etsu; Kowalski, Luiz Paulo; Levine, Paul A.; Medina, Luiz R.; Pradhan, Sangram K.; Schramm, Victor L.; Snyderman, Carl H.; Wei, William I.; Shah, Jatin P.

doi:10.1002/hed.20166

Cited by 296 publications

(339 citation statements)

References 16 publications

(25 reference statements)

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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: 95%

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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Section: Discussionmentioning

confidence: 95%

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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“…To date, the best outcome studies of these tumours are from the International Collaborative Study, which published their results most recently in 2006 (1,3,17,18). In this multicentre case series, in which our institution was included, data from 1307 patients were acquired retrospectively.…”

Section: Resultsmentioning

confidence: 99%

Surgical Approaches to Resection of Anterior Skull Base and Paranasal Sinuses Tumors

Abu‐Ghanem

Fliss

2013

Balkan Med J

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IntroductionTumours involving the anterior skull base and paranasal sinuses are challenging to treat because of their relative rarity, the wide diversity of tumour types represented, and the variability in the extent of involved local structures (1).The route of spread of these tumours is determined by the complex anatomy of the craniomaxillofacial compartments. These tumours may invade laterally into the orbit and middle fossa, inferiorly into the maxillary antrum and palate, posteriorly into the nasopharynx and pterygopalatine fossa (PPF), and superiorly into the cavernous sinus and brain. Surgery remains the important modality of treatment of anterior skull base tumours. Combined craniofacial techniques for the resection of tumours of the anterior skull base were first described by Ketcham et al. (2) in 1963. Since then, anterior skull base surgery has evolved greatly, with a better understanding of the anatomy, pathology, imaging and surgical techniques. The craniofacial approach and the subcranial approach have become the standard of care for the treatment of malignant tumours involving the anterior skull base (3-6) and, because of this and the varied histologic findings, most outcomes data reflect the experience of small patient cohorts. This International Collaborative study examines a large cohort of patients accumulated from multiple institutions experienced in craniofacial surgery, with the aim of reporting benchmark figures for outcomes and identifying patient-related and tumor-related predictors of prognosis after craniofacial resection (CFR. Recent developments in technology have allowed the use of endoscopic endonasal approaches. Nevertheless, several problems still exist, relating to case selection, histology, cost, patient selection, and the experience of the surgeon. This review focuses on the open surgical resection approaches used for anterior skull base tumours, as used in our institution in the last 20 years. AnatomyThe anterior skull base is a complex anatomical compartment. It can be defined as the portion of the skull base adjacent to the anterior cranial fossa. The anterior skull base boundaries include the medial border that is formed by the cribriform plate, making up the roof of the nasal cavity, the lateral border that is formed by the orbital plates of the frontal bone that form the roof of the orbits and ethmoid air cells, and the posterior border that is formed by the planum sphenoidale and lesser wings of the sphenoid (4).The cribiform plate is traversed by multiple olfactory nerves that extend from the olfactory mucosa to the olfactory bulbs. A bony fissure between the lesser and greater sphenoid wings, the superior orbital fissure, gives passage to cranial nerves III, IV, V and VI and to the superior ophthalmic vein. Superior and laterally lies the optic canal bordered by the body of the sphenoid and by the superior and inferior roots of the lesser sphenoid wing, giving passage to the optic nerve, ophthalmic artery, and sympathetic nerves. However, both the superior orbital fi...

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“…Rates of cerebrospinal fluid leak are generally cited at 8% to 10% 12,14,15 with meningitis between 1% and 10%. 16,17 Meticulous closure and use of vascularized pericranial graft to exclude the frontal and sphenoethmoidal sinuses remain imperative steps to allow safe use of the surgical corridor presented. [18][19][20] In each case, the mucosa of the frontal sinus was removed across all areas and an antibioticsoaked gelfoam sponge placed in the cavity during the case.…”

Section: Discussionmentioning

confidence: 99%

Tailored Extended Bifrontal Craniotomy for Anterior Skull Base Tumors: Anatomic Description of a Modified Surgical Technique and Case Series

Safaee

McDermott

Benet

et al. 2017

ONSURG

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BACKGROUND Open transcranial approaches to the anterior skull base remain an integral component of current skull base practice. Evolution of these and other techniques has resulted in revisions of standard, tried-and-true methods in attempts to improve patient outcomes and cosmesis, while still providing the best combination of surgical exposure and ergonomics. OBJECTIVE To describe a modified approach for midline tumors of the anterior skull base. METHODS We describe the anatomy and techniques of a modified extended bifrontal craniotomy for anterior skull base tumors. Case examples and a postoperative 3-dimensional computed tomographic reconstruction of the craniotomy are provided. RESULTS The technique has been employed with success in 3 tuberculum sellae meningiomas where the anterior limit of the tumor is several centimeters back from the inner table of the frontal bone. The mean distance from the tumor to inner table was 2.8 cm (range 1.3-3.8 cm). Mean tumor dimensions were 3.0 cm (transverse), 3.5 cm (anterior-posterior), and 2.2 cm (craniocaudal). Average operative time was 557 min. No cases had new T2/fluid-attenuated inversion recovery magnetic resonance imaging signal of the inferior frontal lobe to indicate retraction injury. CONCLUSION The tailored extended bifrontal craniotomy for anterior skull base tumors provides adequate access to the anterior cranial fossa and has replaced our standard extended bifrontal approach. Keeping the osteotomy cut lines outside of the orbit reduces orbital swelling and mechanical disruption of conjugate eye movements in the early postoperative period, while allowing for minimal frontal lobe retraction and providing sufficient surgical exposure along the anterior skull base.

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Complications of craniofacial resection for malignant tumors of the skull base: Report of an International Collaborative Study

Cited by 296 publications

References 16 publications

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

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

Surgical Approaches to Resection of Anterior Skull Base and Paranasal Sinuses Tumors

Tailored Extended Bifrontal Craniotomy for Anterior Skull Base Tumors: Anatomic Description of a Modified Surgical Technique and Case Series

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