Craniofacial resection of malignant tumors of the anterior skull base: a case series and a systematic review

Abstract

Background: Craniofacial resection (CFR) is still considered as the gold standard for managing sinonasal malignancies of the anterior skull base (ASB), while endoscopic approaches are gaining credibility. The goal of this study was to evaluate outcomes of patients who underwent CFR at our institution and to compare our results to international literature. Method: Retrospective analysis of all patients undergoing CFR between 1995 and 2017, and systematic literature review according to the PRISMA statement. Results: 41 patients with sinonasal malignancy (81% with stage T4) of the ASB were included. There was no operative mortality. Complications were observed in 9 cases. We obtained 100% follow-up with mean observation 100 months. Disease-specific survival rates were 90%, 74% and 62% and recurrence-free survival was 85% at two, 72% at five and ten years follow-up, respectively. CFR as primary treatment, en bloc resection, and resection with negative margins correlated to better survival. Recursive partition analysis identified the latter as the most important prognostic factor, regardless surgical technique. The relative risk of non-radicality was significantly higher after piecemeal resection compared to en bloc resection. Compared to 15 original articles, totaling 2603 patients, eligible for review, the present study has the longest follow-up time, the second highest 5year OS and the third highest 5-year DSS, despite having a higher proportion of patients with high-stage disease. Conclusion: CFR in true en bloc fashion can still be considered as the treatment of choice in cases of advancedstage sinonasal malignancies invading the ASB.

Squamous Cell Carcinoma of the Paranasal Sinuses: A Single Center Experience

“…Therefore, most patients present with advanced stage disease and have extensive involvement of adjacent sites at the time of diagnosis. [9][10][11][12][13][14][15] The tumor sites are usually in close proximity to the orbit, skull base, and the central nervous system, which present particular management difficulties.…”

Large Cell Neuroendocrine Carcinoma in the Sinonasal Cavity with Large Intracranial Extension Treated with Endonasal Endoscopic and Transcranial Combined Surgery: A Case Report

“…A previous study showed that negative margins were achieved in a higher percentage of cases with en bloc resection than with piecemeal resections, and recurrence-free survival was superior with en bloc resection. 8) Therefore, one-piece removal with the craniofacial approach has been considered the gold standard for anterior skull base malignant tumors. 9) However, the craniofacial approach requires a large facial skin incision, which may lead to morbidities such as osteomyelitis, wound infection, facial anesthesia, and diplopia, and postoperative cosmetic results are not satisfactory and involve a longer recovery time.…”

“…A previous study showed that negative margins were achieved in a higher percentage of cases with en bloc resection than with piecemeal resections, and recurrence-free survival was superior with en bloc resection. 8) Therefore, one-piece removal with the craniofacial approach has been considered the gold standard for anterior skull base malignant tumors. 9) …”

Interdisciplinary management of skull base surgery

“…39 In the anterior skull base, these craniofacial approaches have been confirmed as gold standard with an overall survival rate up to 72% and a disease-specific survival rate up to 78% after 5 years. 40 Endoscopic endonasal approaches have emerged as modern treatment options. Although en bloc resections of malignancies are not possible in all situations, several studies demonstrated equivalent or better results of endoscopic approaches when compared to open approaches.…”