Endoscopic Resection of Advanced Anterior Skull Base Lesions: Oncologically Safe?

Abstract

Aims: (1) Learn if margins of resection in advanced anterior skull base tumors that are resected via endoscopic-assisted means are comparable with traditional craniofacial resection (CFR). (2) Understand the difference in patient morbidity with endoscopic surgery compared to traditional CFR. Methods: Retrospective review of 41 patients undergoing surgery for comparably staged advanced malignancies of the anterior skull base between 2000 and 2006. Eighteen patients underwent endoscopic surgery and 23 patients underwent traditional CFR for American Joint Committee on Cancer stage III, IV or Kadish stage C lesions of the paranasal sinuses and anterior skull base. Margins were evaluated and follow-up ranged from 3 months to 5 years. Results: Of the 18 patients undergoing endoscopic resections, margins were positive/close in 17% (3/18). Margins were positive/close in 17% (4/23) of patients undergoing CFR. Five complications were seen in 4/18 patients (22%) undergoing endoscopic surgery and 11 postoperative complications were seen in 7/23 patients (30%) undergoing CFR. Mean duration of hospitalization was 5.22 and 7.17 days for the endoscopic and CFR groups, respectively. Conclusions: There does not appear to be increased risk of positive margins in patients with advanced lesions undergoing endoscopic-assisted resection. Furthermore, the incidence of morbidity and duration of stay may be improved with endoscopic techniques.

Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: A pooled‐analysis of 1826 patients

“…All series were retrospective. Most series presented outcome data from heterogeneous histologies, at differing stages, of patients who received a variety of treatment strategies over a relatively long timeframe. The largest series of ethmoid adenocarcinomas was published by the French GETTEC group .…”

“…Minor complications occurred in 10% of the endoscopic surgery group and in 7.4% of the open approach group, whereas these were recorded in 33.3% of endoscopic‐assisted surgery patients who underwent combined endoscopic and open approach (Figure ). In 9 studies, adjuvant therapy was not documented or impossible to deduce . According to T classification, adjuvant radiotherapy (RT) was administered in 27.1% of T1 cases, 80% of T2 cases, 92.4% of T3 cases, 90.8% of T4a cases, and 91% of T4b cases.…”

“…For what concerns the outcome and survival, statistics varied among the articles, and, in some studies, data were not amenable for meta‐analysis . The mean follow‐up time was 51.9 ± 45.8 months (range, 1–360 months), with 46.4 ± 37.6 months (range, 2–180 months) in the endoscopic surgery group and 53.6 ± 47.6 months (range, 1–360 months) in the open approach group ( p = .09).…”

Minimally Invasive Approach for Orbital and Parameningeal Rhabdomyosarcoma

“…Endonasal endoscopic surgery, specifically, have been a good alternative to classical craniofacial surgery in non-advanced malignant anterior cranial base lesions and there are some reports for its in more advanced lesions [27,28]. In spite of that, there are only few reports of parameningial and none orbital RMS treated by means endonasal endoscopic surgery, maybe due the fact of its low frequency [8].…”

Types of Endoscopic Endonasal Resections for Sinonasal Malignancies

“…6,7,14 In addition, patients may be referred with distant metastasis. Severe headache is the most common symptom in these patients.…”