Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion

Abstract

(1) To determine the occult rate of dural invasion in patients with tumors extending to and/or eroding the bony anterior skull base but without evidence of dural invasion on preoperative imaging. (2) To determine the impact of dural resection and of skull base erosion on survival outcomes in this group of patients (without evidence of dural invasion upon preoperative imaging). Retrospective study. Tertiary care academic center. Patients with sinonasal malignancies with anterior skull base encroachment/erosion without dural invasion on preoperative imaging treated surgically. (1) Histopathologic disease in the dura in patients who had dural resection and (2) Oncologic outcomes (5-year local recurrence, dural recurrence, disease-specific survival, and overall survival) in patients with and without dural resection, and patients with and without skull base erosion. Thirty-seven patients were included. The occult rate of dural invasion was 54%. Patients with dural resection had improved margin control versus those without dural resection (90% vs 56%, = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma compared with bony skull base resection alone (100% vs 75%, = 0.03). Patients with skull base erosion had reduced local control versus those without erosion (63% vs 93%, = 0.047). This study suggests a substantial rate of occult dural invasion despite no overt imaging findings. Dural resection may be associated with improved margin control, but no oncologic benefit except for esthesioneuroblastomas, although treatment heterogeneity and small sample size may limit conclusions.

Pattern of loco‐regional relapses and treatment in pediatric esthesioneuroblastoma: The French very rare tumors group (Fracture) contribution

“…Indeed, in patients with sinonasal malignancies eroding the bony anterior skull base without evidence of dural involvement on preoperative imaging, the occult rate of dural invasion has been estimated as high as 54%, independent of any surgical technique. 28 Additionally, dural resection significantly improved margin control and survival exclusively in the ENB cohort. 28 Interestingly, the poor prognosis of ENB in children is mainly related to neuromeningeal dissemination in our series.…”

“…28 Additionally, dural resection significantly improved margin control and survival exclusively in the ENB cohort. 28 Interestingly, the poor prognosis of ENB in children is mainly related to neuromeningeal dissemination in our series. Indeed, six patients developed leptomeningeal metastases during the first relapse and a total of eight patients had leptomeningeal localization during the course of the disease.…”

“…In case of an intracranial invasion at diagnosis, an endoscopic approach needs to be supplemented with a craniotomy to treat the intracranial component. Indeed, in patients with sinonasal malignancies eroding the bony anterior skull base without evidence of dural involvement on preoperative imaging, the occult rate of dural invasion has been estimated as high as 54%, independent of any surgical technique . Additionally, dural resection significantly improved margin control and survival exclusively in the ENB cohort .…”

Comparing Kadish and Modified Dulguerov Staging Systems for Olfactory Neuroblastoma: An Individual Participant Data Meta‐analysis

“…This is not surprising, as brain involvement, indicating T4 staging, has been shown separately to be a poor prognostic factor ( Figure 5). 34,47 Furthermore, Dulguerov T4 also seems to better prognosticate risk of death over time, as this group continues to have events (death) well beyond 5 years as compared with earlier stages (Figure 3). Indeed, the 10year OS for Kadish C was 68.9%, while for Dulguerov T4, this was only 52.3% (Figures 2 and 3).…”

Imaging of Skull Base and Orbital Invasion in Sinonasal Cancer: Correlation with Histopathology

“…Dural invasion was not foreseen on imaging for nine patients in this study. Ziai et al evaluated the occult rate of dural invasion among 37 patients presenting sinonasal malignancies with skull base encroachment without dural invasion on imaging: dural invasion was observed in seven patients [ 35 ]. Thus, extreme care must be taken at the time of pre-operative and intraoperative dural evaluation.…”