Role of Craniofacial Resection for Malignant Tumors Involving the Anterior Skull Base: Surgical Experience in a Single Institution

Abstract

BackgroundCraniofacial resection (CFR) has been regarded as a standard treatment for various tumors involving the anterior skull base. The purpose of this study was to evaluate the results of CFR for the patients with anterior skull base malignancies in our hospital.MethodsWe retrospectively analyzed 17 patients with anterior skull base malignancies treated with CFR between 2001 and 2012. Mean follow-up duration was 41 months (range, 2-103 months).ResultsIntracranial involvement was found in 11 patients (65%) and orbital extension in 6 patients (35%). Classical bifrontal craniotomy was combined with endoscopic endonasal approach in 14 patients and external approach in 3 patients. Vascularized flap was used for reconstruction of the anterior fossa floor in 16 patients (94%). The most common pathological type was squamous cell carcinoma (6 patients). Gross total resection was achieved in all cases. Postoperative complications developed in 4 patients (24%) and included local wound problem and brain abscess. One patient with liver cirrhosis died from unexpected varix bleeding after the operation. Although postoperative treatment, such as radiotherapy or chemotherapy, was performed in 14 patients, local recurrence was seen in 6 patients. The mean overall survival time after the operation was 69.0 months (95% confidence interval: 47.5-90.5 months) with a 1-, 2-, and 5-year survival rate of 82.3%, 76.5%, and 64.7%, respectively. Postoperative radiotherapy was found to be the powerful prognostic factor for favorable survival.ConclusionConsidering the higher local control rate and acceptable complication or mortality rate, CFR with adjuvant radiotherapy is a gold standard treatment option for malignant tumors involving anterior skull base, especially with extensive intracranial involvement.

Short-term survival in extensive craniofacial resections

“…It is likely that the perioperative mortality rate calculated from our series is relatively high because our definition of perioperative mortality was more inclusive than the definitions used elsewhere. Published studies investigating CFRs have been heterogeneous in terms of histologic types, surgical techniques, surgical approaches (open or endonasal), and this-along with the small sample sizes in these studies-has led to divergent results (3,7,8). For example, Donald et al (20) described 52 skull base operations for invasive scalp cancer; among the tumors operated on, 32% only superficially invaded the periosteum at most, and these procedures, therefore, should not have been classified as skull base operations.…”

“…Even though CFR is the treatment of choice for a wide variety of benign and malignant lesions involving the skull base, these surgeries are relatively uncommon, except in high-volume, specialized centers. This infrequency-in combination with differences in tumor histology and varying definitions of CFRs-leads to heterogeneous reporting in the literature (3,7,8).…”

Complications in Salvage Surgery for Nasal and Paranasal Malignant Tumors Involving the Skull Base

“…Reported causes of postoperative death include systemic disease, such as acute myocardial infarction, unexpected variceal bleeding due to liver cirrhosis, and cerebrovascular complications, such as infarction of the brain, cerebral edema, and rupture of the internal carotid artery. 7,8 The presence of a medical comorbidity, prior radiation exposure, and both dural and brain involvement were also reported to be associated with severe complications. 3 In the present study, prior irradiation was an important predictive factor of postoperative complications, in accordance with our previous study.…”

Risk Factors for Delayed Surgical Recovery and Massive Bleeding in Skull Base Surgery

“…In the early postoperative period (POD 0-5), Donner flap hematoma, thrombotic occlusion after anastomosis, and intracranial hypotension occurred. In the intermediate postoperative period (POD ×× × × ×× × × [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], local infection and wound dehiscence and bone exposure occurred. In the late postoperative period (POD 21 or later), depression and anxiety neurosis were observed.…”

“…However, many head and neck malignancies are locally advanced tumors involving the middle cranial fossa or orbital or pathologically high-grade tumors such as squamous cell carcinoma or sarcoma. Traditional "open" craniofacial resection remains an important surgical technique [9][10][11][12][13].…”