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Duru Birgi S, Özkaya Akagündüz Ö, Dagdelen M, Yazici G, Canyilmaz E, Ceylaner Biçakçi B, Çetinayak HO, Baltalarli PB, Demiröz Abakay C, Kaydihan N, Delikgöz Soykut E, Erdiş E, Akyürek S, Esassolak M, Uzel ÖE, Bakirarar B, Cengiz M. Radiotherapy Results in Locally Advanced Sinonasal Cancer: Turkish Society for Radiation Oncology, Head and Neck Study Group 01-005. Am J Clin Oncol 2024; 47:279-288. [PMID: 38390915 DOI: 10.1097/coc.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVES This study aims to examine the treatment outcomes and related factors in locally advanced sinonasal cancer across Turkiye. METHODS Twelve centers participants of the Turkish Society for Radiation Oncology Head and Neck Study Group attended the study. One hundred and ninety-four patients treated with intensity-modulated radiation therapy between 2001 and 2021 were analyzed retrospectively. The survival analysis was performed using the Kaplan-Meier method. Acute and late toxicity were recorded per Common Toxicity Criteria for Adverse Events V4.0. RESULTS The median age was 58 years and 70% were male. The majority of tumors were located in maxillary sinus (59%). Most of the patients (%83) had T3 and T4A disease. Fifty-three percent of patients were in stage 4A. Radiotherapy was administered to 80% of the patients in the adjuvant settings. Median 66 Gy dose was administered in median 31 fractions. Chemotherapy was administered concomitantly with radiotherapy in 45% of the patients mostly with weekly cisplatin. No grade ≥4 acute and late toxicity was observed. The median follow-up was 43 months. The 5-year and 10-year overall survival (OS); locoregional recurrence-free survival (LRFS); distant metastasis-free survival (DMFS), and progression-free survival (PFS) rates were 61% and 47%; 69% and 61%; 72%, and 69%, and 56% and 49%, respectively. In the multivariate analysis, several factors demonstrated significant influence on OS, such as performance status, surgery, and lymph node involvement. Moreover, surgery was the key prognostic factor for LRFS. For DMFS, lymph node involvement and surgical margin were found to be influential factors. In addition, performance status and lymph node involvement were identified as significantly affecting PFS. CONCLUSIONS In our study, the authors obtained promising results with IMRT. Performance status, lymph node involvement, and surgery emerged as the primary factors significantly influencing OS.
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Affiliation(s)
| | | | - Meltem Dagdelen
- Department of Radiation Oncology, Cerrahpaşa University Faculty of Medicine
| | - Gözde Yazici
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
| | - Emine Canyilmaz
- Department of Radiation Oncology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | | | - Hasan O Çetinayak
- Department of Radiation Oncology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Papatya B Baltalarli
- Department of Radiation Oncology, Pamukkale University Faculty of Medicine, Denizli
| | | | - Nuri Kaydihan
- Department of Radiation Oncology, Memorial Bahçelievler Hospital, İstanbul
| | - Ela Delikgöz Soykut
- Department of Radiation Oncology, Samsun Training and Research Hospital, Samsun
| | - Eda Erdiş
- Department of Radiation Oncology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | | | | | - Ömer E Uzel
- Department of Radiation Oncology, Cerrahpaşa University Faculty of Medicine
| | | | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
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Sommer B, Konietzko I, Bonk MN, Schaller T, Märkl B, Kahl KH, Stüben G, Zenk J, Shiban E. Dural reconstruction with or without a bone graft of paranasal and anterior skullbase malignancies: Retrospective single-center analysis of 11 cases and review of literature. BRAIN & SPINE 2023; 4:102740. [PMID: 38510629 PMCID: PMC10951748 DOI: 10.1016/j.bas.2023.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 03/22/2024]
Abstract
Introduction The reconstruction of frontobasal defects following oncologic resections of paranasal and anterior skull base (ASB) malignancies remains challenging. Ineffective reconstruction could lead to cerebrospinal fluid leak, meningitis, and tension pneumocephalus. Research question Aim of this investigation was to analyse postoperative complication rates with or without bone graft for anterior skull base reconstruction. Material and methods In this retrospective study, we included patients following resection of paranasal and/or anterior skull base malignancies between October 2013 and December 2022. Complications were analysed with regards to the type of skull base reconstruction. Results Eleven patients were identified (2 female, 9 male, age (median, SD) 64 ± 14.1 years (range 38-81). There were nine cases of paranasal sinus and nasal cavity carcinomas and two cases of olfactory neuroblastomas. Overall survival was 22.5 ± 28 months (range: 5-78), progression free survival was 17.0 ± 20.3 months (range: 11-78). Bone skull base reconstruction using a split graft was performed in three cases. Postoperative complications requiring surgical intervention were seen in 33% (one tension pneumocephalus) of cases in the bone reconstruction group and 50% (three patients with cerebrospinal fluid leak, one infection) in the non-bone reconstruction group. Discussion and conclusion The structural reinforcement of structural bone chip grafting might provide additional support of the ASB and prevent CSF leakage or encephalocele. Especially in large (>10 cm2) bone defects of advanced sinonasal malignancies extending into the middle cranial fossa, the full armamentarium of reconstruction possibilities should be considered.
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Affiliation(s)
- Björn Sommer
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Ina Konietzko
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Maximilian Niklas Bonk
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Tina Schaller
- Department of Pathology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Bruno Märkl
- Department of Pathology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Klaus Henning Kahl
- Department of Radiation Therapy, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Georg Stüben
- Department of Radiation Therapy, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Johannes Zenk
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Ryan JF, Tanavde VA, Gallia GL, Boahene KDO, London NR, Desai SC. Reconstruction in open anterior skull base surgery: A review and algorithmic approach. Am J Otolaryngol 2023; 44:103700. [PMID: 36473261 DOI: 10.1016/j.amjoto.2022.103700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Defects resulting from open resection of anterior skull base neoplasms are difficult to reconstruct. Our objective was to review the literature and describe an evidence-based algorithm that can guide surgeons reconstructing anterior skull base defects. METHODS A research librarian designed database search strategies. Two investigators independently reviewed the resulting abstracts and full text articles. Studies on reconstruction after open anterior skull base resection were included. Studies of lateral and posterior skull base reconstruction, endoscopic endonasal surgery, traumatic and congenital reconstruction were excluded. Based on the review, a reconstructive algorithm was proposed. RESULTS The search strategy identified 603 unique abstracts. 53 articles were included. Adjacent subsites resected, defect size, radiotherapy history, and contraindications to free tissue transfer were identified as key factors influencing decision making and were used to develop the algorithm. Discussion of the reconstructive ladder as it applies to skull base reconstruction and consideration of patient specific factors are reviewed. Patients with a prior history of radiotherapy or with simultaneous resection of multiple anatomic subsites adjacent to the anterior skull base will likely benefit from free tissue transfer. CONCLUSIONS Reconstruction of anterior skull base defects requires knowledge of the available reconstructive techniques and consideration of defect-specific and patient-specific factors.
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Affiliation(s)
- John F Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ved A Tanavde
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kofi D O Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaun C Desai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Almeida JP, Marigil-Sanchez M, Karekezi C, Witterick I, Gentili F. Different Approaches in Skull Base Surgery Carry Risks for Different Types of Complications. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 130:13-18. [PMID: 37548718 DOI: 10.1007/978-3-030-12887-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Complications are not uncommon in the complex field of skull base surgery. The intrinsic relationship of lesions in this region to important neurovascular structures, dura mater, and bone may lead to significant morbidity and mortality. The evolution of endoscopic endonasal surgery has had a significant impact on this field as a less invasive option for treatment of selected lesions, but major morbidity may still occur; moreover, endoscopic approaches have been associated with higher rates of some specific complications, such as cerebrospinal fluid leaks. Based on a presented case report, the authors discuss the management of various complications associated with different approaches for resection of skull base malignancies, including epidural and intradural pneumocephalus, subdural hematoma, and subdural empyema. Important lessons learned by the senior author throughout more than 30 years of his skull base surgery practice are highlighted. The inherent risk of complications in skull base surgery emphasizes the importance of their avoidance, prevention, and learning from one's unfavorable experience so as not to repeat them.
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Affiliation(s)
- Joao Paulo Almeida
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Miguel Marigil-Sanchez
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Claire Karekezi
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Ian Witterick
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
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Silveira-Bertazzo G, Li R, Rejane-Heim TC, Martinez-Perez R, Albonette-Felicio T, Sholkamy Diab AG, Mahmoud Mady MS, Hardesty DA, Carrau RL, Prevedello DM. Endoscopic approaches to skull base malignancies affecting the anterior fossa. J Neurosurg Sci 2021; 65:169-180. [PMID: 33491349 DOI: 10.23736/s0390-5616.21.05170-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anterior skull base malignancies are rare and comprise distinct histological entities. Surgery encompasses the traditional craniofacial resections (CFR), and more recently, endoscopic endonasal approaches (EEA) or a hybrid cranioendoscopic (CEA) technique. Although the CFR is still considered the "gold-standard;" there is growing evidence supporting that EEA yield equivalent oncologic outcomes with less morbidity in well-selected cases. Therefore, this article aims to review the current state-of-art in addressing anterior cranial base malignancies using expanded endoscopic endonasal approaches (EEA) with particular references to surgical anatomy and nuances of hybrid cranioendoscopic techniques. Cadaveric dissections and illustrative cases are presented to detail our current surgical technique allied with tailored adjuvant therapies, and treatment strategies are further discussed based on tumor histology.
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Affiliation(s)
- Giuliano Silveira-Bertazzo
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA.,Department of Pediatric Neuroendocrinology and Pediatric Endocrinology, Jeser Amarante Faria Children's Hospital, Neurological and Neurosurgical Clinic of Joinville, Joinville, Brazil
| | - Ruichun Li
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA
| | - Thaïs C Rejane-Heim
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA.,Department of Pediatric Neuroendocrinology and Pediatric Endocrinology, Jeser Amarante Faria Children's Hospital, Neurological and Neurosurgical Clinic of Joinville, Joinville, Brazil
| | | | | | - Ahmed G Sholkamy Diab
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Assiut, Assiut, Egypt
| | - Mohammad S Mahmoud Mady
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, Ain Shams University, El Cairo, Egypt
| | - Douglas A Hardesty
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA - .,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
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Spirin DS, Chernov IV, Cherekaev VA, Kalinin PL, Nazarov VV, Muzyshev IA, Absalyamova OV, Kobyakov GL, Vetlova ER. [Treatment of primary craniofacial (sinonasal) malignant tumors affecting the anterior and middle skull base]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:101-108. [PMID: 32207749 DOI: 10.17116/neiro202084011101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sinonasal malignant tumors are characterized by high histological variability and complexity of the differential diagnosis. Currently, there are classifications of these tumors, which are based on their localization and involvement of various anatomical structures. However, generally accepted algorithms for treatment of this pathology have not yet been developed. This review describes the most important algorithms for treatment of the most common histological variants of sinonasal malignant tumors: squamous cell carcinoma, adenocarcinoma, sinonasal undifferentiated carcinoma, esthesioneuroblastoma, adenoid cystic cancer, and sinonasal adenocarcinoma. The main problems in choosing the approach for treating these tumors are the lack of generally accepted resectability criteria and contradictions between oncological and neurosurgical indications for surgical treatment. Further research is needed to study the role of radiosensitizers and radioprotectors in comprehensive treatment of sinonasal malignant tumors.
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Affiliation(s)
- D S Spirin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - P L Kalinin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - V V Nazarov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | - E R Vetlova
- Burdenko Neurosurgical Center, Moscow, Russia
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Lim X, Rajagopal R, Silva P, Jeyaretna DS, Mykula R, Potter M. A Systematic Review on Outcomes of Anterior Skull Base Reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:1940-1950. [PMID: 32546425 DOI: 10.1016/j.bjps.2020.05.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 04/21/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Anterior skull base resection often results in large defects that need to be reconstructed. This can be done using loco-regional, free flaps or both. OBJECTIVE The aim of this systematic review is to evaluate the surgical outcomes (mortality, complication rates and functional outcomes) for patients undergoing anterior skull base reconstruction. METHODS Electronic databases (MEDLINE, EMBASE and Scopus) were systematically searched for relevant articles from 1974 to March 2018. A total of 41 studies were included in this systematic review. No randomized controlled trials were identified; therefore, a meta-analysis was not performed. RESULTS Mortality from anterior skull base reconstruction were about 0-4% for loco-regional flaps while free flaps were around 0-7%. Overall complications ranged from 0% to 43% in loco-regional flaps, while rate of complications for free flaps ranged from 25% to 66.7%. Flap complications ranged from 0% to 14% for free flaps and 0% to 35% for local flaps. Quality-of-life measures did not differ significantly depending on surgical approach but were worse for patients with malignancies. CONCLUSION Due to varying standards of reporting of outcomes, lack of a standardized classification system for anterior skull base defects and absence of clinical trials, we were unable to perform a meta-analysis in this systematic review. Recommendations to guide future studies are proposed.
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Affiliation(s)
- Xuxin Lim
- Institute of Biomedical Engineering, The University of Oxford, Oxfordshire, UK.
| | - Rajini Rajagopal
- Department of Ear, Nose and Throat, John Radcliffe Hospital, Headington, Oxford, UK
| | - Priyamal Silva
- Blenheim Head and Neck Unit, Department of Plastics and Reconstructive Surgery, Churchill Hospital, Headington, Oxford, UK
| | - Deva Sanjeeva Jeyaretna
- Blenheim Head and Neck Unit, Department of Plastics and Reconstructive Surgery, Churchill Hospital, Headington, Oxford, UK
| | - Roman Mykula
- Blenheim Head and Neck Unit, Department of Plastics and Reconstructive Surgery, Churchill Hospital, Headington, Oxford, UK
| | - Matthew Potter
- Blenheim Head and Neck Unit, Department of Plastics and Reconstructive Surgery, Churchill Hospital, Headington, Oxford, UK
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8
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Surgical management of anterior skull-base malignancies (endoscopic vs. craniofacial resection). J Neurooncol 2020; 150:429-436. [DOI: 10.1007/s11060-020-03413-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/31/2022]
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9
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Cherekayev VA, Kozlov AV, Muzyshev IA, Danilov GV, Lasunin NV, Spirin DS, Nazarov VV, Shishkina LV. [Results of surgical treatment of skull-base primary malignant tumors with intracranial invasion]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:31-43. [PMID: 31825373 DOI: 10.17116/neiro20198305131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Analysis of factors affecting life expectancy at patients with primary malignant tumors of anterior and middle parts of the skull base with intracranial invasion. MATERIAL AND METHODS 139 patients (47 women and 92 men) with primary malignant tumors of the anterior and middle parts of the skull base with intracranial invasion (stage T4 according to TNM classification or stage C according to Kadish classification for estesioneuroblast ) were treated at the NMRCN Burdenko for the period from 2004 till 2018. The study was conducted by the method of total sampling. The observations are divided into 2 groups: primarily operated (group I) and repeatedly operated (group II). RESULTS The average age in both groups was 50 years. In most (64.7%) cases, the tumor affected the medial sections of the base of anterior and middle cranial fossae, and in 35.3% of cases it was localized laterally. All tumors were classified to T4 stage according to TNM classification or (9 olfactory neuroblastomas) to stage C according to Kadish classification. DISCUSSION The impact on life expectancy was largely provided by postoperative radiation therapy, the repeated nature of operation, and the presence of brain infiltration. In the total cohort of patients 5-year OS, 5-year RVS, 5-year-old IDF and 5-year LC were 50.7, 35, 54.2 and 36.4%, respectively. In group I, the medians OS and IDF were equal and amounted to 138.3 months. The median RVS was 43.8 months. 5-year OS equal to 63.6%, 5-year RVS - 40.8%, 5-year-IDF - 64.8%, 5-year LC was up to 65.7%. The survival rate in the analyzed cohort for 1, 2, 3 years was 81.4, 71.8 and 67.8%, respectively. In group II, the treatment results for the group of repeatedly treated patients were significantly worse. There were no cases of 5-year survival. The 1-, 2-, and 3-year survival rates were 59.3, 50.8 and 31.8%, respectively. The median OS was 27.1 months, IDF was 27.1 months, RVS was 18.2 months, and LC was 9.1 months. CONCLUSION The results and analysis of literature justify the feasibility of surgical treatment of patients with malignant tumors of craniofacial localization at T4 stage. The purpose of surgical intervention should be: elimination of the immediate threat to the patient's life due to edema and dislocation of the brain; the maximum possible removal of tumor tissue (cytoreduction); if possible, the elimination of the most significant symptoms for the patient (pain, nasal breathing disorders, cosmetic defect). If there are special reserves, it is obligatory to include radiation and chemotherapy in the treatment process.
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Affiliation(s)
| | - A V Kozlov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - G V Danilov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - N V Lasunin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - D S Spirin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - V V Nazarov
- Burdenko Neurosurgical Center, Moscow, Russia
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Mukoyama N, Nishio N, Kimura H, Kishi S, Tokura T, Kimura H, Hiramatsu M, Maruo T, Tsuzuki H, Fujii M, Iwami K, Takanari K, Kamei Y, Ozaki N, Sone M, Fujimoto Y. Prospective Evaluation of Health-Related Quality of Life in Patients Undergoing Anterolateral Craniofacial Resection with Orbital Exenteration. J Neurol Surg B Skull Base 2019; 81:585-593. [PMID: 33134027 DOI: 10.1055/s-0039-1694010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/28/2019] [Indexed: 12/25/2022] Open
Abstract
Objective This study was aimed to evaluate health-related quality of life in patients undergoing anterolateral craniofacial resection (AL-CFR) with orbital exenteration (OE) for malignant skull base tumors and to investigate the effects of early psychiatric intervention. Design Present study is a prospective, observational study. Setting The study took place at the hospital department. Participants Twenty-six consecutive patients were selected who underwent AL-CFR with OE at our hospital between 2005 and 2015. Main Outcome Measures Health-related quality of life was assessed preoperatively and 3, 6, 12, and 24 months after surgery using the Hospital Anxiety and Depression Scale (HADS) and medical outcomes study 8-items Short Form health survey (SF-8). In all cases, psychiatric intervention was organized by the consultation liaison psychiatry team preoperatively and postoperatively. Results Ten (38.0%) of the 26 patients died and 16 (62.0%) were alive and disease-free at the end of the study. The 3-year overall and disease-free survival rates were 64.9% and 53.3%, respectively. Twenty-one patients (80.8%) developed psychiatric complications after surgery and needed treatment with psychotropic medication. Before surgery, 28% of patients had HADS scores ≥8 for anxiety and 20% had scores ≥8 for depression. Seven of the eight items in the SF-8 were significantly lower than those for the general Japanese population. However, scores for all the SF-8 items gradually improved during postoperative follow-up, reaching approximately 50 points, which is the national standard value, at 2 years after surgery. Conclusions Craniofacial resection with OE was feasible and well tolerated in patients with malignant skull base tumors who received early psychiatric intervention to decrease the considerable psychological impact of this procedure.
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Affiliation(s)
- Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Stanford University, Stanford, California, United States
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichi Kishi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuya Tokura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Kenichiro Iwami
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Ungar OJ, Abergel A, Safadi A, Zaretzki A, Yanko-Arzi R, Fliss DM. Anterior Median Skull Base Reconstruction Using a Vascularized Free Flap: Rationale, Patient Selection and Outcome. J Neurol Surg B Skull Base 2019; 81:30-36. [PMID: 32021747 DOI: 10.1055/s-0038-1676800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives To present our method of median anterior skull base (ASB) reconstruction using a subcranial approach with a free flap in cases of naso-fronto-orbital (NFO) bony segment failure and in patients at high risk for future failure of the bony frontal segment. Design This study presents as a retrospective case series. Setting Tertiary university-affiliated medical center. Participants Adult and pediatric patients who underwent median ASB resection via the subcranial approach with a free flap reconstruction were participated in this study. Main Outcome Measures Pathologic outcome and postoperative quality of life (QoL) as assessed by a validated Hebrew version of the "Anterior Skull Base Quality-of-Life Questionnaire." Results The departmental database yielded 13 suitable patients aged between 15 and 70 years. The main indication ( n = 7) for ASB surgery was osteoradionecrosis (ORN) of the NFO bony segment which was first detected at an average of 3.6 years (range: 2-32 years) postradiation therapy. High-risk patients for future ORN of the NFO segment ( n = 3) were primarily reconstructed using a vascularized free flap. Nine patients had malignant disease, and four of them were alive without evidence of disease during the follow-up period (average, 48 months). Their QoL was comparable to that of patients who had undergone subcranial ASB resection without free flap reconstruction. Conclusions The ASB median free flap method of reconstruction is a safe and reliable in cases of large complex median ASB defects without orbital resection or maxillectomy. This approach is suitable for patients who had undergone previous surgery, radiotherapy and/or those who present with osteoradionecrosis, as well as for patients with high risk of NFO segment ORN.
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Affiliation(s)
- Omer J Ungar
- Department of Otolaryngology Head, Neck, and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology Head, Neck, and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ahmad Safadi
- Department of Otolaryngology Head, Neck, and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arik Zaretzki
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ravit Yanko-Arzi
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology Head, Neck, and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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König M, Osnes T, Jebsen P, Meling TR. Craniofacial resection of malignant tumors of the anterior skull base: a case series and a systematic review. Acta Neurochir (Wien) 2018; 160:2339-2348. [PMID: 30402666 DOI: 10.1007/s00701-018-3716-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
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 Forty-one 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 of 100 months. Disease-specific survival rates were 90%, 74%, and 62% and recurrence-free survival was 85% at two, 72% at five, and 10 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 of 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 5-year 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 advanced-stage sinonasal malignancies invading the ASB.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, PB4950 Nydalen, N-0424, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Terje Osnes
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Peter Jebsen
- Department of Pathology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, PB4950 Nydalen, N-0424, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Service de Neurochirurgie, Département des Neurosciences Cliniques, Hopitaux Universitaires de Genève, Geneva, Switzerland
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13
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Ziai H, Yu E, Fu T, Muhanna N, Monteiro E, Vescan A, Zadeh G, Witterick IJ, Goldstein DP, Gentili F, de Almeida JR. Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion. J Neurol Surg B Skull Base 2018; 79:419-426. [PMID: 30210968 PMCID: PMC6133664 DOI: 10.1055/s-0037-1612617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/13/2017] [Indexed: 02/03/2023] Open
Abstract
Objectives (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). Study Design Retrospective study. Setting Tertiary care academic center. Participants Patients with sinonasal malignancies with anterior skull base encroachment/erosion without dural invasion on preoperative imaging treated surgically. Main Outcome Measures (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. Results 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%, p = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma compared with bony skull base resection alone (100% vs 75%, p = 0.03). Patients with skull base erosion had reduced local control versus those without erosion (63% vs 93%, p = 0.047). Conclusion 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.
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Affiliation(s)
- Hedyeh Ziai
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Terence Fu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nidal Muhanna
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Eric Monteiro
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Allan Vescan
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Ian J. Witterick
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - David P. Goldstein
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Fred Gentili
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - John R. de Almeida
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
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14
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Díaz-Martínez JA, Esquenazi Y, Martir M, Citardi MJ, Karni RJ, Blanco AI. Planned Gamma Knife Boost After Chemoradiotherapy for Selected Sinonasal and Nasopharyngeal Cancers. World Neurosurg 2018; 119:e467-e474. [PMID: 30071329 DOI: 10.1016/j.wneu.2018.07.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the feasibility of a Gamma Knife boost after intensity-modulated radiation therapy in combination with multimodal therapy in patients with nasopharyngeal carcinoma and sinonasal malignancies with skull base or cavernous sinus involvement. METHODS Nine patients were treated with intensity-modulated radiation therapy followed by a Gamma Knife boost. In one case Gamma Knife was given as salvage treatment after resection. Five patients had sinonasal malignancies and 4 had nasopharyngeal carcinoma. The mean radiation therapy dose was 64.3 Gy (range, 54-70 Gy) at 2 Gy per fraction. The median interval from completion of radiation therapy to Gamma Knife boost was 2.2 months (range, 1-4 months). The most common indication for Gamma Knife boost was involvement of the cavernous sinus, which was identified in 7 patients. The median margin Gamma Knife dose delivered was 13 Gy (range, 12-20 Gy), with median prescription isodose of 50%. RESULTS All patients tolerated the procedure well, with minimal toxicity. Local control rates were achieved in all patients and no acute grade 3-5 toxicity was observed. One patient experienced late grade 4 toxicity, which was potentially attributable to treatment. Distant failure occurred in 3 patients (1 patient with nasopharyngeal carcinoma and 2 patients with sinonasal malignancies). CONCLUSIONS Planned Gamma Knife boost followed intensity-modulated radiation therapy is feasible, safe, and provides excellent local control in patients with sinonasal malignancies and nasopharyngeal carcinoma, particularly in cases with cavernous sinus involvement. Further follow-up will be necessary to determine the long-term effectiveness and complication profile.
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Affiliation(s)
- José Armando Díaz-Martínez
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Unit of Functional Neurosurgery, Stereotaxy and Radiosurgery, Mexico General Hospital, Mexico City, Mexico
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital, Houston, Texas, USA.
| | - Magda Martir
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Ron J Karni
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Angel I Blanco
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital, Houston, Texas, USA
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15
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Roh HJ, Batra PS, Citardi MJ, Lee J, Bolger WE, Lanza DC. Endoscopic Resection of Sinonasal Malignancies: A Preliminary Report. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800409] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background A minimally invasive endoscopic approach for the management of sinonasal malignancy offers several advantages including excellent illumination, maximal preservation of uninvolved vital structures, and sparing of facial incisions. The purpose of this study was to evaluate the outcome and morbidity of endoscopic resection with or without combined radiotherapy and/or chemotherapy. Methods Forty-seven patients with sinonasal malignancy were diagnosed and/or treated with an endoscopic approach at The Cleveland Clinic Foundation and The University of Pennsylvania Medical Center from 1996 to 2003. Nineteen patients fulfilled the study criteria and had a minimally invasive endoscopic resection. Fifteen patients were treated with curative intent and four patients underwent palliative resection. Results The mean age was 56.9 (9–78 years) years and the mean follow-up period was 26.4 months. Combined radiation with or without chemotherapy pre- or postoperatively was given to 15 of 19 (78.9%) patients. Thirteen patients were resected strictly with an endoscopic approach and six patients were resected in combination with neurosurgery. There were no peri- and postoperative deaths. The local recurrence (LR) rate was 26.3% (5/19) and the distant metastasis rate was 15.8% (3/19). Overall survival rate (OS) was 78.9% (15/19) at a mean follow-up duration of 32.1 (4–74 months) months. The disease-free survival (DFS) rate was 68.4% (13/19) by clinical, endoscopic, and radiographic surveillance at a mean follow-up duration of 33.1 months. Patients treated with curative intent had LR, OS, and DFS rates of 21.4, 85.7, and 85.7%, respectively, and the patients treated for palliation had LR, OS, and DFS rates of 40, 60, and 15%, respectively. Conclusion Minimally invasive endoscopic resection of sinonasal malignancy in combination with adjunctive therapies reduces treatment morbidity and yields LR, OS, and DFS rates that are comparable with traditional anterior craniofacial approaches.
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Affiliation(s)
- Hwan-Jung Roh
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Pusan National University, Pusan, Korea
| | - Pete S. Batra
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland, Ohio
| | - Martin J. Citardi
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland, Ohio
| | - Joung Lee
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William E. Bolger
- Department of Otolaryngology, Uniformed Services University of the Health Science University, Bethesda, Maryland
| | - Donald C. Lanza
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland, Ohio
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16
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Kobayashi K, Matsumoto F, Miyakita Y, Mori T, Shimoi T, Murakami N, Yoshida A, Arakawa A, Omura G, Fukasawa M, Matsumoto Y, Matsumura S, Itami J, Narita Y, Yoshimoto S. Impact of Surgical Margin in Skull Base Surgery for Head and Neck Sarcomas. J Neurol Surg B Skull Base 2018; 79:437-444. [PMID: 30210970 DOI: 10.1055/s-0037-1615816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022] Open
Abstract
Objective This study aimed to determine the adequate resection margin in skull base surgery for head and neck sarcoma. Design We retrospectively reviewed 22 sarcomas with skull base invasion. Induction chemotherapy, followed by surgery and postoperative radiotherapy and adjuvant chemotherapy, was performed in 18 patients with chemosensitive sarcomas, and surgery with or without postoperative radiotherapy was performed in four patients with chemoresistant sarcomas. Radical resection was performed in patients with chemosensitive sarcomas with a poor response to induction chemotherapy and in patients with chemoresistant sarcomas. Conservative resection with close surgical margin was performed in patients with chemosensitive sarcomas with a good response to induction chemotherapy. Setting and Participants This single-centered retrospective study included patients from the National Cancer Center Hospital, Japan. Results The response to induction chemotherapy was significantly associated with the 3-year local control rate (LCR; good response versus poor response: 100% versus 63%, p = 0.048). Patients with a good response to chemotherapy had a favorable local prognosis even when the local therapy was conservative resection. In radical skull base surgery, patients whose surgical margins were classified as "wide margin positive" had significantly poorer 3-year LCR than did patients with "margin negative" or "micro margin positive" margins (25% versus 83%, p = 0.014). Conclusion Conservative resection with close surgical margins might be acceptable for chemosensitive sarcomas with a good response to chemotherapy. Resection margin status was an important predictive factor for local recurrence after radical skull base surgery. Microscopic microresidual tumor might be controlled by postoperative treatment.
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Affiliation(s)
- Kenya Kobayashi
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuji Miyakita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsunori Shimoi
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumu Arakawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Go Omura
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Fukasawa
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshifumi Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoko Matsumura
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
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17
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Cracchiolo JR, Patel K, Migliacci JC, Morris LT, Ganly I, Roman BR, McBride SM, Tabar VS, Cohen MA. Factors associated with a primary surgical approach for sinonasal squamous cell carcinoma. J Surg Oncol 2017; 117:756-764. [PMID: 29193098 DOI: 10.1002/jso.24923] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/26/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary surgery is the preferred treatment of T1-T4a sinonasal squamous cell carcinoma (SNSCC). METHODS Patients with SNSCC in the National Cancer Data Base (NCDB) were analyzed. Factors that contributed to selecting primary surgical treatment were examined. Overall survival (OS) in surgical patients was analyzed. RESULTS Four-thousand seven hundred and seventy patients with SNSCC were included. In T1-T4a tumors, lymph node metastases, maxillary sinus location, and treatment at high-volume centers were associated with selecting primary surgery. When primary surgery was utilized, tumor factors and positive margin guided worse OS. Adjuvant therapy improved OS in positive margin resection and advanced T stage cases. CONCLUSIONS Tumor and non-tumor factors are associated with selecting surgery for the treatment of SNSCC. When surgery is selected, tumor factors drive OS. Negative margin resection should be the goal of a primary surgical approach. When a positive margin resection ensues, adjuvant therapy may improve OS.
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Affiliation(s)
- Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Krupa Patel
- Weill Cornell Medical College, New York, New York
| | - Jocelyn C Migliacci
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin R Roman
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Viviane S Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Carey RM, Godovchik J, Workman AD, Kuan EC, Parasher AK, Chen J, Palmer JN, Adappa ND, Newman JG, Brant JA. Patient, disease, and treatment factors associated with overall survival in esthesioneuroblastoma. Int Forum Allergy Rhinol 2017; 7:1186-1194. [DOI: 10.1002/alr.22027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Ryan M. Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | - Joseph Godovchik
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA
| | - Alan D. Workman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - Edward C. Kuan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | - Arjun K. Parasher
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia PA
| | - Jinbo Chen
- Department of Biostatistics and Epidemiology, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | - James N. Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | - Jason G. Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
| | - Jason A. Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania; Perelman School of Medicine; Philadelphia PA
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19
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Harvey RJ, Nalavenkata S, Sacks R, Adappa ND, Palmer JN, Purkey MT, Schlosser RJ, Snyderman C, Wang EW, Woodworth BA, Smee R, Havas T, Gallagher R. Survival outcomes for stage-matched endoscopic and open resection of olfactory neuroblastoma. Head Neck 2017; 39:2425-2432. [PMID: 28945299 DOI: 10.1002/hed.24912] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 03/28/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Advanced-stage olfactory neuroblastoma requires multimodal therapy for optimal outcomes. Debate exists over endoscopic endonasal surgery in this situation. Stage-matched open and endoscopic surgical therapy were compared. METHODS Patients from 6 cancer institutions were assessed. Stratification included dural involvement, Kadish stage, nodal disease, Hyams' grade, approach, and margin status. At follow-up, local control, nodal status, and evidence of distant metastases were recorded with any subsequent therapy. Statistical analyses to identify risk factors for developing recurrence and survival differences were performed. RESULTS One hundred nine patients were assessed (age 49.2 ± 13.0 years; 46% women) representing Kadish A stage (10%), Kadish B stage (25%), and Kadish C stage (65%). The majority of the patients (61.5%) underwent endoscopic resection, 53.5% within Kadish C stage. Within-stage survival analysis favored endoscopic subgroup for Kadish C stage (log-rank P = .017) nonsignificant for Kadish B stage (log-rank P = .39). CONCLUSION Stage-matched survival was better for the endoscopically treated group compared to the open surgery group, with high negative margin resections obtained.
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Affiliation(s)
- Richard J Harvey
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Department of Otolaryngology - Head and Neck, Skull Base Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Sunny Nalavenkata
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia
| | - Raymond Sacks
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Department of Otolaryngology, Concord General Hospital and Sydney University, Concord, New South Wales, Australia
| | - Nithin D Adappa
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Palmer
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael T Purkey
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Carl Snyderman
- Department of Otolaryngology/ Head & Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Eric W Wang
- Department of Otolaryngology/ Head & Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bradford A Woodworth
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Prince of Wales, Australia
| | - Tom Havas
- Department of Otolaryngology, Head and Neck Surgery, The Prince of Wales Cancer Centre and Hospital, Prince of Wales, Australia
| | - Richard Gallagher
- Department of Otolaryngology - Head and Neck, Skull Base Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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20
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Perkins EL, Brandon BM, Sreenath SB, Desai DD, Thorp BD, Ebert CS, Zanation AM. Transfacial and Craniofacial Approaches for Resection of Sinonasal and Ventral Skull Base Malignancies. Otolaryngol Clin North Am 2017; 50:287-300. [PMID: 28162241 DOI: 10.1016/j.otc.2016.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malignancies of the paranasal sinuses and ventral skull base present unique challenges to physicians. A transfacial or craniofacial approach allows for wide, possibly en bloc, resection and is ideal for tumors that involve surrounding soft tissue, the palate, the orbit, anterolateral frontal sinus, and lateral dura. Transfacial approaches include a lateral rhinotomy often combined with a medial, subtotal, or total maxillectomy. Reconstruction is most commonly performed with a pericranial flap to separate the intranasal and intracranial compartments. These approaches have evolved and been refined but now are usually reserved for advanced tumors not amenable to endoscopic resection.
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Affiliation(s)
- Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA
| | - Bryan M Brandon
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA
| | - Dipan D Desai
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA; Department of Neurosurgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599, USA.
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21
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Nishio N, Fujii M, Hayashi Y, Hiramatsu M, Maruo T, Iwami K, Kamei Y, Yagi S, Takanari K, Fujimoto Y. Preoperative surgical simulation and validation of the line of resection in anterolateral craniofacial resection of advanced sinonasal sinus carcinoma. Head Neck 2016; 39:512-519. [PMID: 27905167 DOI: 10.1002/hed.24653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 06/15/2016] [Accepted: 10/21/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the usefulness and accuracy of preoperative 3D virtual simulation of anterolateral craniofacial resection in cases of advanced sinonasal sinus carcinoma. METHODS Seven patients with advanced (T4 classification) sinonasal sinus carcinoma who underwent anterolateral craniofacial resection in our hospital between 2011 and 2013 were included in this study. Postsimulation CT images were fused with postoperative CT images and differences between the planned and actual osteotomy were measured in 3 regions of the skull base. RESULTS The differences ranged from 0 mm to 5.8 mm (average, 3.1 mm) at the inferior wall of the cavernous sinus, from 0.8 mm to 8.3 mm (average, 3.5 mm) at the inferior wall of the sphenoid sinus, and from 0 mm to 13.6 mm (average, 2.3 mm) in the palatine bone. CONCLUSION Preoperative 3D virtual surgical simulation and postoperative feedback can contribute to training for surgeons. © 2016 Wiley Periodicals, Inc. Head Neck 39: 512-519, 2017.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Yuichiro Hayashi
- Information and Communications, Nagoya University, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichiro Iwami
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunjiro Yagi
- Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Chen WL, Yang ZH, Huang ZQ, Fan S, Zhang DM, Wang YY. Craniofacial Resection and Reconstruction in Patients With Recurrent Cancer Involving the Craniomaxillofacial Region. J Oral Maxillofac Surg 2016; 75:622-631. [PMID: 27717818 DOI: 10.1016/j.joms.2016.08.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Head and neck tumors that involve the craniomaxillofacial region are classified as stage IVb disease and are clinically challenging. In this study, the outcomes of craniofacial resection and craniofacial reconstruction in patients with recurrent malignant tumors involving the craniomaxillofacial region were evaluated. PATIENTS AND METHODS This retrospective observational study was conducted from January 2008 to August 2015. Data collected for each patient included age, gender, tumor site, initial treatment, craniofacial resection, reconstruction flaps and complications after craniofacial resection, adjuvant treatment, and reported outcomes of craniofacial resection and craniofacial reconstruction. The χ2 test in SPSS was used to analyze the data. RESULTS Twenty-four patients with recurrent malignant tumors involving the craniomaxillofacial region were identified who had undergone craniofacial resection at the Center of Craniomaxillofacial Surgery of Sun Yat-sen University (Guangzhou, Guangdong, China). The study population was comprised of 24 patients (15 men and 9 women; age range, 21 to 73 yr) with recurrent tumors (58.3% with squamous cell carcinoma [SCC], 41.7% with sarcoma [SA]) involving the craniomaxillofacial region who underwent craniofacial resection. Craniofacial resection consisted of orbital exenteration and maxillotomy; anterior skull base surgery, facial resection, and mandibulotomy; or ipsilateral radical neck dissection. The resultant craniomaxillofacial defects were reconstructed using extended vertical lower trapezius island myocutaneous flaps (TIMFs), temporalis myofascial flaps, or submental flaps. All patients with recurrent malignant tumor involving the craniomaxillofacial region underwent gross total resection of the tumor; 22 patients underwent craniofacial reconstruction. There were no major surgical complications. Minor flap failure and wound dehiscence in the donor site occurred in 4 patients. The follow-up period ranged from 8 to 36 months. Seven patients in the SCC group and 7 in the SA group were alive with no evidence of disease (AND), 3 in the SCC group and 2 in the SA group were alive with disease (AWD), and 4 in the SCC and 1 in the SA group died of the disease (DOD) after local recurrence or distant metastases at 8 to 18 months. There were no statistical differences among the AND, AWD, and DOD groups. CONCLUSIONS Craniofacial resection remains an effective salvage treatment for patients with recurrent SCC and SA involving the craniomaxillofacial region. The extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing major defects after a craniofacial resection.
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Affiliation(s)
- Wei-Liang Chen
- Professor and Director, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Zhao-Hui Yang
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Quan Huang
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Song Fan
- Attending, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Da-Ming Zhang
- Attending, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - You-Yuan Wang
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Ducic Y, Miles BA, Sabatini P. Extending the traditional resection limits of squamous cell carcinoma of the anterior skull base. Otolaryngol Head Neck Surg 2016; 137:899-905. [DOI: 10.1016/j.otohns.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 08/23/2007] [Accepted: 09/06/2007] [Indexed: 11/28/2022]
Abstract
Objective Preliminary report to evaluate the efficacy of resection of squamous cell carcinomas that demonstrate intracra-nial invasion. Methods A retrospective review of all cases of extracranial squamous cell carcinomas that extend intracranially treated by a single surgeon. Results A total of 21 cases were reviewed. In 6 cases, there was noted to be overt brain invasion. Complete resection of the intracranial disease was achieved in each of the remaining 15 cases. There were no instances of CSF leak, meningitis, brain abscess, stroke, or other intracranial complication noted either acutely or secondarily. In follow-ups that ranged from 10 months (single patient died of disease at 10 months) to 6 years (average, 3.8 years), there were no instances of intracranial recurrence. There was a disease-free control rate of 67.7% at an average follow-up of 4.1 years. Conclusions Extending the resection of squamous cell carcinoma into the intracranial vault judiciously as outlined appears to be associated with acceptable outcomes in the treatment of advanced squamous cell carcinoma of the skull base.
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Affiliation(s)
- Yadranko Ducic
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
- John Peter Smith Hospital, Fort Worth
| | - Brett A. Miles
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
| | - Peter Sabatini
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
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Roxbury CR, Ishii M, Richmon JD, Blitz AM, Reh DD, Gallia GL. Endonasal Endoscopic Surgery in the Management of Sinonasal and Anterior Skull Base Malignancies. Head Neck Pathol 2016; 10:13-22. [PMID: 26830407 PMCID: PMC4746133 DOI: 10.1007/s12105-016-0687-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022]
Abstract
Sinonasal malignancies represent a rare subset of tumors with a wide variety of histopathologic diagnoses and overall poor prognosis. These tumors tend to have an insidious onset with non-specific symptoms which often leads to delayed diagnosis and advanced local disease at presentation. The principal goal of surgery is to obtain a negative margin resection. Open craniofacial techniques are well established in the management of sinonasal malignancies and remain the treatment of choice for many advanced tumors. Over the past couple of decades, there has been tremendous application of endoscopic techniques to skull base pathologies including sinonasal malignancies. For selected cases, endonasal endoscopic techniques can be performed with curative intent and reduced surgical morbidity and mortality. Here we discuss principles of surgical management of sinonasal malignancies, review the techniques of endonasal endoscopic resection of sinonasal malignancies, and highlight the importance of pathology in the multi-disciplinary management of patients with these complex lesions.
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Affiliation(s)
- Christopher R Roxbury
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps Building, Room 101, Baltimore, MD, 21287, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Ari M Blitz
- Division of Neuroradiology, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Douglas D Reh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps Building, Room 101, Baltimore, MD, 21287, USA
| | - Gary L Gallia
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps Building, Room 101, Baltimore, MD, 21287, USA.
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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Sakata K, Maeda A, Rikimaru H, Ono T, Koga N, Takeshige N, Tokutomi T, Umeno H, Kiyokawa K, Morioka M. Advantage of Extended Craniofacial Resection for Advanced Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Surgical Management. World Neurosurg 2016; 89:240-54. [PMID: 26875653 DOI: 10.1016/j.wneu.2016.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Craniofacial resection (CFR) for advanced sinonasal malignant tumors (SNMTs) is mandatory for radical resection. Surgeons must be aware of perioperative complications and long-term outcome because this procedure is extremely invasive, especially when the tumor involves the anterior skull base. METHODS Thirty-eight consecutive surgical patients with advanced SNMT of T4 stage or Kadish stage C (31 men and 7 women; mean age, 55 years; range: 19-76 years) treated with CFR in the past 28 years were followed up for 59.4 months. In cases of unilateral orbital extension, en-bloc resection was achieved using several neurosurgical techniques (extended CFR) from 2005 onwards. Herein, we evaluated the safety and effectiveness of surgery by comparing survival data between 2 time periods (first stage: 1984-2004, second stage: 2005-2012). RESULTS Squamous cell carcinoma was the most common histological type observed (65.8%), followed by esthesioneuroblastoma (15.8%). Using a combination of adjuvant radiation therapy, the 5-year overall survival and the 5-year disease-specific survival rates were 55.5% and 59.4%, respectively. Sarcomatous histology was a poor prognostic factor. The 5-year disease-specific survival rate was 48.9% in the first stage and improved to 82.1% in the second stage (P = 0.057); this was related to improvements in local control rate. CONCLUSIONS CFR and postoperative radiotherapy are safe and effective for treating advanced SNMTs. Extended CFR, including radical orbital exenteration, may contribute to good long-term outcomes. A diverse surgical team may help perform radical resection and reconstruction in patients with advanced tumors.
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Affiliation(s)
- Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
| | - Akiteru Maeda
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Noriyuki Koga
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Hirohito Umeno
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
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Abstract
Malignancies of the nose, sinus, and skull base are rare. The most common histologies are squamous cell carcinoma and adenocarcinoma. The most common primary sites are the nasal cavity and maxillary sinus. Management of these tumors is technically challenging because they often present in advanced stages with extensive disease invading important structures such as the orbit and the skull base. In the last few decades advances in surgical resection techniques, as well as improved strategies to deliver adjuvant radiation, have substantially improved the outcomes in patients with malignancies of the sinonasal tract and skull base.
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Affiliation(s)
- Victoria Banuchi
- Department of Otolaryngology, Weill Cornell Medical College, 1320 York Avenue, New York, NY 10021, USA
| | - Jonathan Mallen
- Hofstra North Shore-LIJ School of Medicine, 500 Hofstra University, Hempstead, NY 11549, USA
| | - Dennis Kraus
- The Center for Head & Neck Oncology, New York Head & Neck Institute, North Shore-LIJ Cancer Institute, 130 East 77th Street, Black Hall 10th Floor, New York, NY 10075, USA; The Center for Thyroid & Parathyroid Surgery, New York Head and Neck Institute, New York, NY, USA.
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Duru Birgi S, Teo M, Dyker KE, Sen M, Prestwich RJD. Definitive and adjuvant radiotherapy for sinonasal squamous cell carcinomas: a single institutional experience. Radiat Oncol 2015; 10:190. [PMID: 26377408 PMCID: PMC4574072 DOI: 10.1186/s13014-015-0496-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the disease outcomes of patients treated with definitive and adjuvant radiotherapy for squamous cell carcinomas of the nasal cavity and paranasal sinuses in a single institution. METHODS Between 2007-2012 patients were retrospectively identified from electronic databases who had undergone surgery and adjuvant radiotherapy or definitive radiotherapy for sinonasal squamous cell carcinomas with curative intent. RESULTS Fourty three patients with sinonasal squamous cell carcinoma were identified (22 nasal cavity, 21 paranasal sinuses). 31/43 (72%) had T3 or T4 disease; nodal stage was N0 in 38, N1 in 4, Na/b in 0 and N2c in 1 patient. Median age was 67 years (range 41-86). 18 (42%) received definitive and 25 (58%) adjuvant radiotherapy. Radiotherapy was delivered using either conventional radiotherapy (n = 39) or intensity modulated radiotherapy (n = 4). Elective neck radiotherapy was delivered to two patients. Chemotherapy was delivered to 6/43 (14%) of patients. Two-year local control, regional control, distant metastases free survival, progression free survival, cause specific survival and overall survival were 81%, 90%, 95%, 71%, 84% and 80% respectively. There was no significant difference in outcome comparing patients who underwent surgery and adjuvant radiotherapy with patients receiving definitive radiotherapy (2 year locoregional disease free survival 75% and 70% respectively, p = 0.98). Pooly differentiated tumours were significantly associated with inferior disease outcomes. Local, regional, combined local and regional, and distant failure occurred in 7 (16%), 3 (7%), 1 (2%) and 2 (5%) of patients; all 3 regional recurrences were in patients with nasal cavity squamous cell carcinomas who had not undergone elective neck treatment. CONCLUSIONS Definitive or adjuvant radiotherapy provides an effective treatment for sinonasal malignancies. The main pattern of failure remains local, suggesting the need for investigation of intensified local therapy. Whilst remaining uncommon, the cases of regional failure mean that the merits of elective lymph node treatment should be considered on an individual basis.
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Affiliation(s)
- Sumerya Duru Birgi
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mark Teo
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Karen E Dyker
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mehmet Sen
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Robin J D Prestwich
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
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29
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Abstract
We report on a patient who underwent maxillectomy and subsequent coronoid-temporalis flap reconstruction of the surgical defect to treat a maxillary sinus carcinoma invading the middle skull base. The patient underwent successful reconstruction of the middle skull base and displayed acceptable functional result. Middle skull base defects can be successfully repaired using a local coronoid-temporalis pedicled flap. The coronoid process of the mandible is advantageous as a local flap because it is close to the skull base defects and can easily be dissected from adjacent tissues. The use of a coronoid-temporalis pedicled flap offers excellent results without the need for further extensive surgery.
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30
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He Y, Yang H, Sun J, Zhang C, Zhu H, Liu Z. Prognostic factors in pterygopalatine and infratemporal fossa malignant tumours: A single institution experience. J Craniomaxillofac Surg 2015; 43:537-44. [DOI: 10.1016/j.jcms.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/28/2022] Open
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Xu KM, Quan K, Clump DA, Ferris RL, Heron DE. Stereotactic ablative radiosurgery for locally advanced or recurrent skull base malignancies with prior external beam radiation therapy. Front Oncol 2015; 5:65. [PMID: 25853093 PMCID: PMC4362305 DOI: 10.3389/fonc.2015.00065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/03/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Stereotactic ablative radiotherapy (SABR) is an attractive modality to treat malignancies invading the skull base as it can deliver a highly conformal dose with minimal toxicity. However, variation exists in the prescribed dose and fractionation. The purpose of our study is to examine the local control, survival, and toxicities in SABR for the treatment of previously irradiated malignant skull base tumors. MATERIALS AND METHODS A total of 31 patients and 40 locally advanced or recurrent head and neck malignancies involving the skull base treated with a common SABR regimen, which delivers a radiation dose of 44 Gy in 5 fractions from January 1st, 2004 to December 31st, 2013, were retrospectively reviewed. The local control rate (LC), progression-free survival rate, overall survival (OS) rate, and toxicities were reported. RESULTS The median follow-up time of all patients was 11.4 months (range: 0.6-67.2 months). The median tumor volume was 27 cm(3) (range: 2.4-205 cm(3)). All patients received prior external beam radiation therapy with a median radiation dose of 64 Gy (range: 24-75.6 Gy) delivered in 12-42 fractions. Twenty patients had surgeries prior to SABR. Nineteen patients received chemotherapy. Specifically, eight patients received concurrent cetuximab (Erbitux™) with SABR. The median time-to-progression (TTP) was 3.3 months (range: 0-16.9 months). For the 29 patients (93.5%) who died, the median time from the end of first SABR to death was 10.3 months (range: 0.5-41.4 months). The estimated 1-year OS rate was 35%. The estimated 2-year OS rate was 12%. Treatment was well-tolerated without grade 4 or 5 treatment-related toxicities. CONCLUSION Stereotactic ablative radiotherapy has been shown to achieve low toxicities in locally advanced or recurrent, previously irradiated head and neck malignancies invading the skull base.
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Affiliation(s)
- Karen M Xu
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Kimmen Quan
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - David A Clump
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Robert L Ferris
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA ; Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA ; Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
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Manjunath L, Derousseau T, Batra PS. Prognostic value of surgical margins during endoscopic resection of paranasal sinus malignancy. Int Forum Allergy Rhinol 2015; 5:454-9. [PMID: 25758938 DOI: 10.1002/alr.21463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 09/29/2014] [Accepted: 10/21/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Complete tumor resection with intraoperative frozen section control remains a central tenet of head and neck surgical oncology. The purpose of this study was to evaluate the significance of margins in predicting recurrence and disease status following endoscopic resection of sinonasal malignancy. METHODS This single-institution observational cohort study was performed on 68 patients over a 5-year period who underwent curative minimally invasive endoscopic resection (MIER) for sinonasal malignancies. RESULTS The mean age was 58.8 years and 69.1% were male. The mean follow-up after definitive MIER was 15.9 months. A mean of 10.8 margins were taken per surgery (range, 2 to 27). False-negative frozen section analysis was 22.1% for the entire cohort, but slightly higher at 25.0% for T3 or T4 malignancies. At last follow-up, no evidence of disease (NED) status was noted in 60.0% of those with positive margins vs 83.0% in those with negative margins, respectively (p = 0.0795). Regional or distant recurrences were observed in 39.9% of patients with positive margins and 13.2% of those with negative margins, respectively (p = 0.0299). Disease-free survival (DFS) was 9.7 months for patients with positive margins, whereas it was 15.9 months for patients with negative margins. CONCLUSION Disease-free status as a function of residual microscopic disease did not prove to be statistically significant. However, positive margins were correlated with a statistically significant increase in regional or distant recurrence. This suggests that complete resection with clear margins can impact oncologic outcomes in patients managed by MIER for sinonasal cancers.
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Affiliation(s)
| | | | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
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33
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Batra PS. Minimally invasive endoscopic resection of sinonasal and anterior skull base malignant neoplasms. Expert Rev Med Devices 2014; 7:781-91. [DOI: 10.1586/erd.10.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kang SY, McHugh JB, Sullivan SE, Marentette LJ, McKean EL. Sinonasal undifferentiated carcinoma and esthesioneuroblastoma recurring as nonintestinal adenocarcinoma. Laryngoscope 2013; 123:1121-4. [PMID: 23553283 DOI: 10.1002/lary.23746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/17/2012] [Accepted: 08/17/2012] [Indexed: 11/09/2022]
Abstract
Numerous distinct neoplasms are encountered at the anterior cranial base. Management of these primary tumors and their locoregional recurrences are dictated by the histopathologic diagnosis. We present two unusual cases of extra-axial anterior cranial base malignancies with locoregional recurrence where the recurrent tumor encountered was of a distinct histopathologic type. While rare, this report highlights the possibility of encountering a distinct tumor type in the posttreatment surveillance of patients with anterior cranial base malignancies.
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Affiliation(s)
- Stephen Y Kang
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan 48109, USA
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35
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Singh N, Eskander A, Huang SH, Curtin H, Bartlett E, Vescan A, Kraus D, O'Sullivan B, Gentili F, Gullane P, Yu E. Imaging and resectability issues of sinonasal tumors. Expert Rev Anticancer Ther 2013; 13:297-312. [PMID: 23477517 DOI: 10.1586/era.13.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sinonasal tumors can invade into the critical structures of the anterior and central skull base. Although the determination of precise tumor histology is difficult with imaging, radiology is important in helping differentiate malignant from benign disease. Imaging helps to map the anatomical extent of intracranial and intraorbital tumor, which has important implications for staging, treatment and prognosis. Imaging also helps to facilitate and plan for craniofacial or endoscopic surgical approaches and radiation planning. This paper will review the locoregional invasion patterns for sinonasal tumors, with emphasis on their imaging features. The authors will discuss the implications for staging, resection potential, choice and details of radiotherapy with or without chemotherapy and prognosis. The imaging assessment of structures and compartments that are critical to the skull base team are highlighted: orbit, cavernous sinus, anterior cranial fossa dura/intracranial tumor, lateral frontal sinus, vascular tumor encasement, perineural tumor spread and tumor effect on the surrounding bony structures.
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Affiliation(s)
- Navneet Singh
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Halmos GB, Peters TTA, Roodenburg JLN, van Dijk BAC, van der Laan BFAM. Comorbidity, complications, and survival of sinonasal malignancies in young and elderly treated by surgery. Otolaryngol Head Neck Surg 2013; 148:860-6. [PMID: 23389240 DOI: 10.1177/0194599813477354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Sinonasal malignancies are uncommon neoplasms with several histological subtypes, most commonly treated with surgery and postoperative radiotherapy. The aim of this study was to evaluate complications and survival, focusing on differences between elderly and younger patients undergoing surgery. STUDY DESIGN Historical cohort based on medical records. SETTING Tertial referral center. SUBJECTS AND METHODS Medical charts of 103 surgically treated patients (71 patients younger than 70 years and 32 patients aged 70 years and older) in a tertiary referral center with sinonasal malignancy were retrospectively analyzed. Comorbidity was scored according to the Adult Comorbidity Evaluation 27 system. Treatment outcomes were analyzed by collecting treatment-related complications scores and survival data. RESULTS Although comorbidity was more common in elderly patients, no significant differences were recorded in complications. In multivariate analysis, length of surgery was the only predictor for complication. Furthermore, no significant differences were seen in disease-specific survival and recurrence in young and elderly patients. Young patients with malignant epithelial tumors and melanoma had worse overall survival than patients with other histological subtypes. However, in elderly patients, no significant differences were seen in survival between histological subtypes. CONCLUSION For complications, survival, and recurrence, no differences were seen between young and elderly patients. Based on this study, surgery can also be safely performed in elderly sinonasal cancer patients after careful preoperative evaluation and patient selection.
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Affiliation(s)
- Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
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Givi B, Liu J, Bilsky M, Mehrara B, Disa J, Pusic A, Cordeiro P, Shah JP, Kraus DH. Outcome of resection of infratemporal fossa tumors. Head Neck 2013; 35:1567-72. [DOI: 10.1002/hed.23186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2012] [Indexed: 11/11/2022] Open
Affiliation(s)
- Babak Givi
- Department of Otolaryngology; Head and Neck Surgery; New York University; New York NY
| | - Jeffrey Liu
- Department of Otolaryngology; Head and Neck Surgery; Temple University; Philadelphia Pennsylvania
| | - Mark Bilsky
- Neurosurgical Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Babak Mehrara
- Plastic and Reconstructive Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Joseph Disa
- Plastic and Reconstructive Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Andrea Pusic
- Plastic and Reconstructive Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Peter Cordeiro
- Plastic and Reconstructive Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Jatin P. Shah
- Head and Neck Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Dennis H. Kraus
- Head and Neck Service; Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
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Husain Q, Patel SK, Soni RS, Patel AA, Liu JK, Eloy JA. Celebrating the golden anniversary of anterior skull base surgery: reflections on the past 50 years and its historical evolution. Laryngoscope 2013; 123:64-72. [PMID: 23280942 DOI: 10.1002/lary.23687] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 06/29/2012] [Accepted: 07/25/2012] [Indexed: 01/18/2023]
Abstract
With its inception nearly half a century ago through the pioneering work of Dandy, McLean, and Smith, anterior skull base (ASB) surgery is a relatively young discipline. It became a distinct entity in 1963 when Ketcham popularized the combined transcranial transfacial approach for en bloc resection of tumors of the paranasal sinuses extending into the anterior cranial fossa. However, because these procedures resulted in major morbidities and mortalities, alternative modes of treatment were sought. Since the 1970s, the introduction and promotion of the surgical endoscope by Messerklinger, Stammberger, and Kennedy, commenced the era of endoscopic sinus surgery. Thaler and colleagues described the utility of the endoscope for ASB surgery at the turn of the century. This allowed direct visualization and safer, more accurate removal of tumors. In 2001, Casiano reported the first purely endoscopic endonasal ASB resection, a novel technique that has been adopted by major skull base centers. The success of ASB surgery can be attributed to both the development of the skull base team as well as improvements in surgical techniques, instrumentation, and visualization technology. In this article, we review the historical evolution of ASB surgery as we approach the 50th anniversary since its recognition as a distinct entity.
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Affiliation(s)
- Qasim Husain
- Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey 07103, USA
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Mine S, Saeki N, Horiguchi K, Hanazawa T, Okamoto Y. Craniofacial Resection for Sinonasal Malignant Tumors: Statistical Analysis of Surgical Outcome over 17 Years at a Single Institution. Skull Base 2012; 21:243-8. [PMID: 22470267 DOI: 10.1055/s-0031-1280686] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We present a retrospective analysis of surgical outcome of sinonasal malignant tumors. Overall survival (OS), disease-specific survival (DSS), local control (LC), and disease-free survival (DFS) were calculated in 32 patients. Prognostic factors for survival and functional outcomes were investigated. The median follow-up period was 70 months. At 5 years, OS, DSS, LC, and DFS rates were 0.722, 0.745, 0.851, and 0.707, respectively. Prognostic factors for poor OS were involvement of the frontal sinus (p = 0.023), T classification (T4, p = 0.025), surgical complications (p = 0.029), chemotherapy (p = 0.035) postsurgical infection (p = 0.043), involvement of the orbit (p = 0.048), histology (squamous cell carcinoma, p = 0.049), and radiotherapy (p = 0.043). Prognostic factors for poor DSS were radiotherapy (p = 0.030), chemotherapy (p = 0.036), positive surgical margin (p = 0.034), and T classification (T4, p = 0.050). LC was adversely influenced by surgical procedure (combined frontotemporal resection, p = 0.035) and positive surgical margin (p = 0.049). DFS was adversely influenced by positive surgical margin (p = 0.001). Prognostic factors for poor functional outcome were postsurgical infection (p = 0.039), postsurgical complications (p = 0.040), tumor location (maxillary sinus, p = 0.042, orbit, p = 0.0002), number of sinuses involved (number of sinuses involved was inversely proportional to functional outcome, p = 0.027), T classification (T4 p = 0.007), pathology (squamous cell carcinoma, p = 0.023), and chemotherapy (p = 0.048). Craniofacial resection was an effective surgical option.
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Mai JC, Sekhar LN. Modern Management of Anterior Skull Base Tumors. World Neurosurg 2012; 78:60-1. [DOI: 10.1016/j.wneu.2012.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 12/25/2022]
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McIntyre JB, Perez C, Penta M, Tong L, Truelson J, Batra PS. Patterns of dural involvement in sinonasal tumors: prospective correlation of magnetic resonance imaging and histopathologic findings. Int Forum Allergy Rhinol 2012; 2:336-41. [PMID: 22337501 DOI: 10.1002/alr.21022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/31/2011] [Accepted: 12/06/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND The presence of dural invasion serves as an important negative predictive factor for survival in sinonasal and skull-base neoplasms. The objective of this study was to prospectively correlate preoperative magnetic resonance imaging (MRI) findings with intraoperative surgical findings and histopathology to establish key correlates for dural involvement in sinonasal tumors. METHODS Prospective blinded MRI review of 50 sinonasal and anterior skull-base neoplasms was performed by a staff neuroradiologist. Retrospective chart review was performed to accrue salient patient and tumor data. RESULTS The mean patient age was 54.6 years with a male:female ratio of 1.8:1. The most common tumor histology included adenocarcinoma (18%), squamous cell carcinoma (18%), mucosal melanoma (8%), and olfactory neuroblastoma (8%). MRI demonstrated dural enhancement in 20 patients (40%), with 1 mm and ≥2 mm thickening being noted in 14 (70%) and 6 (30%) cases, respectively. Spectrum of MR findings in these 20 patients included linear enhancement in 15 (75%), nodular thickening in 5 (25%), and loss of hypointense zone in 13 (65%) cases. Intraoperative findings and histology confirmed dural invasion in 12 of 20 cases (60%). Positive predictive value (PPV) of linear and nodular dural enhancement for dural invasion was 46.7% and 100%, respectively. One millimeter (1 mm) and ≥2 mm of dural thickening demonstrated PPV of 42.9% and 100%, respectively. Loss of the hypointense zone had PPV of 92.3% for dural invasion. Fisher's exact test demonstrated that loss of hypointense zone and dural thickening ≥2 mm were statistically associated with dural involvement (p < 0.05). CONCLUSION The presence of ≥2 mm of dural thickening, loss of hypointense zone, and nodular dural enhancement were highly predictive for presence of dural invasion by sinonasal malignant tumors. Preoperative knowledge of these MRI patterns may better guide surgical planning and patient counseling.
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Affiliation(s)
- John B McIntyre
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Raza SM, Garzon-Muvdi T, Gallia GL, Tamargo RJ. Craniofacial resection of midline anterior skull base malignancies: a reassessment of outcomes in the modern era. World Neurosurg 2011; 78:128-36. [PMID: 22120268 DOI: 10.1016/j.wneu.2011.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/23/2011] [Accepted: 09/04/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. METHODS We review our experience of open craniofacial resection of midline anterior cranial fossa malignancies in the modern era. RESULTS Between 1995 and 2009, 41 patients underwent bifrontal craniotomy/craniofacial resection for malignancy. A subset of patients had undergone previous treatment, i.e., transfacial resection (34%), chemotherapy (5%), and radiation therapy (10%). Esthesioneuroblastoma (29%) was the most common pathology, followed by squamous cell carcinoma (27%) and the remaining patients presented with various histologic subtypes. All tumors invaded the cribriform plate; tumors invaded dura in 51%, parenchyma in 17% and orbit in 54% of patients. Negative margins were obtained in 85% of the cohort. Postoperative complications included seizure (one patient), cerebrospinal leak (one patient), and symptomatic pneumocephalus (two patients). CONCLUSION Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.
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Affiliation(s)
- Shaan M Raza
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Cantu G, Solero CL, Mariani L, Lo Vullo S, Riccio S, Colombo S, Pompilio M, Perrone F, Formillo P, Quattrone P. Intestinal type adenocarcinoma of the ethmoid sinus in wood and leather workers: a retrospective study of 153 cases. Head Neck 2011; 33:535-42. [PMID: 20665741 DOI: 10.1002/hed.21485] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of our study was to identify the role of work exposure to organic dusts in patients with malignant paranasal sinus tumors. METHODS We analyzed all patients surgically treated for a malignant paranasal sinus tumor at our institution between 1987 and 2006. All patients were specifically asked about their occupational history. The tumor site was classified as maxillary or ethmoid sinus. Adenocarcinomas were divided into intestinal type (ITAC) and non-ITAC. RESULTS The sample included 345 patients with ethmoid sinus and 301 maxillary sinus. Regarding the ethmoid sinus, we found an exposure to organic dusts in 148 of 153 patients with ITAC, in 3 of 16 patients with non-ITAC adenocarcinoma, and in 10 of 176 patients with other tumors. Regarding the maxillary sinus, we found an exposure in 1 of 20 patients with non-ITAC adenocarcinoma and in 4 of 281 patients with other histologies. CONCLUSION Our study demonstrates that only ethmoid ITACs have an indisputable relationship with the exposure to organic dusts.
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Affiliation(s)
- Giulio Cantu
- Cranio-Maxillo-Facial Unit, Fondazione I.R.C.C.S. Istituto Nazionale dei Tumori, Milan, Italy.
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Sakashita T, Oridate N, Homma A, Nakamaru Y, Suzuki F, Hatakeyama H, Taki S, Sawamura Y, Yamamoto Y, Furuta Y, Fukuda S. Complications of skull base surgery: an analysis of 30 cases. Skull Base 2011; 19:127-32. [PMID: 19721768 DOI: 10.1055/s-0028-1096201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the risk factors for perioperative complications among patients undergoing craniofacial resection for the treatment of skull base tumors. DESIGN Retrospective analysis. PARTICIPANTS The study group comprised 29 patients with skull base tumors (22 malignant and 7 benign) who underwent 30 craniofacial resections at Hokkaido University Hospital between 1989 and 2006. Of these cases, 21 had undergone prior treatment by radiation (16 cases), surgery (7 cases), or chemotherapy (1 case). Moreover, 19 needed extended resection involving the dura (11 cases), brain (5 cases), orbit (12 cases), hard palate (5 cases), skin (3 cases), or cavernous sinus (2 cases). MAIN OUTCOME MEASURES Perioperative complications and risk factor associated with their incidence. RESULTS Perioperative complications occurred in 12 patients (40%; 13 cases). There was a significant difference between complication rates for cases with and without prior therapy (52.4% vs. 11.1%). The complication rate for dural resection cases was 81.8%. There was a significant difference between complication rates for cases with and without dura resection. No postoperative mortality was reported. CONCLUSIONS Craniofacial resection is a safe and effective treatment for skull base tumors. However, additional care is required in patients with extended resection (especially dural) and those who have undergone prior therapy.
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Affiliation(s)
- Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Cantu G, Solero CL, Miceli R, Mattana F, Riccio S, Colombo S, Pompilio M, Lombardo G, Formillo P, Quattrone P. Anterior craniofacial resection for malignant paranasal tumors: a monoinstitutional experience of 366 cases. Head Neck 2011; 34:78-87. [PMID: 21469247 DOI: 10.1002/hed.21685] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the results of a mono-institutional series of patients treated with anterior craniofacial resection for malignant paranasal sinus tumors. METHODS We analyzed all patients with malignant paranasal sinus tumors treated with anterior craniofacial resection at our institution between 1987 and 2007. All tumors were classified according to both the American Joint Committee on Cancer (AJCC)-2002 and the Istituto Nazionale Tumori (INT) classifications. RESULTS The sample included 366 patients. There was intraorbital spread in 108 cases. The skull base was eroded in 127 patients, with dura or brain involvement in 93 patients. The 10-year disease-specific survival was 53.1%. Histologic subtype, INT stage, surgical margins, and postsurgical radiotherapy were significant, independent predictors for both local relapse and disease-specific survival (DSS). The AJCC-2002 classification was not significant when tested in place of INT stage. CONCLUSION Our data indicated that craniofacial resection and postsurgical radiotherapy remain the primary option for malignant tumors involving the anterior skull base.
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Affiliation(s)
- Giulio Cantu
- Cranio-Maxillo-Facial Unit, Fondazione I.R.C.C.S. Istituto Nazionale dei Tumori, Milano, Italy.
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Borges A, Coiteiro D, Santos JR, Magalhães M, Fonseca I. Using magnetic resonance for the imaging of dural invasion by head and neck tumors. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/iim.10.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The basic principle of anterior skull base surgery is to provide adequate exposure to enable three dimensional resection of skull base tumors. Negative surgical margins, which is within the control of surgeon, is the principle prognostic factor in anterior skull base tumors. Open skull base approaches is the standard of care for malignant anterior skull base tumors. Benign lesions may be resected by alternate minimally invasive approaches. Advances in anterior skull base surgery, in particular the facial translocation approaches allows wide exposure of the tumors with minimal retraction of the brain. The outcome of anterior skull base tumors have steadily increased over the years with disease free survival comparable to other malignant neoplasm of the head and neck region. This review described various surgical approaches and pertaining anatomy and pathology of anterior skull base tumors.
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Luong A, Citardi MJ, Batra PS. Management of Sinonasal Malignant Neoplasms: Defining the Role of Endoscopy. Am J Rhinol Allergy 2010; 24:150-5. [DOI: 10.2500/ajra.2010.24.3451] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Preliminary reports support the role of endoscopic techniques in the management of selected sinonasal malignancies. The objectives of this review are (1) to assess outcomes for patients undergoing definitive endoscopic tumor extirpation and (2) to elucidate the role of endoscopy in the management of sinonasal malignancies. Methods Retrospective review of patients with sinonasal malignancy managed via endoscopic techniques from September 1998 to December 2007 was conducted. Results Sixty-one patients were identified (38 men and 23 women) with a mean age of 59 years. The five most common pathologies were squamous cell carcinoma (21), melanoma (10), esthesioneuroblastoma (8), adenocarcinoma (7), and sinonasal undifferentiated carcinoma (3). Sixty-nine endoscopic procedures were performed and categorized according to surgical intent: 57 curative resections (82.6%), 8 palliative resections (11.6%), and 4 tumor mappings (5.8%). Adjuvant chemotherapy and/or radiation therapy was used in 29 of the 50 patients (58%). For those patients undergoing definitive treatment, the disease-free and overall survival rates were 69.2 and 84.6% at mean of 34.5 and 42.7 months, respectively. The local and regional recurrence rates were 17 and 10%, respectively. Conclusion The endoscope is a versatile tool for management of sinonasal malignant neoplasms. Although the role was once just limited to biopsy, endoscopic approaches allow for definitive resection for curative intent and palliative resection for patient comfort with acceptable survival. Moreover, endoscopy facilitates three-dimensional tumor mapping and posttreatment surveillance in patients undergoing definitive chemoradiation.
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Affiliation(s)
- Amber Luong
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical School at Houston, and Texas Skull Base Institute, Houston, Texas
| | - Martin J. Citardi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical School at Houston, and Texas Skull Base Institute, Houston, Texas
| | - Pete S. Batra
- Department of Otolaryngology–Head and Neck Surgery and Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, Texas Presented at the fall meeting of the American Rhinologic Society, Chicago, Illinois, September 20–21, 2008
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Ozer E, Bapna S, Agrawal A, Schuller DE. Maxillary removal and reinsertion: A favorable approach for extensive anterior cranial base tumors. Otolaryngol Head Neck Surg 2010; 142:322-6. [DOI: 10.1016/j.otohns.2009.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 09/18/2009] [Accepted: 11/17/2009] [Indexed: 11/16/2022]
Abstract
Objective: To analyze the long-term results and the complications related to an expanded series of maxillary removal and reinsertion (MRRI) with 18-year surgical experience. Study Design: Case series with chart review of the MRRI patients in the last 18 years. Setting: The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute. Subjects and Methods: Seventy-eight patients who underwent MRRI from February 1990 through February 2007. The median age was 51 years (range 11-77 yrs). Sixty-two (80%) patients had malignant lesions. Results: MRRI has been successfully completed in all 78 patients, with no intraoperative mortality. The most commonly encountered malignant neoplasm was squamous cell cancer (40.3%), followed by esthesioneuroblastoma (24.1%), adenoid cystic cancer (8%), and other neoplasms (27.4%). The most commonly encountered postoperative complication was diplopia, which has persisted in five (6.4%) patients in the short-term and in three (4%) patients in the long-term follow-up. Nasal asymmetry was the most common long-term complication (17.9%), followed by plate-associated problems (10.2%) and midface asymmetry (10.2%). Overall five-year survival for the patients with squamous cell carcinoma was 62 percent. Conclusion: MRRI is a favorable surgical technique for the treatment of anterior cranial base (ACB) tumors in adults and even in children. It improves operative morbidity by preserving both function and form of the maxillary region and gives excellent exposure to ACB.
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Affiliation(s)
- Enver Ozer
- Department of Otolaryngology–Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, the Ohio State University, Columbus, OH
| | - Sumit Bapna
- Department of Otolaryngology–Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, the Ohio State University, Columbus, OH
| | - Amit Agrawal
- Department of Otolaryngology–Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, the Ohio State University, Columbus, OH
| | - David E. Schuller
- Department of Otolaryngology–Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, the Ohio State University, Columbus, OH
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Batra PS, Luong A, Kanowitz SJ, Sade B, Lee J, Lanza DC, Citardi MJ. Outcomes of minimally invasive endoscopic resection of anterior skull base neoplasms. Laryngoscope 2010; 120:9-16. [PMID: 19877265 DOI: 10.1002/lary.20680] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to review clinical outcomes of minimally invasive endoscopic resection (MIER) for anterior skull base (ASB) neoplasms. STUDY DESIGN Retrospective data review. METHODS Data analysis was performed on all patients undergoing MIER from October 2000 to December 2008. RESULTS Thirty-one patients with mean age of 58 years underwent MIER. Malignant and benign tumors were managed in 25 (80.6%) and six (19.4%) cases, respectively. Most common histopathologies were squamous cell carcinoma (six), esthesioneuroblastoma (five), mucosal melanoma (five), and sinonasal undifferentiated carcinoma (four). American Joint Committee on Cancer tumor staging was T3N0M0 and T4N0M0 in 14 (56%) and 11 (44%) of the malignant cases, respectively. Surgical resection with curative intent was performed in 28 cases (90.3%). Multilayered skull base reconstruction was performed in most patients; lumbar drains were used in eight cases (25.8%). Twenty-one patients (67.7%) were disease free, five patients (16.1%) were dead from disease, three patients (9.7%) were alive with disease, and two patients (6.5%) died from unrelated causes at mean follow-up of 31.7 months. CONCLUSIONS This study validated technical feasibility of MIER for diversity of benign and malignant ASB histopathology. Majority of patients were able to avoid adjunct craniotomy, whereas lumbar drainage was utilized in selective cases. This surgical strategy resulted in low complication rate and acceptable disease-free survival in patients with advanced T3 and T4 malignant lesions. Future studies should focus on multicenter trials to facilitate more robust survival analysis and comparison to open surgical approaches.
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Affiliation(s)
- Pete S Batra
- Comprehensive Skull Base Program and Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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