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Hunt PJ, Amit M, Kabotyanski KE, Aashiq M, Hanna EY, Kupferman ME, Su SY, Gidley PW, Nader ME, DeMonte F, Raza SM. Predictors of postoperative performance status after surgical management of infratemporal fossa malignancies. Neurosurg Rev 2023; 46:157. [PMID: 37386212 DOI: 10.1007/s10143-023-02063-8] [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: 05/13/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
Infratemporal fossa (ITF) tumors are difficult to access surgically due to anatomical constraints. Moreover, aggressive ITF carcinomas and sarcomas necessitate aggressive treatment strategies that, along with tumor-related symptoms, contribute to decreases in patient performance status. To assess factors that predict postoperative performance in patients undergoing surgery for ITF tumors. We reviewed medical records for all patients surgically treated for an ITF malignancy between January 1, 1999, and December 31, 2017, at our institution. We collected patient demographics, preoperative performance, tumor stage, tumor characteristics, treatment modalities, pathological data, and postoperative performance data. The 5-year survival rate was 62.2%. Higher preoperative Karnofsky Performance Status (KPS) score (n = 64; p < 0.001), short length of stay (p = 0.002), prior surgery at site (n = 61; p = 0.0164), and diagnosis of sarcoma (n = 62; p = 0.0398) were predictors of higher postoperative KPS scores. Percutaneous endoscopic gastrostomy (PEG) (n = 9; p = 0.0327), and tracheostomy tube placement (n = 20; p = 0.0436) were predictors of lower postoperative KPS scores, whereas age at presentation (p = 0.72), intracranial tumor spread (p = 0.8197), and perineural invasion (n = 40; p = 0.2195) were not. Male patients and patients with carcinomas showed the greatest decreases in KPS scores between pretreatment and posttreatment. Higher preoperative KPS score and short length of stay were the best predictors of higher postoperative KPS scores. This work provides treatment teams and patients with better information on outcomes for shared decision-making.
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Affiliation(s)
- Patrick J Hunt
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Rm FC7.2000, Unit 442, Houston, TX, 77030, USA
| | - Moran Amit
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine E Kabotyanski
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Rm FC7.2000, Unit 442, Houston, TX, 77030, USA
| | - Mohamed Aashiq
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Rm FC7.2000, Unit 442, Houston, TX, 77030, USA
| | - Shaan M Raza
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Rm FC7.2000, Unit 442, Houston, TX, 77030, USA.
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Yeung JT, Caminer DM, Young IM, Sughrue ME, Teo C. Radical Exenteration of the Skull Base for End-Stage, Locally Advanced Sinonasal Malignancies: Challenging the Dictum of Unresectability. World Neurosurg 2021; 150:e102-e107. [PMID: 33647490 DOI: 10.1016/j.wneu.2021.02.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The role of surgery is not well defined in locally advanced sinonasal cancers with intracranial involvement after all medical options have been exhausted. We hypothesize that patients whose tumors are deemed unresectable and referred to palliative care may benefit from radical salvage surgery. METHODS We performed a single-center retrospective review of patients with malignant, locally advanced (stage T4b) sinonasal cancers with intracranial involvement from 2000 to 2020, inclusive. Data were collected on the patient demographics, details of chemotherapy, radiation, histology, perioperative complications, surgical approaches, and survival. We compared the survival outcomes of patients with different duration of disease before presentation. RESULTS We identified 17 patients who had undergone salvage surgical resection of treatment-recalcitrant, locally advanced sinonasal tumors. Almost all patients had undergone prior surgery, radiotherapy, and chemotherapy. Perioperative complications occurred in 6 of 17 patients with 1 death. Patients with clinically less aggressive disease had significantly longer progression-free and overall survival compared with the more aggressive group. CONCLUSIONS Salvage surgery for locally advanced sinonasal cancers with intracranial invasion that is recalcitrant to all other therapies should be considered for patients who otherwise have no other treatment options.
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Affiliation(s)
- Jacky T Yeung
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - David M Caminer
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia; Department of Plastic Surgery, St. Vincent's Hospital, Sydney, Australia
| | | | - Michael E Sughrue
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - Charles Teo
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
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Fiani B, Quadri SA, Cathel A, Farooqui M, Ramachandran A, Siddiqi I, Ghanchi H, Zafar A, Berman BW, Siddiqi J. Esthesioneuroblastoma: A Comprehensive Review of Diagnosis, Management, and Current Treatment Options. World Neurosurg 2019; 126:194-211. [PMID: 30862589 DOI: 10.1016/j.wneu.2019.03.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Many controversies exist in the diagnosis and management of this aggressively malignant condition, mainly because of limited literature and lack of randomized control trials, resulting in nonstandardized treatment methods. We performed a comprehensive review of the literature to identify management approach and treatment options for esthesioneuroblastoma. METHODS An extensive review of the published literature was conducted in PubMed, OVID Medline, and EMBASE journals for studies of esthesioneuroblastoma. Terms for search included esthesioneuroblastoma (ENB) and olfactory neuroblastoma (ONB). No date restrictions were used. RESULTS The search yielded 3876 related articles. Cross-checking of articles led to exclusion of duplicate articles. The remaining 1170 articles were screened for their full text and English language availability. Of 609 full-text articles available, animal studies, irrelevant articles, and studies with mixed/confusing data were excluded. We finalized 149 articles pertaining to the topic, including 119 original research articles, 3 book chapters, 11 reviews, 9 case reports, and 7 case series. CONCLUSIONS Surgical resection followed by radiotherapy is the standard for treatment for higher-grade lesions. The endoscopic endonasal approach is gaining further recognition with more favorable outcomes and better survival than for open surgery. Postoperative radiotherapy is associated with the highest overall survival and shows benefit for patients with higher-stage disease and those who receive chemotherapy. Recurrence rates after treatment vary drastically in the literature and, therefore, prolonged follow-up with repeated imaging is recommended. Lifelong surveillance is recommended because of late recurrences associated with this tumor.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California.
| | - Syed A Quadri
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
| | - Mudassir Farooqui
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Anirudh Ramachandran
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Imran Siddiqi
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Atif Zafar
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Blake W Berman
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
| | - Javed Siddiqi
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
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Nishio N, Fujimoto Y, Hiramatsu M, Maruo T, Tsuzuki H, Mukoyama N, Shimono M, Sone M, Kawabe Y, Saito K, Fujii M, Nakashima T. <Editors' Choice> Maxillary sinus carcinoma outcomes over 60 years: experience at a single institution. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:91-98. [PMID: 29581618 PMCID: PMC5857505 DOI: 10.18999/nagjms.80.1.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Advances in the diagnosis and treatment of patients with maxillary sinus carcinoma have improved patient prognosis. This study investigated changes in demographic and clinical characteristics, treatment methods, and outcomes of patients with maxillary sinus carcinomas during three different 10-year periods spanning 60 years at our university hospital. Of the 233 patients with maxillary sinus carcinomas managed at Nagoya University Hospital, 135 were treated between 1951 and 1960 (first period), 35 between 1981 and 1990 (second period), and 63 between 2003 and 2012 (third period). Patient age, sex, TN classifications, treatment methods, and survival rates were compared among patients treated during these time periods. Of the 135, 35, and 63 patients with maxillary sinus carcinomas treated during these time periods, 86 (63.7%), 21 (51.4%), and 48 (76.2%), respectively, were men; 14 (10.4%), six (17.1%), and 14 (22.2%), respectively, were aged ≥70 years; and 135 (100%), 28 (80.0%), and 43 (68.3%), respectively, were treated surgically. The 5-year overall survival rates in patients treated during the first, second, and third periods were 29.7%, 44.3%, and 57.5%, respectively. These findings indicated that advances in the diagnosis and treatment of patients with maxillary sinus carcinoma, including computed tomography and craniofacial resection, have contributed to improvements in patient survival rates.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, 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
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Shimono
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitaka Kawabe
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Tsutomu Nakashima
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Fountas KN, Hadjigeorgiou GF, Kapsalaki EZ, Paschalis T, Rizea R, Ciurea AV. Surgical and functional outcome of olfactory groove meningiomas: Lessons from the past experience and strategy development. Clin Neurol Neurosurg 2018; 171:46-52. [DOI: 10.1016/j.clineuro.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/04/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
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Abstract
Malignant tumors of the nasal cavity are rare but interesting lesions because of the heterogeneity of histologic types. From 1951 to 1992, 102 patients with malignant tumors of the nasal cavity have been treated at the University of Kansas Medical Center. Squamous cell carcinoma was the most common histologic type (41 %), followed by malignant melanoma (15%), and adenoid cystic carcinoma (8%). A number of other rare tumors, including hemangiopericytoma, osteosarcoma, acinic cell carcinoma, and teratoid carcinosarcoma were found in single instances. Despite the high proportion of advanced stage disease in patients undergoing planned combined therapy for all histologic types, a 54% overall determinate 5-year survival rate was achieved. The 5-year cure rate for all forms of treatment was 49%. The purpose of this paper is to present our experience and compare the outcome of the various treatment options; the impact of combined surgery and radiation on survival; and the importance of proper patient selection now made possible by CT and MR imaging and endoscopic examination. The evolution of treatment modalities dating to the beginning of this study period and ending with our current techniques for anterior skull base resections is discussed.
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Affiliation(s)
- Eric C. Christensen
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas
| | - Larry A. Hoover
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas
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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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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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Nishio N, Fujimoto Y, Fujii M, Saito K, Hiramatsu M, Maruo T, Iwami K, Kamei Y, Yagi S, Takahashi M, Hayashi Y, Ando A, Nakashima T. Craniofacial Resection for T4 Maxillary Sinus Carcinoma. Otolaryngol Head Neck Surg 2015; 153:231-8. [DOI: 10.1177/0194599815586770] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/14/2015] [Indexed: 02/03/2023]
Abstract
Objective The objective of this study was to clarify the outcomes of craniofacial resection for locally advanced maxillary sinus carcinoma classified as T4 and to present methods for managing cases involving the skull base. Study Design Case series with chart review. Setting Tertiary university hospital. Subjects and Methods We performed anterolateral craniofacial resection in en bloc fashion for locally advanced maxillary sinus carcinoma at stage T4. Participants comprised 40 patients with T4 maxillary sinus carcinoma treated between 1992 and 2011. Surgical outcomes were analyzed retrospectively. Results Forty patients with stage T4a (n = 26) or stage T4b (n = 14) were included in this study. Five-year overall and disease-free survival rates for the 40 patients with T4 maxillary sinus carcinoma were 62.7% and 52.6%, respectively. Cavernous sinus involvement correlated significantly with worse prognosis ( P = .012). In 35 cases without cavernous sinus involvement, previous treatment ( P = .017) and positive margins ( P = .019) correlated significantly with worse prognosis, and 5-year overall and disease-free survival rates were 72.4% and 55.3%, respectively. Conclusion This study only included cases of locally advanced maxillary sinus carcinoma classified as T4. Considering the advanced stage, our study suggests relatively favorable outcomes and the importance of managing the cavernous sinus in en bloc resections of malignant skull base tumors. Craniofacial resection in en bloc fashion achieved good survival rates.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, 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, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Atsushi Ando
- Department of Otorhinolaryngology, Japan Labor Health, and Welfare, Chubu Rosai Hospital, Nagoya, Japan
| | - Tsutomu Nakashima
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Abstract
Treatment of skull base tumors involves multiple specialities. The lesions are usually advanced and the treatment is often associated with unfavorable results, which may be functional and/or aesthetic. Here we have done an analysis for the complications and unfavorable results of 546 cases treated surgically by a single craniofacial surgeon over a period of 14 years. The major morbidity ranges from death to permanent impairment of vital organ functions (brain, eye, nose), infections, tissue losses, flap failures, treatment associated complications, psychosocial issues, and aesthesis besides others. This article is aimed at bringing forth these unfavorable results and how to avoid them.
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Affiliation(s)
- Hemen Jaju
- Consultant, Jaju Plastic Surgery Center, and Department of Plastic Surgery, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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12
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Treasure TE, Dean JS, Gear RD. Craniofacial approaches and reconstruction in skull base surgery: techniques for the oral and maxillofacial surgeon. J Oral Maxillofac Surg 2014; 71:2137-50. [PMID: 24237775 DOI: 10.1016/j.joms.2013.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Skull base surgery (SBS) is considered the standard of care in treating benign and malignant lesions of the cranial base. SBS is a multidisciplinary team approach used to treat these complex lesions that may have intracranial extension. SBS can be broken down into 3 steps. Transfacial access is performed, followed by resection with sound oncologic principles, and then reconstruction of the cranial base and facial structures. Functional and esthetic concerns must be addressed by the surgeons. Oral and maxillofacial surgeons frequently perform elective facial osteotomies and treat victims of cranial base trauma. These same principles can be applied to SBS as a part of the skull base team.
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Affiliation(s)
- Trevor E Treasure
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas School of Dentistry, Houston, TX.
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Ramakrishnan VR, Lee JY, O'Malley BW, Palmer JN, Chiu AG. 18-FDG-PET in the initial staging of sinonasal malignancy. Laryngoscope 2013; 123:2962-6. [PMID: 23877974 DOI: 10.1002/lary.24317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The utility of fluorine-18 fluorodeoxyglucose-positron emission tomography (PET) has been gradually defined for most head and neck cancers, However, its utility in the initial diagnosis of sinonasal malignancy has not been extensively studied. The aim of this study was to determine if PET scanning accurately diagnoses and stages malignant sinonasal lesions and if maximum standard uptake value (SUV max) correlates with clinically advanced disease. STUDY DESIGN Retrospective chart review. METHODS There were 51 patients with sinonasal malignancy who underwent diagnostic whole body PET or PET-computed tomography scans that were analyzed for patient and disease characteristics, SUV max, and staging. RESULTS Of the 51 patients, 48 scans were positive at the primary site, with a sensitivity of 94%. Four patients were found to have intensely avid uptake, in which the numerical SUV max was not documented, and three patients did not have any uptake in the region of their tumor. Mean SUV max at the primary site was 16.1 (range, 3.1-59). Metastasis was detected in 31% (16/51) of the patients. There was a potential positive correlation between SUV max at the primary site and detection of metastasis on univariate analysis (r = 0.19, P = .09), but on multivariate analysis, SUV max was not found to correlate with T staging or metastasis. CONCLUSIONS For diagnosis of sinonasal malignancy, PET scans have a high sensitivity, although false negatives occurred in 6% of cases. PET scanning detected metastasis in 31% of patients, but SUV max did not function as a marker for clinically advanced disease. The role of diagnostic PET for sinonasal malignancy is currently limited to cases with a high suspicion of metastatic disease.
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Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Colorado, Denver, Colorado
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Rowland NC, Jermakowicz WJ, Tihan T, El-Sayed IH, McDermott MW. Subacute cystic expansion of intracranial juvenile psammomatoid ossifying fibroma. J Neurosurg Pediatr 2013; 11:687-91. [PMID: 23540525 DOI: 10.3171/2013.2.peds12253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Juvenile psammomatoid ossifying fibroma (JPOF) is a benign fibro-osseous lesion typically associated with the jaw, paranasal region, or orbit. However, JPOF may also originate from the skull base and locally invade the cranium. In published reports, intracranial JPOFs constitute only a small percentage of cases, and therefore it is not known whether more aggressive behavior typifies this distinct population of JPOFs compared with those in other locations. Nevertheless, JPOF histopathology is characterized by a number of active processes, including cystic transformation, that may precipitate violation of skull base boundaries. In the following article, the authors present a case of skull base JPOF that underwent cystic expansion in a young girl, produced a focal neurological deficit, and was resolved using a staged surgical approach.
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Affiliation(s)
- Nathan C Rowland
- Brain Tumor Center, Department of Neurological Surgery, University of California-SanFrancisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA.
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Eibling DE, Janecka IP, Snyderman CH, Cass SP. Meta-analysis of outcome in anterior skull base resection for squamous cell and undifferentiated carcinoma. Skull Base Surg 2011; 3:123-9. [PMID: 17170901 PMCID: PMC1656443 DOI: 10.1055/s-2008-1060574] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple reports now demonstrate the technical feasibility of combined intra- and extracranial procedures for the excision of malignancy involving the anterior skull base-Anatomic proximity to vital structures in this region often precludes en bloc resection, however, and margins are often measured in millimeters. Nevertheless, multiple cases of prolonged survival following craniofacial excision of high-grade malignancies have been reported. These are usually included in larger series that encompass tumors of various histologic characteristics and grade. A meta-analysis of the reported outcome of craniofacial resection for squamous cell and undifferentiated carcinoma was performed. Ninety-six articles on craniofacial resection were reviewed and a total of 425 patients who had undergone craniofacial resection were identified in 30 of these. Of 89 patients with squamous cell carcinoma in whom follow-up data were available from seven larger series, the disease-free survival at 2 or greater years was 64%. Forty-one patients with undifferentiated carcinoma were identified who had undergone surgical excision, and 45% were disease-free at 2 or greater years (range, 2 to 24 years). This meta-analysis suggests that high-grade carcinoma involving the anterior cranial base is amenable to surgical excision with acceptable disease-free survival in selected patients at 2 years.
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Ross DA, Marentette LJ, Moore CE, Switz KL. Craniofacial resection: decreased complication rate with a modified subcranial approach. Skull Base Surg 2011; 9:95-100. [PMID: 17171124 PMCID: PMC1656816 DOI: 10.1055/s-2008-1058155] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The authors have successfully utilized a modified subcranial approach to the anterior skull base, based upon the procedure first described by Joram Raveh, as an alternative to standard craniofacial resection. The complication rate of this procedure in 31 consecutive cases (28 tumors, 2 congenital malformations, and 1 mucocele) has been 19.4% with no permanent complications, no deaths, no new neurological deficits, no brain injuries, no infections, and no seizures. Minor complications without permanent sequelae included two cases of tension pnenmocephalus, a subdural hygroma, two transient cerebrospinal fluid leaks, and a case of bacterial meningitis secondary to fecal contamination of a lumbar drain in a child. Average length of hospitalization was 7.1 days (range 2 to 16 days). The overall complication rate is considerably below the complication rate for other reported craniofacial procedures. We describe the technique we have used and the results. The subcranial approach as described herein provides wide exposure of the anterior cranial base without brain retraction, does not require prolonged operating times or hospitalization, and has a potentially lower complication rate than reported for other transfrontal transbasal approaches.
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17
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Deschler DG, Gutin PH, Mamelak AN, McDermott MW, Kaplan MJ. Complications of anterior skull base surgery. Skull Base Surg 2011; 6:113-8. [PMID: 17170985 PMCID: PMC1656572 DOI: 10.1055/s-2008-1058652] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The complications associated with anterior skull base surgery were reviewed in 49 consecutive patients treated between November 1986 and August 1993. All procedures involved a combined otolaryngologic and neurosurgical approach, and the senior otolaryngologist was the same. Fifty-two procedures were completed; 37 for malignant disease and 15 for benign disease. Twenty-one of the 52 procedures had postoperative complications, a 40% complication rate. One postoperative death occurred from a myocardial infarction, for a 2% mortality rate. Infections complications were the most common, occurring in 19% of cases. The one case of meningitis responded to antibiotic therapy, without neurologic sequelae. Seven cerebrospinal fluid leaks occurred (13%); five resolved with conservative management, and two required reoperation. There was no significant difference between complication rates for patients with previous craniotomy, radiation therapy, or chemotherany compared with those with no prior therapy (p > .05). More complications occurred in patients with malignant disease than in those with benign disease (46% vs 27%), but this was not statistically significant (p > .05). Anterior and anterolateral skull base resection as part of a multidisciplinary approach to diseases of this region may provide improved palliation and may offer possible improved survival with acceptable surgical mortality. Although only 6% of patients were left with permanent neurologic sequelse in this series, the risks of serious complications are considerable.
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Jittapiromsak P, Wu A, Deshmukh P, Feiz-Erfan I, Nakaji P, Spetzler RF, Preul MC. Comparative analysis of extensions of transbasal approaches: effect on access to midline and paramedian structures. Skull Base 2011; 19:387-99. [PMID: 20436840 DOI: 10.1055/s-0029-1224773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We sought to quantitate the effect of extensions of transbasal approaches (TBAs) on midline and paramedian targets of the cranial base. Eight silicone-injected cadaveric heads were dissected with extensions of TBA level I removal of the orbital bar. Objective measures were the comparisons of the accessibility of midline and paramedian targets with progressive dissections by level II detachment of the medial canthal ligaments and removal of the nasal bone and by level III removal of the lateral orbital walls with lateral orbital retraction. Mean areas of freedom increased for most targets with progressive bone removal. For midline targets, the most effective freedom increment was at the pituitary gland (level II: 28.8%, p = 0.05; level III: 107.1%, p < 0.001). For paramedian targets, the best freedom increment was for the foramen rotundum (level II: 56.4%; level III: 134.5%, all p < 0.001). Extensions of the TBA can increase the surgical corridor to midline and paramedian structures, especially for pituitary and maxillary regions. Level II exposure offers no clear benefit for most targets except the foramen rotundum. With level III exposure, all targets are effectively exposed compared with levels I and II.
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Affiliation(s)
- Pakrit Jittapiromsak
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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19
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Close LG, Mickey B. Transcranial resection of ethmoid sinus cancer involving the anterior skull base. Skull Base Surg 2011; 2:213-9. [PMID: 17170870 PMCID: PMC1656385 DOI: 10.1055/s-2008-1057138] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present 11 cases of ethmoid sinus careinoma treated primarily by transcranial surgical resection and followed 1(1/2) to 7 years. Morbidity and mortality following surgery has proved acceptable. Local disease control and survival prognosis of the patients have been determined primarily by the histopathologic classification of the cancer rather than by invasion of dura or orbit. Good to excellent control has been achieved in cases of adenocarcinoma, adenoid cystic carcinoma, and squamous cell careinoma, but could not be demonstrated for undifferentiated carcinoma. Alternate means of treatment, including adjuvant chemotherapy and radiation therapy, are recommended for such anaplastic malignancies.
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20
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Pitman KT, Costantino PD, Lassen LF. Sinonasal undifferentiated carcinoma: current trends in treatment. Skull Base Surg 2011; 5:269-72. [PMID: 17170968 PMCID: PMC1656535 DOI: 10.1055/s-2008-1058925] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly aggressive neoplasm of the paranasal sinuses, which has recently been characterized as a distinct pathologic entity. The prognosis for patients with SNUC is poor. Early case reports describe patients with lesions that were clinically advanced at initial presentation and surgically unresectable. Survival was reported in months after treatment with chemotherapy and radiation. As more experience was gained with treatment of SNUC, it was found that aggressive, combined surgical therapy of lesions previously considered unresectable has shown increased survival. We report a case of a 38-year-old man with SNUC originating in the posterior ethmoid, extending into the anterior cranial fossa and orbit, who was treated with preoperative hyperfractionated radiation therapy, chemotherapy, and craniofacial resection.
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Varshney S, Bist SS, Gupta N, Singh RK, Bhagat S. Anterior craniofacial resection - for paranasal sinus tumors involving anterior skull base. Indian J Otolaryngol Head Neck Surg 2010; 62:103-7. [PMID: 23120693 DOI: 10.1007/s12070-010-0045-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the "gold standard" for surgery is the anterior craniofacial approach. Craniofacial resection represents a major advance in the surgical treatment of tumors of the paranasal sinuses involving anterior skull base. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. This study presents a series of 18 patients with anterior skull base tumors, treated by a team of head-neck surgeons and neurosurgeons. The series included 15 malignant tumors of the nose and paranasal sinuses and 3 extensive benign lesions. All tumors were resected by a combined bi-frontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, cerebrospinal fluid-leakage or meningitis. Recurrent tumor growth or systemic metastasis occurred in 3 out of 15 patients with malignant tumors, 6 months to 2 years postoperatively. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumors of anterior skull base.
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Affiliation(s)
- Saurabh Varshney
- Department of ENT and Head Neck Surgery, Himalayan Institute of Medical Sciences (HIHT University), Jollygrant, Doiwala, Dehradun, 248 140 Uttaranchal India
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22
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JIMBO H, KAMATA S, MIURA K, ASAMOTO S, TADA S, ENDO T, MASUBUCHI T, NAKAMURA N, FUSHIMI C. Operative Management of Skull Base Malignant Tumors Arising From the Nasal Cavity and Paranasal Sinus: Recent Strategies Used in 25 Cases. Neurol Med Chir (Tokyo) 2010; 50:20-6; discussion 26. [DOI: 10.2176/nmc.50.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hiroyuki JIMBO
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Shinetsu KAMATA
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Kouki MIURA
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Shunji ASAMOTO
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Shinichiro TADA
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Takahiro ENDO
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Tatsuo MASUBUCHI
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Narihiro NAKAMURA
- Skull Base Center, International University of Health and Welfare, Mita Hospital
| | - Chihiro FUSHIMI
- Skull Base Center, International University of Health and Welfare, Mita Hospital
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Endoscopic versus traditional craniofacial resection for patients with sinonasal tumors involving the anterior skull base. Clin Exp Otorhinolaryngol 2008; 1:148-53. [PMID: 19434247 PMCID: PMC2671747 DOI: 10.3342/ceo.2008.1.3.148] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 04/05/2008] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES With the advent of microdebriders and image guidance systems, endoscope-assisted surgery is now more widely used for the treatment of tumors involving the base of the skull. The aim of this study was to analyze the clinical features of tumors involving the anterior skull base and to evaluate the treatment outcomes according to the surgical approach, which included the traditional craniofacial resection (TCFR) and the endoscopic craniofacial resection with craniotomy (ECFR). METHODS Forty-six patients who underwent craniofacial resection from 1989 through 2006 at Seoul National University Hospital and Seoul National University Bundang Hospital were included in this study. Demographics, histology, surgical management, surgical outcomes, complications, and morbidity were analyzed. RESULTS The number of malignant and benign lesions was 40 and 6 cases respectively. The most common diagnosis was olfactory neuroblastoma occurring in 41% of the cases followed by squamous cell carcinoma and malignant melanoma. Thirty-six patients underwent TCFR, while ECFR was performed with or without adjunctive chemotherapy or radiotherapy in 10 patients. The overall five-year survival rate for patients with malignant tumors of the anterior skull base was 47.4%. Out of 19 patients with olfactory neuroblastomas, 10 patients had TCFR and six among them died of their disease. Nine patients underwent ECFR, and none of them died of their disease. The ECFR group had lower morbidity and cosmetic deformity than did the TCFR group. CONCLUSION The ECFR may be considered as an alternative option for the treatment of selected tumors with anterior skull base invasion. This approach offers the advantages of avoiding facial incisions with comparable treatment results.
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Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory Groove Meningiomas: Clinical Outcome and Recurrence Rates after Tumor Removal Through the Frontolateral and Bifrontal Approach. Neurosurgery 2007; 60:844-52; discussion 844-52. [PMID: 17460519 DOI: 10.1227/01.neu.0000255453.20602.80] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Olfactory groove meningiomas account for 8 to 13% of all intracranial meningiomas. Surgical removal is often performed through the bifrontal, unilateral subfrontal (frontolateral), or pterional approach. We report on the clinical outcome and recurrence rate after surgical treatment of olfactory groove meningiomas in our neurosurgical department.
METHODS
A retrospective study was conducted by analyzing the charts of the patients, including surgical records, discharge letters, histological records, follow-up records, and imaging studies.
RESULTS
A total of 1800 meningiomas were operated on between 1978 and 2002 in our department. There were 82 patients with olfactory groove meningiomas, including 63 women and 19 men with a mean age of 57.8 years (age range, 33–91 yr). Most patients presented with mental disturbance. Tumors were operated through the bifrontal (n = 46), frontolateral (n = 34), and pterional (n = 2) approaches. Total tumor removal (Simpson Grade 1 or 2) was achieved in most cases (91.2% frontolateral, 93.5% bifrontal). Perioperative mortality was 4.9% (four out of 82 patients, all operated through the bifrontal approach). The overall recurrence rate was 4.9%, with four patients requiring surgery. The mean follow-up period was 63.4 months (range, 4–270 mo).
CONCLUSION
Olfactory groove meningiomas were removed mainly through two different surgical approaches. Even in large tumors, high rates of total tumor resection could also be achieved with low recurrence rates using the simple and minimally invasive frontolateral approach. In recent years, we have preferred to use the frontolateral approach, which provides quick access to the tumor with less brain exposure while still enabling total tumor removal with a low morbidity rate and no mortality.
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25
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Gil Z, Patel SG, Singh B, Cantu G, Fliss DM, Kowalski LP, Kraus DH, Snyderman C, Shah JP. Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study. Cancer 2007; 110:1033-41. [PMID: 17614334 DOI: 10.1002/cncr.22882] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Single-institutional studies lack sufficient power to assess the role of surgery and radiotherapy in the management of sarcomas involving the anterior skull base. For this study, an international collaborative study group analyzed a large cohort of patients who underwent surgery for the treatment of skull base tumors. METHODS A subset of 146 patients who had a histologic diagnosis of skull base sarcoma (SBS) formed the basis of this report. Most patients were aged > or =21 years (77%) and had stage IV disease (56%). Adjuvant radiotherapy was received by 35% of patients, and chemotherapy was received by 10% of patients. RESULTS Orbital involvement was encountered in 53% of patients, involvement of the orbital wall was encountered in 46% of patients, and intracranial extension was encountered in 28% of patients. Positive microscopic margins were reported in 43% of patients (51 of 118 patients). Treatment-related complications were reported in 27% of patients, and postoperative mortality was reported in 1.4% of patients. With a median follow-up of 34 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 62%, 64%, and 57%, respectively. Tumor grade and adjuvant radiotherapy were not significant predictors of survival. Prior radiotherapy, intraorbital extension, positive margins, and postoperative complications were significant predictors of reduced disease-specific survival on univariate analysis. The presence of positive/close margins, however, was the only independent predictor of poor overall, recurrence-free, and disease-specific survival on multivariate analysis (relative risk, 2.4; P = .006). The 5-year disease-specific survival rate was 77%, 43%, and 36% for patients with negative, close, and positive margins, respectively. CONCLUSIONS The current results indicated that wide craniofacial resection with negative margins is an independent prognostic predictor of better outcome. Patients with positive margins have a high risk for tumor recurrence independent of tumor grade.
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Affiliation(s)
- Ziv Gil
- Department of Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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26
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Feiz-Erfan I, Han PP, Spetzler RF, Porter RW, Klopfenstein JD, Ferreira MAT, Beals SP, Joganic EF. Exposure of midline cranial base without a facial incision through a combined craniofacial-transfacial procedure. Neurosurgery 2006; 56:28-35; discussion 28-35. [PMID: 15799790 DOI: 10.1227/01.neu.0000144209.03703.c6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Accepted: 06/04/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A single-stage combined craniofacial-transfacial approach that exposes the midline cranial base without visible facial incisions is described. METHODS Between 1992 and 1998, eight patients underwent surgery for five different anterior cranial base pathological findings: four angiofibromas, one mesenchymal chondrosarcoma, one esthesioneuroblastoma, one odontogenic myxoma, and one encephalocele. In all cases, the surgical exposure consisted of a bicoronal scalp incision with a bifrontal craniotomy and fronto-orbitonasal osteotomy, and then a sublabial incision for transmaxillary exposure. RESULTS Gross total resection was achieved in five cases. The encephalocele was resected with complete reconstruction of the bony defect. Seven patients developed complications, primarily wound infections, cerebrospinal fluid leaks, and anemia. Postoperative Karnofsky Performance Scale scores ranged between 80 and 100 (mean, 92.5). Long-term follow-up information (mean, 56 mo; median, 59.5 mo; range, 5-108 mo) was available for all patients. CONCLUSION Large anterior cranial base lesions can be resected and excellent cosmetic outcomes can be achieved with a single-stage combined transfacial-craniofacial approach that exposes the entire midline cranial base and requires no facial incisions.
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Affiliation(s)
- Iman Feiz-Erfan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Origitano TC, Petruzzelli GJ, Leonetti JP, Vandevender D. Combined anterior and anterolateral approaches to the cranial base: complication analysis, avoidance, and management. Neurosurgery 2006; 58:ONS-327-36; discussion ONS-336-7. [PMID: 16582657 DOI: 10.1227/01.neu.0000192680.48095.bd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE During the past decade, applications of anterior and anterolateral cranial approaches for both benign and malignant pathologies have expanded in frequency and application. Complications associated with these procedures impact significantly on patient outcome. The primary aim of this study is to detail the strategies for complication management and avoidance developed from experience with 120 patients who underwent anterior and anterolateral cranial base procedures during the past 14 years. METHODS Between July 1990 and February 2004, 62 male and 58 female patients underwent 120 combined (neurological surgery and otolaryngology joint participation) anterior and anterolateral cranial base procedures. Fifty-four percent had malignant pathology, and 46% had benign pathology. The approaches taken were transfacial (10%), extended subfrontal (33%), lateral craniofacial (23%), and anterior craniofacial (35%). Thirty-day morbidity and mortality were analyzed. RESULTS Twenty (17%) patients experienced at least one complication. Malignancy and reoperation, regardless of histology, appeared to affect the complication rate. A decline in complications occurred with experience, in part because of changes in management that reflected the complication experience (25% in Patients 0-31, 18% in Patients 32-70, 10% in Patients 71-120). Methodology is detailed for avoidance and management of retraction injury, infection, tension pneumocephalus, cerebrospinal fluid leak, pericranial flap failure, free flap sizing, dural banding, intracranial hypotension, and cerebrovascular events. Individual patient analysis, complications timing, and strategy for management are discussed. CONCLUSION Improved patient outcomes for anterior and anterolateral cranial base surgery are, in part, directly related to the ability to avoid and manage associated complications. Experience, avoidance, and interdiction are key factors in complication management.
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Affiliation(s)
- Thomas C Origitano
- Department of Neurological Surgery, Loyola Center for Cranial Base Surgery, Loyola Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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Granados-García M, Celis-López MA, Aguilar-Ponce JL, Villavicencio-Valencia V, Luna-Ortiz K, Poitevin-Chachón A, Carrillo-Hernández F, Herrera-Gómez A. Craniofacial resection for sinunasal tumors. Clin Transl Oncol 2006; 8:119-23. [PMID: 16632426 DOI: 10.1007/s12094-006-0168-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Malignant sinonasal tumors are very rare in Mexico. They ussually present as advanced disease because it is extremely difficult to make an early diagnosis; in addition, its treatment is complicated by a variety of lesions. Surgical resection remains the mainstay of treatment, but its relative therapeutic value compared with alternative treatments is controversial. OBJECTIVE We undertook a retrospective analysis in order to evaluate results of craniofacial resections for sinonasal tumors. MATERIALS AND METHODS A total of 20 patients, 11 men and 9 women were considered, median age was 49 years (18-74). Eleven had received previous treatment elsewhere. In 13 patients tumor was limited to maxillo-ethmoid complex, but in 6 cases tumor involved anteroinferior aspect of sphenoid sinus, in 7 extended to the orbit, in 3 to dura and two to the brain. One had cervical metastases. Median tumoral size was 5.8 cm (1-10). RESULTS Overall complication rate was 50%. Major surgical complications occurred in 4 patients (20%): one patient developed isolated cerebrospinal fluid leakage (CEFL), 1 developed deterioration of mental status, and two developed meningitis associated with CEFL. Late complications occurred in 30% of the patients. There was not any operative death. Eleven patients received postoperative radiotherapy. Fifteen patients recurred. There were 11 local relapses, although one associated with a regional relapse, and another with regional and distant relapse. There were four isolated regional fails and six isolated distant failures. Three year overall survival was 65%, and 3-year disease free survival was 50%. Patients without previous treatment median survival was 28.3 months, meanwhile with previous treatment was 18.2 months. CONCLUSIONS Craniofacial resection is a safe and valuable tool in the treatment of advanced sinonasal tumors involving cranial base.
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Affiliation(s)
- M Granados-García
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, México, Tlalpan.
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29
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Feiz-Erfan I, Han PP, Spetzler RF, Horn EM, Klopfenstein JD, Kim LJ, Porter RW, Beals SP, Lettieri SC, Joganic EF. Preserving olfactory function in anterior craniofacial surgery through cribriform plate osteotomy applied in selected patients. Neurosurgery 2006; 57:86-93; discussion 86-93. [PMID: 15987573 DOI: 10.1227/01.neu.0000163487.94463.4a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 02/16/2005] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Olfaction is often sacrificed to gain access to the cranial base in anterior craniofacial surgery. We describe the long-term results of olfactory function in patients who underwent anterior craniofacial surgery and a cribriform plate osteotomy to preserve olfaction. METHODS Between 1992 and 2004, 28 patients underwent 29 cribriform plate osteotomies in an attempt to preserve olfaction during anterior craniofacial surgery performed through modified extended transbasal approaches. Patients' charts and office notes were reviewed retrospectively. Formal olfactory testing was available in 5 patients, but most data were based on patients' subjective reports of olfaction. Olfactory preservation was defined by the subjective ability to detect fumes such as coffee, chocolate, roses, and orange juice regardless of the intensity of the sensation. Follow-up was based on phone calls to patients. RESULTS Four patients were lost to follow-up and excluded. Therefore, follow-up was available in 24 patients after 25 procedures. On the basis of patients' subjective reports, olfaction was spared in 22 patients after 23 procedures (92%) and was confirmed objectively in the five patients formally tested. After surgery, only two patients were anosmic. CONCLUSION Olfaction can be preserved in selected patients undergoing anterior craniofacial surgery. At least 1 cm of nasal mucosa should remain attached to the cribriform plate, which can be achieved by including the nasal bone in the osteotomy of the orbital bar. A medial orbital canthopexy is therefore necessary after these procedures.
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Affiliation(s)
- Iman Feiz-Erfan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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30
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Wong LY, Lam LK, Fan YW, Yuen APW, Wei WI. OUTCOME ANALYSIS OF PATIENTS WITH CRANIOFACIAL RESECTION: HONG KONG EXPERIENCE. ANZ J Surg 2006; 76:313-7. [PMID: 16768689 DOI: 10.1111/j.1445-2197.2006.03713.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical outcome of patients who underwent craniofacial resection for tumour in the anterior skull base at the University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong between January 1993 and June 2003. METHODS A retrospective review was conducted. The duration of follow up ranged from 1.7 to 119 months (median, 41.8 months). The setting was a tertiary referral centre. Thirty-nine patients, 23 males and 16 females, aged 8-79 years were included. Thirty-four patients had malignant tumour and five patients had benign pathology. The tumour pathology was diversified. Nineteen patients had no treatment before the surgery, and the remaining 20 patients had received surgery, radiotherapy or combined treatment before resection. Patients were given postoperative irradiation and/or chemotherapy depending on the pathology of the tumour and the extent of the disease and clearance at the time of surgery. RESULTS There was no operative mortality. Complications occurred in 10 patients and among them, three required reoperation. The other complications were managed successfully with conservative measures. The 5-year actuarial disease-free survival for patients with benign and malignant pathology was 100 and 77.6%, respectively. For patients with malignant pathology, 5-year actuarial disease-free survival was 90% when the resection margin was negative at surgery. However, the survival dropped to 53.6% when the resection margin was involved macroscopically. CONCLUSION Craniofacial resection was an appropriate surgical approach with acceptable morbidity in selected patients with tumour located at the anterior skull base. Complete excision of malignant tumour could achieve 90% 5-year disease-free actuarial survival.
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Affiliation(s)
- Ling Yuen Wong
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Laigle-Donadey F, Taillibert S, Martin-Duverneuil N, Hildebrand J, Delattre JY. Skull-base metastases. J Neurooncol 2005; 75:63-9. [PMID: 16215817 DOI: 10.1007/s11060-004-8099-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Metastasis to the skull-base particularly affects patients with carcinoma of the breast and prostate. Clinically, the key feature is progressive ipsilateral involvement of cranial nerves. Five syndromes have been described according to the metastatic site including the orbital, parasellar, middle-fossa, jugular foramen and occipital condyle syndromes. Magnetic resonance imaging (MRI) is nowadays the most useful examination to establish the diagnosis but plain films, CT scans with bone windows and isotope bone scans remain helpful to demonstrate bone erosion. Normal imaging studies do not exclude the diagnosis. The treatment depends on the nature of the underlying tumor. Radiotherapy is generally the standard treatment, while some patients with chemosensitive or hormonosensitive lesions benefit from chemotherapy or hormonotherapy and selected patients from surgical removal. Gamma Knife radiosurgery is sometimes a useful alternative, particularly for previously irradiated skull-base regions, and for small tumors (diameter < 30 mm). The overall prognosis is poor, with an overall median survival of about 2.5 years, probably because skull-base metastases appear late in the course of the disease.
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Affiliation(s)
- Florence Laigle-Donadey
- Fédération de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'hôpital, 75651, Paris Cedex 13, France
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Madison Michael L, Sorenson JM, Samant S, Robertson JH. The treatment of advanced sinonasal malignancies with pre-operative intra-arterial cisplatin and concurrent radiation. J Neurooncol 2005; 72:67-75. [PMID: 15803378 DOI: 10.1007/s11060-004-2712-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Malignancies of the nasal and paranasal sinuses are uncommon tumors, accounting for only 3% of all aerodigestive tract neoplasms. Despite advances in surgical techniques and continued evolution of adjuvant therapies, the 5-year mortality remains unusually high at greater than 50%. In 1996, we begin utilizing a novel strategy in the treatment of advanced sinonasal carcinomas. This consisted of neoadjuvant selective intra-arterial cisplatin with concurrent radiation therapy (acronym RADPLAT) followed by a conservative craniofacial resection. We now report our results for 11 patients treated with this regimen. METHODS Between July 1996 and April 2003, 11 patients with advanced sinonasal malignancies underwent treatment utilizing the RADPLAT protocol followed by a planned surgical resection via a craniofacial approach. Patient charts, operative notes, follow-up clinic notes, and pre- and post-operative imaging studies were reviewed in detail for each subject. RESULTS Histopathological analysis of the tumors revealed seven squamous cell carcinomas (64%), two adenocarcinomas (18%), one adenoid cystic carcinoma (9%), and one sinonasal undifferentiated carcinoma (9%). T4N0M0 disease was present in nine patients (81%), and two patients had T3N0M0 disease (19%). Survival was calculated using the Kaplan-Meier method with an overall survival of 81% at 5 years and a progression-free survival at 5 years of 67%. Mean follow-up is 57.2 months ranging from 12 to 95 months. CONCLUSIONS The treatment of advanced sinonasal malignancies with pre-operative intra-arterial cisplatin and concurrent radiation results in a significant improvement in survival. This can be done safely with high response rates and excellent loco-regional control in T3 and T4 disease. Although are results are encouraging, there is a need for a cooperative, multi-institutional, prospective study.
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Affiliation(s)
- L Madison Michael
- Department of Neurosurgery, UT College of Medicine, 847 Monroe Avenue, Suite 427, Memphis, TN, 38163, USA.
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Patel SG, Singh B, Polluri A, Bridger PG, Cantu G, Cheesman AD, deSa GM, Donald P, Fliss D, Gullane P, Janecka I, Kamata SE, Kowalski LP, Kraus DH, Levine PA, dos Santos LRM, Pradhan S, Schramm V, Snyderman C, Wei WI, Shah JP. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 2003; 98:1179-87. [PMID: 12973841 DOI: 10.1002/cncr.11630] [Citation(s) in RCA: 222] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Malignant tumors of the skull base are rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after craniofacial surgery (CFS). The current report was based on a large cohort that was analyzed retrospectively by an International Collaborative Study Group. METHODS One thousand three hundred seven patients who underwent CFS in 17 institutions were analyzable for outcome. The median age was 54 years (range, 1-98 years). Definitive treatment prior to CFS had been administered in 59% of patients and included radiotherapy in 367 patients (28%), chemotherapy in 151 patients (12%), and surgery in 523 patients (40%). The majority of tumors (87%) involved the anterior cranial fossa. Squamous cell carcinoma (29%) and adenocarcinoma (16%) were the most common histologic types. The margins of surgical resection were reported close/positive in 412 patients (32%). Adjuvant postoperative radiotherapy was received by 510 patients (39%), and chemotherapy was received by 57 patients (4%). RESULTS Postoperative complications were reported in 433 patients (33%), with local wound complications the most common (18%). The postoperative mortality rate was 4%. With a median follow-up of 25 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 54%, 60%, and 53%, respectively. The histology of the primary tumor, its intracranial extent, and the status of surgical margins were independent predictors of overall, disease-specific, and recurrence-free survival on multivariate analysis. CONCLUSIONS CFS is a safe and effective treatment option for patients with malignant tumors of the skull base. The histology of the primary tumor, its intracranial extent, and the status of surgical margins are independent determinants of outcome.
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Affiliation(s)
- Snehal G Patel
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Bentz BG, Bilsky MH, Shah JP, Kraus D. Anterior skull base surgery for malignant tumors: a multivariate analysis of 27 years of experience. Head Neck 2003; 25:515-20. [PMID: 12808653 DOI: 10.1002/hed.10250] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Few studies have examined prognostic factors that have an impact on outcomes in anterior skull base surgery by multivariate analysis. METHODS We retrospectively examined our institution's skull base experience from 1973-2000. RESULTS During this time, 166 patients underwent an anterior skull base resection for malignancy (median age, 53 years; range, 6-92 years). The 5-year relapse-free and disease-specific survival was 41% and 57% (median follow-up, 53 months). Multivariate analysis found that dural invasion, primary histologic diagnosis, and margin status had a significant impact on relapse-free and disease-specific survival. CONCLUSIONS These data indicate that patients with anterior skull base malignancies are treated successfully with skull base surgery. Patients demonstrating adverse prognostic variables such as dural invasion, adverse histologic findings, and/or positive margins should be considered for the addition of adjuvant therapy or innovative therapies as they become available in the future.
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Affiliation(s)
- Brandon G Bentz
- Head & Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, New York 10021, USA
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Hunt JA, Hobar PC. Common craniofacial anomalies: conditions of craniofacial atrophy/hypoplasia and neoplasia. Plast Reconstr Surg 2003; 111:1497-508; quiz 1509-10. [PMID: 12618611 DOI: 10.1097/01.prs.0000049646.25757.be] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The spectrum of craniofacial malformations includes conditions of congenital and acquired etiology. The conditions of craniofacial atrophy and hypoplasia may arise primarily or secondary to previous therapeutic interventions. The conditions of progressive hemifacial atrophy (Romberg disease) and radiation-induced hypoplasia will be reviewed on the basis of their etiology, pathogenesis, anatomy, and treatment. Approaches to the surgical management of these conditions will be discussed. The craniofacial neoplastic conditions of fibrous dysplasia, neurofibromatosis, and craniofacial tumors will also be reviewed and discussed.
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Affiliation(s)
- Jeremy A Hunt
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75246, USA
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Califano J, Cordeiro PG, Disa JJ, Hidalgo DA, DuMornay W, Bilsky MH, Gutin PH, Shah JP, Kraus DH. Anterior cranial base reconstruction using free tissue transfer: changing trends. Head Neck 2003; 25:89-96. [PMID: 12509790 DOI: 10.1002/hed.10179] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION A consecutive series of 135 patients undergoing resection for malignant tumors involving the anterior cranial base between 1976 and 1999 was reviewed. PATIENT AND METHODS In the years from 1976-1991, free-tissue transfer was used in 5 of 76 or 6.6% of cases, whereas free-tissue reconstruction was used in 24 of 59 or 40% of cases in the years 1992-1999. Of those cases reconstructed with free-tissue transfer in 1976-1991, 60% (three of five) underwent a complex resection defined as involving dura, brain, or more than one major structure adjacent to skull base. Of those patients reconstructed with conventional (pericranial or pericranial/galeal) pedicled flaps in this time period, 35% (25 of 71) underwent a complex resection. From 1992-1999, 75% (18 of 24) of patients reconstructed with free-tissue transfer received a complex resection, whereas only 6% (2 of 35) of patients reconstructed by other means received a complex resection. OUTCOMES For those patients reconstructed by free-tissue transfer, there were no instances of flap loss. Comparison of these two time periods was notable for a similar patient composition in terms of age, histologic findings, and extent of resection. Major complication rates for patients who are reconstructed with free-tissue transfer for anterior cranial base resections (31%) are similar compared with patients who have been reconstructed with conventional pedicled flaps (35%). This was noted despite an increased extent and complexity of resection in those patients who underwent free-tissue transfer reconstruction (72%) compared with those patients reconstructed by more conventional means (26%) p <.001. CONCLUSION In our institution, the use of vascularized, free-tissue transfer has replaced pedicled flaps as the preferred modality for reconstructing complex anterior cranial base defects involving resection of dura, brain, or multiple major structures adjacent to local skull base, including the orbit, palate, and other structures. Complication rates for patients reconstructed with free-tissue transfer techniques is similar to those patients reconstructed by conventional techniques, despite an increase in complexity of resection in this group.
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Affiliation(s)
- Joseph Califano
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA
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Abstract
Malignant tumors of the skull base have traditionally been difficult to control because of adjacent crucial anatomical structures and because of the inherent difficulty in accessing/resecting tumors and reconstructing surgical defects. Techniques in craniofacial surgery for malignant tumors of the skull base have advanced significantly since their first description. Advances in neuroimaging, surgical technique, perioperative care, and adjuvant treatment have contributed to improved results. Because the majority of malignant tumors requiring craniofacial resection involve the anterior skull base, this review focuses mainly on state-of-the-art surgical techniques as well as pertinent variations, complications and results.
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Affiliation(s)
- Jatin P Shah
- Head and Neck Service, and Neurosurgical Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Origitano TC, Petruzzelli GJ, Vandevender D, Emami B. Management of malignant tumors of the anterior and anterolateral skull base. Neurosurg Focus 2002; 12:e7. [PMID: 16119905 DOI: 10.3171/foc.2002.12.5.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Malignant tumors of the skull base represent a group of diverse and infrequent lesions. Comprehensive oncological management requires a multidisciplinary team of neurological surgeons, otolaryngologists, radiation oncologists, plastic surgeons, and medical oncologists. The authors describe an institutional experience in performing 54 combined anterior-anterolateral cranial base resections for malignant disease. METHODS The technical considerations for preoperative workup, surgical approach, resection, and reconstruction are outlined and illustrated. Considerations for complication management and avoidance are detailed. CONCLUSIONS Overall mortality (0%) and morbidity rates (18%) are acceptable. The influence on the natural history of the disease process is an ongoing study.
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Affiliation(s)
- Thomas C Origitano
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
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Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 2001; 92:3012-29. [PMID: 11753979 DOI: 10.1002/1097-0142(20011215)92:12<3012::aid-cncr10131>3.0.co;2-e] [Citation(s) in RCA: 377] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The authors reviewed treatment results in patients with nasal and paranasal sinus carcinoma from a large retrospective cohort and conducted a systematic literature review. METHODS Two hundred twenty patients who were treated between 1975 and 1994 with a minimum follow-up of 4 years were reviewed retrospectively. A systematic review of published articles on patients with malignancies of the nasal and paranasal sinuses during the preceding 40 years was performed. RESULTS The 5-year survival rate was 40%, and the local control rate was 59%. The 5-year actuarial survival rate was 63%, and the local control rate was 57%. Factors that were associated statistically with a worse prognosis, with results expressed as 5-year actuarial specific survival rates, included the following: 1) histology, with rates of 79% for patients with glandular carcinoma, 78% for patients with adenocarcinoma, 60% for patients with squamous cell carcinoma, and 40% for patients with undifferentiated carcinoma; 2) T classification, with rates of 91%, 64%, 72%, and 49% for patients with T1, T2, T3, and T4 tumors, respectively; 3) localization, with rates of 77% for patients with tumors of the nasal cavity, 62% for patients with tumors of the maxillary sinus, and 48% for patients with tumors of the ethmoid sinus; 4) treatment, with rates of 79% for patients who underwent surgery alone, 66% for patients who were treated with a combination of surgery and radiation, and 57% for patients who were treated exclusively with radiotherapy. Local extension factors that were associated with a worse prognosis included extension to the pterygomaxillary fossa, extension to the frontal and sphenoid sinuses, the erosion of the cribriform plate, and invasion of the dura. In the presence of an intraorbital invasion, enucleation was associated with better survival. In multivariate analysis, tumor histology, extension to the pterygomaxillary fossa, and invasion of the dura remained significant. Systematic review data demonstrated a progressive improvement of results for patients with squamous cell and glandular carcinoma, maxillary and ethmoid sinus primary tumors, and most treatment modalities. CONCLUSIONS Progress in outcome for patients with nasal and paranasal carcinoma has been made during the last 40 years. These data may be used to make baseline comparisons for evaluating newer treatment strategies.
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Affiliation(s)
- P Dulguerov
- Division of Head and Neck Surgery, Department of Surgery, University of California-Los Angeles, Los Angeles, California, USA.
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Kelly MB, Waterhouse N, Slade DE, Carr R, Peterson D. A 5-year review of 71 consecutive anterior skull base tumours. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:184-90. [PMID: 10738321 DOI: 10.1054/bjps.1999.3297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Techniques used in craniofacial surgery have found extensive application in the management of skull base tumours. The improved exposure gained via osteotomies for facial disassembly has facilitated the en-bloc resection of tumours with clear surgical margins, and the advent of vascularised seals has significantly reduced the risk of meningeal contamination. We present our experience with the extirpation and reconstruction of 71 benign and malignant tumours of the anterior skull base over a 5-year period. Survival and functional outcome data are presented, with an emphasis on the wide range of pathologies and primary treatment strategies seen at presentation. Criteria used in flap selection and the role of prosthetics are discussed. Observations are offered on salvage surgery, demonstrating that excellent palliation can be achieved, even in cases with massive recurrent disease.
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Affiliation(s)
- M B Kelly
- Craniofacial Unit, Chelsea and Westminster Hospital, London, UK
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Cantù G, Solero CL, Mariani L, Salvatori P, Mattavelli F, Pizzi N, Riggio E. Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients. Head Neck 1999; 21:185-91. [PMID: 10208659 DOI: 10.1002/(sici)1097-0347(199905)21:3<185::aid-hed1>3.0.co;2-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anterior craniofacial resection is now recognized as the best treatment for ethmoid tumors involving the cribriform plate with or without invasion of anterior cranial fossa. METHODS Ninety-one patients underwent an anterior craniofacial resection for ethmoid malignant tumors at the Milan Cancer Institute between 1987 and 1994. The patient population was divided into two sections (30 and 61 patients) based upon some important variants (type of craniotomy, antibiotic treatment, postoperative care). RESULTS The mean age was 53.4 years (range, 24 to 78 years). There were 62 men and 29 women. Forty-nine patients had a recurrence after previous treatments (surgery and/or radiotherapy). The subdivision by histology was as follows: 50 cases of adenocarcinoma, 16 cases of epidermoid and undifferentiated carcinoma, 8 cases of esthesioneuroblastoma, 5 cases of adenoid cystic carcinoma, 5 cases of melanoma, and 6 rare tumors. The stages (according to our new staging) were as follows: 37 cases with T2, 27 cases with T3, and 27 cases with T4. The mean follow-up was 47 months. Seven patients died after surgery (6 in the first series). The survival at 3 and 5 years was, respectively, 52% and 47%, and the disease-free survival (DFS) was 30% and 24%, with a statistically significant difference at multivariate analysis in favor of patients without prior treatment (p = .033) or T2 versus T3 and T4 (p<.007). CONCLUSIONS An anterior craniofacial resection should be performed in cases of ethmoid tumors reaching or eroding the cribriform plate. A scrupulous intra- and postoperative approach is necessary to avoid severe complications. The patients often survive for a long time with recurrence ongoing. Our new staging identifies the critical extensions of ethmoid tumors.
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Affiliation(s)
- G Cantù
- Section of Cranio-Maxillo-Facial Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Sánchez Aniceto G, Romance García A, Gutiérrez Díaz R, Montalvo Moreno J, Díez Lobato R, Cabrera Yesares A. Métodos reconstructivos en cirugía tumoral de base de cráneo. Neurocirugia (Astur) 1999. [DOI: 10.1016/s1130-1473(99)70971-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gutiérrez Díaz R, Sánchez Aniceto G, Romance A, Lobato R, Cabrera A, Alday R. Resección craneofacial anterior. Neurocirugia (Astur) 1999. [DOI: 10.1016/s1130-1473(99)70788-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sharma S, Sahota JS, Hazarika P, Sharma S, Raja A. Olfactory neuroblastoma - our experience. Indian J Otolaryngol Head Neck Surg 1999; 51:68-73. [PMID: 23119492 PMCID: PMC3451491 DOI: 10.1007/bf02996853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The authors present six cases of olfactory neuroblastoma with or without intracranial extension operated on by the team headed by Otolaryngologists and Neurosurgeons. Data was analysed with respect lo age group, sex, presenting symptoms and signs, stage, and results of combined modality of treatment. The author's experience suggests excellent local control can be achieved by combined craniofacial resection followed by radiation therapy. Hence the authors recommend planned combined radical treatment for all the resectable lesions and routine use of nasal endoscope along with other conventional methods for compehensive follow-up of all cases.
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Affiliation(s)
- S Sharma
- Kasturba Medical College Hospital, 576 119 Manipal, India
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Abstract
Advances in combined transcranial and transfacial (craniofacial) approaches for malignant tumors involving the anterior skull base have demonstrated improved survival. The technique allows adequate assessment of the intracranial extent of the tumor through an appropriate craniotomy. Vital structures, such as the dura, brain, and blood vessels, can be protected or resected and reconstructed safely. An en bloc excision can be accomplished. Dural defects and/or tears are satisfactorily repaired under direct vision, ensuring a watertight closure. Finally, adequate closure of the soft tissue defect is obtained, thus segregating the cranial cavity from the potentially infected nasal cavity and the nasopharynx with a resultant decrease in morbidity. Operative mortality is low, although complication rates are high. The technique is safe and continues to be improved to reduce morbidity. To evaluate the true impact of this surgical procedure on improvement in survival as well as quality of life, a multiinstitutional registry with uniform indications is indicated. With increasing experience and well-defined indications, improvement in survival (from 50% to 60%) and reduction in morbidity (from 30% to 40%) can be demonstrated through multiinstitutional, cooperative efforts.
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Affiliation(s)
- J O Boyle
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Salvan D, Julieron M, Marandas P, Janot F, Leridant AM, Domenge C, Mamelle G, Schwaab G, Luboinski B. Combined transfacial and neurosurgical approach to malignant tumours of the ethmoid sinus. J Laryngol Otol 1998; 112:446-50. [PMID: 9747472 DOI: 10.1017/s0022215100140745] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In order to understand the risks and benefits of a combined transfacial and neurosurgical procedure for neoplasms of the ethmoid sinus, we reviewed all patients who underwent this surgical approach in our department between 1986 and 1994. The study included 41 patients. Pathological diagnoses included adenocarcinoma (31 patients), squamous cell carcinoma (three patients), aesthesioneuroblastoma (three patients), other (four patients). The overall morbidity rate was 39 per cent, and the post-operative mortality rate was 2.5 per cent. Complications were statistically more likely in patients with bone skull base reconstruction. The main carcinologic failures were local recurrences (24 per cent) and metastases (22 per cent). The one-year, three-year and five-year Kaplan Meir survival rates were respectively 84 per cent, 53 per cent and 36 per cent. In conclusion, the mortality and morbidity were acceptable, especially when no bone skull base reconstruction was performed. Better local control justifies a combined procedure with post-operative radiotherapy when tumours involve or reach the skull base.
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Affiliation(s)
- D Salvan
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute Gustave Roussy, Villejuif, France
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Cernea CR, Teixeira GV, Medina dos Santos LR, Vellutini EA, Siqueira MG. Indications for, contraindications to, and interruption of craniofacial procedures. Ann Otol Rhinol Laryngol 1997; 106:927-33. [PMID: 9373083 DOI: 10.1177/000348949710601108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In spite of increasing experience with skull base surgery, some of the guidelines for indications for operations may vary according to the institution. One-hundred two patients underwent craniofacial oncologic resections at our institution from 1982 to 1995. A retrospective analysis of the indications for and contraindications to these procedures was undertaken. The main indications for malignant tumors were skin lesions with direct invasion of the anterior or lateral skull base (69%) and nasal-paranasal sinus tumors (21%). The main indications for benign tumors were glomus lesions (26%), menigiomas (22%), and fibro-osseous lesions of the anterior skull base (19%). The main contraindications were extensive invasion of the central nervous system, invasion of the cavernous sinus and/or internal carotid artery by aggressive malignancies, and bilateral orbital invasion in a nonblind patient. Also, 6 patients had their procedures interrupted during craniotomy for several reasons - extensive central nervous system invasion (2 cases), bilateral orbital invasion (1), lack of brain retraction (1), lack of histologic diagnosis during the operation (1), and purulent discharge at the frontal sinus (1). Craniofacial oncologic operations are extensive surgical procedures that have to be properly indicated in order to obtain low levels of morbidity and mortality. The selection of cases is of paramount importance. In some instances, it seems advisable even to interrupt these operations in the first phase.
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Affiliation(s)
- C R Cernea
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo Medical School, Brazil
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48
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Craniofacial resection for lesions involving anterior base of skull. Indian J Otolaryngol Head Neck Surg 1996. [DOI: 10.1007/bf03048656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cole I, Dan N, Anker A. Bone replacement in head and neck surgery: a biocompatible alternative. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:469-72. [PMID: 8678877 DOI: 10.1111/j.1445-2197.1996.tb00784.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Defects in the skull have presented difficult reconstructive problems. Recently glass-ionomer cement and preformed. implants have been used to repair bony defects in the skull base and in cranio-facial surgery. Three patients are reported to illustrate possible applications for this new material. METHODS Ionocap cement and Ionoroc-skull standardized implants have been used. The cement is available as a two component blister pack. When mixed and blended a gel is produced which can be worked for approximately 5 min before hardening. It can then be contoured and drilled to the required shape. The resultant material is biocompatible and biostable, is non-toxic and permanently bonds to bone with no increase in temperature or shrinkage. RESULTS The material has been used to fill the temporal defect left by transplantation of the temporalis muscle for oral reconstruction, the anterior and lateral walls of the maxilla and following craniofacial resection, the posterior wall of the frontal sinus and anterior skull base. CONCLUSIONS Three patients with different reconstructive problems have been presented to illustrate the use of an alloplastic material that has a tensile strength similar to bone and firmly adheres to it. The material was found to be safe and easy to use. All three patients have now been followed for 12 months with no adverse affects.
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Affiliation(s)
- I Cole
- Department of Otolaryngology, Head & Neck and Facio-Maxillary Surgery, Sutherland Hospital, Caringbah, Sydney, Australia
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50
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Kraus DH, Shah JP, Arbit E, Galicich JH, Strong EW. Complications of craniofacial resection for tumors involving the anterior skull base. Head Neck 1994; 16:307-12. [PMID: 8056574 DOI: 10.1002/hed.2880160403] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A consecutive series of 85 patients undergoing craniofacial resection for malignant tumors involving the anterior cranial base between 1974 and 1992 was reviewed. RESULTS There were two (2%) postoperative deaths. Postoperative complications occurred in 33 (39%) patients. Local major complications occurred in 26 (31%) patients, local minor in 7 (8%), and systemic in 5 (6%). More than one complication occurred in a number of patients. Bacterial contamination led to a significant proportion of local, septic complications. Repair of the skull base defect with a pedicled pericranial flap was unsatisfactory and was associated with an increased incidence of local major complications. A local major complication was associated with a dramatic lengthening of hospitalization. CONCLUSION Future endeavors for prevention of complications should focus on antibiotic prophylaxis and reconstruction of the cranial base defect with better vascularized flaps.
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Affiliation(s)
- D H Kraus
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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