TY - JOUR
T1 - Craniofacial resection of midline anterior skull base malignancies
T2 - A reassessment of outcomes in the modern era
AU - Raza, Shaan M.
AU - Garzon-Muvdi, Tomas
AU - Gallia, Gary L.
AU - Tamargo, Rafael J.
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2012
Y1 - 2012
N2 - Objective: Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. Methods: We review our experience of open craniofacial resection of midline anterior cranial fossa malignancies in the modern era. Results: Between 1995 and 2009, 41 patients underwent bifrontal craniotomy/craniofacial resection for malignancy. A subset of patients had undergone previous treatment, i.e., transfacial resection (34%), chemotherapy (5%), and radiation therapy (10%). Esthesioneuroblastoma (29%) was the most common pathology, followed by squamous cell carcinoma (27%) and the remaining patients presented with various histologic subtypes. All tumors invaded the cribriform plate; tumors invaded dura in 51%, parenchyma in 17% and orbit in 54% of patients. Negative margins were obtained in 85% of the cohort. Postoperative complications included seizure (one patient), cerebrospinal leak (one patient), and symptomatic pneumocephalus (two patients). Conclusion: Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.
AB - Objective: Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. Methods: We review our experience of open craniofacial resection of midline anterior cranial fossa malignancies in the modern era. Results: Between 1995 and 2009, 41 patients underwent bifrontal craniotomy/craniofacial resection for malignancy. A subset of patients had undergone previous treatment, i.e., transfacial resection (34%), chemotherapy (5%), and radiation therapy (10%). Esthesioneuroblastoma (29%) was the most common pathology, followed by squamous cell carcinoma (27%) and the remaining patients presented with various histologic subtypes. All tumors invaded the cribriform plate; tumors invaded dura in 51%, parenchyma in 17% and orbit in 54% of patients. Negative margins were obtained in 85% of the cohort. Postoperative complications included seizure (one patient), cerebrospinal leak (one patient), and symptomatic pneumocephalus (two patients). Conclusion: Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.
KW - Anterior skull base
KW - Craniofacial resection
KW - Malignancy
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U2 - 10.1016/j.wneu.2011.09.014
DO - 10.1016/j.wneu.2011.09.014
M3 - Review article
C2 - 22120268
AN - SCOPUS:84864719782
SN - 1878-8750
VL - 78
SP - 128
EP - 136
JO - World neurosurgery
JF - World neurosurgery
IS - 1-2
ER -