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Craniofacial resection of malignant tumors of the anterior skull base: a case series and a systematic review

  • Original Article - Neurosurgical technique evaluation
  • Published:
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Abstract

Background

Craniofacial resection (CFR) is still considered as the gold standard for managing sinonasal malignancies of the anterior skull base (ASB), while endoscopic approaches are gaining credibility. The goal of this study was to evaluate outcomes of patients who underwent CFR at our institution and to compare our results to international literature.

Method

Retrospective analysis of all patients undergoing CFR between 1995 and 2017, and systematic literature review according to the PRISMA statement.

Results

Forty-one patients with sinonasal malignancy (81% with stage T4) of the ASB were included. There was no operative mortality. Complications were observed in 9 cases. We obtained 100% follow-up with mean observation of 100 months. Disease-specific survival rates were 90%, 74%, and 62% and recurrence-free survival was 85% at two, 72% at five, and 10 years follow-up, respectively. CFR as primary treatment, en bloc resection, and resection with negative margins correlated to better survival. Recursive partition analysis identified the latter as the most important prognostic factor, regardless of surgical technique. The relative risk of non-radicality was significantly higher after piecemeal resection compared to en bloc resection. Compared to 15 original articles, totaling 2603 patients, eligible for review, the present study has the longest follow-up time, the second highest 5-year OS, and the third highest 5-year DSS, despite having a higher proportion of patients with high-stage disease.

Conclusion

CFR in true en bloc fashion can still be considered as the treatment of choice in cases of advanced-stage sinonasal malignancies invading the ASB.

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Abbreviations

AC:

Adenocarcinoma

ACC:

Adenoid-cystic carcinoma

ASB:

Anterior skull base

AWD:

Alive with disease

BC:

Before Christ

CFR:

Craniofacial resection

ChT:

Chemotherapy

CI:

Confidence interval

DOD:

Died of disease

DSS:

Disease-specific survival

EEA:

Extended endonasal approach

GTR:

Gross total resections

MA:

Melanoma

NED:

No evidence of disease

ONB:

Olfactory neuroblastoma

OUH:

Oslo University Hospital

OS:

Overall survival

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RFS:

Recurrence-free survival

RPA:

Recursive partitioning analysis

SA:

Sarcoma

SCC:

Squamous cell carcinoma

SNUC:

Sinonasal undifferentiated carcinoma

XRT:

Radiotherapy

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital – Rikshospitalet, PB4950 Nydalen, N-0424, Oslo, Norway

    Marton König & Torstein R. Meling

  2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

    Marton König, Terje Osnes & Torstein R. Meling

  3. Department of Otorhinolaryngology, Oslo University Hospital – Rikshospitalet, Oslo, Norway

    Terje Osnes

  4. Department of Pathology, Oslo University Hospital – Rikshospitalet, Oslo, Norway

    Peter Jebsen

  5. Service de Neurochirurgie, Département des Neurosciences Cliniques, Hopitaux Universitaires de Genève, Geneva, Switzerland

    Torstein R. Meling

Authors
  1. Marton König
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  4. Torstein R. Meling
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Correspondence to Marton König.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the data protection official at OUH (ePhorte 2015-5042). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study does not contain any studies with animals performed by any of the authors.

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This article is part of the Topical Collection on Neurosurgical technique evaluation

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König, M., Osnes, T., Jebsen, P. et al. Craniofacial resection of malignant tumors of the anterior skull base: a case series and a systematic review. Acta Neurochir 160, 2339–2348 (2018). https://doi.org/10.1007/s00701-018-3716-4

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  • DOI: https://doi.org/10.1007/s00701-018-3716-4

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