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

  • Marton König
  • Terje Osnes
  • Peter Jebsen
  • Torstein R. Meling
Original Article - Neurosurgical technique evaluation
Part of the following topical collections:
  1. Neurosurgical technique evaluation

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.

Keywords

Skull base tumors Craniofacial resection Multidisciplinary approach Multimodal treatment Survival 

Abbreviations and acronyms

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

Notes

Compliance with ethical standards

Conflict of interest

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.

Informed consent

For this type of study, formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryOslo University Hospital – RikshospitaletOsloNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Department of OtorhinolaryngologyOslo University Hospital – RikshospitaletOsloNorway
  4. 4.Department of PathologyOslo University Hospital – RikshospitaletOsloNorway
  5. 5.Service de Neurochirurgie, Département des Neurosciences CliniquesHopitaux Universitaires de GenèveGenevaSwitzerland

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