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Management of Malignant Tumors of the Anterior Skull Base and Paranasal Sinuses

  • Paranasal Sinus Tumors (P Bradley, Section Editor)
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Abstract

Purpose of Review

Treating malignant tumors of the anterior skull base (ASB) is a challenging task, involving complex surgery in an intricate anatomical space. The effective treatment of ASB tumors requires careful pretreatment evaluation and preoperative surgical planning by the skull base surgical team.

Recent Findings

Review of the available literature demonstrates that the gradual refinement of imaging and surgical techniques, as well as improvement in reconstructive procedures, has dramatically improved patient outcomes and reduced morbidity and mortality. Furthermore, multicenter collaborations have provided higher quality evidence regarding disease behavior and treatment efficacy and safety.

Summary

Current and past review of the literature continues to demonstrate the need for future investigation. High-quality evidence-based medicine is still lacking in the field of skull base surgery, and well-planned collaborative studies are needed in order to consolidate our understanding of disease behavior and treatment strategies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Patel CR, Fernandez-Miranda JC, Wang WH, Wang EW. Skull base anatomy. Otolaryngol Clin North Am. 2016;9:9–20.

    Article  Google Scholar 

  2. Lund VJ, Stammberger H, Nicolai P, et al. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl. 2010;22:1–143.

    Google Scholar 

  3. Castelnuovo P, Turri-Zanoni M, Battaglia P, Antognoni P, Bossi P, Locatelli D. Sinonasal malignancies of anterior skull base: histology-driven treatment strategies. Otolaryngol Clin North Am. 2016;49:183–200.

    Article  PubMed  Google Scholar 

  4. Ganly I, Patel SG, Singh B, et al. Craniofacial resection for malignant paranasal sinus tumors: report of an international collaborative study. Head Neck. 2005;27:575–84.

    Article  PubMed  Google Scholar 

  5. Howard DJ, Lund VJ, Wei WI. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses: a 25-year experience. Head Neck. 2006;28:867–73.

    Article  PubMed  Google Scholar 

  6. Patel SG, Singh B, Polluri A, et al. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer. 2003;98:1179–87.

    Article  PubMed  Google Scholar 

  7. Parmar H, Gujar S, Shah G, Mukherji SK. Imaging of the anterior skull base. Neuroimaging Clin N Am. 2009;19:427–39.

    Article  PubMed  Google Scholar 

  8. Lloyd G, Lund VJ, Howard D, Savy L. Optimum imaging for sinonasal malignancy. J Laryngol Otol. 2000;114:557–62.

    CAS  PubMed  Google Scholar 

  9. Borges A. Skull base tumours part I: imaging technique, anatomy and anterior skull base tumours. Eur J Radiol. 2008;66:338–47.

    Article  PubMed  Google Scholar 

  10. Gil Z, Even-Sapir E, Margalit N, Fliss DM. Integrated PET/CT system for staging and surveillance of skull base tumors. Head Neck. 2007;29:537–45.

    Article  PubMed  Google Scholar 

  11. Mehta RP, Cueva RA, Brown JD, et al. What’s new in skull base medicine and surgery? Skull base committee report. Otolaryngol Head Neck Surg. 2006;135:620–30.

    Article  PubMed  Google Scholar 

  12. Harvey RJ, Pitzer G, Nissman DB, et al. PET/CT in the assessment of previously treated skull base malignancies. Head Neck. 2010;32:76–84.

    PubMed  Google Scholar 

  13. Helsel JC, Bardales RH, Mukunyadzi P. Fine-needle aspiration biopsy cytology of malignant neoplasms of the sinonasal tract. Cancer. 2003;99:105–12.

    Article  PubMed  Google Scholar 

  14. Boyle JO, Shah KC, Shah JP. Craniofacial resection for malignant neoplasms of the skull base: an overview. J Surg Oncol. 1998;69:275–84.

    Article  CAS  PubMed  Google Scholar 

  15. Kasemsiri P, Carrau RL, Prevedello DM, Otto BA, Ditzel L. Principles of anterior skull base resection: open and endoscopic techniques. Oper Tech Otolaryngol Neck Surg. 2013;24:197–207.

    Article  Google Scholar 

  16. Husain Q, Patel SK, Soni RS, Patel AA, Liu JK, Eloy JA. Celebrating the golden anniversary of anterior skull base surgery: Reflections on the past 50 years and its historical evolution. Laryngoscope. 2013;123:64–72.** Clear review of the historical evolution of ASB surgery.

  17. Ketcham AS, Wilkins RH, Van Buren JM, Smith RR. A combined intracranial facial approach to the paranasal sinuses. Am J Surg. 1963;106:698–703.

    Article  CAS  PubMed  Google Scholar 

  18. Mantravadi AV, Zender CA. Craniofacial approaches to the anterior skull base. Oper Tech Otolaryngol Neck Surg. 2010;21:181–7.

    Article  Google Scholar 

  19. Sakata K, Maeda A, Rikimaru H, et al. 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.

    Article  PubMed  Google Scholar 

  20. Kim YS, Moon KS, Kim GW, et al. Role of craniofacial resection for malignant tumors involving the anterior skull base: surgical experience in a single institution. Brain tumor Res Treat. 2015;3:81–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fliss DM, Zucker G, Amir A, et al. The subcranial approach for anterior skull base tumors. Oper Tech Otolaryngol Neck Surg. 2000;11:238–53.

    Article  Google Scholar 

  22. Fliss DM, Abergel A, Cavel O, Margalit N, Gil Z. Combined subcranial approaches for excision of complex anterior skull base tumors. Arch Otolaryngol Head Neck Surg. 2007;133:888–96.

    Article  PubMed  Google Scholar 

  23. Raveh J, Turk JB, Lädrach K, et al. Extended anterior subcranial approach for skull base tumors: long-term results. J Neurosurg. 1995;82:1002–10.

    Article  CAS  PubMed  Google Scholar 

  24. McCutcheon IE, Blacklock JB, Weber RS, et al. Anterior transcranial (craniofacial) resection of tumors of the paranasal sinuses: surgical technique and results. Neurosurgery. 1996;38:471–9 discussion 479–80.

    CAS  PubMed  Google Scholar 

  25. Buchmann L, Larsen C, Pollack A, Tawfik O, Sykes K, Hoover LA. Endoscopic techniques in resection of anterior skull base/paranasal sinus malignancies. Laryngoscope. 2006;116:1749–54.

    Article  PubMed  Google Scholar 

  26. Nicolai P, Battaglia P, Bignami M, et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol. 2008;22:308–16.

    Article  PubMed  Google Scholar 

  27. Castelnuovo P, Dallan I, Battaglia P, Bignami M. Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol. 2010;267:649–63.

    Article  PubMed  Google Scholar 

  28. Roxbury CR, Ishii M, Richmon JD, Blitz AM, Reh DD, Gallia GL. Endonasal endoscopic surgery in the management of sinonasal and anterior skull base malignancies. Head Neck Pathol. 2016;10:13–22.

    Article  PubMed  Google Scholar 

  29. Farquhar D, Kim L, Worrall D, et al. Propensity score analysis of endoscopic and open approaches to malignant paranasal and anterior skull base tumor outcomes. Laryngoscope. 2016. [Epub ahead of print].

  30. Wood JW, Eloy JA, Vivero RJ, et al. Efficacy of transnasal endoscopic resection for malignant anterior skull-base tumors. Int Forum Allergy Rhinol. 2012;2:487–95.

    Article  PubMed  Google Scholar 

  31. Casler JD, Doolittle AM, Mair EA. Endoscopic surgery of the anterior skull base. Laryngoscope. 2005;115:16–24.

    Article  PubMed  Google Scholar 

  32. Lund V, Howard DJ, Wei WI. Endoscopic resection of malignant tumors of the nose and sinuses. Am J Rhinol. 2007;21:89–94.

    Article  PubMed  Google Scholar 

  33. Meccariello G, Deganello A, Choussy O, et al. Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: a pooled-analysis of 1826 patients. Head Neck. 2016;38(Suppl 1):E2267–74.

    Article  PubMed  Google Scholar 

  34. Lund VJ, Wei WI. Endoscopic surgery for malignant sinonasal tumours: an eighteen year experience. Rhinology. 2015;53:204–11.

    PubMed  Google Scholar 

  35. Snyderman CH, Carrau RL, Kassam AB, et al. Endoscopic skull base surgery: principles of endonasal oncological surgery. J Surg Oncol. 2008;97:658–64.

    Article  PubMed  Google Scholar 

  36. Harvey RJ, Gallagher RM, Sacks R. Extended endoscopic techniques for sinonasal resections. Otolaryngol Clin North Am. 2010;43:613–38.

    Article  PubMed  Google Scholar 

  37. Hanna E, DeMonte F, Ibrahim S, Roberts D, Levine N, Kupferman M. Endoscopic resection of sinonasal cancers with and without craniotomy: oncologic results. Arch Otolaryngol Head Neck Surg. 2009;135:1219–24.

    Article  PubMed  Google Scholar 

  38. • Rawal RB, Farzal Z, Federspiel JJ, Sreenath SB, Thorp BD, Zanation AM. Endoscopic resection of sinonasal malignancy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2016 [Epub ahead of print]. Extensive systematic review that investigated the existing data to determine overall survival rates and possible predictors for increased survival in patients undergoing endoscopic resection for sinonasal malignancy.

  39. Hanna EY, Holsinger C, DeMonte F, Kupferman M. Robotic endoscopic surgery of the skull base: a novel surgical approach. Arch Otolaryngol Head Neck Surg. 2007;133:1209–14.

    Article  PubMed  Google Scholar 

  40. • Kupferman ME, Hanna E. Robotic surgery of the skull base. Otolaryngol Clin North Am. 2014;47:415–23. Fascinating insight into the development of endonasal robotic instrumentation for skull base surgery.

  41. Snyderman CH, Janecka IP, Sekhar LN, Sen CN, Eibling DE. Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope. 1990;100:607–14.

    Article  CAS  PubMed  Google Scholar 

  42. Clayman GL, DeMonte F, Jaffe DM, et al. Outcome and complications of extended cranial-base resection requiring microvascular free-tissue transfer. Arch Otolaryngol Head Neck Surg. 1995;121:1253–7.

    Article  CAS  PubMed  Google Scholar 

  43. Neligan PC, Mulholland S, Irish J, et al. Flap selection in cranial base reconstruction. Plast Reconstr Surg. 1996;98:1159–66 discussion 1167–8.

    Article  CAS  PubMed  Google Scholar 

  44. Amir A, Gatot A, Zucker G, Sagi A, Fliss DM. Harvesting large fascia lata sheaths: a rational approach. Skull Base Surg. 2000;10:29–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Califano J, Cordeiro PG, Disa JJ, et al. Anterior cranial base reconstruction using free tissue transfer: changing trends. Head Neck. 2003;25:89–96.

    Article  PubMed  Google Scholar 

  46. Thakker JS, Fernandes R. Evaluation of reconstructive techniques for anterior and middle skull base defects following tumor ablation. J Oral Maxillofac Surg. 2014;72:198–204.

    Article  PubMed  Google Scholar 

  47. Neovius E, Engstrand T. Craniofacial reconstruction with bone and biomaterials: review over the last 11 years. J Plast Reconstr Aesthet Surg. 2010;63:1615–23.

    Article  PubMed  Google Scholar 

  48. Gil Z, Abergel A, Leider-Trejo L, et al. A comprehensive algorithm for anterior skull base reconstruction after oncological resections. Skull Base. 2007;17:25–37.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Katz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Villaret DB. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck. 2002;24:821–9.

    Article  PubMed  Google Scholar 

  50. Gabriele AM, Airoldi M, Garzaro M, et al. Stage III-IV sinonasal and nasal cavity carcinoma treated with three-dimensional conformal radiotherapy. Tumori. 2008;94:320–6.

    PubMed  Google Scholar 

  51. Dirix P, Nuyts S, Geussens Y, et al. Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2007;69:1042–50.

    Article  PubMed  Google Scholar 

  52. Hoppe BS, Stegman LD, Zelefsky MJ, et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting–the MSKCC experience. Int J Radiat Oncol Biol Phys. 2007;67:691–702.

    Article  PubMed  Google Scholar 

  53. Mendenhall WM, Amdur RJ, Morris CG, et al. Carcinoma of the nasal cavity and paranasal sinuses. Laryngoscope. 2009;119:899–906.

    Article  PubMed  Google Scholar 

  54. Robbins KT, Ferlito A, Silver CE, et al. Contemporary management of sinonasal cancer. Head Neck. 2011;33:1352–65.

    Article  PubMed  Google Scholar 

  55. Hoppe BS, Nelson CJ, Gomez DR, et al. Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities. Int J Radiat Oncol Biol Phys. 2008;72:763–9.

    Article  PubMed  Google Scholar 

  56. Duthoy W, Boterberg T, Claus F, et al. Postoperative intensity-modulated radiotherapy in sinonasal carcinoma: clinical results in 39 patients. Cancer. 2005;104:71–82.

    Article  PubMed  Google Scholar 

  57. Daly ME, Chen AM, Bucci MK, et al. Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys. 2007;67:151–7.

    Article  PubMed  Google Scholar 

  58. Madani I, Bonte K, Vakaet L, Boterberg T, De Neve W. Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys. 2009;73:424–32.

    Article  PubMed  Google Scholar 

  59. Dirix P, Vanstraelen B, Jorissen M, Vander Poorten V, Nuyts S. Intensity-modulated radiotherapy for sinonasal cancer: improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78:998–1004.

    Article  PubMed  Google Scholar 

  60. Russo AL, Adams JA, Weyman EA, et al. Long-term outcomes after proton beam therapy for sinonasal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2016;95:368–76.

    Article  PubMed  Google Scholar 

  61. Bhattasali O, Holliday E, Kies MS, et al. Definitive proton radiation therapy and concurrent cisplatin for unresectable head and neck adenoid cystic carcinoma: a series of 9 cases and a critical review of the literature. Head Neck. 2016;38(Suppl 1):E1472–80.

    Article  PubMed  Google Scholar 

  62. Dagan R, Bryant C, Li Z, et al. Outcomes of sinonasal cancer treated with proton therapy. Int J Radiat Oncol Biol Phys. 2016;95:377–85.

    Article  PubMed  Google Scholar 

  63. Patel SH, Wang Z, Wong WW, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol. 2014;15:1027–38.

    Article  CAS  PubMed  Google Scholar 

  64. Martin H. Cancer of the head and neck. J Am Med Assoc. 1948;137:1366.

    Article  CAS  PubMed  Google Scholar 

  65. Frazell EL, Lewis JS. Cancer of the nasal cavity and accessory sinuses. A report of the management of 416 patients. Cancer. 1963;16:1293–301.

    Article  CAS  PubMed  Google Scholar 

  66. Fliss DM, Zucker G, Cohen A, et al. Early outcome and complications of the extended subcranial approach to the anterior skull base. Laryngoscope. 1999;109:153–60.

    Article  CAS  PubMed  Google Scholar 

  67. 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.

    Article  CAS  PubMed  Google Scholar 

  68. Thorup C, Sebbesen L, Danø H, et al. Carcinoma of the nasal cavity and paranasal sinuses in Denmark 1995-2004. Acta Oncol. 2010;49:389–94.

    Article  PubMed  Google Scholar 

  69. Koivunen P, Mäkitie AA, Bäck L, et al. A national series of 244 sinonasal cancers in Finland in 1990-2004. Eur Arch Otorhinolaryngol. 2012;269:615–21.

    Article  PubMed  Google Scholar 

  70. Cantu G, Solero CL, Miceli R, et al. Anterior craniofacial resection for malignant paranasal tumors: a monoinstitutional experience of 366 cases. Head Neck. 2012;34:78–87.

    Article  PubMed  Google Scholar 

  71. Mirghani H, Mortuaire G, Armas GL, et al. Analysis of oncological failures in 156 consecutive cases. Head Neck. 2014;36:667–74.

    Article  PubMed  Google Scholar 

  72. Ganly I, Patel SG, Singh B, et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck. 2005;27:445–51.

    Article  PubMed  Google Scholar 

  73. Ganly I, Patel SG, Singh B, et al. Craniofacial resection for malignant tumors involving the skull base in the elderly: an international collaborative study. Cancer. 2011;117:563–71.

    Article  PubMed  Google Scholar 

  74. Gil Z, Patel SG, Cantu G, et al. Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck. 2009;31:308–17.

    Article  PubMed  Google Scholar 

  75. Ganly I, Patel SG, Singh B, et al. Craniofacial resection for malignant melanoma of the skull base: report of an international collaborative study. Arch Otolaryngol Head Neck Surg. 2006;132:73–8.

    Article  PubMed  Google Scholar 

  76. Gil Z, Patel SG, Singh B, et al. Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: an international collaborative study. Cancer. 2007;110:1033–41.

    Article  PubMed  Google Scholar 

  77. Patel SG, Singh B, Stambuk HE, et al. Craniofacial surgery for esthesioneuroblastoma: report of an international collaborative study. J Neurol Surg B Skull Base. 2012;73:208–20.

    Article  PubMed  PubMed Central  Google Scholar 

  78. • Beswick DM, Holsinger FC, Kaplan MJ, et al. Design and rationale of a prospective, multi-institutional registry for patients with sinonasal malignancy. Laryngoscope. 2016 [ahead of print]. This paper introduces the CORSICA registry which is a new cloud-based registry that will provide prospective oncologic and QoL outcomes data for patients with sinonasal malignancy.

  79. Gil Z, Patel SG, Bilsky M, Shah JP, Kraus DH. Complications after craniofacial resection for malignant tumors: are complication trends changing? Otolaryngol Head Neck Surg. 2009;140:218–23.

    Article  PubMed  Google Scholar 

  80. Dias FL, Sá GM, Kligerman J, et al. Complications of anterior craniofacial resection. Head Neck. 1999;21:12–20.

    Article  CAS  PubMed  Google Scholar 

  81. Solero CL, DiMeco F, Sampath P, et al. Combined anterior craniofacial resection for tumors involving the cribriform plate: early postoperative complications and technical considerations. Neurosurgery. 2000;47:1296–304 1304–5.

    Article  CAS  PubMed  Google Scholar 

  82. Gil Z, Fliss DM. Quality of life in patients with skull base tumors: current status and future challenges. Skull Base. 2010;20:11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Gil Z, Abergel A, Spektor S, Shabtai E, Khafif A, Fliss DM. Development of a cancer-specific anterior skull base quality-of-life questionnaire. J Neurosurg. 2004;100:813–9.

    Article  PubMed  Google Scholar 

  84. Amit M, Abergel A, Fliss DM, Gil Z. The clinical importance of quality-of-life scores in patients with skull base tumors: a meta-analysis and review of the literature. Curr Oncol Rep. 2012;14:175–81.

    Article  PubMed  Google Scholar 

  85. •• Kirkman MA, Borg A, Al-Mousa A, Haliasos N, Choi D. Quality-of-life after anterior skull base surgery: a systematic review. J Neurol Surg B. 2014;75:73–89. Comprehensive systematic review pertaining to QoL assessment in adults undergoing anterior skull base surgery.

  86. Abergel A, Cavel O, Margalit N, Fliss DM, Gil Z. Comparison of quality of life after transnasal endoscopic vs open skull base tumor resection. Arch Otolaryngol - Head Neck Surg. 2012;138:142–7.

    Article  PubMed  Google Scholar 

  87. Cavel O, Abergel A, Margalit N, Fliss DM, Gil Z. Quality of life following endoscopic resection of skull base tumors. J Neurol Surg B Skull Base. 2012;73:112–6.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Fitzpatrick R, Fletcher A, Gore S, Jones D, Spiegelhalter D, Cox D. Quality of life measures in health care. I: applications and issues in assessment. BMJ. 1992;305:1074–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Dan M. Fliss.

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Dr. Sara Abu-Ghanem, Dr. Moshe Yehuda, Dr. Garrett D Locketz, Dr. Avraham Abergel, and Dr. Dan M Fliss declare that they have no conflicts of interest.

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This article is part of the Topical Collection on Paranasal Sinus Tumors.

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Abu-Ghanem, S., Yehuda, M., Locketz, G.D. et al. Management of Malignant Tumors of the Anterior Skull Base and Paranasal Sinuses. Curr Otorhinolaryngol Rep 4, 259–265 (2016). https://doi.org/10.1007/s40136-016-0131-3

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