Endoscopic Anterior Skull Base Resection: University of Miami Experience

Abstract

Objectives: To report: (1) Oncological safety of endoscopic technique using disease free survival and a Kaplan Maier analysis for malignant tumors and recurrence rate for benign tumors; (2) Type of reconstruction of large anterior skull base defects and rate of postoperative cerebrospinal fluid leak; (3) Postoperative major (cranial and orbital) and minor complications. Methods: Retrospective chart review identifying patients undergoing endoscopic anterior skull base resection for malignant and benign tumors at a tertiary care medical center between September 1997 and June 2013. Results: Preliminary analysis shows that 34 patients underwent transnasal endoscopic resection for malignant disease and 2 patients for benign disease. The median follow-up was 30 months. Olfactory neuroblastoma was the most common pathology. There were 3 major and 5 minor complications. Three patients recurred locally resulting in a local control rate of 90.9%. The overall mortality rate was 18%, and the disease specific mortality was 3%. Reconstruction of the skull base defect was done using acellular dermis as a sole graft with a success rate of 97% and a cerebrospinal fluid leak in 1 case. Conclusions: Endoscopic anterior skull base resection for benign or malignant disease is a safe and valid alternative compared to standard approaches. It is gaining more popularity, and with increasing surgical expertise, the indications of this procedure are expanding.