OP100: Craniomaxillofacial approaches to skull base tumours

Abstract

Introduction This study’s aim is to present our experience in the use of craniomaxillofacial approaches to skull base used for the treatment of tumours involving nasal cavity, paranasal sinuses, oral cavity and tumours extending to the skull base or intracranially with dura or brain involvement or vice versa. The complex anatomy of the vital structures at the base of the skull makes surgical resection of this area’s tumours extremely difficult particularly in cases of malignancy. The study’s material is from one centre over a 10-year period and the surgical technique; the contraindications; the complications and patients’ treatment outcome are presented. Materials and methods Forty-one patients surgically treated were included in the study. Complete data regarding the demographic details of the patients, presence of regional/distant metastases, tumour histology and follow up were compiled. Surgical approaches regarding intracranial tumours were performed by a combined surgical team of maxillofacial surgeons and neurosurgeons. With reference to the type of skull base surgical approach, anterior and lateral approaches were used. In particular 15 patients were treated with anterior and 26 with lateral approaches. Results The surgical aim was achieved in all cases. Various complications occurred, including CFS leakage, olfactory nerve damage, malocclusion, infra-orbital nerve compulsory sacrifice and infection, while tumour recurrences also occurred. Discussion Skull base tumour surgery is very demanding and requires team-work. The goals of the surgical approach design must be maximum exposure, minimal morbidity and good aesthetic result. The selection of the appropriate surgical approach must always be individualized and based on tumour size, anatomical location of the tumour, histopathology of the tumour, age and general condition of the patient.