Outcome of Surgical Management of Skull Base Tumors with Infratemporal Fossa Involvement

Abstract

Background: Skull base tumors involving the infratemporal fossa comprise a wide variety of malignancies. These tumors were previously considered unresectable. By advent of new surgical techniques and immediate reconstruction, it is possible to resect tumors involving infratemporal fossa in an en block fashion and with low morbidity. The purpose of our study was to investigate the outcome of surgical management of this class of tumors. Methods: We conducted a retrospective review of the craniofacial approach to infratemporal tumors in a tertiary cancer center. All the patients from 1992–2008 that had undergone resection of infratemporal malignancies were included. Results: Between 1992 and 2008, 43 patients (28 males [65%] and 15 females [35%]) underwent resection of infratemporal tumors. The median age at referral was 46 years (range, 1–81 years). The most common pathology was sarcoma (16 patients [37%]) followed by squamous cell carcinoma (21%). Twenty-two cases (51%) were recurrent tumors after prior treatments. Twenty patients (46%) underwent resection of infratemporal fossa and maxillary sinus, five (12%) required anterior skull base resection in addition to infratemporal fossa, and 18 (42%) required orbital exenteration. Thirty-one patients (72%) required reconstruction with free tissue transfer and 8 (18%) with local flaps. Complications occurred in 8 patients (18%). Twenty-eight (65%) patients required further treatments in forms of surgery, radiation, chemotherapy, or a combination of all modalities. Median follow-up was 17 months. Median overall survival was 40 months. Three- and 5-year overall survival rates were 60% and 45%, respectively. Conclusion: With careful patient selection and a multidisciplinary approach, infratemporal fossa tumors can be resected with acceptable morbidity and long-term overall survival.