Surgical Management of Giant Cell Tumors in Temporomandibular Joint Region Involving Lateral Skull Base: A Multidisciplinary Approach

Abstract

Giant cell tumors (GCTs) in the temporomandibular joint (TMJ) region invading the lateral skull base are relatively uncommon. The management of these lesions is still controversial because of their proximity to vital neurovascular structures. Although sporadically reported, the clinical outcomes of such disease after surgery are still largely unknown. We retrospectively reviewed the records of 28 patients with resectable GCTs in the TMJ region involving the lateral skull base treated from 1994 to 2013. A multidisciplinary team, formed by oral and maxillofacial surgeons, neurosurgeons, and otorhinolaryngologists, had surgically treated all these patients by craniomaxillofacial resection. Clinical variables, different treatment modalities, and outcomes are compared. Representative cases also are presented. Our case series consisted of 15 male and 13 female patients with a median age of 41years. The median follow-up duration for our series was 5.4years (range, 0.8-18.5years). The average tumor size measured 8.6cm. Most of the GCTs (n= 19, 67.9%) extended through the skull base bones into the brain parenchyma and other surrounding soft tissues. Titanium meshes for cranioplasty of skull base bones was used in 9 patients (32.1%), whereas temporalis fascia (n= 5, 17.9%) or free flaps (n= 6, 21.4%) were used more frequently for duraplasty. A postoperative cerebrospinal fluid leak was found in only 1 patient. During follow-up, the local control rate reached 85.7%. Thoroughness of tumor resection (hazard ratio, 15.763; 95% confidence interval, 1.630-152.437; P= .017) was found to be associated with recurrence-free survival. Craniomaxillofacial surgery for GCTs in the TMJ region invading the skull base is feasible in selected patients. A meticulous plan via a multidisciplinary approach is mandatory for the success of such treatment.