Surgical treatment of skull-base malignancy.

Abstract

Improved radiographic diagnosis and new surgical approaches make it possible to consider surgical treatment of skull‐base malignancies. For many years treatment of external auditory canal and middle ear malignancies has involved subtotal or radical temporal bone surgery; these approaches and techniques will be discussed in detail, in our experience the need for radical temporal bone resection has changed considerably. Total tumor removal followed by radiation therapy seems to yield survival rates and relief of pain equal to formal temporal bone resection with the attendant complications. The new radio‐diagnostic techniques, including high‐resolution computerized tomographic scans and digital subtraction angiography, allow better assessment of skull‐base lesions. If we can determine by computerized tomography that a skull‐base malignancy is well defined and not extending into different areas, en bloc surgical resection might be indicated. Details of this radiologic evaluation will be presented along with some surgical approaches to lesions possibly amenable to surgical resection.