Central Skull Base Tumors Research Articles

Facial translocation approach in the management of central skull base and infratemporal tumors.

The objectives were to systematize the indications of various types of facial translocation and to present a technical modification to avoid some sequelae of this approach. Retrospective analysis was made of patients treated with different types of facial translocation approach to resect nasopharyngeal, infratemporal, and sinonasal tumors. Thirty-nine patients underwent facial translocation approaches for neoplasms originally involving the nasopharynx (27) infratemporal fossa (7), and nasal cavity (5). Of the 21 malignant tumors, 2 were stage T2, 5 were stage T3, and 14 were stage T4. From the entire series of patients, 10 received a unilateral medial translocation, 3 a bilateral medial translocation, 25 a standard facial translocation, and 1 an extended medial facial translocation. Fifteen patients (38%) developed some kind of complication, such as wound infection (nine cases) and osteomyelitis and cerebrospinal fluid leak (five cases each). Two patients died as a result of postoperative complications (5.2%). Overall 5-year survival for malignant tumors was 43%. Neither the histological appearance of the tumor nor the T stage influenced the survival of patients. Survival of patients with intracranial involvement was significantly decreased compared with patients with involvement of other areas (P =.0003). The facial translocation approach offers an excellent exposure in tumors with large degree of involvement of the nasopharynx, infratemporal fossa, nasal cavity, and maxillary sinus. More limited osteotomies are indicated in smaller tumors. The use of midfacial degloving minimizes the number of sequelae of these approaches.

Respective indications for orbital rim, zygomatic arch and orbito-zygomatic osteotomies in the surgical approach to central skull base lesions. Critical, retrospective review in 146 cases.

Orbital Rim (ORo) Zygomatic Arch (ZAo) and Orbito-Zygomatic (OZo) osteotomies can be useful adjuncts to the classical Fronto-Pteriono-Temporal craniotomy in facilitating the exposure of deep seated skull base lesions, sparing brain retraction injuries. Based on a review of 146 "operated" cases, the authors suggest their guidelines for patient selection for each of these osteotomies. 146 lesions (100 central skull base tumors, 29 deep vascular lesions and 17 mesial temporal epileptogenic foci) were surgically treated by the senior author between 1988-1999 using ORo (59 cases), ZAo (12 cases) and OZo (75 cases). The lesion were radically cured in 85% of the cases. A retrospective critical analysis of patients' records by an independent observer evaluated: 1)--the usefulness and the appropriateness of the performed osteotomy for obtaining an optimal approach to the lesion and 2)--morbidity related to the osteotomy and to brain retraction. In only one case, the osteotomy (ORo) was found not to be useful. An other 17 patients who underwent OZo would have benefited from a reduced osteotomy (ORo in 15 cases, ZAo in 2 cases). In another case an ORo was found insufficient for an effective exposure of the lesion. Osteotomy-related morbidity rate was 10.2% (15 patients), mostly due to transient Temporo Mandibular Joint dysfunction. In spite of an appropriate approach, 12 patients (8.2%) showed neurological deficits (temporary) and/or CT manifestations attributable to brain retraction. The additional osteotomies were found useful and relatively safe in facilitating the exposure of most of the lesions in this series. A target (rather than pathology) and surgical axis oriented list of indications for ORo, ZAo and OZo is given.

Le Fort I osteotomy and skull base tumors: a pediatric experience.

The Le Fort I maxillary osteotomy approach for skull base tumor removal in the pediatric age group has not been widely discussed in the literature except for sporadic case reports and limited case series. To review our experience with the Le Fort I osteotomy and to propose that it be used as an alternative approach because of its many advantages for the removal of tumors of the central skull base and paranasal sinuses. Case series. Tertiary academic center. A 5-year retrospective chart review of cases involving children who had undergone skull base tumor resection via the Le Fort I osteotomy approach. Skull base tumor removal via the Le Fort I osteotomy approach. Tumor type, location, and size; intraoperative and postoperative complications; and residual tumor and/or tumor recurrence associated with the surgical approach. Eleven patients (9 boys and 2 girls; mean age, 14.3 years) were identified through the chart review. The tumor types included 8 angiofibromas, 1 malignant fibrous histiocytoma, 1 giant cell tumor, and 1 cavernous hemangioma. All these lesions had extensive tumor growth into at least 1 of the following sites: pterygomaxillary space, sphenoidal sinus, and areas adjacent to the optic nerve, cavernous sinus, clivus, and anterior cranial fossa. The mean follow-up for this cohort was 12.8 months. No intraoperative complications were noted. Postoperative complications were reviewed with respect to the approach. To date, there have been no cases of residual tumor or tumor recurrence that can be attributed to the procedure. Our experience suggests that the Le Fort I osteotomy approach is a useful technique for the removal of extensive central skull base tumors and paranasal sinuses in the pediatric age group. It has distinct advantages over traditional anterior or lateral approaches, including a more direct line of vision and improved exposure and cosmesis.