Malignant Tumors Of Anterior Skull Base Research Articles

Expanded endoscopic endonasal transcribriform approach for resection of anterior skull base olfactory schwannoma.

Anterior skull base (ASB) schwannomas are extremely rare and can often mimic other pathologies involving the ASB such as olfactory groove meningiomas, hemangiopericytomas, esthesioneuroblastomas, and other malignant ASB tumors. The mainstay of treatment for these lesions is gross-total resection. Traditionally, resection for tumors in this location is performed through a bifrontal transbasal approach that can involve some degree of brain retraction or manipulation for tumor exposure. With the recent advances in endoscopic skull base surgery, various ASB tumors can be resected successfully using an expanded endoscopic endonasal transcribriform approach through a "keyhole craniectomy" in the ventral skull base. This approach represents the most direct route to the anterior cranial base without any brain retraction. Tumor involving the paranasal sinuses, medial orbits, and cribriform plate can be readily resected. In this video atlas report, the authors demonstrate their step-by-step techniques for resection of an ASB olfactory schwannoma using a purely endoscopic endonasal transcribriform approach. They describe and illustrate the operative nuances and surgical pearls to safely and efficiently perform the approach, tumor resection, and multilayered reconstruction of the cranial base defect. The video can be found here: http://youtu.be/NLtOGfKWC6U .

Esthesioneuroblastomas in an Asian Population: Similarities and Differences

Objective: Esthesioneuroblastomas is an uncommon malignant tumor of the olfactory neuroepithelium in the white population. However, in our series with predominantly Asian patients, it is the most common anterior skull base malignancy requiring a craniofacial resection. Method: Twenty-four patients who underwent craniofacial resections for malignant anterior skull base tumors and were diagnosed with esthesioneuroblastomas were recruited in this prospective study over a 10-year period. All patients were operated on by the same surgeon with the same technique. Results: Twenty-four out of 48 patients with anterior skull base malignancies had esthesioneuroblastomas. The mean age of patients with esthesioneuroblastomas was 53 years old with no bimodal distribution. Most patients were Chinese (92%) with a male predominance (62%). Major complication rate was 13% and we had 1 unrelated perioperative mortality. Fifty percent of our patients had either local or regional recurrence. Three patients passed away in our series from tumor-unrelated reasons. Two-thirds of the patients in our series are alive more than 5 years after the initial diagnosis. The overall 5 year survival rate was 86%. Conclusion: The predominant malignant anterior skull base tumor requiring a craniofacial resection was an esthesioneuroblastoma (50%). This is much more common than described in other series. There is a good curability with this tumor, with most patients surviving well beyond 5 years.

Anterior skull base surgery

The basic principle of anterior skull base surgery is to provide adequate exposure to enable three dimensional resection of skull base tumors. Negative surgical margins, which is within the control of surgeon, is the principle prognostic factor in anterior skull base tumors. Open skull base approaches is the standard of care for malignant anterior skull base tumors. Benign lesions may be resected by alternate minimally invasive approaches. Advances in anterior skull base surgery, in particular the facial translocation approaches allows wide exposure of the tumors with minimal retraction of the brain. The outcome of anterior skull base tumors have steadily increased over the years with disease free survival comparable to other malignant neoplasm of the head and neck region. This review described various surgical approaches and pertaining anatomy and pathology of anterior skull base tumors.

The Interdisciplinary Concept in Treating Patients with Malignant Anterior Skull Base Tumors and Outcomes

Objective: Malignant tumors of the anterior skull base are complex lesions that require an understanding of the tumor pathology, principles of resection, and nonsurgical therapeutic modalities. In order to justify a complex interdisciplinary surgical approach, the indications and contraindications for resection should be influenced by prognostic factors and anticipated outcome.

Quality of Life following Surgery for Malignancies of the Anterior Skull Base

Radical surgery combined with postoperative radiation is recommended to achieve the best outcomes in patients suffering from malignant anterior skull base tumors. However, information on the impact of such treatment on the quality of life of these patients is sparse. This retrospective study evaluated quality of life in patients with anterior skull base malignancies after transdural resection and radiotherapy. At follow-up, 36% of the patients were alive (mean survival time, 39 months). Only 45% of the patients were able to work in their previous occupation a mean of 15 months after surgery. At follow-up, 58% of the patients had a recurrent tumor. The mean quality of life index was 42 points (range, 0 to 100). The lowest values were on the job item, and the highest mean value was on the family item. All patients, dependents, or both would agree to surgery in the future. Based on these findings, quality of life after transdural surgery for the treatment of anterior skull base malignancies seems to be low.

The Interdisciplinary Concept in Treating Patients with Malignant Anterior Skull Base Tumors and Outcomes

Objective: Malignant tumors of the anterior skull base are complex lesions that require an understanding of the tumor pathology, principles of resection, and nonsurgical therapeutic modalities. In order to justify a complex interdisciplinary surgical approach, the indications and contraindications for resection should be influenced by prognostic factors and anticipated outcome.

Stellenwert der endonasalen mikro-endoskopischen Tumorchirurgie

The aim of the present study was to establish the efficacy of endonasal micro-endoscopic surgery for removal of benign and malignant neoplastic lesions of the paranasal sinuses and the anterior skull base. This retrospective study evaluated 350 patients with tumors of the paranasal sinuses and the anterior skull base (215 benign and 135 malignant tumors) that were treated surgically at the ENT-Department of the Hospital Fulda gAG between 1993 and 2003. Median follow-up was 65 months. Most frequent entities of benign tumors were osteomas, inverted papillomas and juvenile angiofibromas. Adenocarcinomas, squamous cell carcinomas and esthesioneuroblastomas were most frequently treated in the group of malignomas. 54 % of the benign (n = 118) and 41 % of the malignant tumors (n = 54) were resected exclusively via the endonasal micro-endoscopic approach. Within the follow-up period 3 recurrencies were observed, two inverted papillomas (one was operated endonasally) and one juvenile angiofibroma. In the malignoma group 34 patients died because of tumor disease (16 cases due to recurrencies, 18 cases due to metastases formation). The 5 year survival rate was 66.4 % with respect to the disease-specific survival. The Kaplan-Meier analysis revealed statistically significant differences for the pT stage: pT2 and pT3 tumors have had a 5-year disease-specific survival of 92.3 % and 83.8 %, respectively, compared to 61.5 % of the pT4 tumors. Disease-specific survival also showed differences dependent on histology, tumor site and occurrence, but was without proven significancy. In the patient subgroup who suffered from adenocarcinoma, squamous cell carcinoma or esthesioneuroblastoma the 5-year disease-specific survival was 78.4 % of 29 patients after endonasal resection compared to 66.4 % in 51 patients operated via an external approach. The advances in endonasal micro-endoscopic surgery also allow a safe and effective removal of benign and malignant anterior skull base tumors with low morbidity. Thereby, indication is dependent on tumor site and size as well as histology.