Anterior Skull Base Tumors Research Articles

Ophthalmological outcome following orbital resection in anterior and anterolateral skull base surgery

Partial resection of the orbital bones is not uncommon during the excision of anterior and anterolateral skull base tumors. Controversy exists regarding the need for and extent of the reconstruction necessary following this resection. The authors studied this factor in a series of patients. The authors conducted a retrospective review of 56 patients in whom resection of 57 anterior or anterolateral skull base tumors and partial excision of the orbital bone were performed. Adverse ophthalmological outcomes were noted in 16 patients, in nine of whom adverse outcomes were believed to be directly related to resection of the orbital walls. Some degree of orbital reconstruction was performed during 23 of the 57 procedures. An adverse orbit-related outcome was strongly associated with resection of the orbital floor and with resection of two thirds or more of two or more orbital walls but not with the presence of absence or orbital reconstruction. The latter finding, however, is likely a function of selection bias. In most patients after partial excision of the orbital bones, elaborate reconstruction is not necessary. Isolated medial and lateral orbital wall defects or combined superior and lateral orbital wall defects, especially in cases in which the periorbita is intact, probably do not require primary reconstruction. In cases of orbital floor defects, whether isolated or part of a multiple wall resection, primary reconstruction is recommended.

A 5-year review of 71 consecutive anterior skull base tumours

Techniques used in craniofacial surgery have found extensive application in the management of skull base tumours. The improved exposure gained via osteotomies for facial disassembly has facilitated the en-bloc resection of tumours with clear surgical margins, and the advent of vascularised seals has significantly reduced the risk of meningeal contamination. We present our experience with the extirpation and reconstruction of 71 benign and malignant tumours of the anterior skull base over a 5-year period. Survival and functional outcome data are presented, with an emphasis on the wide range of pathologies and primary treatment strategies seen at presentation. Criteria used in flap selection and the role of prosthetics are discussed. Observations are offered on salvage surgery, demonstrating that excellent palliation can be achieved, even in cases with massive recurrent disease.

Craniofacial resection of anterior skull base tumours: factors contributing to success.

A case series of 20 consecutive patients followed for a minimum of 54 months following craniofacial resection of anterior skull base tumours is presented, with the aim of identifying complications and factors influencing survival. A retrospective review of a case series of 20 consecutive patients was carried out. Dural invasion was significantly correlated with poorer survival. There was also a tendency for tumour grade and positive resection margins to be associated with poorer outcome. Most local recurrences occurred within 6 months of surgery, with the exception of adenocarcinoma of the ethmoids, in which recurrence occurred up to 36 months postoperatively. A variety of complications were encountered, with a marked decrease in serious complications from midway through the series. The change in pattern of complications may be indicative of a learning curve, or the discontinuation of the use of lumbar drainage.

Endoscopic cranionasal resection of anterior skull base tumor

The commonly used techniques in the surgical resection of anterior skull base tumor are craniofacial resection*-2 or transcranial resection.3 Craniofacial resection uses a bicoronal scalp flap with a lateral rhinotomyl or an extended lateral rhinotomy2 to expose the anterior skull base; the transfacial approach is necessary in the resection of the lower part of the tumor. In the present case report, we describe a new technique of endoscopic cranionasal resection using the bicoronal scalp flap and transnasal videoendoscopic approach to the anterior skull base, which can avoid the unsightly facial scar of the lateral rhinotomy.

Anterior skull base tumors extending to the sphenoclival, infratemporal, and nasomaxillary area: Approaches, resection, and reconstruction in 156 cases

Anterior skull base tumors extending to the sphenoclival, infratemporal, and nasomaxillary area: Approaches, resection, and reconstruction in 156 cases

Anterior Skull Base Tumors Extending to the Sphenoclival, Infratemporal, and Nasomaxillary Area: Approaches, Resection, and Reconstruction in 156 Cases

Anterior Skull Base Tumors Extending to the Sphenoclival, Infratemporal, and Nasomaxillary Area: Approaches, Resection, and Reconstruction in 156 Cases

Internal Carotid Artery Sacrifice for Radical Resection of Skull Base Tumors

When dealing with skull base tumors that encase the internal carotid artery (ICA), the surgeon must decide between ICA preservation and incomplete tumor resection, or radical resection with ICA sacrifice. In our experience with more than 300 anterior skull base tumors, the ICA was sacrificed in only 10 patients. These tumors were malignant, except for one meningioma that occluded the ICA and produced translent ischemic symptoms. All patients had the ICA resected with the tumor, and all patients underwent revascularization (cervical ICA-MCA saphenous bypass, n = 4; cervical-to-supraclinoid bypass, n = 1; petrous-to-supraclinoid bypass, n = 3; bonnet bypass, n = 2). This small patient series reflects our practice of preserving the ICA whenever possible. We recommend preserving the ICA with benign tumors because they do not invade the artery, or do so only to a limited extent. In addition, similar rates of tumor recurrence are seen after aggressive resection with or without ICA sacrifice. In contrast, we recommend radical tumor resection and sacrifice of the ICA with malignant tumors because they directly threaten the integrity of the ICA and the patient's survival. The ICA should not be considered a limitation to radical tumor resection because the ICA can be reconstructed safely with an appropriate bypass procedure.

Factors affecting survival of patients with tumors of the anterior skull base

Fifty-four patients with primary neoplasms of the anterior skull base were treated by craniofacial resection with curative intent. The most common tumor was esthesioneuroblastoma (24), followed by squamous cell carcinoma (10). The overall 2-year and 5-year survivals were 75% and 49%, respectively. High-grade tumors, grades 3 and 4, had a poorer prognosis. Tumor size, dural involvement, sphenoid sinus involvement, age, and sex had no significant influence on survival when examined by multivariate survival analysis. Sixteen complications were noted in the postoperative period. Cerebrospinal fluid leakage occurred in 2 patients and loss of frontal bone occurred in 4. There were no operative or perioperative deaths. Craniofacial resection permits surgical resection of the majority of anterior skull base tumors with acceptable morbidity.

Transnasal illumination to guide the craniofacial resection of anterior skull base neoplasms

The authors describe use of a flexible fiberoptic light source to guide the craniofacial resection of anterior skull base neoplasms. The light is introduced transnasally and serves to outline the perimeter of the tumor, helping to direct the safe placement of intracranial osteotomies and en bloc tumor removal.

Craniofacial resection for anterior skull base tumours

This study presents a series of 10 patients with anterior skull base tumours, treated by a team of neurosurgeons and head- and neck surgeons. The series included 7 malignant tumours of the nose and paranasal sinuses and 1 retinoblastoma, all with intracranial extension through the lamina cribrosa. There were also 2 patients with an anterior base meningioma, growing into the ethmoid sinus and the nasal cavity. 8 tumours were resected by a combined bifrontal craniotomy and uni- or bilateral rhinotomy. In 2 cases a bifrontal craniotomy alone without facial incision sufficed. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, CSF-leakage or meningitis. Recurrent tumour growth or systemic metastasis occurred in 5 out of 7 patients with malignant tumours, 6 months to 2 years postoperatively. The related literature and especially questions of operative indications and technique, including different possibilities of closure and reconstruction of the skull base, are discussed.

Craniofacial resection for anterior skull base tumors.

We present the results of treatment of 30 patients with anterior skull base tumors operated on over an 11-year period. At the time of surgery, intracranial invasion was present in 10 patients. Histology revealed epithelial tumors in 18 patients, sarcoma in 6, esthesioneuroblastoma in 4, and 2 miscellaneous histologies. The overall median survival was 5 years and varied according to histology and grade of tumor. Currently malignancies involving the skull base can be successfully resected using a craniofacial approach, with minimum operative mortality. Limited intracranial invasion need not necessarily represent a major contraindication of this procedure if morbidity can be kept to a minimum.

Supraorbital rim approach to the anterior skull base

Advances in the surgical approach to the anterior skull base have resulted in increased opportunity for the cure of tumors involving these structures. This paper describes a modification of the frontal craniotomy technique which allows excellent access to the anterior cranial fossa and orbit. This technique results in the en bloc removal of a bone flap which incorporates the orbital roof, superior orbital rim, and frontal bone. We have utilized this approach in 5 anterior skull base tumors (2 esthesioneuroblastomas, an angiofibroma, a case of orbital invasion by an aggressive inverted papilloma, and a squamous cell carcinoma of the ethmoid complex). This approach has the advantage of excellent exposure, clear visibility in the placement of chisel cuts, and less brain retraction than conventional techniques. It is the approach of choice for orbital tumors.