Combined anterior craniofacial resection for tumors involving the cribriform plate: Early postoperative complications and technical considerations

Carlo L. Solero, Francesco DiMeco, Prakash Sampath, Franco Mattavelli, Natalia Pizzi, Pietro Salvatori, Giulio Cantù

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Combined craniofacial resection has become the standard approach for malignant tumors involving the cribriform plate and anterior cranial fossa. Despite its widespread application, however, many surgeons agree that the procedure carries a risk of significant morbidity and even mortality. The purpose of this study was to analyze the experience at a single institution to determine the incidence of early postoperative complications encountered after combined craniofacial resection of tumors involving the cribriform plate and to provide information to improve management. METHODS: Between 1987 and 1997, 168 patients underwent combined craniofacial resection at the National Cancer Institute of Milan for tumors involving the cribriform plate. Patient charts, operative notes, follow-up clinic notes, radiographic studies, and pathology reports were analyzed. Morbidity encountered in the first 30 cases was compared with that encountered in the subsequent 138 cases. RESULTS: The most frequently encountered pathological findings were adenocarcinoma (53.6%), squamous cell carcinoma (17%), and esthesioneuroblastoma (9.8%). Eight patients (4.7%) died, 6 of whom were among the first 30 patients to undergo resection. Among patients with fatal complications were three with meningoencephalitis, three with intracranial hemorrhage, and one with myocardial infarction. Fifty patients (29.7%) had nonfatal morbidity; 16 of these patients were among the first 30 patients operated. Transient cerebrospinal fluid leakage was the most frequent adverse effect (9.5%); 12 patients (7.1%) had pneumocephalus, 3 (1.8%) had meningitis, 4 (2.4%) had wound infections, 3 (1.8%) experienced transient impairment of mental status, 3 (1.8%) had transient diplopia, 2 (1.2%) had diabetes insipidus, and 1 (0.6%) had bone flap necrosis. CONCLUSION: We observed a dramatic decrease in mortality and morbidity in patients who underwent combined craniofacial resection after the first 30 cases in our series. Improvement of specific aspects of surgical technique, such as more refined reconstructive methods and improved prophylactic antibiotic therapy, is at least partly responsible for this favorable trend.

Original languageEnglish (US)
Pages (from-to)1296-1305
Number of pages10
JournalNeurosurgery
Volume47
Issue number6
StatePublished - 2000

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Ethmoid Bone
Neoplasms
Morbidity
Anterior Cranial Fossa
Olfactory Esthesioneuroblastoma
Pneumocephalus
Diabetes Insipidus
Meningoencephalitis
Diplopia
Osteonecrosis
National Cancer Institute (U.S.)
Mortality
Intracranial Hemorrhages
Wound Infection
Meningitis
Squamous Cell Carcinoma
Adenocarcinoma
Myocardial Infarction

Keywords

  • Cranial base surgery
  • Cranial base tumors
  • Craniofacial resection
  • Ethmoid tumors
  • Paranasal sinuses

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Solero, C. L., DiMeco, F., Sampath, P., Mattavelli, F., Pizzi, N., Salvatori, P., & Cantù, G. (2000). Combined anterior craniofacial resection for tumors involving the cribriform plate: Early postoperative complications and technical considerations. Neurosurgery, 47(6), 1296-1305.

Combined anterior craniofacial resection for tumors involving the cribriform plate : Early postoperative complications and technical considerations. / Solero, Carlo L.; DiMeco, Francesco; Sampath, Prakash; Mattavelli, Franco; Pizzi, Natalia; Salvatori, Pietro; Cantù, Giulio.

In: Neurosurgery, Vol. 47, No. 6, 2000, p. 1296-1305.

Research output: Contribution to journalArticle

Solero, CL, DiMeco, F, Sampath, P, Mattavelli, F, Pizzi, N, Salvatori, P & Cantù, G 2000, 'Combined anterior craniofacial resection for tumors involving the cribriform plate: Early postoperative complications and technical considerations', Neurosurgery, vol. 47, no. 6, pp. 1296-1305.
Solero, Carlo L. ; DiMeco, Francesco ; Sampath, Prakash ; Mattavelli, Franco ; Pizzi, Natalia ; Salvatori, Pietro ; Cantù, Giulio. / Combined anterior craniofacial resection for tumors involving the cribriform plate : Early postoperative complications and technical considerations. In: Neurosurgery. 2000 ; Vol. 47, No. 6. pp. 1296-1305.
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abstract = "OBJECTIVE: Combined craniofacial resection has become the standard approach for malignant tumors involving the cribriform plate and anterior cranial fossa. Despite its widespread application, however, many surgeons agree that the procedure carries a risk of significant morbidity and even mortality. The purpose of this study was to analyze the experience at a single institution to determine the incidence of early postoperative complications encountered after combined craniofacial resection of tumors involving the cribriform plate and to provide information to improve management. METHODS: Between 1987 and 1997, 168 patients underwent combined craniofacial resection at the National Cancer Institute of Milan for tumors involving the cribriform plate. Patient charts, operative notes, follow-up clinic notes, radiographic studies, and pathology reports were analyzed. Morbidity encountered in the first 30 cases was compared with that encountered in the subsequent 138 cases. RESULTS: The most frequently encountered pathological findings were adenocarcinoma (53.6{\%}), squamous cell carcinoma (17{\%}), and esthesioneuroblastoma (9.8{\%}). Eight patients (4.7{\%}) died, 6 of whom were among the first 30 patients to undergo resection. Among patients with fatal complications were three with meningoencephalitis, three with intracranial hemorrhage, and one with myocardial infarction. Fifty patients (29.7{\%}) had nonfatal morbidity; 16 of these patients were among the first 30 patients operated. Transient cerebrospinal fluid leakage was the most frequent adverse effect (9.5{\%}); 12 patients (7.1{\%}) had pneumocephalus, 3 (1.8{\%}) had meningitis, 4 (2.4{\%}) had wound infections, 3 (1.8{\%}) experienced transient impairment of mental status, 3 (1.8{\%}) had transient diplopia, 2 (1.2{\%}) had diabetes insipidus, and 1 (0.6{\%}) had bone flap necrosis. CONCLUSION: We observed a dramatic decrease in mortality and morbidity in patients who underwent combined craniofacial resection after the first 30 cases in our series. Improvement of specific aspects of surgical technique, such as more refined reconstructive methods and improved prophylactic antibiotic therapy, is at least partly responsible for this favorable trend.",
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AU - Solero, Carlo L.

AU - DiMeco, Francesco

AU - Sampath, Prakash

AU - Mattavelli, Franco

AU - Pizzi, Natalia

AU - Salvatori, Pietro

AU - Cantù, Giulio

PY - 2000

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N2 - OBJECTIVE: Combined craniofacial resection has become the standard approach for malignant tumors involving the cribriform plate and anterior cranial fossa. Despite its widespread application, however, many surgeons agree that the procedure carries a risk of significant morbidity and even mortality. The purpose of this study was to analyze the experience at a single institution to determine the incidence of early postoperative complications encountered after combined craniofacial resection of tumors involving the cribriform plate and to provide information to improve management. METHODS: Between 1987 and 1997, 168 patients underwent combined craniofacial resection at the National Cancer Institute of Milan for tumors involving the cribriform plate. Patient charts, operative notes, follow-up clinic notes, radiographic studies, and pathology reports were analyzed. Morbidity encountered in the first 30 cases was compared with that encountered in the subsequent 138 cases. RESULTS: The most frequently encountered pathological findings were adenocarcinoma (53.6%), squamous cell carcinoma (17%), and esthesioneuroblastoma (9.8%). Eight patients (4.7%) died, 6 of whom were among the first 30 patients to undergo resection. Among patients with fatal complications were three with meningoencephalitis, three with intracranial hemorrhage, and one with myocardial infarction. Fifty patients (29.7%) had nonfatal morbidity; 16 of these patients were among the first 30 patients operated. Transient cerebrospinal fluid leakage was the most frequent adverse effect (9.5%); 12 patients (7.1%) had pneumocephalus, 3 (1.8%) had meningitis, 4 (2.4%) had wound infections, 3 (1.8%) experienced transient impairment of mental status, 3 (1.8%) had transient diplopia, 2 (1.2%) had diabetes insipidus, and 1 (0.6%) had bone flap necrosis. CONCLUSION: We observed a dramatic decrease in mortality and morbidity in patients who underwent combined craniofacial resection after the first 30 cases in our series. Improvement of specific aspects of surgical technique, such as more refined reconstructive methods and improved prophylactic antibiotic therapy, is at least partly responsible for this favorable trend.

AB - OBJECTIVE: Combined craniofacial resection has become the standard approach for malignant tumors involving the cribriform plate and anterior cranial fossa. Despite its widespread application, however, many surgeons agree that the procedure carries a risk of significant morbidity and even mortality. The purpose of this study was to analyze the experience at a single institution to determine the incidence of early postoperative complications encountered after combined craniofacial resection of tumors involving the cribriform plate and to provide information to improve management. METHODS: Between 1987 and 1997, 168 patients underwent combined craniofacial resection at the National Cancer Institute of Milan for tumors involving the cribriform plate. Patient charts, operative notes, follow-up clinic notes, radiographic studies, and pathology reports were analyzed. Morbidity encountered in the first 30 cases was compared with that encountered in the subsequent 138 cases. RESULTS: The most frequently encountered pathological findings were adenocarcinoma (53.6%), squamous cell carcinoma (17%), and esthesioneuroblastoma (9.8%). Eight patients (4.7%) died, 6 of whom were among the first 30 patients to undergo resection. Among patients with fatal complications were three with meningoencephalitis, three with intracranial hemorrhage, and one with myocardial infarction. Fifty patients (29.7%) had nonfatal morbidity; 16 of these patients were among the first 30 patients operated. Transient cerebrospinal fluid leakage was the most frequent adverse effect (9.5%); 12 patients (7.1%) had pneumocephalus, 3 (1.8%) had meningitis, 4 (2.4%) had wound infections, 3 (1.8%) experienced transient impairment of mental status, 3 (1.8%) had transient diplopia, 2 (1.2%) had diabetes insipidus, and 1 (0.6%) had bone flap necrosis. CONCLUSION: We observed a dramatic decrease in mortality and morbidity in patients who underwent combined craniofacial resection after the first 30 cases in our series. Improvement of specific aspects of surgical technique, such as more refined reconstructive methods and improved prophylactic antibiotic therapy, is at least partly responsible for this favorable trend.

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