Craniofacial resection of midline anterior skull base malignancies: A reassessment of outcomes in the modern era

Shaan M. Raza, Tomas Garzon-Muvdi, Gary L Gallia, Rafael J Tamargo

Research output: Contribution to journalArticle

Abstract

Objective: Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. Methods: We review our experience of open craniofacial resection of midline anterior cranial fossa malignancies in the modern era. Results: Between 1995 and 2009, 41 patients underwent bifrontal craniotomy/craniofacial resection for malignancy. A subset of patients had undergone previous treatment, i.e., transfacial resection (34%), chemotherapy (5%), and radiation therapy (10%). Esthesioneuroblastoma (29%) was the most common pathology, followed by squamous cell carcinoma (27%) and the remaining patients presented with various histologic subtypes. All tumors invaded the cribriform plate; tumors invaded dura in 51%, parenchyma in 17% and orbit in 54% of patients. Negative margins were obtained in 85% of the cohort. Postoperative complications included seizure (one patient), cerebrospinal leak (one patient), and symptomatic pneumocephalus (two patients). Conclusion: Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.

Original languageEnglish (US)
Pages (from-to)128-136
Number of pages9
JournalWorld Neurosurgery
Volume78
Issue number1-2
DOIs
StatePublished - Jul 2012

Fingerprint

Skull Base
Neoplasms
Anterior Cranial Fossa
Ethmoid Bone
Olfactory Esthesioneuroblastoma
Pneumocephalus
Morbidity
Craniotomy
Orbit
Endoscopy
Squamous Cell Carcinoma
Seizures
Radiotherapy
Pathology
Drug Therapy

Keywords

  • Anterior skull base
  • Craniofacial resection
  • Malignancy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Craniofacial resection of midline anterior skull base malignancies : A reassessment of outcomes in the modern era. / Raza, Shaan M.; Garzon-Muvdi, Tomas; Gallia, Gary L; Tamargo, Rafael J.

In: World Neurosurgery, Vol. 78, No. 1-2, 07.2012, p. 128-136.

Research output: Contribution to journalArticle

@article{877b4291433a4080a96abb6f65e3082c,
title = "Craniofacial resection of midline anterior skull base malignancies: A reassessment of outcomes in the modern era",
abstract = "Objective: Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. Methods: We review our experience of open craniofacial resection of midline anterior cranial fossa malignancies in the modern era. Results: Between 1995 and 2009, 41 patients underwent bifrontal craniotomy/craniofacial resection for malignancy. A subset of patients had undergone previous treatment, i.e., transfacial resection (34{\%}), chemotherapy (5{\%}), and radiation therapy (10{\%}). Esthesioneuroblastoma (29{\%}) was the most common pathology, followed by squamous cell carcinoma (27{\%}) and the remaining patients presented with various histologic subtypes. All tumors invaded the cribriform plate; tumors invaded dura in 51{\%}, parenchyma in 17{\%} and orbit in 54{\%} of patients. Negative margins were obtained in 85{\%} of the cohort. Postoperative complications included seizure (one patient), cerebrospinal leak (one patient), and symptomatic pneumocephalus (two patients). Conclusion: Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.",
keywords = "Anterior skull base, Craniofacial resection, Malignancy",
author = "Raza, {Shaan M.} and Tomas Garzon-Muvdi and Gallia, {Gary L} and Tamargo, {Rafael J}",
year = "2012",
month = "7",
doi = "10.1016/j.wneu.2011.09.014",
language = "English (US)",
volume = "78",
pages = "128--136",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "1-2",

}

TY - JOUR

T1 - Craniofacial resection of midline anterior skull base malignancies

T2 - A reassessment of outcomes in the modern era

AU - Raza, Shaan M.

AU - Garzon-Muvdi, Tomas

AU - Gallia, Gary L

AU - Tamargo, Rafael J

PY - 2012/7

Y1 - 2012/7

N2 - Objective: Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. Methods: We review our experience of open craniofacial resection of midline anterior cranial fossa malignancies in the modern era. Results: Between 1995 and 2009, 41 patients underwent bifrontal craniotomy/craniofacial resection for malignancy. A subset of patients had undergone previous treatment, i.e., transfacial resection (34%), chemotherapy (5%), and radiation therapy (10%). Esthesioneuroblastoma (29%) was the most common pathology, followed by squamous cell carcinoma (27%) and the remaining patients presented with various histologic subtypes. All tumors invaded the cribriform plate; tumors invaded dura in 51%, parenchyma in 17% and orbit in 54% of patients. Negative margins were obtained in 85% of the cohort. Postoperative complications included seizure (one patient), cerebrospinal leak (one patient), and symptomatic pneumocephalus (two patients). Conclusion: Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.

AB - Objective: Craniofacial resection has been considered the gold standard in the management of malignancies involving the anterior skull base, where the goal of surgery is negative margins with minimal morbidity. In recent years, there has been growing enthusiasm for purely endoscopic techniques for craniofacial malignancies. Given recent advancements in open surgical approaches, there is a need to review the technique of open craniofacial resection in the modern surgical era. Methods: We review our experience of open craniofacial resection of midline anterior cranial fossa malignancies in the modern era. Results: Between 1995 and 2009, 41 patients underwent bifrontal craniotomy/craniofacial resection for malignancy. A subset of patients had undergone previous treatment, i.e., transfacial resection (34%), chemotherapy (5%), and radiation therapy (10%). Esthesioneuroblastoma (29%) was the most common pathology, followed by squamous cell carcinoma (27%) and the remaining patients presented with various histologic subtypes. All tumors invaded the cribriform plate; tumors invaded dura in 51%, parenchyma in 17% and orbit in 54% of patients. Negative margins were obtained in 85% of the cohort. Postoperative complications included seizure (one patient), cerebrospinal leak (one patient), and symptomatic pneumocephalus (two patients). Conclusion: Since its introduction more than 50 years ago, craniofacial resection has undergone several important technical advancements concurrent to the introduction of endoscopy. With these improvements, our results indicate good oncologic disease control with minimal morbidity for extensive malignancies invading the intracranial cavity. With improvements in both open and endoscopic techniques, there is a need to reassess outcomes to determine relative indications.

KW - Anterior skull base

KW - Craniofacial resection

KW - Malignancy

UR - http://www.scopus.com/inward/record.url?scp=84864719782&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864719782&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2011.09.014

DO - 10.1016/j.wneu.2011.09.014

M3 - Article

C2 - 22120268

AN - SCOPUS:84864719782

VL - 78

SP - 128

EP - 136

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 1-2

ER -