Sinonasal Malignancies of Anterior Skull Base

AbstractBackground:The subcranial approach is a modification of traditional craniofacial resection. It provides similar broad access to the anterior skull base, but with lower mortality and morbidity. It has been the surgical technique of choice at our institution since 2006 for treating advanced stage sinonasal tumours (American Joint Committee on Cancer stage III or above). This paper reports our experience and outcomes.Method and results:Eighteen patients underwent subcranial craniofacial resection over a seven-year period, this being combined with a second adjunctive procedure in 89 per cent of cases. Forty per cent of patients required reconstruction of the primary defect. No peri-operative deaths occurred. One patient had a transient cerebrospinal fluid leak. The major complication rate was 33 per cent, of which 67 per cent were directly related to soft tissue reconstruction. Tumour recurrence rate was 17 per cent and the five-year disease-free survival estimate was 40 per cent.Conclusion:The subcranial approach is a safe and effective technique that may be used to successfully treat advanced sinonasal malignancies with anterior skull base extension.

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Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1612617 ◽

2017 ◽

Vol 79 (05) ◽

pp. 419-426 ◽

Cited By ~ 3

Author(s):

Hedyeh Ziai ◽

Eugene Yu ◽

Terence Fu ◽

Nidal Muhanna ◽

Eric Monteiro ◽

...

Keyword(s):

Overall Survival ◽

Skull Base ◽

Tertiary Care ◽

Small Sample ◽

Anterior Skull Base ◽

Preoperative Imaging ◽

Sinonasal Malignancies ◽

Control Versus ◽

Margin Control ◽

The Impact

Objectives (1) To determine the occult rate of dural invasion in patients with tumors extending to and/or eroding the bony anterior skull base but without evidence of dural invasion on preoperative imaging. (2) To determine the impact of dural resection and of skull base erosion on survival outcomes in this group of patients (without evidence of dural invasion upon preoperative imaging). Study Design Retrospective study. Setting Tertiary care academic center. Participants Patients with sinonasal malignancies with anterior skull base encroachment/erosion without dural invasion on preoperative imaging treated surgically. Main Outcome Measures (1) Histopathologic disease in the dura in patients who had dural resection and (2) Oncologic outcomes (5-year local recurrence, dural recurrence, disease-specific survival, and overall survival) in patients with and without dural resection, and patients with and without skull base erosion. Results Thirty-seven patients were included. The occult rate of dural invasion was 54%. Patients with dural resection had improved margin control versus those without dural resection (90% vs 56%, p = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma compared with bony skull base resection alone (100% vs 75%, p = 0.03). Patients with skull base erosion had reduced local control versus those without erosion (63% vs 93%, p = 0.047). Conclusion This study suggests a substantial rate of occult dural invasion despite no overt imaging findings. Dural resection may be associated with improved margin control, but no oncologic benefit except for esthesioneuroblastomas, although treatment heterogeneity and small sample size may limit conclusions.

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Overcoming Challenges in the Endoscopic Management of Sinonasal Tumors

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1077 ◽

2011 ◽

Vol 3 (3) ◽

pp. 168-175

Author(s):

Balagopal Kurup

Keyword(s):

Skull Base ◽

Meta Analysis ◽

Surgical Techniques ◽

Anterior Skull Base ◽

Endoscopic Management ◽

International Studies ◽

En Bloc ◽

Sinonasal Malignancies ◽

Successful Removal

ABSTRACT Introduction The complex anatomical relationships of the sinonasal compartment with the surrounding vital structures make it vulnerable, yet simultaneously surgically accessible. Sinonasal tumors, especially those extending beyond, toward the anterior skull base and orbit have always posed a challenge, as far as their en bloc, and when applicable, oncologically safe removal is concerned. Traditionally, numerous external approaches have been employed for their successful removal. With advancements in endoscopic sinus surgical techniques and instrumentation, a majority of these tumors can be removed via purely transnasal endoscopic, and sometimes endoscopicassisted procedures. Materials and methods A series of 61 sinonasal tumors have been managed by endoscopic or endoscopic-assisted procedures over the last 6 years. The principles of their management and the challenges posed have been highlighted. Methods to tackle the same, backed by evidence from numerous international studies have been applied to these, and the outcome discussed. Conclusion Endoscopic and endoscopic-assisted procedures are proving to be an effective alternative to the traditional external approaches for the management of sinonasal malignancies with comparable results. However, a long-term meta-analysis is imperative to corroborate these results.

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Endoscopy skull-base resection for ethmoid adenocarcinoma and olfactory neuroblastoma

Rhinology Journal ◽

10.4193/rhino09.128 ◽

2011 ◽

Vol 49 (1) ◽

pp. 74-79

Author(s):

Filippo Carta ◽

Romain Kania ◽

Elisabeth Sauvaget ◽

Damien Bresson ◽

Bernard George ◽

...

Keyword(s):

Skull Base ◽

Local Control ◽

Postoperative Radiotherapy ◽

Disease Free Survival ◽

Olfactory Neuroblastoma ◽

Anterior Skull Base ◽

Facial Skeleton ◽

Craniofacial Resection ◽

Free Survival ◽

Sinonasal Malignancies

Statement of problem: Olfactory neuroblastoma (ON) and ethmoid adenocarcinoma (AC) are rare sinonasal malignancies that often involve the skull base. Standard surgical treatment is craniofacial resection (CFR), which allows for efficient removal but entails significant morbidity and mortality. Because expanded endoscopy nasal approaches are newly developed, we aimed to describe the procedure in patients with ON and AC and compare it with CFR in terms of efficiency and morbidity. Methods: This work reports on a retrospective series of 16 patients with AC and ON treated endoscopically with anterior skull-base resection in a single institution over 9 years. Invasion of the frontal sinus, massive extension to the cerebral parenchyma, spread of the tumour above the orbits or lysis of anterior facial skeleton were contraindications for endoscopy resection. Results: Of the 16 patients, 11 had AC and 5 ON. In total, 37.5% (6) exhibited skull-base invasion. All patients had postoperative radiotherapy. In the early postoperative period, one patient experienced delayed seizure due to a minor subdural hematoma. Two delayed complications were observed: one encephalocele related to inappropriate postoperative care, which required revision surgery, and one extended radionecrosis. Five-year disease-free survival was 83% and 5-year recurrence-free survival 58%. Local control rate was 91% for AC and 100% for ON. Conclusions: With low perioperative morbidity and efficient local control, ethmoidectomy combined with anterior skull-base resection is a promising approach for managing selected cases of AC and ON. These findings need further investigation with prolonged follow-up.

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The neurosurgical management of sinonasal malignancies involving the anterior skull base: a 28-year experience at The MD Anderson Cancer Center

Journal of Neurosurgery ◽

10.3171/2021.5.jns21772 ◽

2021 ◽

pp. 1-9

Author(s):

Gautam U. Mehta ◽

Joel Z. Passer ◽

Shaan M. Raza ◽

Betty Y. S. Kim ◽

Shirley Y. Su ◽

...

Keyword(s):

Skull Base ◽

Surgical Management ◽

Anterior Skull Base ◽

Brain Invasion ◽

Lumbar Drain ◽

Sinonasal Malignancies ◽

Stage Disease ◽

Over Time

OBJECTIVE Sinonasal malignancies that extend to the anterior skull base frequently require neurosurgical intervention. The development of techniques for craniofacial resection revolutionized the management of these neoplasms, but modern and long-term data are lacking, particularly those related to the incorporation of endoscopic techniques and novel adjuvant chemotherapeutics into management schema. The present study was performed to better define the utility of surgical management and to determine factors related to outcome. METHODS Patients who underwent surgery between 1993 and 2020 were included in this retrospective cohort study. Only patients with greater than 6 months of clinical and radiological follow-up were included. Outcome measures included progression, survival, and treatment-related complications. RESULTS Two hundred twenty-five patients were included. The mean clinical follow-up was 6.5 years. The most common histological diagnosis was olfactory neuroblastoma (33%). Overall, metastatic disease and brain invasion were present in 8% and 19% of patients, respectively, at the time of surgery. A lumbar drain was used in 54% of patients. When stratified by decade, higher-stage disease at surgery became more frequent over time (15% of patients had metastatic disease in the 3rd decade of the study period vs 4% in the 1st decade). Despite the inclusion of patients with progressively higher-stage disease, median overall survival (OS) remained stable in each decade at approximately 10 years (p = 0.16). OS was significantly worse in patients with brain invasion (p = 0.006) or metastasis at the time of surgery (p = 0.014). Complications occurred after 28% of operations, but typically resulted in no long-term negative sequelae. Use of a lumbar drain was a significant predictor of complications (p = 0.02). Permanent ophthalmological disabilities were observed after 4% of surgical procedures. One patient died during the perioperative period. Finally, major complications (Clavien-Dindo grade ≥ IIIb) decreased from 27% of patients in the 1st decade to 10% in the 3rd decade (p = 0.007). CONCLUSIONS The surgical management of sinonasal malignancies with anterior skull base involvement is effective and generally safe. Surgical management, however, is only one facet of the overall multimodal management paradigms created to optimize patient outcomes. Survival outcomes have remained stable despite more extensive disease at surgery in patients who have presented in recent decades. The safety of such surgery has improved over time owing to the incorporation of endoscopic surgical techniques and the avoidance of lumbar spinal drainage with open resection.

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Endonasal Endoscopic Anterior Skull Base Surgery for Sinonasal Malignancies: Juntendo’s Experience

Juntendo Medical Journal ◽

10.14789/jmj.63.279 ◽

2017 ◽

Vol 63 (4) ◽

pp. 279-284

Author(s):

KATSUHISA IKEDA ◽

SHIN ITO ◽

HIROTOMO HOMMA ◽

NORITSUGU ONO ◽

HIROKO OKADA ◽

...

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Anterior Skull Base ◽

Sinonasal Malignancies

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Incisional Recurrence after Midface and Anterior Skull Base Surgery in Sinonasal Malignancies

Skull Base ◽

10.1055/s-2006-958358 ◽

2007 ◽

Vol 16 (S 1) ◽

Author(s):

Michael Moore ◽

Derrick Lin ◽

Daniel Deschler ◽

Vicente Resto ◽

Annie Chan

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Anterior Skull Base ◽

Sinonasal Malignancies

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Expanded Endonasal Approaches to the Anterior Skull Base

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1078 ◽

2011 ◽

Vol 3 (3) ◽

pp. 176-183 ◽

Cited By ~ 2

Author(s):

Pornthep Kasemsiri ◽

Matthew Old ◽

Leo FS Ditzel Filho ◽

Danielle de Lara ◽

Daniel M Prevedello ◽

...

Keyword(s):

Skull Base ◽

Selection Criteria ◽

Anterior Skull Base ◽

Surgical Approaches ◽

Olfactory Groove ◽

Sinonasal Malignancies ◽

Technological Advances ◽

Cranial Fossa ◽

Patient Selection Criteria ◽

Ventral Skull Base

ABSTRACT Recent technological advances and growing cooperation between otorhinolaryngologists and neurosurgeons, coupled with an increasing knowledge of the anatomy of the ventral skull base, have led to the development of a series of surgical approaches to this region. Utilizing the nasal corridor, these expanded endonasal approaches (EEAs) benefit from the increased luminosity and definition provided by the endoscope to navigate through this corridor and reach a multitude o pathologies, both neoplastic and degenerative in nature. One of their common uses is to address tumors that arise from or invade the anterior cranial fossa; these lesions may include olfactory groove meningiomas, esthesioneuroblastomas and sinonasal malignancies. In order to safely resect these tumors through EEAs the surgical team must adhere to a series of steps, while planning the procedure as well as carrying it out. In this review article, the authors present these steps and describe the main patient selection criteria and complication avoidance strategies related to expanded endonasal approaches to the anterior skull base.

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