Paranasal sinus cancer has been difficult to treat with surgery. A sig
nificant negative factor has been the high frequency of tumor positive
surgical margins. The goal of this study was to evaluate the effectiv
eness of cranial base surgery in achieving higher tumor-free resective
margins and its impact on the disease control. Fifty patients with pa
ranasal sinus cancer were treated with cranial base surgery and retros
pectively evaluated. Surgery was performed for both primary and recurr
ent disease (''salvage''), with more than half of the surgeries being
salvage procedures. The survival at 40 months of mean follow-up is 74%
, and 64% of the patients either have no evidence of disease (NED) or
have died of other causes (DOC). Cranial base surgery is an effective
treatment of paranasal sinus cancer. The ability to achieve tumor-free
surgical margins (77% in squamous cell carcinoma [SCC]) is directly r
elated to NED status (75% of NED patients had free margins).