CRANIAL BASE SURGERY - RESULTS IN 183 PATIENTS

OBJECTIVE: To learn about the effects of cranial base surgery. DESIGN: Cohort study with a mean follow-up of 30 months. SETTING: Population- based. PATIENTS: A consecutive sample of 183 patients who underwent cr anial base surgery; 118 patients had malignant skull base tumors, the majority of which were previously treated; 50 had benign tumors; 9 had congenital malformations of the skull base; 3 had inflammatory lesion s, and 3 had traumatic defects of the skull base. MAIN OUTCOME MEASURE S: Disease-free interval, overall survival, and rate of complications and functional status. INTERVENTION: Cranial base surgery was followed by radiotherapy (in previously untreated patients). RESULTS: After co mpletion of follow-up (mean, 30 months), 30 (25.4%) patients had died of their malignant tumors and 8 (6.8%) had died of other causes. One p atient (0.84%) was lost to follow-up. The overall cancer survival rate without regard to histologic type was 67% (63% with no evidence of di sease). Among the patients who were treated for benign neoplasm, 72% h ad no evidence of disease at a mean follow-up of 39 months. The group of patients with congenital malformations and inflammatory and traumat ic lesions demonstrated successful correction of their presurgical pro blem with skull base surgery. One patient (who had invasive aspergillo sis) died of disease. The overall surgical-medical mortality rate was 2%; the complication rate was 33%, and the Karnofsky performance score was improved or unchanged after surgery in 83% of patients. The avera ge duration of surgery, number of blood transfusions used, and length of the hospital stay were 10 hours, 3 units, and 15 days, respectively . CONCLUSIONS: Cranial base surgery is a valid surgical technique for treatment of cranial base afflictions. In this study it was found to b e beneficial in controlling benign and malignant disease and to be the treatment of choice for selected congenital malformations, trauma, an d inflammatory lesions.