METAANALYSIS OF OUTCOME IN ANTERIOR SKULL BASE RESECTION FOR SQUAMOUS-CELL AND UNDIFFERENTIATED CARCINOMA

Multiple reports now demonstrate the technical feasibility of combined intra- and extracranial procedures for the excision of malignancy inv olving the anterior skull base. Anatomic proximity to vital structures in this region often precludes en bloc resection, however, and margin s are often measured in millimeters. Nevertheless, multiple cases of p rolonged survival following craniofacial excision of high-grade malign ancies have been reported. These are usually included in larger series that encompass tumors of various histologic characteristics and grade . A meta-analysis of the reported outcome of craniofacial resection fo r squamous cell and undifferentiated carcinoma was performed. Ninety-s ix articles on craniofacial resection were reviewed and a total of 425 patients who had undergone craniofacial resection were identified in 30 of these. Of 89 patients with squamous cell carcinoma in whom follo w-up data were available from seven larger series, the disease-free su rvival at 2 or greater years was 64%. Forty-one patients with undiffer entiated carcinoma were identified who had undergone surgical excision , and 45% were disease-free at 2 or greater years (range, 2 to 24 year s). This meta-analysis suggests that high-grade carcinoma involving th e anterior cranial base is amenable to surgical excision with acceptab le disease-free survival in selected patients at 2 years.