Treatment of malignant neoplasms of the lateral cranial base with the combined frontotemporal-anterolateral approach: Five-year follow-up

Technical advances in accessing the lateral cranial base have permitted dis ease in this area previously deemed inoperable to be resected. The procedur es required to effect an oncologically adequate resection are often long an d accompanied by the potential for serious, even life-threatening, complica tions. Although it has been demonstrated that such disease can be extirpate d, the question of whether such heroic surgery improves long-term survival remains unanswered. We retrospectively reviewed the records of 25 patients who underwent a combination of frontotemporal craniotomy with other, more c onventional, anterolateral procedures (eg, infratemporal fossa approach, ma xillectomy, orbitectomy, mandibulopharyngectomy) to resect stage IV maligna nt disease of the lateral to midcranial base between 1983 and 1990. Periope rative deaths occurred in 2 patients, 1 patient died of unrelated causes fr ee of disease, and 2 patients were lost to follow-up, leaving 20 patients w ith a minimum B-year evaluation. Five (25%) of the 20 patients we monitored were free of disease. Of those patients in whom recurrent disease develope d, local control was achieved in about 50%; however in 80% of those with re currence, metastatic disease developed. Surgical treatment of selected stag e IV malignant disease of the lateral to midcranial base appears to have pr ovided long-term disease-free survival to 25% of patients in this series wh o would otherwise have had little hope of survival.