Anterior craniofacial resection for malignant ethmoid tumors - A series of91 patients

Background. Anterior craniofacial resection is now recognized as the best t reatment for ethmoid tumors involving the cribriform plate with or without invasion of anterior cranial fossa. Methods. Ninety-one patients underwent an anterior craniofacial resection f or ethmoid malignant tumors at the Milan Cancer Institute between 1987 and 1994. The patient population was divided into two sections (30 and 61 patie nts) based upon some important variants (type of craniotomy, antibiotic tre atment, postoperative care). Results. The mean age was 53.4 years (range, 24 to 78 years). There were 62 men and 29 women. Forty-nine patients had a recurrence after previous trea tments (surgery and/or radiotherapy). The subdivision by histology was as f ollows: 50 cases of adenocarcinoma, 16 cases of epidermoid and undifferenti ated carcinoma, 8 cases of esthesioneuroblastoma, 5 cases of adenoid cystic carcinoma, 5 cases of melanoma, and 6 rare tumors. The stages (according t o our new staging) were as follows: 37 cases with T2, 27 cases with T3, and 27 cases with T4. The mean follow-up was 47 months. Seven patients died af ter surgery (6 in the first series). The survival at 3 and 5 years was, res pectively, 52% and 47%, and the disease-free survival (DFS) was 30% and 24% , with a statistically significant difference at multivariate analysis in f avor of patients without prior treatment (p =.033) or T2 versus T3 and T4 ( p <.007). Conclusions. An anterior craniofacial resection should be performed in case s of ethmoid tumors reaching or eroding the cribriform plate. A scrupulous intra- and postoperative approach is necessary to avoid severe complication s. The patients often survive for a long time with recurrence ongoing. Our new staging identifies the critical extensions of ethmoid tumors. (C) 1999 John Wiley & Suns, Inc.