CRANIOFACIAL RESECTION FOR MALIGNANT-TUMORS INVOLVING THE ANTERIOR SKULL BASE

Objectives: To review our experience with craniofacial resection for m alignant neoplasms of the anterior skull base and report long-term res ults, and to analyze survival in terms of the overall experience, tumo r histological diagnoses, and tumor extent. Also, to report complicati ons of this surgical procedure. Design: Retrospective review. Setting: Tertiary cancer facility. Patients: We evaluated 115 consecutive pati ents undergoing craniofacial resection for malignant neoplasms involvi ng the anterior skull base. Forty-five (39%) presented with recurrent or persistent disease after prior therapy. Main Outcome Measures: Surv ival was evaluated with the Kaplan-Meier product limit method and comp arisons between individual subgroups were performed using the log-rank test. Results: The operative mortality rate was 3.5%. Major complicat ions occurred in 40 patients (35%). For the entire group, disease-spec ific survival rates were 58% and 48% at 5 and 10 years, respectively. The highest survival rate was observed in patients with esthesioneurob lastoma and lowest in those with mucosal melanoma. Survival was signif icantly better for those whose tumors could be excised with a limited resection in comparison with those requiring an extended procedure (P = .009). Conclusions: A 23-year experience with craniofacial resection performed for malignant tumors involving the anterior skull base conf irms the durable results obtained with this intervention. The diversit y of histological diagnoses, site of origin, extent of tumor invasion, and impact of prior therapy hampers any attempt at reporting meaningf ul survival statistics for comparison with other series or other means of treatment.