Combined anterior craniofacial resection for tumors involving the cribriform plate: Early postoperative complications and technical considerations

OBJECTIVE: Combined craniofacial resection has become the standard approach for malignant tumors involving the cribriform plate and anterior cranial f ossa. Despite its widespread application, however, many surgeons agree that the procedure carries a risk of significant morbidity and even mortality. The purpose of this study was to analyze the experience at a single institu tion to determine the incidence of early postoperative complications encoun tered after combined craniofacial resection of tumors involving the cribrif orm plate and to provide information to improve management. METHODS: Between 1987 and 1997, 168 patients underwent combined craniofacia l resection at the National Cancer Institute of Milan for tumors involving the cribriform plate. Patient charts, operative notes, follow-up clinic not es, radiographic studies, and pathology reports were analyzed. Morbidity en countered in the first 30 cases was compared with that encountered in the s ubsequent 138 cases. RESULTS: The most frequently encountered pathological findings were adenoca rcinoma (53.6%), squamous cell carcinoma (17%), and esthesioneuroblastoma ( 9.8%). Eight patients (4.7%) died, 6 of whom were among the first 30 patien ts to undergo resection. Among patients with fatal complications were three with meningoencephalitis, three with intracranial hemorrhage, and one with myocardial infarction. Fifty patients (29.7%) had nonfatal morbidity; 16 o f these patients were among the first 30 patients operated. Transient cereb rospinal fluid leakage was the most frequent adverse effect (9.5%); 12 pati ents (7.1%) had pneumocephalus, 3 (1.8%) had meningitis, 4 (2.4%) had wound infections, 3 (1.8%) experienced transient impairment of mental status, 3 (1.8%) had transient diplopia, 2 (1.2%) had diabetes insipidus, and 1 (0.6% ) had bone flap necrosis. CONCLUSION: We observed a dramatic decrease in mortality and morbidity in p atients who underwent combined craniofacial resection after the first 30 ca ses in our series. Improvement of specific aspects of surgical technique, s uch as more refined reconstructive methods and improved prophylactic antibi otic therapy, is at least partly I responsible for this favorable trend.