PROGNOSTIC FACTORS AND OUTCOME IN CRANIOFACIAL SURGERY FOR MALIGNANT CUTANEOUS TUMORS INVOLVING THE ANTERIOR SKULL BASE

Background: We retrospectively reviewed the medical charts of 57 patie nts with advanced malignant cutaneous tumors involving the anterior sk ull base who underwent combined craniofacial resection in our departme nt from January 1, 1981, to December 31, 1994. Methods: The data regar ding histological results, demographic aspects, clinical presentation, previous treatment, extent of the disease, extent of surgical procedu re, type of reconstruction, complications, and follow-up were analyzed using the chi(2) method. Survival analysis was performed using the Ka plan-Meier method. Results: We found prevalence of the male sex (60%) and white race (86%), with a mean age of 62 years. Thirty-five patient s (61%) showed extensive lesions directly invading the anterior skull base (type II); 46 patients (81%) had been treated previously; 10 pati ents (18%) had dural invasion; 29 patients (51%) could not have the ey e-ball preserved; 32 patients (56%) underwent microsurgical reconstruc tion; and 45 patients (79%) underwent pericranial or galeal-pericrania l flap reconstruction for the anterior skull base defect. postoperativ e complications occurred in 29 patients (51%). The most common complic ation was postoperative infection (17 patients [59%]). Thirty-two pati ents (56%) were free of disease, and 4 (7%) were alive with disease at the time of our study. Conclusions: The extent of facial disease (P=. 005) and the type of facial reconstruction (P=.01) were the most impor tant risk factors in the development of infectious complications. Inva sion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid le akage (P=.003) and meningoencephalitis (P=.06). Invasion of the dura m ater significantly affected survival (P=.005).