Diagnosis, treatment and results of malignant skull base tumours.

Background: Malignant tumours of the cranial base are rare and present usua lly in advanced tumour stage due to the lack of early clinical symptoms. Pa tients and Methods: Sixty patients with malignant tumours infiltrating the skull base were treated at the Department of Otorhinolaryngology Head and N eck Surgery, University of Wurzburg between 1987 and 1999. Most of the tumo urs (n = 51) originated from the nose or paranasal sinuses, the epipharynx, the outer ear canal or the middle ear. Seven tumours were malignant brain tumours; infiltrating the bony structures of the skull base or originated f rom the cranial base itself. Two patients suffered from metastases of an ad enocarcinoma of the prostata. The histological diagnosis was confirmed in 5 3 patients preoperatively and in seven patients during tumour resection. Sq uamous cell carcinoma (n = 24), adenocarcinoma (n = 10) and sarcoma (n = 7) were the most common histologies found. Results: A radical en bloc resecti on of the tumour was only possible in 26 out of 60 cases. A surgical tumour reduction with postoperative radiation therapy was performed in seven pati ents as a palliative approach. Eight patients underwent a combined radio- a nd chemotherapy according to the histological diagnosis. Primary radiothera py was the treatment of choice in eleven patients, where the tumours were l ocated in the central area of the cranial base. Palliative radiotherapy or solely medical pain control were applied to eight patients who presented ei ther with distant metastases or an advanced tumour growth. The mean postope rative survival following radical surgery was 48 months and after primary r adiotherapy 27 months. Discussion: A statistical analysis of the results is not applicable due to the great variety of the disease concerning the hist ological diagnosis, the tumour size and the location as well as the small n umber of patients.