Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 casesin Japan

We analyzed 143 cases of skull base surgery collected from the eight instit utions of the Study Group supported by the Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan. Histologically, the most common type was squamous cell carcinoma (n = 78), which was followed by ol factory neuroblastoma (n = 16) and adenoid cystic carcinoma (n = 16). The m ost frequent surgical approach was frontal craniotomy (n = 66), followed by front-temporal craniotomy (n = 54) and infratemporal fossa approach (n = 8 ). For repair of dura matter, fascia lata was used in 37 cases, galeopericr anial flap in 35 and temporal muscle fascia in 16. The 5-year survival rate by Kaplan-Meier method of nose and paranasal sinus carcinoma (n = 119) was 48%. As for histological classification, the survival rates were both 65% in adenoid cystic carcinoma (n = 12) and bone soft tissue malignancy (n = 1 0), 62% in olfactory neuroblastoma (n = 16), 46% in squamous cell carcinoma (n = 62) and 33% in adenocarcinoma (n = 11). All the three cases of malign ant melanoma died within 1 year, so we considered skull base surgery to be contraindicated for this disease, Complications were observed in 62 out of the 143 cases (43%); local infection was most frequent in 29 cases, liquorr hea in 18, abscess in 16, necrosis of the flap and meningitis in ten cases, DIC in four, rupture of the internal carotid artery in two and cerebral th rombosis in one. Death caused directly by surgery was in ten cases (7%). It is important that a multi-center registry be maintained to have a large en ough database for comparison of results, and prognosis for each histologica l entity and further define the role of multidisciplinary treatment. (C) 20 01 Elsevier Science Ireland Ltd. All rights reserved.