title: Treatment of recurrent carcinoma at the base of the skull with carbon dioxide laser.
abstract: The extension of carcinoma to the cribriform plate is a poor prognostic finding. Two extremes of treatment approach have been advocated. On the one hand, patients may be abandoned to palliative chemotherapy. On the other hand, heroic and aggressive resections may be advocated including combined neurosurgical transdural and otolaryngologic facial-orbital resection. Armed with the surgical microscope and the CO2 laser there may be a place for a middle ground of therapy. We present our experience with recurrent tumor after full course radiation therapy and maxilloethmoidectomy. The biopsy proven recurrences were found at the cribriform plate but could not be shown to have crossed into the anterior cranial fossa by polytomography or high resolution CT scanning. The CO2 surgical laser delivered through the surgical microscope was used with repeated applications. Recurrent epidermoid carcinoma found to be confined to the nasal side of the cribriform plate can be controlled by careful microscopic stripping of soft tissue from the cribriform plate with a surgical laser.
mesh_terms: D000328:Adult; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005004:Ethmoid Bone; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008437:Maxilla / Q000601:surgery; D008441:Maxillary Neoplasms / Q000601:surgery; D008722:Methods; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011379:Prognosis; D012888:Skull Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*