title: Extended anterior craniofacial resection for intracranial extension of malignant tumors.
abstract: OBJECTIVE
  To review our experience with anterior craniofacial resection for malignant neoplasms with intracranial extension. Survival was analyzed in terms of presence of intracranial extension, extent of intradural disease, tumor histology, and histological status of margins.
  
  
  METHODS
  In a retrospective review made at a tertiary cancer facility, 26 of the 115 consecutive patients undergoing craniofacial resection for malignant lesions of the anterior skull base had intracranial extension, defined as dural and/or brain extension. Survival was evaluated with the Kaplan-Meier product limit method, and comparisons between individual subgroups were performed using the log-rank test.
  
  
  RESULTS
  Patients with intradural extension have a statistically worse disease-specific survival than patients without intracranial extension (P = 0.05). Surgical margins and tumor histology impact on survival. The incidence of local complications was 42% and of systemic complications, 8%.
  
  
  CONCLUSIONS
  Anterior craniofacial resection is indicated for patients with resectable disease. The complication rate is comparable with that of patients without intracranial extension. Gross total resection with histologically negative margins portends a better prognosis. Esthesioneuroblastoma has a better prognosis than other tumor types.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Bilsky
authors.forename: D H
authors.initials: DH
authors.lastname: Kraus
authors.forename: E W
authors.initials: EW
authors.lastname: Strong
authors.forename: L B
authors.initials: LB
authors.lastname: Harrison
authors.forename: P H
authors.initials: PH
authors.lastname: Gutin
authors.forename: J P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009669:Nose Neoplasms / Q000473:pathology / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis