title: Craniofacial resection for malignant tumors involving the anterior skull base.
abstract: OBJECTIVE
  To review our experience with craniofacial resection for malignant neoplasms of the anterior skull base and report long-term results, and to analyze survival in terms of the overall experience, tumor histological diagnoses, and tumor extent. Also, to report complications of this surgical procedure.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary cancer facility.
  
  
  METHODS
  We evaluated 115 consecutive patients undergoing craniofacial resection for malignant neoplasms involving the anterior skull base. Forty-five (39%) presented with recurrent or persistent disease after prior therapy.
  
  
  METHODS
  Survival was evaluated with the Kaplan-Meier product limit method and comparisons between individual subgroups were performed using the log-rank test.
  
  
  RESULTS
  The operative mortality rate was 3.5%. Major complications occurred in 40 patients (35%). For the entire group, disease-specific survival rates were 58% and 48% at 5 and 10 years, respectively. The highest survival rate was observed in patients with esthesioneuroblastoma and lowest in those with mucosal melanoma. Survival was significantly better for those whose tumors could be excised with a limited resection in comparison with those requiring an extended procedure (P = .009).
  
  
  CONCLUSIONS
  A 23-year experience with craniofacial resection performed for malignant tumors involving the anterior skull base confirms the durable results obtained with this intervention. The diversity of histological diagnoses, site of origin, extent of tumor invasion, and impact of prior therapy hampers any attempt at reporting meaningful survival statistics for comparison with other series or other means of treatment.
authors.affiliation: Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Shah
authors.forename: D H
authors.initials: DH
authors.lastname: Kraus
authors.forename: M H
authors.initials: MH
authors.lastname: Bilsky
authors.forename: P H
authors.initials: PH
authors.lastname: Gutin
authors.forename: L H
authors.initials: LH
authors.lastname: Harrison
authors.forename: E W
authors.initials: EW
authors.lastname: Strong
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D018304:Esthesioneuroblastoma, Olfactory / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D012888:Skull Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate