title: Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study.
abstract: BACKGROUND
  Advances in imaging, surgical technique, and perioperative care have made craniofacial resection (CFR) an effective and safe option for treating malignant tumors involving the skull base. The procedure does, however, have complications. Because of the relative rarity of these tumors, most existing data on postoperative complications come from individual reports of relatively small series of patients. This international collaborative report examines a large cohort of patients accumulated from multiple institutions with the aim of identifying patient-related and tumor-related predictors of postoperative morbidity and mortality and set a benchmark for future studies.
  
  
  METHODS
  One thousand one hundred ninety-three patients from 17 institutions were analyzed for postoperative mortality and complications. Postoperative complications were classified into systemic, wound, central nervous system (CNS), and orbit. Statistical analyses were carried out in relation to patient characteristics, extent of disease, prior radiation treatment, and type of reconstruction to determine factors that predicted mortality or complications.
  
  
  RESULTS
  Postoperative mortality occurred in 56 patients (4.7%). The presence of medical comorbidity was the only independent predictor of mortality. Postoperative complications occurred in 433 patients (36.3%). Wound complications occurred in 237 (19.8%), CNS-related complications in 193 (16.2%), orbital complications in 20 (1.7%), and systemic complications in 57 (4.8%) patients. Medical comorbidity, prior radiation therapy, and the extent of intracranial tumour involvement were independent predictors of postoperative complications.
  
  
  CONCLUSIONS
  CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR.
authors.affiliation: Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Bhuvanesh
authors.initials: B
authors.lastname: Singh
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Bridger
authors.forename: Giulo
authors.initials: G
authors.lastname: Cantu
authors.forename: Anthony
authors.initials: A
authors.lastname: Cheesman
authors.forename: Geraldo
authors.initials: G
authors.lastname: De Sa
authors.forename: Paul
authors.initials: P
authors.lastname: Donald
authors.forename: Dan
authors.initials: D
authors.lastname: Fliss
authors.forename: Patrick
authors.initials: P
authors.lastname: Gullane
authors.forename: Ivo
authors.initials: I
authors.lastname: Janecka
authors.forename: Shin-etsu
authors.initials: SE
authors.lastname: Kamata
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Paul
authors.initials: P
authors.lastname: Levine
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Medina
authors.forename: Sultan
authors.initials: S
authors.lastname: Pradhan
authors.forename: Victor
authors.initials: V
authors.lastname: Schramm
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
authors.forename: William I
authors.initials: WI
authors.lastname: Wei
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D019292:Skull Base Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*