Craniofacial resection for cranial base malignancies involving the infratemporal fossa.
OBJECTIVE
Cranial base malignancies involving the infratemporal fossa have been considered unresectable. Advanced operative techniques have made tumor resection feasible in an en bloc fashion with negative histological margins, but there are limited data regarding outcome analysis in patients who have undergone resection of malignant tumors in this area.


METHODS
At Memorial Sloan-Kettering Cancer Center, 25 patients underwent anterolateral cranial base resections for tumors that involved the infratemporal fossa during a 7-year period. The most common tumors were sarcoma (n = 9), squamous cell carcinoma (n = 6), and adenoid cystic carcinoma (n = 3). The median size of the tumors was 6 cm, and 12 tumors involved the anterior cranial base and/or orbit. Tumor resections were divided into three types. Twelve patients underwent Type 1 dissection for tumors involving only the infratemporal fossa and maxillary sinus; 2 patients underwent Type 2 dissections involving the infratemporal fossa and anterior cranial base; and 11 patients underwent Type 3 dissection, which included the infratemporal fossa, anterior cranial base, and orbit. All patients required free flap reconstruction, 22 of which were rectus abdominis free flaps.


RESULTS
Complications occurred in seven patients, including a single mortality resulting from a myocardial infarction. The 2-, 3-, and 5-year survival rates were 69, 63, and 56%, respectively. The relapse-free survival rates were 47% at 2 and 3 years and 41% at 5 years. Recurrences were local in nine patients and distant in four patients.


CONCLUSIONS
Despite the extensive nature of many infratemporal fossa tumors, they can be resected with acceptable morbidity. Survival rates approach those of anterior cranial base malignancies without infratemporal fossa involvement.
Bilsky
Mark H
MH
Department of Surgery, Memorial Sloan-Kettering Cancer Center, Weill Medical College, Cornell University, New York, New York, USA. bilskym@mskcc.org
Bentz
Brandon
B
Vitaz
Todd
T
Shah
Jatin
J
Kraus
Dennis
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035262:Cranial Fossa, Anterior / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005500:Follow-Up Studies; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D008577:Meningeal Neoplasms / Q000145:classification / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000145:classification / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome