Revision lateral skull base surgery.
OBJECTIVE
To describe functional and reconstructive results after revision lateral skull base surgery with comparison of benign and malignant lesions.


METHODS
Retrospective case review.


METHODS
Tertiary referral center.


METHODS
All patients undergoing revision surgery for benign and malignant lateral skull base tumors.


METHODS
Surgical resection of recurrent lateral skull base tumors and reconstruction of resulting defects.


METHODS
Cranial nerve function postoperative complications.


RESULTS
Forty operations for recurrent lateral skull base tumors occurred between January 1, 1987, and December 31, 2003, with follow-up of at least 1 year. Thirty-three operations were for benign lesions, 27 of which were glomus tumors. Seven operations were for malignant tumors. Fifty-eight percent of patients had preoperative cranial nerve deficits (66% of benign tumors and 14% of malignancies). The most common preoperative deficit occurred in the Xth cranial nerve. Postoperative cranial nerve deficits were seen in 95% of patients and multiple nerve deficits were seen in 75%. The most common postoperative deficits were observed in the IXth and Xth cranial nerves. Thirty-one patients had one previous procedure, six had two previous procedures, and three had three previous procedures. Abdominal fat and temporoparietal fascia were the most common reconstruction materials. There was one case of meningitis, two cerebrospinal fluid leaks, and one pseudomeningocele. There was one recurrent adenoid cystic tumor resulting in death and two partially resected glomus tumors. Subsequent procedures are discussed.


CONCLUSIONS
Postoperative cranial deficits are more common after revision skull base surgery than after primary surgery. Complete resection without recurrence can be expected for revision skull base surgery. Modern reconstruction techniques reduce major postoperative complications and morbidity from cranial nerve deficits.
Kaylie
David M
DM
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA. david.kaylie@vanderbilt.edu
Wittkopf
Justin E
JE
Coppit
George
G
Warren
Frank M
FM
Netterville
James L
JL
Jackson
C Gary
CG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003389:Cranial Nerve Diseases / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005918:Glomus Tumor / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome