title: [Navigated "targeted surgery" for skull base malignomas: additional space for surgical manipulation by neoadjuvant tumor downsizing].
abstract: BACKGROUND
  Multimodal strategies are required due to the poor prognosis for locally advanced frontal skull base tumors staged as T4. Therefore, a further increase in the degree of invalidity caused by therapy should be avoided, if possible, to preserve the quality of life. As the incidence of these tumors is low, there are no evidence-based, generally accepted therapeutic strategies.
  
  
  METHODS
  We evaluated the clinical results of three patients with extended frontal skull base malignomas staged as T4 tumors. The clinical course as well as the surgical technique were analyzed.
  
  
  RESULTS
  High dose neoadjuvant therapy for tumor downsizing was performed in all three patients within a multimodal therapy concept. The additional space for surgical manipulation close to the tumor borders, non-traumatically produced by tumor remission, permitted a safely navigated, controlled resection of the tumor under endoscopic or microscopic viewing using an approach associated with reduced trauma as "targeted surgery".
  
  
  CONCLUSIONS
  Surgical radicality is limited by the direct vicinity of locally progressive T4 tumors to the frontal brain and other vital structures. A controlled tumor downsizing allows the resection of such tumors using a minimally invasive approach assisted by instrumental navigation leading to less traumatization.
authors.affiliation: Universitätsklinik für HNO, Heinrich-Heine-Universität Düsseldorf, Deutschland. georg.schipper@med.uni-duesseldorf.de
authors.forename: J
authors.initials: J
authors.lastname: Schipper
authors.forename: A
authors.initials: A
authors.lastname: Berlis
authors.forename: T
authors.initials: T
authors.lastname: Klenzner
authors.forename: A
authors.initials: A
authors.lastname: Schramm
authors.forename: N-C
authors.initials: NC
authors.lastname: Gellrich
authors.forename: S
authors.initials: S
authors.lastname: Rosahl
authors.forename: W
authors.initials: W
authors.lastname: Maier
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000601:surgery*; D020360:Neoadjuvant Therapy / Q000379:methods; D010027:Osteotomy / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D019292:Skull Base Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome