Combined subcranial approaches for excision of complex anterior skull base tumors.
OBJECTIVE
To present our method for excision of complex anterior skull base tumors via combinations of the subcranial approach.


METHODS
Of 120 anterior skull base tumor resections, 41 that included 27 (66%) malignant and 14 (34%) benign lesions were performed via combinations of the subcranial approach. Unilateral or bilateral medial maxillectomy was performed using the subcranial approach alone for 13 tumors infiltrating the anterior skull base, ethmoid bones, and medial maxillary wall. A combined subcranial-transfacial approach in 2 lesions or a combined subcranial-midfacial degloving approach in 14 lesions was performed for tumors involving the skull base and the lower or lateral segments of the maxilla. A combined subcranial-transorbital or transfacial-transorbital approach was used for 5 tumors invading the orbit. An extended subcranial-orbitozygomatic approach was used for 6 tumors invading the middle cranial fossa or involving the cavernous sinus. A combined subcranial-Le Fort I down-fracture approach was used for 1 dedifferentiated chordoma invading the anterior skull base and lower clivus. The surgical results, patient quality of life, survival, and complications were measured.


RESULTS
Thirty-seven of 41 tumors (90%) were completely resected. Fifteen patients (35.5%) had perioperative complications. There were no postoperative deaths. Two-year overall and disease-free survival in patients with malignant tumors who underwent combined approaches was 66% and 60%, respectively. There was no significant difference in the quality of life between patients operated on via combined or classic subcranial approaches.


CONCLUSIONS
Combinations and modifications of the subcranial approach for excision of complex anterior skull base tumors yield surgical results, survival, quality of life, and complications similar to those found with the classic subcranial technique.
Fliss
Dan M
DM
Head and Neck Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Abergel
Avraham
A
Cavel
Oren
O
Margalit
Nevo
N
Gil
Ziv
Z
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002817:Chordoma / Q000401:mortality / Q000523:psychology / Q000601:surgery; D035262:Cranial Fossa, Anterior / Q000601:surgery*; D003399:Craniotomy / Q000379:methods* / Q000523:psychology; D005145:Face / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D015996:Survival Rate