Long-term outcome following radical temporal bone resection for lateral skull base malignancies: a neurosurgical perspective.
OBJECTIVE
Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations.


METHODS
Between 1994 and 2006, 17 patients (10 men and 7 women) underwent total or subtotal TBR for primary temporal bone malignancies. Tumors were graded according to the University of Pittsburgh system. The effects of surgical margins and tumor extensions on patient survival were analyzed using the Kaplan-Meier method.


RESULTS
All tumors, except 1, were graded T4 (most advanced). Subtotal TBR was performed in 14 patients, and total TBR was performed in 3. The surgical margin was tumor negative in 10 patients and tumor positive in 7. For large tumors extending into the infratemporal fossa or encroaching on the jugular foramen, orbitozygomatic (3 patients) and posterior transjugular (4 patients) approaches were combined with the standard approach, and en bloc resection with a negative margin was achieved in all cases but 1. The follow-up time ranged from 0.3-11.6 years (mean 3.3 years). The 5-year recurrence-free and disease-specific survival rates were 67.5 and 60.1%, respectively. When a negative surgical margin was achieved, the survival rates improved to 100 and 89%, respectively.


CONCLUSIONS
The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.
Kawahara
Nobutaka
N
Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. kawahara-tky@umin.ac.jp
Sasaki
Tomio
T
Asakage
Takahiro
T
Nakao
Kazunari
K
Sugasawa
Masashi
M
Asato
Hirotaka
H
Koshima
Isao
I
Saito
Nobuhito
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013701:Temporal Bone / Q000601:surgery*; D016896:Treatment Outcome