title: Surgical management of cranial base metastases.
abstract: BACKGROUND
  Cranial base metastases (CBM) are rare and have received limited attention in the medical literature. Questions remain regarding the role of surgery, if any, in the management of these tumors.
  
  
  OBJECTIVE
  To report surgical outcomes in a consecutive series of patients with CBM and to better define the role of surgery in their management.
  
  
  METHODS
  Twenty-seven patients with CBM underwent surgery between 1996 and 2009 at MD Anderson Cancer Center. A retrospective review of their prospectively collected data was performed after obtaining institutional review board approval. The median patient age was 52 years. The most common pathology was renal cell carcinoma (6 patients). Surgical indications were worsening neurological deficit, disfiguring mass, and the need for a diagnosis.
  
  
  RESULTS
  Gross total resection was achieved in 59% of the cases. The median survival was 11.4 months. The median progression-free survival was 5.8 months. A Karnofsky Performance Scale score less than 90, dural invasion, and brain invasion were associated with a shorter survival. Seven patients were neurologically intact preoperatively; all of them remained intact after surgery. Among all patients with preoperative neurological deficit, 11 remained stable, 7 improved, and 2 had worsening of their deficit postoperatively.
  
  
  CONCLUSIONS
  The goal of surgery for CBM is to provide symptom relief and to preserve functional status in well-selected cases. Patient selection is critical because the surgery is usually palliative, and only a minority of patients are surgical candidates. Radiation therapy remains the management option of choice for the majority of patients.
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA.
authors.forename: Roukoz B
authors.initials: RB
authors.lastname: Chamoun
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.forename: Franco
authors.initials: F
authors.lastname: DeMonte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019292:Skull Base Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D055815:Young Adult