title: Extended orbital exenteration for sinonasal malignancy with orbital apex extension: surgical technique and clinical analysis.
abstract: OBJECTIVE
  The majority of sinonasal malignancies present with advanced disease, and cure rates are generally poor. Surgical extirpation remains the mainstay of treatment. In cases of sinonasal malignancy with orbital apex extension, gross-total tumor resection requires orbital exenteration and bony skull base resection around the orbital apex to provide sufficient margins. In this retrospective study, the authors describe their surgical strategy in and technique for orbital exenteration with orbital apex resection in patients at Tokyo Medical and Dental University who had sinonasal malignancy with orbital apex extension. They also analyzed the clinical features of and the results in these patients.
  
  
  METHODS
  Between February 2001 and August 2012 at the authors' institution, sinonasal malignancy with orbital apex extension was treated using craniofacial tumor resection with orbital exenteration including skull base bone around the orbital apex. The authors describe this technique and analyze the surgical indications, extent of resection, primary tumor location, outcome, pathological findings, and neoadjuvant and adjuvant therapies of the patients who underwent the technique.
  
  
  RESULTS
  The patients consisted of 12 men and 3 women with a mean age of 47.7 years (range 14-79 years). The longest postoperative follow-up was 9.5 years, and the shortest was 0.67 year (mean 3.0 years). Tumor originated at the ethmoid sinus in 6 patients (40%), maxillary sinus in 5 (33%), nasal cavity in 2 (13%), and orbital cavity and maxillary bone in 1 patient each (7%). Histological analysis of tumor specimens revealed squamous cell carcinoma in 9 patients (60%), rhabdomyosarcoma in 2 (13%), and small cell carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and Ewing sarcoma in 1 patient each (7%). Two patients experienced recurrences at 1 and 5 months after treatment; these patients died at 5 and 10 months after surgery, respectively. Estimated 5-year recurrence-free survival (RFS) was 86.7%, and estimated 5-year overall survival (OS) was 86.2%; there was no perioperative mortality. None of the patients had new neurological deficits as a result of the surgery, but 5 patients suffered infectious complications from the graft transplanted into the cavity after resection. There were no other perioperative complications.
  
  
  CONCLUSIONS
  These authors are the first to describe a technique for extended orbital exenteration with orbital apex skull base resection. The technique provided sufficient margins for gross-total resection of the sinonasal malignancy with orbital apex extension. The estimated 5-year OS and RFS rates were high, and the perioperative complication rate was acceptably low, demonstrating the safety and efficacy of this technique.
authors: Departments of 1 Neurosurgery.
authors: Takashi
authors: T
authors: Sugawara
authors: Departments of 1 Neurosurgery.
authors: Masaru
authors: M
authors: Aoyagi
authors: Departments of 1 Neurosurgery.
authors: Takahiro
authors: T
authors: Ogishima
authors: Departments of 1 Neurosurgery.
authors: Yoshihisa
authors: Y
authors: Kawano
authors: Department of Neurosurgery, Musashino Red Cross Hospital, Tokyo, Japan.
authors: Masashi
authors: M
authors: Tamaki
authors: Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo;
authors: Tomoyuki
authors: T
authors: Yano
authors: Head and Neck Surgery.
authors: Atsunobu
authors: A
authors: Tsunoda
authors: Departments of 1 Neurosurgery.
authors: Kikuo
authors: K
authors: Ohno
authors: Departments of 1 Neurosurgery.
authors: Taketoshi
authors: T
authors: Maehara
authors: Head and Neck Surgery.|Department of Head and Neck Surgery, Kameda Medical Center, Chiba; and.
authors: Seiji
authors: S
authors: Kishimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009669:Nose Neoplasms / Q000401:mortality / Q000601:surgery*; D010256:Paranasal Sinuses / Q000601:surgery; D017397:Prefrontal Cortex / Q000601:surgery*; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000401:mortality / Q000601:surgery*; D019291:Skull Base / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: OS = overall survival; RFS = recurrence-free survival; craniofacial resection; orbital exenteration; sinonasal malignancies; surgical technique