title: Endoscopic Endonasal Management of Metastatic Lesions of the Anterior Skull Base: Case Series and Literature Review.
abstract: BACKGROUND
  The anterior skull base is an uncommon site for brain metastases. A limited number of cases have been reported where a region of the skull base is accessed through an expanded/extended transsphenoidal route. In addition, reports of overall and progression-free survival rates are lacking.
  
  
  OBJECTIVE
  To report progression-free and overall survival rates for skull base metastases treated with aggressive endoscopic endonasal surgery and radiation therapy.
  
  
  METHODS
  We retrospectively review a prospective database of patients at New York Presbyterian Hospital undergoing expanded endoscopic endonasal surgery from 2004 to 2014. From this database, we identified all patients whose final pathology revealed a metastatic lesion in the midline skull base.
  
  
  RESULTS
  Seven hundred forty-nine patients underwent endonasal endoscopic surgery. Final pathology in 12 patients (1.6%) revealed metastasis to the sellar or parasellar region. Tumors were located in the sella, suprasellar cistern, clivus, ethmoid sinuses, sphenoid sinus, cavernous sinus, and craniovertebral junction. Breast and lung cancers were the most common primary diagnoses. Gross total resection was achieved in 41.6% of patients. There were no postoperative cerebrospinal fluid leaks. Adjuvant radiation therapy was used in 92% of cases. Median follow-up was 14 months (range, 1-55). Median progression-free and overall survival were 18 and 16 months, respectively.
  
  
  CONCLUSIONS
  The range of anterior skull base metastatic lesions that can be managed endonasally has increased with the advent of extended endonasal endoscopic surgical approaches. Favorable results can be obtained with this surgical approach as part of the overall management paradigm for patients with skull base metastases.
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA. Electronic address: bez2103@columbia.edu.
authors.forename: Brad E
authors.initials: BE
authors.lastname: Zacharia
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Flavio R
authors.initials: FR
authors.lastname: Romero
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Rapoport
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Shaan M
authors.initials: SM
authors.lastname: Raza
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Neuroscience, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010901:Pituitary Function Tests; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Endoscopic endonasal approach; Parasellar metastasis; Sellar metastasis; Skull base