title: A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.
abstract: Cranial-nasal-orbital communicating tumors involving the anterior and middle skull base are among the most challenging to treat surgically, with high rates of incomplete resection and surgical complications. Currently, there is no recognized classification of tumors with regard to the choice of surgical approaches. From January 2004 to January 2014, we classified 32 cranial-nasal-orbital communicating tumors treated in our center into three types according to the tumor body location, scope of extension and direction of invasion: lateral (type I), central (type II) and extensive (type III). This classification considerably facilitated the choice of surgical routes and significantly influenced the surgical time and amount of hemorrhage during operation. In addition, we emphasized the use of transnasal endoscopy for large and extensive tumors, individualized treatment strategies drafted by a group of multidisciplinary collaborators, and careful reconstruction of the skull base defects. Our treatment strategies achieved good surgical outcomes, with a high ratio of total resection (87.5 %, 28/32, including 16 cases of benign tumors and 12 cases of malignant tumors) and a low percentage of surgical complications (18.8 %, 6/32). Original symptoms were alleviated in 29 patients. The average KPS score improved from 81.25 % preoperatively to 91.25 % at 3 months after surgery. No serious perioperative complications occurred. During the follow-up of 3 years on average, four patients with malignant tumors died, including three who had subtotal resections. The 3-year survival rate of patients with malignant tumors was 78.6 %, and the overall 3-year survival rate was 87.5 %. Our data indicate that the simple classification method has practical significance in guiding the choice of surgical approaches for cranial-nasal-orbital communicating tumors and may be extended to other types of skull base tumors.
authors.affiliation: Department of Neurosurgery, Center of Cranio-Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, 510120, China. fly4040@163.com.
authors.forename: Yue-Fei
authors.initials: YF
authors.lastname: Deng
authors.affiliation: Department of Neurosurgery, Center of Cranio-Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, 510120, China.
authors.forename: Bing-Xi
authors.initials: BX
authors.lastname: Lei
authors.affiliation: Department of Neurosurgery, Center of Cranio-Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, 510120, China.
authors.forename: Mei-Guang
authors.initials: MG
authors.lastname: Zheng
authors.affiliation: Department of Otolaryngology, Center of Cranio-Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yi-Qing
authors.initials: YQ
authors.lastname: Zheng
authors.affiliation: Department of Maxillofacial Surgery, Center of Cranio-Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wei-Liang
authors.initials: WL
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Center of Cranio-Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yu-Qing
authors.initials: YQ
authors.lastname: Lan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005005:Ethmoid Sinus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D061646:Operative Time; D009918:Orbital Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
keywords: Classification; Cranial–nasal–orbital region; Surgical approach; Tumor