title: Combined approaches to the skull base for intracranial extension of tumors via perineural spread can improve patient outcomes.
abstract: Many neoplasms of the head and neck extend centripetally, gaining access to the central nervous system via nerves through the skull base foramina. Often patients with perineural spread have been excluded from aggressive interventions given the overall poor prognosis and technical difficulty when addressing the perineural components. However, in carefully selected patients combined surgical approaches can provide the greatest potential for disease control as well as neural decompression for symptom relief. We performed a retrospective chart review of 20 consecutive patients who underwent skull base approaches for resection of tumors with intracranial extension via perineural spread from 2011 to 2014. Patients were evaluated for symptom change, surgical approaches, histopathology, adjuvant therapy, outcome, and prognosis. The most common presenting symptoms were pain or cranial nerve palsies. 55% of patients underwent endoscopic endonasal approaches, 50% transcranial approaches, and 15% underwent transfacial approaches. Overall 85% of patients reported symptom improvement in the post-operative period while 40% were completely asymptomatic following surgical resection. Ultimately, we observed a 45% mortality rate with an average survival of 8 months after diagnosis. In carefully selected patients, an aggressive multidisciplinary approach using a combination of surgical avenues to the skull base for the treatment of intracranial tumor via perineural extension can improve patient quality of life.
authors: University of Arizona, Department of Surgery, Division of Neurosurgery, 1501 N. Campbell Ave., Tucson, AZ, 85724-5070, USA. Electronic address: Spalejwala@email.arizona.edu.
authors: Sheri K
authors: SK
authors: Palejwala
authors: University of Arizona, Department of Otolaryngology, 1501 N. Campbell Ave., Tucson, AZ, 85724-5070, USA. Electronic address: Jonnaeb@oto.arizona.edu.
authors: Jonnae Y
authors: JY
authors: Barry
authors: University of Arizona, College of Medicine, 1501 N. Campbell Ave., Tucson, AZ, 85724-5070, USA. Electronic address: Crod14@email.arizona.edu.
authors: Crystal N
authors: CN
authors: Rodriguez
authors: University of Arizona, Norton School of Family and Consumer Sciences, 650 N. Park Ave., Tucson, AZ, 85721-0078, USA. Electronic address: Parikhchandni@email.arizona.edu.
authors: Chandni A
authors: CA
authors: Parikh
authors: University of Arizona, Department of Otolaryngology, 1501 N. Campbell Ave., Tucson, AZ, 85724-5070, USA. Electronic address: Sgoldstein@oto.arizona.edu.
authors: Stephen A
authors: SA
authors: Goldstein
authors: University of Arizona, Department of Surgery, Division of Neurosurgery, 1501 N. Campbell Ave., Tucson, AZ, 85724-5070, USA. Electronic address: Mlemole@surgery.arizona.edu.
authors: G Michael
authors: GM
authors: Lemole
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery*; D002675:Child, Preschool; D003390:Cranial Nerve Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: Cranial nerve neuropathy; Head and neck carcinoma; Perineural spread; Skull base tumors; Surgical approaches