Neurosurgical impact in the management of malignant tumors involving the lateral skull base: Review of 49 cases

Despite the advances (improved understanding of the anatomy, high-resolution imaging modalities, innovative surgical approaches, and multidisciplinary collaboration) in managing lateral skull base malignancies, it still remains a difficult and yet evolving problem for the surgeon-if compared with the well-established treatment modalities for sinonasal carcinomas involving the anterior skull base. We analyzed retrospectively the hospital and office records of 49 patients who underwent surgery for the treatment of head and neck subcranial cancers at our institution. The aim was to assess the impact of the neurosurgical participation in the multidisciplinary effort in terms of morbidity and outcome. Chordomas and low-grade chondrosarcomas, also considered malignant, were excluded from the study since they pose a different management problem. The series includes 24 primary tumors and 25 recurrent tumors. The variables used to assess the neurosurgical aspect of the management of these pathologies were: type of tumor, time to recurrence, anatomical areas involved, type of neurosurgical procedure performed, number of those procedures, complications, length of hospital stay (as well as the one related to the involved areas), functional status, and survival. The statistical analysis applied was of the simple descriptive type. Squamous Cell CA appears to be more aggressive and more frequent than other types. Adenocystic CA recurred most often and had the shortest time to recurrence. Sixty-one percent of patients had 3 or 4 anatomical areas involved; 45% of patients required 2 or more operations. The most frequent complication, among others, was the cranial nerves' impairment; 73.4% of patients regressed after surgery in the Karnofsky Performance Score. Head and neck CA's that invade the lateral skull base have a poor prognosis. Involvement of the cavernous sinus, the internal carotid artery or the temporal bone are unfavorable factors. CS excision has formidable risks and has to be decided on a patient-by-patient basis. An aggressive tumor resection allows prolongation of life, but complications are higher for this group of patients. The length of hospital stay was directly proportional to the extent of the disease. The quality of life was influenced by the morbidity of the operation, the time of hospitalization, as well as the functional capacity afterwards.