Abstract
We retrospectively examined 27 skull base surgeries for nasal-paranasal sinus malignancy treated from 1992 to 2003 in Chiba University Hospital. There were 22 anterior and 5 middle skull base invasions. Eight out of 27 presented with dura mater invasion. The most frequent pathologic entity was squamous cell carcinoma (n=9), followed by 8 epithelial tumors (4 adenocarcinoma, 3 adenoid cystic carcinoma, and 1 malignant melanoma). Ten non-epithelial tumors encompassed primitive neuroectodermal tumor (PNET), 2 chondrosarcoma, 1 osteosarcoma, 1 f ibrosarcoma, 1 rhabdomyosarcoma, 1 olfactory neuroblastoma, 1 malignant glomus tumor, and 1 malignant fibrous histiocytoma (MFH). Patients with epithelial carcinoma were treated with radiotherapy (60 Gy) before skull base resection. Postoperative complications were reported in 7 patients (26%), with local wound infection as the most common (19%). The cumulative 5-year survival rate of 18 cases treated from 1992 to 1999 was 67% in both epithelial and non-epithelial malignancies. The 5-year absolute survival rate was 79% in the anterior skull base resection, and 25% in the anterior-middle and middle skull base resection. The 5-year absolute survival rate for patients with and without dural invasion was 43% and 91% respectively. Multivariate analysis showed that dural invasion and middle skull base invasion had a significant impact on relapse-free and disease-specific survival. These data indicate that patients with anterior skull base malignancies can be treated successfully with skull base surgery.
