An Algorithm for Surgical Approach to the Anterior Skull Base

Matthew R. Naunheim, Neerav Goyal, Matthew M. Dedmon, Kyle J. Chambers, Ahmad R. Sedaghat, Benjamin S. Bleier, Eric H. Holbrook, William T. Curry, Stacey T. Gray, Derrick T. Lin

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective characterize our experience with the surgical management of anterior skull base malignancy, and to propose an algorithm for surgical approach to anterior skull base malignancies. Design Retrospective review. Setting Academic cranial base center. Participants Sixty-seven patients who underwent resection of paranasal sinus or anterior skull base malignancy with an endoscopic, cranioendoscopic, or traditional anterior craniofacial approach. Outcome Measures Complications, recurrence, and survival. Results There were 48 males and 19 females, ranging from 6 to 88 years old. There were three groups: endonasal endoscopic resection (n = 10), cranioendoscopic resection (n = 12), and traditional craniofacial resection (n = 45). The most common tumor pathologies included esthesioneuroblastoma, squamous cell carcinoma, and sinonasal undifferentiated carcinoma. Patients with T3/T4 disease were less likely to undergo endoscopic resection (p = 0.007). The 5-year disease-free survival was 82.1% overall, with no statistically significant differences among approaches. There were no differences in orbital complications, meningitis, or cerebrospinal fluid leak. Use of a transfacial incisions predisposed patients to surgical site infection and sinocutaneous fistulae. An algorithm for surgical approach was developed based on these results. Conclusion Sinonasal and skull base malignancies can be safely surgically addressed via several approaches. Surgical approach should be selected algorithmically based on preoperative clinical assessment of the tumor and known postoperative complication rates.

Original languageEnglish (US)
Pages (from-to)364-370
Number of pages7
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume77
Issue number4
DOIs
StatePublished - Aug 1 2016

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Skull Base
Neoplasms
Olfactory Esthesioneuroblastoma
Surgical Wound Infection
Paranasal Sinuses
Meningitis
Disease-Free Survival
Fistula
Squamous Cell Carcinoma
Outcome Assessment (Health Care)
Pathology
Recurrence
Survival

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Naunheim, M. R., Goyal, N., Dedmon, M. M., Chambers, K. J., Sedaghat, A. R., Bleier, B. S., ... Lin, D. T. (2016). An Algorithm for Surgical Approach to the Anterior Skull Base. Journal of Neurological Surgery, Part B: Skull Base, 77(4), 364-370. https://doi.org/10.1055/s-0036-1580598
Naunheim, Matthew R. ; Goyal, Neerav ; Dedmon, Matthew M. ; Chambers, Kyle J. ; Sedaghat, Ahmad R. ; Bleier, Benjamin S. ; Holbrook, Eric H. ; Curry, William T. ; Gray, Stacey T. ; Lin, Derrick T. / An Algorithm for Surgical Approach to the Anterior Skull Base. In: Journal of Neurological Surgery, Part B: Skull Base. 2016 ; Vol. 77, No. 4. pp. 364-370.
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abstract = "Objective characterize our experience with the surgical management of anterior skull base malignancy, and to propose an algorithm for surgical approach to anterior skull base malignancies. Design Retrospective review. Setting Academic cranial base center. Participants Sixty-seven patients who underwent resection of paranasal sinus or anterior skull base malignancy with an endoscopic, cranioendoscopic, or traditional anterior craniofacial approach. Outcome Measures Complications, recurrence, and survival. Results There were 48 males and 19 females, ranging from 6 to 88 years old. There were three groups: endonasal endoscopic resection (n = 10), cranioendoscopic resection (n = 12), and traditional craniofacial resection (n = 45). The most common tumor pathologies included esthesioneuroblastoma, squamous cell carcinoma, and sinonasal undifferentiated carcinoma. Patients with T3/T4 disease were less likely to undergo endoscopic resection (p = 0.007). The 5-year disease-free survival was 82.1{\%} overall, with no statistically significant differences among approaches. There were no differences in orbital complications, meningitis, or cerebrospinal fluid leak. Use of a transfacial incisions predisposed patients to surgical site infection and sinocutaneous fistulae. An algorithm for surgical approach was developed based on these results. Conclusion Sinonasal and skull base malignancies can be safely surgically addressed via several approaches. Surgical approach should be selected algorithmically based on preoperative clinical assessment of the tumor and known postoperative complication rates.",
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Naunheim, MR, Goyal, N, Dedmon, MM, Chambers, KJ, Sedaghat, AR, Bleier, BS, Holbrook, EH, Curry, WT, Gray, ST & Lin, DT 2016, 'An Algorithm for Surgical Approach to the Anterior Skull Base', Journal of Neurological Surgery, Part B: Skull Base, vol. 77, no. 4, pp. 364-370. https://doi.org/10.1055/s-0036-1580598

An Algorithm for Surgical Approach to the Anterior Skull Base. / Naunheim, Matthew R.; Goyal, Neerav; Dedmon, Matthew M.; Chambers, Kyle J.; Sedaghat, Ahmad R.; Bleier, Benjamin S.; Holbrook, Eric H.; Curry, William T.; Gray, Stacey T.; Lin, Derrick T.

In: Journal of Neurological Surgery, Part B: Skull Base, Vol. 77, No. 4, 01.08.2016, p. 364-370.

Research output: Contribution to journalArticle

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AU - Naunheim, Matthew R.

AU - Goyal, Neerav

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AU - Lin, Derrick T.

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N2 - Objective characterize our experience with the surgical management of anterior skull base malignancy, and to propose an algorithm for surgical approach to anterior skull base malignancies. Design Retrospective review. Setting Academic cranial base center. Participants Sixty-seven patients who underwent resection of paranasal sinus or anterior skull base malignancy with an endoscopic, cranioendoscopic, or traditional anterior craniofacial approach. Outcome Measures Complications, recurrence, and survival. Results There were 48 males and 19 females, ranging from 6 to 88 years old. There were three groups: endonasal endoscopic resection (n = 10), cranioendoscopic resection (n = 12), and traditional craniofacial resection (n = 45). The most common tumor pathologies included esthesioneuroblastoma, squamous cell carcinoma, and sinonasal undifferentiated carcinoma. Patients with T3/T4 disease were less likely to undergo endoscopic resection (p = 0.007). The 5-year disease-free survival was 82.1% overall, with no statistically significant differences among approaches. There were no differences in orbital complications, meningitis, or cerebrospinal fluid leak. Use of a transfacial incisions predisposed patients to surgical site infection and sinocutaneous fistulae. An algorithm for surgical approach was developed based on these results. Conclusion Sinonasal and skull base malignancies can be safely surgically addressed via several approaches. Surgical approach should be selected algorithmically based on preoperative clinical assessment of the tumor and known postoperative complication rates.

AB - Objective characterize our experience with the surgical management of anterior skull base malignancy, and to propose an algorithm for surgical approach to anterior skull base malignancies. Design Retrospective review. Setting Academic cranial base center. Participants Sixty-seven patients who underwent resection of paranasal sinus or anterior skull base malignancy with an endoscopic, cranioendoscopic, or traditional anterior craniofacial approach. Outcome Measures Complications, recurrence, and survival. Results There were 48 males and 19 females, ranging from 6 to 88 years old. There were three groups: endonasal endoscopic resection (n = 10), cranioendoscopic resection (n = 12), and traditional craniofacial resection (n = 45). The most common tumor pathologies included esthesioneuroblastoma, squamous cell carcinoma, and sinonasal undifferentiated carcinoma. Patients with T3/T4 disease were less likely to undergo endoscopic resection (p = 0.007). The 5-year disease-free survival was 82.1% overall, with no statistically significant differences among approaches. There were no differences in orbital complications, meningitis, or cerebrospinal fluid leak. Use of a transfacial incisions predisposed patients to surgical site infection and sinocutaneous fistulae. An algorithm for surgical approach was developed based on these results. Conclusion Sinonasal and skull base malignancies can be safely surgically addressed via several approaches. Surgical approach should be selected algorithmically based on preoperative clinical assessment of the tumor and known postoperative complication rates.

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