1
|
Kuan EC, Badran KW, Yoo F, Bhandarkar ND, Haidar YM, Tjoa T, Armstrong WB, Palmer JN, Adappa ND, Wang MB, John MAS. Predictors of Short-term Morbidity and Mortality in Open Anterior Skull Base Surgery. Laryngoscope 2018; 129:1407-1412. [PMID: 30325512 DOI: 10.1002/lary.27494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe rates of complications and mortality within 30 days of open anterior skull base surgery using a large, multi-institutional outcomes database. STUDY DESIGN Retrospective cohort study. METHODS The study included patients who underwent open anterior skull base surgery as listed in the American College of Surgeons National Surgical Quality Improvement Project database from 2007 through 2014. RESULTS A total of 336 open anterior skull base surgeries were identified. One hundred nine (32.4%) patients experienced a complication, reoperation, or mortality. The most common events were postoperative transfusion (15.8%), reoperation (10.1%), and readmission (8.0%). Significant independent predictors of any adverse event included higher American Society of Anesthesiologists (ASA) score and increased total operative time (both P < .05). The only predictor of mortality was higher ASA score (P = .02). Predictors of increased hospital stay included impaired sensorium (P = .04), coma >24 hours (P < .001), lower preoperative hematocrit (P = .02), higher ASA score (P = .04), and increased total operative time (P < .001). CONCLUSIONS Open anterior skull base surgery is understandably complex, and is thus associated with a relatively high adverse event rate. Knowledge of factors associated with adverse events has the potential to improve preoperative optimization of controllable variables and translate into improved surgical outcomes for patients. LEVEL OF EVIDENCE NA Laryngoscope, 129:1407-1412, 2019.
Collapse
Affiliation(s)
- Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Karam W Badran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Frederick Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Naveen D Bhandarkar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - William B Armstrong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A
| | - Maie A St John
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A
| |
Collapse
|
2
|
Choi PJ, Iwanaga J, Tubbs RS, Yilmaz E. Surgical Interventions for Advanced Parameningeal Rhabdomyosarcoma of Children and Adolescents. Cureus 2018. [PMID: 29541566 PMCID: PMC5844646 DOI: 10.7759/cureus.2045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Owing to its rarity, rhabdomyosarcoma of the head and neck (HNRMS) has seldom been discussed in the literature. As most of the data is based only on the retrospective experiences of tertiary healthcare centers, there are difficulties in formulating a standard treatment protocol. Moreover, the disease is poorly understood at its pathological, genetic, and molecular levels. For instance, 20% of all histological assessment is inaccurate; even an experienced pathologist can confuse rhabdomyosarcoma (RMS) with neuroblastoma, Ewing’s sarcoma, and lymphoma. RMS can occur sporadically or in association with genetic syndromes associated with predisposition to other cancers such as Li-Fraumeni syndrome and neurofibromatosis type 1 (von Recklinghausen disease). Such associations have a potential role in future gene therapies but are yet to be fully confirmed. Currently, chemotherapies are ineffective in advanced or metastatic disease and there is lack of targeted chemotherapy or biological therapy against RMS. Also, reported uses of chemotherapy for RMS have not produced reasonable responses in all cases. Despite numerous molecular and biological studies during the past three decades, the chemotherapeutic regimen remains unchanged. This vincristine, actinomycin, cyclophosphamide (VAC) regime, described in Kilman, et al. (1973) and Koop, et al. (1963), has achieved limited success in controlling the progression of RMS. Thus, the pathogenesis of RMS remains poorly understood despite extensive modern trials and more than 30 years of studies exploring the chemotherapeutic options. This suggests a need to explore surgical options for managing the disease. Surgery is the single most critical therapy for pediatric HNRMS. However, very few studies have explored the surgical management of pediatric HNRMS and there is no standard surgical protocol. The aim of this review is to explore and address such issues in the hope of maximizing the number of options available for young patients with HNRMS.
Collapse
Affiliation(s)
- Paul J Choi
- Clinical Anatomy, Seattle Science Foundation
| | | | | | - Emre Yilmaz
- Swedish Medical Center, Swedish Neuroscience Institute
| |
Collapse
|
3
|
Abstract
A variety of histologic tumor types are present in the anterior skull base. Primary tumors of this area may be derived from the bone, paranasal sinuses, nasopharynx, dura, cranial nerves, pituitary gland and brain. Symptoms are caused mostly through mass effect but, if the tumor becomes aggressive, also through invasion. Selection of surgical approaches to the anterior skull base is based upon balancing risk reduction with maximizing extent of resection. Here we review a spectrum of neoplastic entities found in the anterior skull base in adults and discuss clinical and radiographic presentation, treatment options, and outcomes. Surgical resection remains the mainstay in treatment of these tumors, particularly in the hands of experienced surgeons exercising proper patient and case selection.
Collapse
Affiliation(s)
- Michael E Ivan
- Department of Neurological Surgery, University of California, San Francisco, CA, USAand
| | | | | |
Collapse
|
4
|
Ivan ME, Jahangiri A, El-Sayed IH, Aghi MK. Minimally invasive approaches to the anterior skull base. Neurosurg Clin N Am 2012; 24:19-37. [PMID: 23174355 DOI: 10.1016/j.nec.2012.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of minimally invasive approaches to the anterior skull base is a valuable tool to improving the treatment in patients with aggressive anterior skull base neoplasms. This article discusses the history, advantages and disadvantages relative to open approaches, the corridors and pathways used in approach, the equipment and operating room setup, perioperative care, and complication avoidance. Although outcomes are difficult to compare to open approaches, due to often small and varying patient cohorts, these approaches continue to gain acceptance as an effective treatment of anterior skull base tumors in the experienced surgeon's hands with proper patient selection.
Collapse
Affiliation(s)
- Michael E Ivan
- Department of Neurological Surgery, University of California San Francisco, CA 94143-0112, USA
| | | | | | | |
Collapse
|
5
|
Pitman KT, Costantino PD, Lassen LF. Sinonasal undifferentiated carcinoma: current trends in treatment. Skull Base Surg 2011; 5:269-72. [PMID: 17170968 PMCID: PMC1656535 DOI: 10.1055/s-2008-1058925] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly aggressive neoplasm of the paranasal sinuses, which has recently been characterized as a distinct pathologic entity. The prognosis for patients with SNUC is poor. Early case reports describe patients with lesions that were clinically advanced at initial presentation and surgically unresectable. Survival was reported in months after treatment with chemotherapy and radiation. As more experience was gained with treatment of SNUC, it was found that aggressive, combined surgical therapy of lesions previously considered unresectable has shown increased survival. We report a case of a 38-year-old man with SNUC originating in the posterior ethmoid, extending into the anterior cranial fossa and orbit, who was treated with preoperative hyperfractionated radiation therapy, chemotherapy, and craniofacial resection.
Collapse
|
6
|
Varshney S, Bist SS, Gupta N, Singh RK, Bhagat S. Anterior craniofacial resection - for paranasal sinus tumors involving anterior skull base. Indian J Otolaryngol Head Neck Surg 2010; 62:103-7. [PMID: 23120693 DOI: 10.1007/s12070-010-0045-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the "gold standard" for surgery is the anterior craniofacial approach. Craniofacial resection represents a major advance in the surgical treatment of tumors of the paranasal sinuses involving anterior skull base. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. This study presents a series of 18 patients with anterior skull base tumors, treated by a team of head-neck surgeons and neurosurgeons. The series included 15 malignant tumors of the nose and paranasal sinuses and 3 extensive benign lesions. All tumors were resected by a combined bi-frontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, cerebrospinal fluid-leakage or meningitis. Recurrent tumor growth or systemic metastasis occurred in 3 out of 15 patients with malignant tumors, 6 months to 2 years postoperatively. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumors of anterior skull base.
Collapse
Affiliation(s)
- Saurabh Varshney
- Department of ENT and Head Neck Surgery, Himalayan Institute of Medical Sciences (HIHT University), Jollygrant, Doiwala, Dehradun, 248 140 Uttaranchal India
| | | | | | | | | |
Collapse
|
7
|
Feiz-Erfan I, Han PP, Spetzler RF, Lanzino G, Ferreira MAT, Gonzalez LF, Porter RW. Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization. Neurosurg Focus 2003; 14:e6. [PMID: 15709723 DOI: 10.3171/foc.2003.14.3.7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable.
Methods
Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47–69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial–intracranial (EC–IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected.
Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2–40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens.
Conclusions
A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC–IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.
Collapse
Affiliation(s)
- Iman Feiz-Erfan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | | | | | | | | | | |
Collapse
|
8
|
Sharara N, Muller S, Olson J, Grist WJ, Grossniklaus HE. Sinonasal undifferentiated carcinoma with orbital invasion: report of three cases. Ophthalmic Plast Reconstr Surg 2001; 17:288-92. [PMID: 11476180 DOI: 10.1097/00002341-200107000-00009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report three patients with sinonasal undifferentiated carcinoma (SNUC) that invaded the orbit. METHODS Retrospective small case series. The clinical, radiographic, and pathologic features of three patients with SNUC were reviewed. RESULTS Three patients with SNUC that invaded the orbit were evaluated. A biopsy was performed on the tumors, which were composed of small, hyperchromatic cells with numerous mitoses and areas of necrosis. Immunohistochemical staining was positive for cytokeratins AE1.3, epithelial membrane antigen, and neuron-specific enolase in all three tumors. Electron microscopic examination showed absence of neurosecretory granules and presence of basement membrane production. Two patients were treated with surgical resection and postoperative chemotherapy and/or radiation. One patient was treated with preoperative radiation and chemotherapy. CONCLUSIONS Sinonasal undifferentiated carcinoma is a high-grade tumor that arises in the nasal and paranasal sinuses and may invade the orbit. SNUC should be distinguished from other small, round, blue cell tumors, in particular, esthesioneuroblastoma.
Collapse
Affiliation(s)
- N Sharara
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | |
Collapse
|
9
|
Saito K, Fukuta K, Takahashi M, Tachibana E, Yoshida J. Management of the cavernous sinus in en bloc resections of malignant skull base tumors. Head Neck 1999. [DOI: 10.1002/(sici)1097-0347(199912)21:8<734::aid-hed9>3.0.co;2-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
10
|
Janecka IP, Sen C, Sekhar LN, Ramasastry S, Curtin HD, Barnes EL, D'Amico F. Cranial base surgery: results in 183 patients. Otolaryngol Head Neck Surg 1994; 110:539-46. [PMID: 8208569 DOI: 10.1177/019459989411000611] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To learn about the effects of cranial base surgery. DESIGN Cohort study with a mean follow-up of 30 months. SETTING Population-based. PATIENTS A consecutive sample of 183 patients who underwent cranial base surgery; 118 patients had malignant skull base tumors, the majority of which were previously treated; 50 had benign tumors; 9 had congenital malformations of the skull base; 3 had inflammatory lesions, and 3 had traumatic defects of the skull base. MAIN OUTCOME MEASURES Disease-free interval, overall survival, and rate of complications and functional status. INTERVENTION Cranial base surgery was followed by radiotherapy (in previously untreated patients). RESULTS After completion of follow-up (mean, 30 months), 30 (25.4%) patients had died of their malignant tumors and 8 (6.8%) had died of other causes. One patient (0.84%) was lost to follow-up. The overall cancer survival rate without regard to histologic type was 67% (63% with no evidence of disease). Among the patients who were treated for benign neoplasm, 72% had no evidence of disease at a mean follow-up of 39 months. The group of patients with congenital malformations and inflammatory and traumatic lesions demonstrated successful correction of their presurgical problem with skull base surgery. One patient (who had invasive aspergillosis) died of disease. The overall surgical-medical mortality rate was 2%; the complication rate was 33%, and the Karnofsky performance score was improved or unchanged after surgery in 83% of patients. The average duration of surgery, number of blood transfusions used, and length of the hospital stay were 10 hours, 3 units, and 15 days, respectively. CONCLUSIONS Cranial base surgery is a valid surgical technique for treatment of cranial base afflictions. In this study it was found to be beneficial in controlling benign and malignant disease and to be the treatment of choice for selected congenital malformations, trauma, and inflammatory lesions.
Collapse
Affiliation(s)
- I P Janecka
- University of Pittsburgh School of Medicine, PA
| | | | | | | | | | | | | |
Collapse
|
11
|
Janecka IP, Sen C, Sekhar LN, Ramasastry S, Curtin HD, Barnes EL, D'Amico F. Cranial base surgery. Results in 183 patients. J Neurooncol 1994. [DOI: 10.1007/bf01053044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|