Minimally Invasive Approaches for Resection of Parameningeal Rhabdomyosarcomas

Background: Forty percent of rhabdomyosarcomas arise in the head and neck with parameningeal primaries accounting for half of these. Current principles of management involve chemotherapy and/or radiation in addition to surgical biopsy, debulking, or resection based on the tumor site. In the head and neck, diagnostic biopsies have historically been performed without attempt at resection due to proximity to critical structures as well as cosmetic considerations.

Methods: Three separate cases of parameningeal rhabdomyosarcomas managed via minimally invasive endoscopic techniques were reviewed retrospectively.

Results: Endoscopic approaches for debulking and/or adequate negative margin resections can be performed without delay of further therapy. These patients not only benefit from immediate symptom improvement, but may also benefit long term as surgical resection has the potential for positive impact on locoregional recurrence and survival.

Conclusion: Skull base surgeons should routinely be involved in multidisciplinary treatment planning for parameningeal rhabdomyosarcomas, as surgical options have evolved to allow for improved resections with low morbidity and no delay in chemotherapeutic or radiation treatment options.