J Neurol Surg B Skull Base 2015; 76 - P001
DOI: 10.1055/s-0035-1546630

Quantitative Analysis of Decision Making in Endoscopic versus Open Skull Base Cancer Surgery

Adam M. Zanation 1, Allison M. Deal 1, Rounak B. Rawal 1, Justin D. Miller 1
  • 1University of North Carolina at Chapel Hill Hospitals, North Carolina, United States

Background: The endoscopic era has revealed the feasibility and safety of the endoscopic approach to the skull base; subsequently, the use of the open approach requires increasing justification. Endoscopic outcomes for malignancy are preliminary promising, yet no study has quantitatively assessed factors associated with pursuing an open, rather than endoscopic, approach to skull base cancer surgery.

Study Design: This study is a retrospective chart review.

Methods: The retrospective chart review revealed 401 patients who underwent 444 consecutive skull base surgeries done by a single surgeon from December 2008 to December 2012. Of these, 67 were open skull base cancer surgeries. Multivariate Fisher exact tests evaluated associations of reasons for an open approach correlated with lesion histopathology and lesion location.

Results: The open skull base cancer cohort consisted of 58% males and 42% females with a mean age of 51 years (range, 1–89 years). The most common pathology was squamous cell carcinoma (57%). The open approach was most frequently utilized for lesions occupying the infratemporal fossa (ITF)(48%), ethmoid/cribriform (27%), maxillary sinus (18%), orbit (10%), and middle fossa (9%). The most common reason for utilizing the open rather than endoscopic approach were skin (27%), ITF/parotid (15%), orbital (22%), and palatal involvement (9%). Multivariate analysis of lesion histopathology and location and reasons for open surgery is demonstrated.

Conclusion: In the endoscopic era, open skull base cancer surgery is largely reserved for high stage and complex disease. Subsequently, the decision to pursue an open approach must be made with discretion. In select cases, a lesion's histopathology and location may indicate reasons for an open approach. The primary determinants of pursuing an open approach to a skull base cancer in a comprehensive skull base practice are involvement of the skin, lesion located lateral to the infratemporal fossa or involving the parotid gland, and involvement of the orbit or palate.