Skull Base Invasion Patterns of Malignant Head and Neck Tumors: A Neurosurgical Perspective

Kenichiro Iwami; Masazumi Fujii; Naoki Nishio; Takashi Maruo; Yasushi Fujimoto; Keisuke Takanari; Yuzuru Kamei; Masayuki Yamada; Tetsuya Ogawa; Koji Osuka; Kiyoshi Saito

doi:10.1055/s-0039-3402034

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2021; 82(S 03): e120-e130
DOI: 10.1055/s-0039-3402034

Original Article

Skull Base Invasion Patterns of Malignant Head and Neck Tumors: A Neurosurgical Perspective

Authors

Kenichiro Iwami

¹Department of Neurosurgery, Aichi Medical University, Aichi, Japan
Masazumi Fujii

²Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
Naoki Nishio

³Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Takashi Maruo

³Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Yasushi Fujimoto

³Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Keisuke Takanari

⁴Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Yuzuru Kamei

⁴Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Masayuki Yamada

²Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
Tetsuya Ogawa

⁵Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
Koji Osuka

¹Department of Neurosurgery, Aichi Medical University, Aichi, Japan
Kiyoshi Saito

²Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan

Abstract

Objective Craniofacial resection (CFR) and temporal bone resection (TBR) on malignant head and neck tumors (MHNTs) invading skull base require accurate and precise determination of the tumor invasion. We investigated tumor skull base invasion patterns and surgical results in CFR and TBR cases.

Methods We performed either CFR or TBR for 75 selected patients with the possibility of en bloc resection over the period between 2011 and 2018. The medical charts of the selected patients were reviewed.

Results Primary tumor onset site (TOS) groups were: (1) nasal cavity/ethmoid sinus, 20 cases; (2) orbit, 10 cases; (3) maxillary sinus, 28 cases; and (4) external ear/temporomandibular joint, 17 cases. Grades for tumor invasion depth (TID) included: (I) extracranial invasion and skull base bone invasion; (II) extradural invasion; or (III) intradural invasion. Patients in groups 1 and 2 had a significantly higher frequency of grade II and III invasions than patients in groups 3 and 4. The main invasion site was nasal cavity superior wall and ethmoid sinus superior wall for group 1 tumors, orbit superior wall, and lateral skull base sphenoid bone for group 2 and 3 tumors, and lateral skull base temporal bone for group 4 tumors. Positive resection margins represented a significant negative prognostic factor. TID and TOS did not affect skull base margin status.

Conclusion Skull base invasion of MHNTs exhibits certain fixed patterns in sites susceptible to invasion based on the TOS. The frequencies of extradural and intradural invasions differed, indicating the importance for accurate preoperative tumor evaluation.

Keywords

en bloc resection - malignant head and neck tumor - skull base invasion - outcomes

Full Text

References

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