Subscribe to RSS
The Role of Advanced Endoscopic Resection of Diverse Skull Base Malignancies: Technological Analysis during an 8-Year Single Institutional ExperienceFunding None.
Background Resection of skull base malignancies poses complex pathological and treatment-related morbidities. Recent technological advancements of endoscopic endonasal surgery (EES) offer the ability to reexamine traditional treatment paradigms with endoscopic procedures. The utility of EES was quantitatively examined in a longitudinal series with attention to morbidities and postoperative outcomes.
Methods A single-center retrospective review was performed of all malignant sinonasal tumors from 2010 to 2018. Patients with purely EES were selected for analysis. Disease features, resection extent, complications, adjuvant treatment, recurrence, and survivability were assessed. Despite the mixed pathological cohort, analysis was performed to identify technical aspects of resection.
Results A total of 68 patients (47.6% males and 52.4% females, average age: 60.3 years) were included. A diversity of histotypes included clival chordoma (22.1%), olfactory neuroblastoma (14.7%), squamous cell carcinoma (11.8%), and adenoid cystic carcinoma (11.8%). Gross total resection (GTR) was achieved in 83.8% of cases. Infection (4.4%) and cerebrospinal fluid leak (1.5%) were the most common postoperative complications. Total 46 patients (67.6%) underwent adjuvant treatment. The average time between surgery and initiation of adjunctive surgery was 55.7 days.
Conclusion In our 8-year experience, we found that entirely endoscopic resection of mixed pathology of malignant skull base tumors is oncologically feasible and can be accomplished with high GTR rates. There may be a role for EES to reduce operative morbidity and attenuate time in between surgery and adjuvant treatment, which can be augmented through recent mixed reality platforms. Future studies are required to systematically compare the outcomes with those of open surgical approaches.
Keywordsendoscopic endonasal surgery - skull base malignancy - craniofacial resection - gross total resection - oncological outcomes
This work has not been previously presented in any manner.
Received: 20 August 2019
Accepted: 02 June 2020
05 August 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Hofstetter CP, Shin BJ, Mubita L. et al. Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurg Focus 2011; 30 (04) E10
- 2 Dmytriw AA, Witterick IJ, Yu E. Endoscopic resection of malignant sinonasal tumours: current trends and imaging workup. OA Minim Invasive Surg 2013; 1 (01) 3
- 3 Lund V, Howard DJ, Wei WI. Endoscopic resection of malignant tumors of the nose and sinuses. Am J Rhinol 2007; 21 (01) 89-94
- 4 Nicolai P, Battaglia P, Bignami M. et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 2008; 22 (03) 308-316
- 5 Hanna E, DeMonte F, Ibrahim S, Roberts D, Levine N, Kupferman M. Endoscopic resection of sinonasal cancers with and without craniotomy: oncologic results. Arch Otolaryngol Head Neck Surg 2009; 135 (12) 1219-1224
- 6 Riley CA, Soneru CP, Tabaee A, Kacker A, Anand VK, Schwartz TH. Technological and ideological innovations in endoscopic skull base surgery. World Neurosurg 2019; S1878-8750 (19)30220-7
- 7 Li L, Yang J, Chu Y. et al. A novel augmented reality navigation system for endoscopic sinus and skull base surgery: a feasibility study. PLoS One 2016; 11 (01) e0146996
- 8 Thoranaghatte RU, Giraldez JG, Zheng G. Landmark based augmented reality endoscope system for sinus and skull-base surgeries. Available at: https://ieeexplore.ieee.org/abstract/document/4649094 . Accessed October 14, 2008
- 9 Bong JH, Song HJ, Oh Y, Park N, Kim H, Park S. Endoscopic navigation system with extended field of view using augmented reality technology. Int J Med Robot 2018; 14 (02) e1886
- 10 Kadish S, Goodman M, Wang CC. Olfactory neuroblastoma: a clinical analysis of 17 cases. Cancer 1976; 37 (03) 1571-1576
- 11 Moya-Plana A, Bresson D, Temam S, Kolb F, Janot F, Herman P. Development of minimally invasive surgery for sinonasal malignancy. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133 (06) 405-411
- 12 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas. World Neurosurg 2011;76(3-4):318–327, discussion 259–262
- 13 Cohen MA, Liang J, Cohen IJ, Grady MS, O'Malley Jr BW, Newman JG. Endoscopic resection of advanced anterior skull base lesions: oncologically safe?. ORL J Otorhinolaryngol Relat Spec 2009; 71 (03) 123-128
- 14 Ong YK, Solares CA, Carrau RL, Snyderman CH. New developments in transnasal endoscopic surgery for malignancies of the sinonasal tract and adjacent skull base. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (02) 107-113
- 15 Devaiah AK, Andreoli MT. Treatment of esthesioneuroblastoma: a 16-year meta-analysis of 361 patients. Laryngoscope 2009; 119 (07) 1412-1416
- 16 Walch C, Stammberger H, Anderhuber W, Unger F, Köle W, Feichtinger K. The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment. Laryngoscope 2000; 110 (04) 635-640
- 17 Elkon D, Hightower SI, Lim ML, Cantrell RW, Constable WC. Esthesioneuroblastoma. Cancer 1979; 44 (03) 1087-1094
- 18 Baron SH. Brain radiation necrosis following treatment of an esthesioneuroblastoma (olfactory neurocytoma). Laryngoscope 1979; 89 (2 Pt 1): 214-223
- 19 McKay SP, Shibuya TY, Armstrong WB. et al. Cell carcinoma of the paranasal sinuses and skull base. Am J Otolaryngol 2007; 28 (05) 294-301
- 20 Ramakrishna R, Raza SM, Kupferman M, Hanna E, DeMonte F. Adenoid cystic carcinoma of the skull base: results with an aggressive multidisciplinary approach. J Neurosurg 2016; 124 (01) 115-121
- 21 Ko YH, Lee MA, Hong YS. et al. Prognostic factors affecting the clinical outcome of adenoid cystic carcinoma of the head and neck. Jpn J Clin Oncol 2007; 37 (11) 805-811
- 22 Barrett TF, Dyvorne HA, Padormo F. et al. First application of 7-T magnetic resonance imaging in endoscopic endonasal surgery of skull base tumors. World Neurosurg 2017; 103: 600-610
- 23 Rutland JW, Schefflein J, Arrighi-Allisan AE. et al. Measuring degeneration of the lateral geniculate nuclei from pituitary adenoma compression detected by 7T ultra-high field MRI: a method for predicting vision recovery following surgical decompression of the optic chiasm. J Neurosurg 2019; 1-10
- 24 Rutland JW, Padormo F, Yim CK. et al. Quantitative assessment of secondary white matter injury in the visual pathway by pituitary adenomas: a multimodal study at 7-Tesla MRI. J Neurosurg 2019; 132 (02) 333-342
- 25 Rutland JW, Delman BN, Feldman RE. et al. Utility of 7 tesla MRI for preoperative planning of endoscopic endonasal surgery for pituitary adenomas. J Neurol Surg B Skull Base. Doi: 10.1055/s-0039-3400222 2019
- 26 Zanation AM, Carrau RL, Snyderman CH. et al. Nasoseptal flap takedown and reuse in revision endoscopic skull base reconstruction. Laryngoscope 2011; 121 (01) 42-46
- 27 Wheless SA, McKinney KA, Carrau RL. et al. Nasoseptal flap closure of traumatic cerebrospinal fluid leaks. Skull Base 2011; 21 (02) 93-98
- 28 Seth R, Revenaugh PC, Scharpf J, Shipchandler TZ, Fritz MA. Free anterolateral thigh fascia lata flap for complex nasal lining defects. JAMA Facial Plast Surg 2013; 15 (01) 21-28
- 29 Zoli M, Milanese L, Bonfatti R. et al. Clival chordomas: considerations after 16 years of endoscopic endonasal surgery. J Neurosurg 2018; 128 (02) 329-338