Craniofacial Resection: Universiti Kebangsaan Malaysia Medical Center Experience

Objective: To review our experience with craniofacial resection for malignant tumors of the anterior skull base.

Methods: This is a retrospective review conducted over a period of 6 years, from October 1997 to June 2005, at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur. Case records of patients who had craniofacial resection during this period were reviewed.

Results: Of the 10 patients, 7 (70%) were men and 3 (30%) were women. The mean age was 46 years, (range, 22–71 years). All patients had undergone bifrontal craniotomy; 5 (50%) had extended lateral or total rhinotomy, 4 (40%) had lateral rhinotomy, and 2 (20%) had Weber-Ferguson incision. One (10%) patient had orbital exenteration due to erosion of the orbit, which required a free abdominal flap for coverage. One (10%) patient had partial maxillectomy and fascia lata graft for closure of dural defect. One (10%) postoperative death occurred due to meningitis. Two (20%) patients had minor cerebrospinal fluid leak, 3 (30%) had meningitis, 2 (20%) had wound infections, 1 (10%) had parotitis, and 1 (10%) had frontal lobe syndrome. Three (30%) histopathological examinations showed malignant undifferentiated carcinoma; 3 (30%) had squamous cell carcinoma; and 2 (20%) had inverted papilloma, with 1 associated with squamous cell carcinoma. The rest were adenoid cystic carcinoma, neuroendocrine carcinoma, and neuroectodermal carcinoma with 1 patient each. Four (40%) patients were treated with surgery alone, and 6 (60%) had both surgery and postoperative radiotherapy. Five patients (50%) died within 6 months of the surgery due to local recurrence. Three (30%) patients are still alive with residual tumor, and 2 (20%) patients had complete remission and are free of disease.

Conclusions: The management of sinonasal tumors poses a major oncologic challenge. Cure is often compromised by late presentation of patients. Craniofacial surgery for malignant tumors of the anterior skull base remains one of the treatment modalities despite the aggressiveness of the tumor and late presentation of the disease.