Abstract
Objectives (1) To determine the occult rate of dural invasion in patients with tumors extending
to and/or eroding the bony anterior skull base but without evidence of dural invasion
on preoperative imaging. (2) To determine the impact of dural resection and of skull
base erosion on survival outcomes in this group of patients (without evidence of dural
invasion upon preoperative imaging).
Study Design Retrospective study.
Setting Tertiary care academic center.
Participants Patients with sinonasal malignancies with anterior skull base encroachment/erosion
without dural invasion on preoperative imaging treated surgically.
Main Outcome Measures (1) Histopathologic disease in the dura in patients who had dural resection and (2)
Oncologic outcomes (5-year local recurrence, dural recurrence, disease-specific survival,
and overall survival) in patients with and without dural resection, and patients with
and without skull base erosion.
Results Thirty-seven patients were included. The occult rate of dural invasion was 54%. Patients
with dural resection had improved margin control versus those without dural resection
(90% vs 56%, p = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma
compared with bony skull base resection alone (100% vs 75%, p = 0.03). Patients with skull base erosion had reduced local control versus those
without erosion (63% vs 93%, p = 0.047).
Conclusion This study suggests a substantial rate of occult dural invasion despite no overt
imaging findings. Dural resection may be associated with improved margin control,
but no oncologic benefit except for esthesioneuroblastomas, although treatment heterogeneity
and small sample size may limit conclusions.
Keywords
nose and paranasal sinuses (head and neck) - skull base (head and neck) - radiology
- survival
