Surgical Management of Skull Base/Infratemporal Fossa Malignancies: Predictors of Postoperative Performance

Background: Infratemporal fossa (ITF) tumors are difficult to treat due to nearby vital structures and cranial nerves, necessitating aggressive multimodal strategies balanced with efforts to avoid treatment-associated decline in performance.

Objective: We sought to assess factors that predict better postoperative performance in patients undergoing surgery for ITF tumors.

Methods: We reviewed all patients surgically treated for ITF malignancy between 1999 and 2017 at our institution. One hundred patients had sufficient pre- and posttreatment data for evaluation and were included. Patient demographics, preoperative performance, tumor stage, tumor characteristics, treatment modalities, pathologic data, and postoperative performance were collected. Postoperative performance scores were collected between 3 and 13 months following surgery.

Results: The 5-year survival rate was 62.2%. Ages ranged from 6 to 84 years, 61% were male, and 62% had a diagnosis of sarcoma. We found that higher preoperative KPS (p < 0.001), short length of stay (p = 0.004), and a diagnosis of sarcoma (62 patients; p = 0.0243) are predictors of higher postoperative KPS. Additionally, we found that soft tissue tumor origin (57 patients; p = 0.0036), high-pathology grade (75 patients; p = 0.0136), and percutaneous endoscopic gastrostomy (nine patients; p = 0.0247), but not age at presentation (p = 0.4), intracranial tumor spread (p = 0.6375), perineural invasion (40 patients; p = 0.5699), or tracheostomy tube placement (21 patients; p = 0.0552) were predictors of lower postoperative KPS. Male patients, patients with sarcomas, and patients with high-grade tumors were all groups that demonstrated greater decreases in KPS scores between pre- and posttreatment.

Conclusion: Our findings will guide difficult treatment decisions in patients with tumors of the ITF, including the decisions to pursue surgery, radiotherapy, and chemotherapy. Additionally, this work will allow treatment teams to better describe expected patient outcomes during patient consultations.