En Bloc Modified Subtotal Temporal Bone Resection for Advanced Squamous Cell Carcinoma of the Temporal Bone

Objective: The temporal bone’s complex, intricate structure is a product of its close association with vital organs; anatomical structures it houses, in whole or in part, include the internal carotid artery, otic capsule, jugular bulb, superior and inferior petrosal sinuses, and facial, trigeminal, and lower cranial nerves. The malignancies of the temporal bone are rare. Squamous cell carcinoma (SCC) is the most common form. The rarity of the temporal bone squamous cell carcinoma (TB-SCC) has delayed the establishment of the standard treatment strategy. There is little consensus about how best to treat TB-SCC. Margin-negative surgical resection seems to offer the best prognosis, which has cemented its status as the first-choice treatment for the disease. However, en bloc resection of the temporal bone is challenging due to the anatomical complexity of the temporal bone. In this study, we summarize the outcomes for surgical cases of advanced (T3-T4) TB-SCC in our department, with an accompanying description of the surgical procedure utilized: modified STBR.

Study Design: Retrospective chart review.

Method: Chart information was collected for all patients who underwent initial treatment includes surgical resection for TB-SCC at our Hospital between September 1998 and February 2019. Tumor staging followed the modified Pittsburgh classification. Local control rate was the primary outcome of interest, calculated according to the Kaplan–Meier’s method.

Results: Thirty-two patients with advanced TB-SCC underwent surgery during the review period. En bloc lateral temporal bone resection (LTBR) was employed in a total of 21 cases (5-year local control rate: 77.43%). En bloc STBR was utilized in seven cases (control: 75%). TB-SCC was recurrent in three, and fresh in the other four. Three cases were T3, and four were T4. Negative medial resection margins were achieved in six of the seven cases.

Conclusion: En bloc margin-negative resection is a good treatment strategy for advanced TB-SCC, and affords excellent local control. Our hospital’s procedure, modified subtotal bone resection, can be an effective option for the TB-SCC without posterior fossa dura invasion.