Treatment Results of Craniofacial Resection for Sinonasal Tumors Involving the Anterior Skull Base

Objective: Over the years, endoscopic craniofacial resection (CFR) has replaced traditional CFR and has shown comparable or even better results with less morbidity and complication for treatment of sinonasal tumors involving the anterior skull base. The objective of this study was to analyze clinical features of tumors involving the anterior skull base treated with CFR and compare treatment outcomes, complications, and morbidity according to approach and pathology. Furthermore, we studied the change in trends of surgical approach over time.

Methods: Patients who were treated for sinonasal tumors involving the anterior skull base with endoscopic endonasal craniofacial resection (EECFR), endoscopy-assisted craniofacial resection (EACFR) or open craniofacial resection (CFR) from January 1994 to March 2021 at two tertiary referral hospitals were included in this retrospective cohort study. Medical records were reviewed for demographic data and clinical information such as surgical approach, histology, complications and morbidity. Disease-free survival and overall survival were analyzed.

Results: One-hundred patients were included in this study. Twenty-five cases were treated with CFR, 17 cases were treated with EACFR, and 58 cases were treated with EECFR. Olfactory neuroblastoma (ONB) was the most common pathology, consisting of 53% of all craniofacial resections, while squamous cell carcinoma (SqCC, 17%) and malignant melanoma (MM, 7%) followed. Other pathologies included neuroendocrine carcinoma (4%), adenocarcinoma (3%), and osteosarcoma (3%). The ONB patients were classified according to the Kadish staging system; 1 patient (1.8%) was Kadish stage A, 16 (30.2%) were Kadish stage B, 34 (64.2%) Kadish stage C, and 2 (3.8%) were Kadish stage D. Transdural resection was performed in 60.9% of ONB patients including those with olfactory bulb resection. In Kadish C stage ONB patients, those who underwent EECFR showed significantly higher disease-free survival (DFS) compared to CFR (p = 0.039) but not EACFR (p = 0.153). The rate of intracranial complications such as CSF leak, hematoma, or meningitis was significantly lower in the EECFR group compared to EACFR and CFR (5.2 vs. 26.2%, p < 0.004). Factors regarding morbidity such as estimated blood loss, operation time, ICU, and hospital stay were significantly less or shorter in EECFR compared to CFR. Over time, the trend in surgical approach mainly used to treat sinonasal tumor involving the anterior skull base has changed from open CFR to EECFR; 92.9% of surgeries were open CFR in the 1990s while 95.1% were EECFR after 2015.

Conclusion: Endoscopic CFR has become the main surgical approach for sinonasal tumors involving the anterior skull base in recent years. Complication rates and morbidity has decreased with the EECFR approach, and treatment results were comparable, or better compared to the open approach. Nevertheless, pathology and staging should be taken into consideration when selecting surgical approach and extent of excision.

Publication History

Article published online:
05 February 2024