J Neurol Surg B Skull Base 2024; 85(S 01): S1-S398
DOI: 10.1055/s-0044-1780092
Presentation Abstracts
Oral Abstracts

Colossal Collision Tumors of the Skull Base in NF-2 Patients: 14 Years’ Experience of a Complex Surgical Treatment Paradigm

Authors

  • Peyton L. Nisson

    1   Cedars Sinai, Los Angeles, California, United States

  • Steven Curry

    2   University of California Los Angeles, Los Angeles, California, United States

  • Dominic Chau

    3   House Institute, Los Angeles, California, United States

  • William H. Slattery

    3   House Institute, Los Angeles, California, United States

  • Derald E. Brackman

    3   House Institute, Los Angeles, California, United States

  • Gregory P. Lekovic

    3   House Institute, Los Angeles, California, United States
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Objective: Collision tumors of the skull base are rare lesions that frequently arise in neurofibromatosis-2 (NF2) patients. They are known to exhibit accelerated growth rates and behave more aggressively. Gross total resection is not often feasible due to the high morbidity of cranial nerve palsies. Management from a technical and decision-making standpoint can be very challenging, though little research or guidance is available on this topic.

Methods: Consecutive patients with an intracranial, skull base tumor treated by the senior author were queried using a prospective database at a tertiary care medical center. Dates ranged from January 2009 to March 2023. Those that had at least two distinct masses found to have a histological diagnosis consistent with a collision tumor and were 4 cm or greater in size were included. Collision tumors 4 to 4.99 cm were categorized as “giant” while tumors 5 cm or greater were categorized as colossal.

Results: A total of 26 surgeries were performed on 11 patients. Most were in the third decade of life at the time of evaluation (mean: 26 years, range: 19–35). Mean tumor size was 5 cm (range 4–7.7 cm); 4 (36%) were considered colossal and 7 giant (64%). Sixty-four percent had either prior radiation or surgery at the skull base before initial evaluation.

Gross total resection was not feasible in any of the cases. Eight revision surgeries were performed, which averaged every 4.6 years (range: 0.8–14.6, median: 3.9 years). Kaplan–Meier estimates for 5-year revision-free time after surgery was 65% and 10-year survival was 88%. The majority of patients had a Karnofsky score of 70% (6/11) at the time of most recent follow-up ([Figs. 1]–[4]).

Conclusion: Gross total resection was not feasible for NF2 patients without significant morbidity for colossal and giant collision tumors of the skull base. We found a strategy of palliative, serial debulking afforded sufficient time between repeat surgeries and with an acceptable quality of life.



Publication History

Article published online:
05 February 2024

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