Subkranialer Zugang bei Malignomen mit Beteiligung der Frontobasis

Zusammenfassung

Hintergrund: Überleben und Lebensqualität von Patienten nach chirurgischer Resektion eines Malignoms mit Infiltration der Frontobasis über einen subkranialen Zugang sollten beschrieben werden. Methoden: Die Datenerhebung erfolgte retrospektiv aus den Krankenakten, durch Telefoninterview sowie durch Kontaktaufnahme mit dem Hausarzt. Zur Ermittlung der Lebensqualität wurden der EORTC-QLQ30 und H&N35 eingesetzt. Ergebnisse: Im Zeitraum von 1996 bis 2004 wurden 19 Patienten (mittl. Alter 52 Jahre, 4 weiblich, 15 männlich) über einen subkranialen Zugang behandelt. 15 Patienten hatten ein Karzinom und 3 ein Ästhesioneuroblastom in fortgeschrittenen Stadien. 1 Patient hatte ein Fibrosarkom. 15 Patienten erhielten eine postoperative Strahlentherapie. Im mittleren Nachbeobachtungszeitraum von 44 Monaten (12 - 109 Monate) verstarben 6 Patienten, davon ein Patient tumorunabhängig. Die 5-Jahres-Überlebenswahrscheinlichkeit betrug 50 %, die mittlere Überlebenszeit 72 Monate. Bei 18 der 19 Patienten kam es zur Anosmie. Bei 2 Patienten trat postoperativ ein Spannungpneumozephalus auf, einmal mit letalem Ausgang. Es kam zu 1 Visusminderung und 1 Visusverlust, 1 persistierenden Diplopie, 2 tiefe Wundinfektionen und 2 Liquorfisteln. Die Lebensqualität unterschied sich durchschnittlich 36 Monate nach Abschluss der Therapie nicht wesentlich von der anderer Patienten mit Kopf-Hals-Tumoren. Schlussfolgerung: Malignome mit Infiltration der Frontobasis sind insgesamt selten. Die Therapieempfehlung erfolgt für jeden Patienten individuell. Hierbei ist zu berücksichtigen, dass trotz Infiltration der Frontobasis 5-Jahres-Überlebensraten von ca. 50 % bei annehmbarer Lebensqualität erreicht werden.

Abstract

Background: Survival and quality of life after subcranial resection of malignant tumors infiltrating the anterior skull base should be evaluated. Methods: Data were acquired retrospectively from patient charts and by telephone interview. Quality of life was assessed with the EORTC QLQ30 and H&N35 modules. Results: From 1996 to 2004, 19 patients (mean age 52 years, 4 woman, 15 men) were surgically treated via a subcranial approach. Fifteen patients suffered from advanced carcinoma, 3 from advanced esthesioneuroblastoma, and 1 patient had a fibrosarcoma. Fifteen patients received adjuvant radiotherapy. During the mean follow-up period of 44 months (12 - 109 months), 6 patients died, 1 unrelated to the tumor. The probability to survive 5 years was 50 %, the mean survival time was 72 months. Anosmia was reported by 18 of 19 patients. A tension pneumocephalus was observed in 2 patients, one with lethal outcome, decreased vision in 1 patient, loss of vision in 1, persisting diplopia in 1, deep wound infections in 2, and CSF leak in 2 patients. Quality of life was assessed on the average 36 months following end of therapy and did not differ substantially from other patients with head-neck malignancies. Conclusion: Most, malignant tumors infiltrating the anterior skull base can be treated curatively. The treatment outcome is well comparable to other head and neck tumors of corresponding stage.

Karzinom - Ästhesioneuroblastom - Schädelbasis - Chirurgie - Radiotherapie

Carcinoma - esthesioneuroblastoma - skull base - surgery - radiotherapy

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