Surgery for Malignant Maxillary Tumors Involving the Middle Cranial Fossa

Giulio Cantu; Carlo L Solero; Stefano Riccio; Sarah Colombo; Madia Pompilio; Ikenna V. Aboh; Paolo Formillo; Gabriel Hübner Arana

doi:10.1055/s-0029-1234021

Skull Base 2010; 20(2): 055-060
DOI: 10.1055/s-0029-1234021

ORIGINAL ARTICLE

Surgery for Malignant Maxillary Tumors Involving the Middle Cranial Fossa

Giulio Cantu¹ , Carlo L. Solero² , Stefano Riccio¹ , Sarah Colombo¹ , Madia Pompilio¹ , Ikenna V. Aboh¹ , Paolo Formillo¹ , Gabriel Hübner Arana¹

¹Department of Cranio-Maxillo-Facial Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori (National Cancer Institute), Milano, Italy
²Department of Neurosurgery, Istituto Nazionale Neurologico “C. Besta,” Milano, Italy

Abstract

ABSTRACT

The purpose of this study was to evaluate the disease-free survival (DFS) of patients with maxillary malignant tumors invading the middle cranial fossa (MCF) who underwent a lateral or anterolateral skull base resection. This study was a retrospective analysis in a tertiary referral center and included 62 patients with maxillary malignant tumors invading the MCF (stage T4b) treated with surgery with or without postoperative radiotherapy. All patients had sharp pain and involvement of at least one branch of the trigeminal nerve. Twenty-eight patients had not been treated previously, and 34 had previously been treated elsewhere. The MCF dura was infiltrated and resected in 36 cases, and in nine of these, there was an intradural extension of the tumor, with temporal lobe and/or cavernous sinus invasion. Thirty-six patients underwent reconstruction with a temporalis muscle pedicled flap, and 26 patients with a free flap. There was a 22% overall rate of postoperative complications, but no intraoperative deaths. The median follow-up time was 49 months (range 2 to 186). Overall DFS was 33.9% and was higher for untreated patients (46.4% versus 23.5%) and for patients in whom clean margins were achieved (51.4% versus 12.5%). The survival time for patients who died of disease was 9 months for squamous cell carcinoma and 38 months for adenoid-cystic carcinoma. All patients experienced anesthesia in the territory of the resected trigeminal branches, but their pain vanished, and their quality of life improved. Lateral skull base surgery may achieve satisfactory oncologic results for patients with low-grade tumors, with improved quality of life for almost all patients.

KEYWORDS

Maxillary malignant tumors - middle cranial fossa - skull base surgery - quality of life

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Giulio CantuM.D.

National Cancer Institute, Via Venezian 1

20133 Milano, Italy

Email: giulio.cantu@istitutotumori.mi.it