Carcinoma escamoso primario de órbita / Primary orbital squamous cell carcinoma

El carcinoma escamoso primario de órbita es una entidad poco frecuente. Hay escasa literatura publicada al respecto. Presentamos un caso de carcinoma escamoso primario de los tejidos blandos de la órbita. La resección quirúrgica ofrecía el mejor tratamiento para esta paciente. Se realizó un abordaje cráneo-facial y se logró la resección completa de la lesión. La paciente recibió radioterapia adyuvante debido a la proximidad de la lesión a los márgenes quirúrgicos. El tratamiento quirúrgico es factible y debe ser considerado como parte del arsenal del cirujano. Sin embargo, las decisiones terapéuticas deben tomarse teniendo en cuenta las particularidades de cada caso.

Primary orbital squamous cell carcinoma is a rare entity. There is little published literature. We report a case of primary squamous cell carcinoma of the orbital soft tissues. Surgical resection offered the best treatment for the patient. Complete resection of the lesion was achieved. The patient received adjuvant radiotherapy due to the proximity of the lesion to the surgical margins. Surgical treatment is feasible and should be considered as part of the surgeon´s arsenal. However, therapeutic decisions must be made on a case-by-case basis.

Role of Craniofacial Resection for Malignant Tumors Involving the Anterior Skull Base: Surgical Experience in a Single Institution

BACKGROUND: Craniofacial resection (CFR) has been regarded as a standard treatment for various tumors involving the anterior skull base. The purpose of this study was to evaluate the results of CFR for the patients with anterior skull base malignancies in our hospital. METHODS: We retrospectively analyzed 17 patients with anterior skull base malignancies treated with CFR between 2001 and 2012. Mean follow-up duration was 41 months (range, 2-103 months). RESULTS: Intracranial involvement was found in 11 patients (65%) and orbital extension in 6 patients (35%). Classical bifrontal craniotomy was combined with endoscopic endonasal approach in 14 patients and external approach in 3 patients. Vascularized flap was used for reconstruction of the anterior fossa floor in 16 patients (94%). The most common pathological type was squamous cell carcinoma (6 patients). Gross total resection was achieved in all cases. Postoperative complications developed in 4 patients (24%) and included local wound problem and brain abscess. One patient with liver cirrhosis died from unexpected varix bleeding after the operation. Although postoperative treatment, such as radiotherapy or chemotherapy, was performed in 14 patients, local recurrence was seen in 6 patients. The mean overall survival time after the operation was 69.0 months (95% confidence interval: 47.5-90.5 months) with a 1-, 2-, and 5-year survival rate of 82.3%, 76.5%, and 64.7%, respectively. Postoperative radiotherapy was found to be the powerful prognostic factor for favorable survival. CONCLUSION: Considering the higher local control rate and acceptable complication or mortality rate, CFR with adjuvant radiotherapy is a gold standard treatment option for malignant tumors involving anterior skull base, especially with extensive intracranial involvement.

Endoscopic Versus Traditional Craniofacial Resection for Patients with Sinonasal Tumors Involving the Anterior Skull Base

OBJECTIVES: With the advent of microdebriders and image guidance systems, endoscope-assisted surgery is now more widely used for the treatment of tumors involving the base of the skull. The aim of this study was to analyze the clinical features of tumors involving the anterior skull base and to evaluate the treatment outcomes according to the surgical approach, which included the traditional craniofacial resection (TCFR) and the endoscopic craniofacial resection with craniotomy (ECFR). METHODS: Forty-six patients who underwent craniofacial resection from 1989 through 2006 at Seoul National University Hospital and Seoul National University Bundang Hospital were included in this study. Demographics, histology, surgical management, surgical outcomes, complications, and morbidity were analyzed. RESULTS: The number of malignant and benign lesions was 40 and 6 cases respectively. The most common diagnosis was olfactory neuroblastoma occurring in 41% of the cases followed by squamous cell carcinoma and malignant melanoma. Thirty-six patients underwent TCFR, while ECFR was performed with or without adjunctive chemotherapy or radiotherapy in 10 patients. The overall five-year survival rate for patients with malignant tumors of the anterior skull base was 47.4%. Out of 19 patients with olfactory neuroblastomas, 10 patients had TCFR and six among them died of their disease. Nine patients underwent ECFR, and none of them died of their disease. The ECFR group had lower morbidity and cosmetic deformity than did the TCFR group. CONCLUSION: The ECFR may be considered as an alternative option for the treatment of selected tumors with anterior skull base invasion. This approach offers the advantages of avoiding facial incisions with comparable treatment results.

Esthesioneuroblastoma Treated by Craniofacial Resection: Case Report

The authors report a case of esthesioneuroblastoma with intracranial extension treated by craniofacial resection. The tumor was resected by transbasal approach and repaired the dural defect using pericranial flap. The defect of floor of anterior cranial fossa was repaired with splitted calvarium and pericranial flap. Otorhinolaryngologist removed the residual tumor mass located at paranasal sinuses using lateral rhinotomy. Using cranifacial resection, the authors could remove the mass completely. The patient was referred to hemato-oncologist for chemotherapy.

Transcranial Approach for Resection of Tumors in Area of the Anterior Skull Base, Orbit and Paranasal Sinuses / 中国医师杂志

Objective To investigate the feasibility and complications of the transcranial approach for resection of tumors that involve the anterior skull base, orbit and paranasal sinuses. Methods Nine cases of tumors involving the anterior skull base, orbit and paranasal sinuses, which were resected by transcranial approach alone in our hospital from July 2000 to April 2001, were retrospectively analyzed. All patients had the lesion of the anterior skull base and orbit, and 5 cases had additional paranasal sinuses involvement. Results The tumors in all patients were removed completely. Complications occurred in three cases, including one case of cerebrospinal fluid leaking and two cases of blepharoptosis. One died of tumor recurrence one year after operation. Eight were tumor-free survival during the follow-up period of 20～29 months. Conclusion The transcranial approach can completely remove the tumors widely invading the anterior skull base, orbit and paranasal sinuses. Separation of the periosteum of the orbital roof can cause blepharoptosis, which leads to failure of cosmetics. Extending approach must be avoided if it is possible. The reconstruction of the skull base with pedicle pericranial flap may be the key factor to reduce complications.

Complications and Outcome of Craniofacial Resection for Anterior Skull Base Tumors

The purpose of this study is to evaluate the complications of anterior craniofacial resection for the neoplasms of invading the anterior cranial base and the effectiveness of anterior craniofacial resection on local control and survival. We analyzed clinical experience of 19 patients with anterior skull base lesions retrospectively, who underwent anterior craniofacial resection between January 1991 and November 1997 at the Department of Neurosurgery joining with Otolaryngology. Seventeen cases were malignant tumor. The spectrum of disease included esthesioneurobla- stoma(7 patients), squamous cell carcinoma(4 patients), malignant teratoma(2 patients), and others were malignant melanoma, undifferented cell carcinoma, osteogenic sarcoma, Ewing's sarcoma. Two patients had ossifying fibroma. There was no operative mortality. The complications occurred in 11 cases(58%). Patients with complications included six cases of infection, two with CSF leak. Others were transient impairment of mental status pneumoce-phalus and transient diplopia. In six cases with infection, two case of osteomyelitis were managed by surgical removal of infected bone flap, the others were controlled conservatively without any sequelae. The overall survival rate for malignant tumor at 14 months is 53%. There was a t rend to decreased survival time in regard of tumor invasion to the bone, the dura, and the parenchyme. Presence of orbital invasion showed significant influence on survival tirne. Anterior craniofacial resection is a relatively safe procedure for surgical management of tumors involving the anterior skull base with o r without intracranial invasion.

Craniofacial Resection with Subfrontal Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The classic craniofacial resection for anterior skull base tumor uses bifrontal craniotomies together with lateral rhinotomies. This approach requires frontal lobe retraction and may be associated with the development of brain edema and encephalomalacia. The subfrontal approach by use of supraorbital-frontal bone osteotomy permits removal of anterior skull base lesions with minimal retraction of frontal lobe and provides excellent exposure by reducing the depth and obliquity of the approaches and lowering the inferior visual angle. MATERIALS AND METHODS: We reviewed 3 cases of anterior skull base tumor involving the frontal, sphenoid sinus and partially clivus, or frontal lobe. They were 1 female patient and 2 male patients aging from 56 to 64. RESULTS: We obtained sound results, both functionally and cosmetically, except for one who died of brain metastasis. CONCLUSION: The craniofacial resection with subfrontal approach using supraorbital-frontal bone osteotomy provides excellent exposure, particularly in high grade malignancy of the anterior skull base, and can reduce postoperative morbidities.

A Case of Inverted Papilloma without Associated Malignancy Invading the Anterior Skull Base / 대한이비인후과학회지

The inverted papilloma is an uncommon benign tumor constituting 0.5% to 4% of all primary nasal tumors. The tumor is characterized by local aggressiveness, high rate of recurrence and association with malignancy. Intracranial extension or encroachment without associated malignancy is very rare. The treatment should be en bloc resection to prevent the recurrence. Recently, the authors have experienced a case of large inverted papilloma of the nasal cavity invading the anterior cranial base without associated malignancy. The tumor was removed en bloc by craniofacial resection combined with medial maxillectomy through lateral rhinotomy approach. The defect of the skull base was repaired with pericranial flap and temporal muscle flap. The patient has been followed for 2 years and has showed no recurrence.

Craniofacial Resection for the Anterior Skull Base Tumors

Craniogacial resection(CFR) is an ideal approaches for tumors involving the anterior skull base. This technique may be used for benign and malignant tumors arising from the paranasal sinus, nasal cavity, and orbit that extend into the anterior skull base. Recently, we have experienced 12 cases of craniogacial resection for anterior skull ase tumors. Most of them were recurrent tumors, and received previous local excision, preoperative radiotherapy, or chemotherapy before craniofacial resection. Histologic types of tumors included 6 squamous cell carcinomas, one each of adenoid cystic carcinoma, rhabdomyosarcoma, osteoma, ossifying fibroma, cavernous hemangioma, and malignant schwannoma. Two patients died after surgery; one from recurrent infection and the other from rupture of the tumor invaded ICA. Four malignant tumors recurred after the CFR. Remaining 5 patients are doing well without tumor recurrence. In conclusion, CFR is a commendable procedure for anterior skull base tumors, providing cure for benign tu mors and at least a local control for malignancies.