Craniofacial resections for paranasal malignancies

ABSTRACT

From 1984-1989, 18 patients underwent craniofacial resections for paranasal sinus malignancies involving the anterior skull base. Histologic types included 9 epidermoid cancer, 3 undifferentiated carcinoma, 3 adenoidcystic carcinoma, 2 adenocarcinoma and 1 esthesioneuroblastoma. A 44% complication rate included predominantly meningitis [22%], resulting from cerebrospinal fluid leaks [33%] and osteomyelitis [11%] An overall survival rate of 50% was recorded with follow up in all patients ranging from 26-38 months [mean 29 months]. Two surgery related deaths [11.1%] resulted from uncontrolled gram-negative meningitis. Disease free survival rate was notably better in those cases who underwent planned craniofacial surgery pre-post-operative radiation [58%] than in those in whom surgical salvage was carried for radio-recurrent tumors [33%]. Accurate pre-surgical assessment by high resolution computed tomography, satisfactory en bloc resection, meticulous repair of skull base defect and vigilant post-operative care seem to be critical factors enhancing local control sans overt morbidity