Craniofacial resection for sinunasal tumors

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ABSTRACT

Introduction. Malignant sinunasal tumors are veryrare in Mexico. They ussually present as advanceddisease because it is extremely difficult to make anearly diagnosis; in addition, its treatment is complicatedby a variety of lesions. Surgical resection remainsthe mainstay of treatment, but its relativetherapeutic value compared with alternative treatmentsis controversial.Objective. We undertook a retrospective analysis inorder to evaluate results of craniofacial resectionsfor sinunasal tumors.Materials and methods. A total of 20 patients, 11men and 9 women were considered, median agewas 49 years (18- 74). Eleven had received previoustreatment elsewhere. In 13 patients tumor was limitedto maxilo-etmoidal complex, but in 6 cases tumorinvolved anteroinferior aspect of esfenoidal sinus,in 7 extended to the orbit, in 3 to dura and twoto the brain. One had cervical metastases. Mediantumoral size was 5.8 cm (1-10).Results. Overall complication rate was 50%. Majorsurgical complications occurred in 4 patients (20%)one patient developed isolated cerebrospinal fluidleakage (CEFL), 1 developed deterioration of mentalstatus, and two developed meningitis associatedwith CEFL. Late complications occurred in 30% ofthe patients. There was not any operative death.Eleven patients received postoperative radiotherapy.Fifteen patients recurred. There were 11 local relapses,although one associated with a regional relapse,and another with regional and distant relapse.There were four isolated regional fails andsix isolated distant failures. Three year overall survivalwas 65%, and 3-year disease free survival was50%. Patients without previous treatment mediansurvival was 28.3 months, meanwhile with previoustreatment was 18.2 months.Conclusions. Craniofacial resection is a safe andvaluable tool in the treatment of advanced sinunasaltumors involving cranial base