Anterior and Middle Skull Base Surgery: The SNUH Experience

Lee, Chul Hee; Jung, Ha Won; Rhee, Chae Seo; Park, Hong Ju; Hah, Jeong Hun; Min, Yang Gi; Jung, Hee Won; Oh, Chang Wan

Abstract

OBJECTIVES
The purpose of this study is to evaluate the effectiveness of skull base surgery on local control and survival of skull base lesions. In addition, the complications and their impact on the tumor control status as well as postoperative morbidity are considered.
MATERIALS AND METHODS
We report our experience on 35 patients with skull base lesions. The patients were divided into two subgroups: (1) anterior skull base group (n=27) and (2) middle skull base group (n=8).
RESULTS
For the anterior skull base group, the overall survival rate for malignant tumor (n=15) at 16 months was 53% without regard to histologic types. The overall operative mortality rate was 0% and the complication rate was 25% with craniofacial resection for control of neoplasm (n=20) and all of these complications were managed successfully without any sequelae. The technique of craniofacial resection was applied to the management of skull base trauma (n=4) and encephaloceles (n=3) successfully. The middle skull base group consisted of 5 patients with juvenile nasopharyngeal angiofibroma, and one patient each with malignant meningioma, meningioma, fibrous dysplasia, respectively. All JNA patients were managed with a combined intracranial and transmaxillary/transpalatal approach. Among them, 4 patients were cured and one patient developed a recurrence near the cavernous sinus. Surgical morbidity was minimal and there was no mortality. Facial translocation approach to the skull base was utilized in 2 patients.
CONCLUSION
Craniofacial resection is a valid surgical technique for surgical management of tumors involving the anterior skull base and also can be applied to the treatment of selected trauma and malformations. The combined intracranial and transmaxillary/transpalatal approach is a safe and reliable method to remove nasopharyngeal angiofibroma with intracranial invasion.