Radical Exenteration of the Skull Base for End-Stage, Locally Advanced Sinonasal Malignancies: Challenging the Dictum of Unresectability

Yeung, Jacky T.; Caminer, David; Young, Isabella M.; Sughrue, Michael E.; Teo, Charles

doi:10.1016/j.wneu.2021.02.092

Cited by 8 publications

(12 citation statements)

References 23 publications

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“…Traditionally, a craniofacial resection was used to encounter sinonasal cancer invading the anterior skull base. Over time, endoscopic endonasal techniques revolutionized surgery of skull base and sinonsal malignancies [15][16][17]. To achieve the maximum extent of resection of skull base tumors, especially those with extensive antero-lateral involvement of the frontal sinus, dural in ltration of orbital roof, optic chiasm or brain parenchyma, a combined endoscopic and transcranial approach is recommended [18].…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Dural Reconstruction with or without A Bone Graft Following Oncologic Resections of Paranasal and Anterior Skullbase Malignancies

Konietzko¹,

Bonk²,

Schaller³

et al. 2022

Preprint

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The reconstruction of frontobasal defects following oncologic resections of paranasal and anterior skull base malignancies remains challenging. Ineffective reconstruction could lead to cerebrospinal fluid leak, meningitis, and tension pneumocephalus. Aim of this investigation was to analyse postoperative complication rates with or without bone graft for anterior skull base reconstruction. In this retrospective study, we included patients following resection of paranasal and/or anterior skull base malignancies between October 2013 and November 2020. Complications were analysed with regards to the type of skull base reconstruction. Ten patients were identified (2 female, 8 male, age (median, SD) 65±14.8 years (range 38 – 81). There were eight cases of paranasal sinus and nasal cavity carcinomas and two cases of olfactory neuroblastomas. Overall survival was 20±25.1 months (range: 5-72), progression free survival was 17.0±20.3 months (range: 4-72). Bone skull base reconstruction using a split graft was performed in three cases. Postoperative complications requiring surgical intervention were seen in 33% (one tension pneumocephalus) of cases in the bone reconstruction group and 57% (three patients with cerebrospinal fluid leak, one infection) in the non-bone reconstruction group. Additional bone reconstruction of the anterior skull base seems to lower the CSF leakage rate due to the additional abutment following resection of paranasal and anterior skullbase malignancies.

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Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Dural Reconstruction with or without A Bone Graft Following Oncologic Resections of Paranasal and Anterior Skullbase Malignancies

Konietzko¹,

Bonk²,

Schaller³

et al. 2022

Preprint

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show abstract

Section: Discussionmentioning

confidence: 99%

“…In patients with unresectable T4b squamous cell carcinoma, induction therapy may allow for downstaging, in some cases enabling surgical resection without orbital exenteration 12 . Increased consideration of surgical resection in the management of T4b sinonasal cancer has additionally extended to the salvage setting, with a recent report indicating that cases with intracranial invasion could be managed with aggressive resection 13 …”

Section: Discussionmentioning

confidence: 99%

“…12 Increased consideration of surgical resection in the management of T4b sinonasal cancer has additionally extended to the salvage setting, with a recent report indicating that cases with intracranial invasion could be managed with aggressive resection. 13 The role of neoadjuvant therapy remains unclear, as neoadjuvant chemotherapy or chemoradiotherapy followed by surgery may contribute to better outcomes than upfront surgery by tumor downstaging. 14,15 Another promising potential approach with induction chemotherapy involves patient selection for (1) chemoradiotherapy in those achieving a good response after initial chemotherapy and (2) surgery in those with a poor response to initial chemotherapy, which has been evaluated in sinonasal undifferentiated carcinomas.…”

Section: Discussionmentioning

confidence: 99%

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Including Surgical Resection in the Multimodal Management of Very Locally Advanced Sinonasal Cancer

Karp¹,

Hu²,

Persky

et al. 2021

Otolaryngol.--head neck surg.

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Objective Sinonasal cancer often presents as locoregionally advanced disease. National guidelines recommend management of stage T4b tumors with systemic therapy and radiotherapy, but recent studies suggest that including surgical resection in the multimodal treatment of these tumors may improve local control and survival. We queried the National Cancer Database to examine patterns of care and outcomes in T4b sinonasal squamous cell carcinoma (SCC). Study Design Prospectively gathered data. Setting National Cancer Database. Methods Patients with T4b N0-3 M0 sinonasal squamous cell carcinoma diagnosed in 2004 to 2016 were stratified between those who received chemoradiotherapy and those who underwent surgical resection with neoadjuvant or adjuvant treatment. The overall survival of each cohort was assessed via Kaplan-Meier analysis and Cox proportional hazard models, with repeat analysis after reweighting of data via inverse probability of treatment weighting. Results Among 805 patients included in analysis, 2-year overall survival for patients undergoing surgical resection was 60.8% (95% CI, 56.1%-65.9%), while for patients undergoing chemoradiotherapy it was 46.7% (95% CI, 41.9%-52.0%). On Cox regression analysis, the inclusion of surgery in management was associated with improved survival in univariate analysis (hazard ratio [HR], 0.723 [95% CI, 0.606-0.862]; P < .001) and multivariate analysis (HR, 0.739 [95% CI, 0.618-0.885]; P = .001). Results with reweighted data were consistent in univariate analysis (HR, 0.765 [95% CI, 0.636-0.920]; P = .004]). Conclusion Surgical treatment with neoadjuvant or adjuvant treatment for stage T4b sinonasal SCC was associated with promising survival outcomes, suggesting a role for incorporating surgery in treatment of select T4b SCC, particularly when removal of all macroscopic disease is feasible.

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“…Yeung et al [ 31 ] retrospectively evaluated 17 patients who had local sinonasal malignancy progression. All patients were previously operated on and had also received chemotherapy and radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Intracranially Extended Sinonasal Undifferentiated Carcinoma: A Case Report and Literature Review

et al. 2022

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Patient: Male, 41-year-old Final Diagnosis: Sinonasal undifferentiated carcinoma Symptoms: Nasal congestion Medication:— Clinical Procedure: Craniotomy Specialty: Neurosurgery Objective: Unusual clinical course Background: Sinonasal undifferentiated carcinomas (SNUC) are highly malignant and rare lesions. Therapeutic efforts often provide frustrating results. Their course is characterized by indolent progression, until it culminates in extensive local infiltration of adjacent anatomical structures or cervical lymphadenopathy in approximately one-third of patients upon admission. It most frequently affects males, with a sex ratio of 3: 1. The age at manifestation tends to be about 40–50 years. Case Report: We report the case of a 41-year-old man with intracranial expansion of SNUC. Two previous sinus surgeries were performed endoscopically because the lesion at that moment was exclusively located endonasally. Within the last few months, he had been having persistent headaches. Magnetic resonance imaging (MRI) revealed an anterior cranial fossa lesion. Therefore, he underwent a bifrontal craniotomy and excision of the space-occupying lesion (SOL). The osseous defect of the skull base was covered with a titanium mesh. Finally, we performed a duraplasty using a pericranial flap and fat tissue taken from his abdomen. Postoperatively, his wound was dehisced. We proceeded then to a frontal craniectomy with surgical debridement, subgaleal empyem and epidural abscess removal, and copious irrigation with oxygen peroxide. Enterococcus spp. were isolated from pus cultures. Despite receiving bacteria-focused antibiotics, he unfortunately developed sepsis and died. The histopathologic findings revealed a SNUC, which is the criterion standard for diagnosis. Conclusions: Multimodal treatment offers the best prognosis to patients with SNUC. Combined operations by otolaryngologists and neurosurgeons provide the necessary radicality. There is high risk of wound healing disorders, especially when local irradiation had been administered.

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Radical Exenteration of the Skull Base for End-Stage, Locally Advanced Sinonasal Malignancies: Challenging the Dictum of Unresectability

Cited by 8 publications

References 23 publications

WITHDRAWN: Dural Reconstruction with or without A Bone Graft Following Oncologic Resections of Paranasal and Anterior Skullbase Malignancies

WITHDRAWN: Dural Reconstruction with or without A Bone Graft Following Oncologic Resections of Paranasal and Anterior Skullbase Malignancies

Including Surgical Resection in the Multimodal Management of Very Locally Advanced Sinonasal Cancer

Intracranially Extended Sinonasal Undifferentiated Carcinoma: A Case Report and Literature Review

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