Short-term survival in extensive craniofacial resections

Abstract

Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years ( ± 18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

Complications After Open Skull Base Surgery for Brain Tumors: A 26-Year Experience

“…Infection is the most frequent postoperative complication encountered with anterior craniofacial surgery [ 2 , 5 , 6 , 8 ]. Prior radiation therapy increases the risk of infection in this type of surgery due to poor tissue vascularity [ 3 , 6 ].…”

“…These procedures carry significant morbidity as they are traditionally reserved for advanced and extensive cases. The literature cites a complication rate of 28-47% [2,[5][6][7][8][9][10][11][12][13][14]. Mortality can range between 1.0% and 4.7% [6,[8][9][10][14][15][16][17].…”

“…However, open skull base approaches remain a viable option for complex and extensive skull base tumors [1][2][3][4]. Combined craniofacial resection represents the most effective approach for skull base malignancies despite the evolution and advances of endonasal endoscopic techniques [1,2,[4][5][6]. Endoscopic and open skull base surgery aims to perform a radical resection with clear margins while limiting the complication rate [1,4].…”

Comprehensive management of nonmelanoma skin cancer involving the skull base

“…However, in most cases, these are very complex and extensive operations with considerable morbidity and mortality, requiring a multidisciplinary and specialized team and treatment at a tertiary center. CFS is especially indicated for patients with high-performance status and a lack of major comorbidities, major vessel involvement, extensive brain invasion, or lower cranial nerve involvement and the presence of only local or locoregional disease at presentation [7,12 ▪ ].…”

Scalp Complications of Craniofacial Surgery: A Comprehensive Systematic Review

“…Even though free-flapreconstructions and reoperations were not associated withperioperative deaths according to the multivariate analysis,their high frequencies indirectly reflect the complexity ofthese operations.Brazilian demographic and socioeconomic characteristicsstrongly influenced the high proportion of patients withskin cancer (63.4%), many (51%) of whom underwent skull-convexity resections, meaning that this was a unique cohort.Skin cancers with cranial invasion usually reflect a longclinical course of untreated disease, and the excision of skinand soft tissue in addition to the cranial base may predisposepatients to complications. 3 Reconstruction of scalp defects after oncologic surgery in plastic and reconstructive surgery still remains a challenge given the limited elasticity of the scalp soft tissue, with only defects 3 cm in diameter or smaller being able to be closed primarily. The anatomy of galea and pericranium play a crucial role in the inelasticity of the scalp.…”