Skull Base Tumors: A Kaleidoscope of Challenge

Abstract

Resection of skull base lesions has always been riddled with problems like inadequate access, proximity to major vessels, dural tears, cranial nerve damage, and infection. Understanding the modular concept of the facial skeleton has led to the development of transfacial swing osteotomies that facilitates resection in a difficult area with minimal morbidity and excellent cosmetic results. In spite of the current trend toward endonasal endoscopic management of skull base tumors, our series presents nine cases of diverse extensive skull base lesions, 33% of which were recurrent. These cases were approached through different transfacial swing osteotomies through the mandible, a midfacial swing, or a zygomaticotemporal osteotomy as dictated by the three-dimensional spatial location of the lesion, and its extent and proximity to vital structures. Access osteotomies ensured complete removal and good results through the most direct and safe route and good vascular control. This reiterated the fact that transfacial approaches still hold a special place in the management of extensive skull base lesions.

Access to the skull base - Maxillary swing procedure - Long term analysis

“…Although technological advances have expanded the use of endoscopic techniques to include endonasal approaches to skull base lesions, its scope has been limited. [ 9 ]…”

“…These approaches have limitations because the access here is through a small window with limited surgical field, which may preclude the wide exposure required for complete clearance of oncological lesions. [ 9 ]…”

“…Based on the path chosen and bones mobilized, transfacial swing osteotomies can be transmandibular, transmaxillary, zygomaticotemporal, fronto-orbital (glabellar) approach, and combination approaches including zygomaticomaxillary, nasomaxillary, and nasozygomaticomaxillary. [ 9 ] The approach may be tailored according to the requirements of the lesion in the individual patient.…”

A retrospective study of skull base neoplasia in 42 dogs

“…31 The complex anatomy and tissue heterogeneity of the skull base gives rise to a wide variety of neoplasms that are typically difficult to access by the neurosurgeon in human medicine. 11 Therefore, benign or malignant skull base neoplasms typically hold a guarded or a poor prognosis. 31 Given the challenges imposed by these lesions, most of the medical research in this field is concentrated on the development of minimally invasive and precise surgical approaches that aim to replace traditional and frequently life-threatening surgical procedures and on the improvement of potential therapeutic plans that increase postsurgical survival rates and quality of life.…”

“…12,13 As a direct result of these efforts, important information has surfaced on the prevalence, location, biology, and therapy of skull base tumors. 1,5,8,11–13,29,31,39 In contrast, similar studies have not been conducted in veterinary medicine, and while there have been a number of reports describing primary and secondary intracranial neoplasia in dogs, none has addressed skull base neoplasia as a distinct clinicopathological entity. 7,16,19,20,33,34…”