METAANALYSIS OF OUTCOME IN ANTERIOR SKULL BASE RESECTION FOR SQUAMOUS-CELL AND UNDIFFERENTIATED CARCINOMA

Multiple reports now demonstrate the technical feasibility of combined intra- and extracranial procedures for the excision of malignancy involving the anterior skull base. Anatomic proximity to vital structures in this region often precludes en bloc resection, however, and margins are often measured in millimeters. Nevertheless, multiple cases of prolonged survival following craniofacial excision of high-grade malignancies have been reported. These are usually included in larger series that encompass tumors of various histologic characteristics and grade. A meta-analysis of the reported outcome of craniofacial resection for squamous cell and undifferentiated carcinoma was performed. Ninety-six articles on craniofacial resection were reviewed and a total of 425 patients who had undergone craniofacial resection were identified in 30 of these. Of 89 patients with squamous cell carcinoma in whom follow-up data were available from seven larger series, the disease-free survival at 2 or greater years was 64%. Forty-one patients with undifferentiated carcinoma were identified who had undergone surgical excision, and 45% were disease-free at 2 or greater years (range, 2 to 24 years). This meta-analysis suggests that high-grade carcinoma involving the anterior cranial base is amenable to surgical excision with acceptable disease-free survival in selected patients at 2 years.