Anterolateral and lateral skull-base approaches for treatment of neoplastic diseases

Neoplasms affecting the anterolateral and lateral skull base have different sites of origin and histology, and its resection is technically difficult. The purpose of this study was to describe the surgical outcome and overall and disease-free survival of patients who had anterolateral and lateral skull base procedures for treatment of neoplasms with and without adjuvant therapy.

A retrospective study was performed on 26 patients who underwent anterolateral or lateral skull-base procedures through subcranial approaches such as maxillectomy with ethmoidectomy, osteoplastic maxillotomy, transmandibular, infratemporal, and transtemporal/infratemporal techniques for treatment of neoplastic diseases. Twenty-one cases were malignancies, with no evidence of metastasis. These approaches were combined frequently with a transbasal, pterional, subtemporal, or temporo-occipital craniotomy. Survival and disease-free intervals were evaluated with the Kaplan-Meier product limit method.

Nine cases were maxillary antrum malignancies with extension to the middle fossa and/or infratemporal fossa, 7 with nasopharyngeal neoplasms, 3 malignant lesions in the infratemporal fossa, and 3 with auditory canal carcinomas. The rest had miscellaneous diagnosis. Major morbidity occurred in 15% of cases. Perioperative mortality was 0. From 21 cases with malignancies, 4 had recurrences and the overall survival was 78% at 36 months of follow-up.

Anterolateral and lateral skull-base surgery is done with low morbidity and no operative mortality. The oncologic results are better than those reported in the literature probably because of a stringent selection of cases, although a longer follow-up period is required.