[Craniofacial block-resections for malignant tumors of the skull base]

The study was a result of joint studies conducted by the Academician N. N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences, and the P. A. Herzen Moscow Cancer Research Institute, Ministry of Health of the Russian Federation, in 1996 to 2001. During this period, the joint team operated on 32 patients with malignant craniofacial tumors. Of them there were 18 males and 14 females whose age was 8 to 74 years. Most patients were aged 36 to 60 years. Epithelial tumors were predominant in the histological pattern of 18 (56%) patients. Squamous-cell (8 patients) and adenoid cystic (4 patients) carcinomas were prevalent among the epithelial tumors and rhabdomyosarcoma (4 patients) was prevalent among the mesenchymal tumors. Craniofacial block-resection was one of the stages of complex treatment in patients with malignant tumors of the base of the skull. Malignant craniofacial tumors are prone to local spread and rarely give rise to both regional and distal metastases. This is the basis for the concept that the patient may be cured via block removal of a tumor with a portion of its adjacent intact tissues in a combination with pre- and/or postoperative multidrug and radiation therapies. There were intraoperative and postoperative fatal cases. The signs of tumor remnants were absent, as evidenced by computed tomography and magnetic resonance imaging (MRI) performed in all cases. Further control MRIs were performed every 3 months during 2 years, then every 6 months, Complications as graft rejection were observed in 2 cases: on day 2 after surgery in one case and on day 6 in the other. They were not a cause of liquorrhea and meningitis due to the effectiveness of a pedicle periosteal graft that restricts the dura matter. Repeated microsurgical operations using other types of grafts. The patients were followed up for 3 to 5 years. During this period, 12 (37.5%) patients died of dissemination in the period of 1 month to 2 years; 1 (3.1%) patient died of the causes unassociated with the underlying pathological process. In 7 (21.8%) patients, the relapse-free was 5 years or more; of them there were 5 patients with epithelial tumors, 1 with a mesenchymal tumor, and 1 with a malignant chondroid tumor. In these patients, cosmetic corrective operations were made by plastic surgeons. Twelve patients, including 5 with epithelial tumors, 4 with mesenchymal tumors, and 3 with chondroid ones, were operated on for recurrences. Seven patients underwent lymphadenectomy due to the cervical lymph nodal metastases. Nineteen (59.4%) and 17 (53.1%) patients survived > or = 3 and > or = 5 years, respectively.