Evolving role of skullbase surgery for patients with low and high grade malignancies

Malignancy involving the skull base remains a formidable management challenge. Advances and refinements in diagnostic imaging, instrumentation, microvascular reconstruction, and an improved overall appreciation of the anatomy of the skullbase have extended the boundaries of tumor resectability and in some cases, obviated the need for adjuvant therapies. Successful management of high-grade malignancy however, requires a carefully constructed multi-modal treatment plan to maximize patient outcome. Over the course of an 11-year period, 259 patients with skullbase malignancies were treated by the author in the setting of a tertiary care comprehensive cancer center. All patients were evaluated by a multidisciplinary team experienced in the assessment and treatment of skullbase malignancy. Management paradigms were constructed and treatment based on categorization into low or high-grade malignancy was recommended and undertaken. This manuscript discusses this patient population and the outcome of the management paradigms that were constructed. Differences in outcome based on the characterization of malignancies as either low or high grade is discussed. Complications of treatment and patient reported quality of life outcomes are reviewed.