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Microsurgery for Potential Radiosurgical Skull Base Lesions: A Retrospective Analysis and Comparison of Results
Anil Nanda1, Ajay Jawahar, Satish Sathyanarayana
1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Abstract:
The outcomes of 26 complex skull base tumors treated with microsurgery were compared with the outcomes of similar tumors treated with radiosurgery as reported in the literature. The University neurosurgery database was searched for patients who underwent microsurgery for the treatment of skull base tumors between 1990 and 2001 at Louisiana State University Health Sciences Center in Shreveport, Louisiana. Twenty-six skull base meningiomas treated by microsurgery by the senior author (AN) were identified retrospectively. On imaging, the tumors were well defined and less than 3 cm in the greatest diameter, making them ideal candidates for a radiosurgical procedure had this modality been available. The follow-up and outcomes of these 26 patients were compared with the published outcomes of similar tumors treated with radiosurgery. Total excision was achieved in 17 (65.3 %) patients. Excision was subtotal in 9 (34.6 %) patients due to the critical locations of their tumors. The median hospital stay for these patients was 4 days (range, 3 to 12 days). Two patients (7.6 %) had transient cerebrospinal fluid leaks from the wound, and 2 (7.6 %) had transient facial paresis. Overall, preoperative symptoms improved in 23 (88.4 %) patients. The median follow-up was 56 months (range, 3 to 120 months). The overall survival rate for all was 87.2 +/- 3.7 % at 50 months. Two patients (7.6 %) subsequently underwent repeat surgery for a recurrent or progressive disease. The actuarial 8-year tumor control rate was 86.4 +/- 4.4 % using the Kaplan-Meier method. For small skull base tumors with benign histology, microsurgery is as safe and effective a treatment option as stereotactic radiosurgery. The symptomatic improvement in patients is better with microsurgery than with radiosurgery because the volume of the tumor is reduced immediately. A combined approach using both modalities is usually needed for larger tumors when attempts at total resection would jeopardize the neurologic function of the patient.
Insights
Microsurgery offers comparable safety and efficacy to radiosurgery for small skull base tumors. This approach provides immediate tumor volume reduction, leading to better symptomatic improvement in patients.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Skull base tumors present complex treatment challenges.
- Microsurgery and radiosurgery are primary treatment modalities.
- Comparing outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To compare the outcomes of microsurgery for skull base tumors with published radiosurgery data.
- To evaluate the safety and efficacy of microsurgery in a specific patient cohort.
Main Methods:
- Retrospective review of 26 skull base meningioma cases treated with microsurgery.
- Comparison of patient outcomes with literature data for radiosurgery-treated tumors.
- Analysis of tumor excision rates, complications, symptom improvement, and long-term tumor control.
Main Results:
- Total excision achieved in 65.3% of microsurgery patients; subtotal in 34.6%.
- Low rates of transient complications (CSF leak, facial paresis).
- Significant preoperative symptom improvement (88.4%) and an 8-year tumor control rate of 86.4%.
Conclusions:
- Microsurgery is a safe and effective option for small, benign skull base tumors, comparable to radiosurgery.
- Microsurgery offers superior immediate symptomatic relief due to rapid tumor debulking.
- Combined approaches may be necessary for larger tumors to preserve neurological function.