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Skull base surgery for malignancy: when not to operate.

P J Donald1

  • 1Department of Otorhinolaryngology, Head and Neck Surgery, University of California Davis, 2521 Stockton Boulevard Ste 7200, Sacramento, CA 95817, USA. Mary.Mccarthy@ucdmc.ucdavis.edu

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|April 18, 2007
PubMed
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This study outlines surgical contraindications for head and neck cancers invading the brain. Key factors include anatomical invasion, tumor virulence, and patient fitness, guiding treatment decisions for intracranial malignancies.

Area of Science:

  • Neurosurgery
  • Oncology
  • Head and Neck Surgery

Background:

  • Head and neck malignancies can invade the intracranial space, posing complex treatment challenges.
  • Surgical intervention for these advanced tumors requires careful consideration of potential contraindications.

Purpose of the Study:

  • To detail the contraindications for curative-intent surgery in patients with head and neck cancer invading the intracranial space.
  • To provide guidance based on extensive clinical experience.

Main Methods:

  • Retrospective analysis of over 250 patients treated over a 30-year period.
  • Identification and categorization of anatomical, tumor-related, and patient-related contraindications.

Main Results:

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  • Absolute anatomical contraindications include invasion of the brain stem, eloquent cerebral areas, superior sagittal sinus, bilateral internal carotid arteries, bilateral cavernous sinuses, and critical bridging veins.
  • Relative contraindications include distant metastatic disease and highly virulent tumors defying complete resection.
  • Lack of patient medical fitness or commitment are significant contraindications.

    • Conclusions:

    • Careful evaluation of contraindications is crucial for optimizing surgical decision-making in intracranial head and neck malignancies.
    • Identifying these factors improves patient selection and surgical outcomes.