[Efficacy analysis of different surgical approaches for anterior skull base malignant tumors involving the orbit]

Objective: To analyze the efficacy and safety of different surgical approaches for the treatment of anterior skull base malignancies involving the orbit. Methods: Retrospective analysis was conducted on patients with anterior skull base malignancies involving orbit who attended Xuanwu Hospital of Capital Medical University from April 2013 to July 2021. They were divided into endoscopic endonasal approach(EEA), lateral orbital approach(ELOA), and sublabial transmaxillary approach(ESTMA) groups according to the primary surgical approach. One-way analysis of variance and χ² test were used to compare the clinical characteristics, degree of tumour resection, rate of postoperative cranial nerve palsy and improvement of visual acuity; Log-rank test was applied to assess the difference in overall survival (OS). Results: One hundred and ninety-eight patients were enrolled, including 107 males and 91 females, aged (48.5±15.3) years. There were 153, 33, and 12 patients in the EEA, ESTMA, and ELOA groups, respectively. There were no significant differences among the three groups in age, gender, and history of radiotherapy, chemotherapy or surgery (P>0.05 for all). All patients in ELOA group had preoperative visual impairment (12/12), with a significantly higher percentage than EEA group (56/153) and ESTMA group (14/33) (χ²=19.72, P<0.001). There was no significant difference between three groups in the degree of tumor resection (gross total resection: 84.97% vs. 81.82% vs. 58.33%, χ²=5.58, P>0.05), postoperative cranial nerve palsy rate (13.07% vs. 30.30% vs. 16.67%, χ²=5.95, P>0.05), visual improvement rate (58.93% vs. 57.14% vs. 58.33%, χ²=0.04, P>0.05) and 5-year OS (60.69% vs. 42.66% vs. 50.00%, χ²=3.22, P>0.05). Conclusion: All three surgical approaches were safe, effective and feasible treatment modalities.