Endoscopic Craniofacial Resection for Anterior Skull Base Tumors: A Singapore Center Review

Anterior skull base (ASB) tumors are rare and comprise a variety of pathologies. In recent years, the surgical management of ASB tumors has undergone a paradigm shift from open craniofacial resection (CFR) to minimally invasive endoscopic approaches. Endoscopic-assisted (EaCFR) and entirely endoscopic (ECFR) CFR have shown equivalent oncological outcomes without the morbidity of open surgery. This study presents our tertiary center experience and outcomes with endoscopic approaches for ASB tumors.

A retrospective review of all patients who underwent EaCFR and ECFR for ASB tumors from January 2010 to December 2024 at Singapore General Hospital was performed. Relevant patient characteristics, histologic diagnoses, treatment protocols, and perioperative data were collected and analyzed to determine complication rates, recurrence, and mortality.

Thirty-seven patients were included in the study, with 22 (59.5%) undergoing ECFR and 15 (40.5%) undergoing EaCFR. The mean age was 51.5 years. The most common presenting symptoms were epistaxis (70.3%) and nasal obstruction (48.6%). The primary histologic diagnoses were olfactory neuroblastoma (62.2%), sarcoma (13.5%), adenocarcinoma (8.1%), and sinonasal carcinoma (8.1%). R0 resection was achieved in 26 (70.3%) cases, and intraoperative hemorrhage necessitating staged surgery occurred in 2 (5.4%) cases. The mean follow-up duration was 4.6 years. There were no cases of perioperative mortality. Eight (21.6%) cases had postoperative complications, including 1 (2.7%) case of cerebrospinal fluid leak after completion of adjuvant radiotherapy. The 5-year recurrence-free, disease-specific, and overall survival rates were 61.8%, 94.2%, and 80.1%, respectively.

In appropriately selected patients, EaCFR and ECFR are effective management approaches for ASB tumors.