Surgical Treatment Of Anterior Skull Base Communicating Tumor

Object:Because of the specificity of the location and anatomic structure,anterior skull base communicating tumor often invades adjacent structures,such as the skull base,sinuses,orbital and its surrounding neurovascular,making the surgical risks great and difficulty.The complete removal rate is low,but the recurrent rate are very high.After resection of the tumor,cranial cavity and nasal cavity are connected,so postoperative complications are very high,such as cerebrospinal fluid leakage,intracranial infection and other serious complications.So the surgical approaches and skull base reconstruction in removing these tumors are always difficult topics for neurosurgeons.To explore the ideal treatment strategy and surgical approach,we retrospectively analyzed 38 patients who came from Cancer Hospital Chinese Academy of Medical Sciences from the year 2009 to 2016 with communicative tumor invading anterior skull base.Methods:Of the 38 patients,there were 19 men and 19 women.All patients underwent MRI and CT examinations to confirm the characterization and extent of tumor invasion.All patients were examined by multi-disciplinary treatment to discuss the feasibility of induction therapy,possible surgical approach and adjuvant therapy.All patients were treated by the modified Derome' approach.According to the tumor resection and pathological results postoperative,comprehensive treatment was finished by the Department of Oncology and Radiation Therapy.Results:Fifteen patients had benign and 23 patients had malignant tumor.Total resection were achieved in 32 patients(84.2%),subtotal resection in 6 patients(15.8%).The incidence of complications were 31.6%(12/38),no surgical death occurred.36 patients were followed up for a period from 2 to 89 months,and 2 patients were lost to follow-up.For patients with malignant tumors,5-year survival rate was 66.2%.Conclusion:The pathological type of the anterior skull base tumor are complex,and the most is malignant(60.5%of this group).Surgery-based multi-disciplinary comprehensive treatment can significantly prolong the survival rate and improve the quality of life;The modified Derome' approach for resection of anterior skull base communicating tumor was fit for one-stage radical resection and avoided facial scars;Reconstruction of the skull base with both temporalis myofascial flap and pedicled frontal muscle periosteous flap can obviously decrease the complications rate,such as cerebrospinal fluid leakage and intracranial infection.Postoperative standardized comprehensive treatment can improve the local control rate and overall survival rate.