Abstract
Introduction:
Malignant invasion of the brain and/or dura are known negative prognostic factors for patients undergoing craniofacial resection for cancer. However, no evaluation has been conducted to identify factors that stratify prognosis in this subgroup.
Methods:
Between 1993 and 2003, 212 patients underwent craniofacial resection. Twenty-eight patients (8 females, 20 males; mean age 50.9 y, range 26–76 y) had evidence of transdural invasion (subdural tumor or brain invasion) of skull base malignancy. These patients were retrospectively identified and reviewed.
Results:
Subdural tumor was found in 16. Brain invasion was detected in 12. Gross total resections were achieved in 22 patients (13 with microscopically negative margins). Surgical complications occurred in 6 patients. There was no surgical mortality. The mean overall survival was 40 months. Eleven had no evidence of disease (NED), 11 were dead of disease (DOD), and 6 were alive with disease (AWD). Progression-free survival was 29 months. One of 12 patients (8%) with brain invasion was alive without disease versus 10 of 16 patients (63%) in the group with subdural spread. Seven of 12 patients (58%) with low-grade cancers were alive without disease. Four of 16 (25%) with high-grade cancers were alive without disease.
Conclusions:
Patients with transdural disease associated with malignant skull base tumors have a worse prognosis when treated for cure. Brain invasion seems to decrease survival when compared with subdural spread without brain invasion. Low-grade tumors have a better prognosis in the cohort with transdural invasion.