Brad E Zacharia1, Flavio R Romero2, Sarah K Rapoport3, Shaan M Raza2, Vijay K Anand4, Theodore H Schwartz5. 1. Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA. Electronic address: bez2103@columbia.edu. 2. Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA. 3. Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC, USA. 4. Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA. 5. Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Neuroscience, Weill Medical College of Cornell University, New York, New York, USA.
Abstract
BACKGROUND: The anterior skull base is an uncommon site for brain metastases. A limited number of cases have been reported where a region of the skull base is accessed through an expanded/extended transsphenoidal route. In addition, reports of overall and progression-free survival rates are lacking. OBJECTIVE: To report progression-free and overall survival rates for skull base metastases treated with aggressive endoscopic endonasal surgery and radiation therapy. METHODS: We retrospectively review a prospective database of patients at New York Presbyterian Hospital undergoing expanded endoscopic endonasal surgery from 2004 to 2014. From this database, we identified all patients whose final pathology revealed a metastatic lesion in the midline skull base. RESULTS: Seven hundred forty-nine patients underwent endonasal endoscopic surgery. Final pathology in 12 patients (1.6%) revealed metastasis to the sellar or parasellar region. Tumors were located in the sella, suprasellar cistern, clivus, ethmoid sinuses, sphenoid sinus, cavernous sinus, and craniovertebral junction. Breast and lung cancers were the most common primary diagnoses. Gross total resection was achieved in 41.6% of patients. There were no postoperative cerebrospinal fluid leaks. Adjuvant radiation therapy was used in 92% of cases. Median follow-up was 14 months (range, 1-55). Median progression-free and overall survival were 18 and 16 months, respectively. CONCLUSIONS: The range of anterior skull base metastatic lesions that can be managed endonasally has increased with the advent of extended endonasal endoscopic surgical approaches. Favorable results can be obtained with this surgical approach as part of the overall management paradigm for patients with skull base metastases.
BACKGROUND: The anterior skull base is an uncommon site for brain metastases. A limited number of cases have been reported where a region of the skull base is accessed through an expanded/extended transsphenoidal route. In addition, reports of overall and progression-free survival rates are lacking. OBJECTIVE: To report progression-free and overall survival rates for skull base metastases treated with aggressive endoscopic endonasal surgery and radiation therapy. METHODS: We retrospectively review a prospective database of patients at New York Presbyterian Hospital undergoing expanded endoscopic endonasal surgery from 2004 to 2014. From this database, we identified all patients whose final pathology revealed a metastatic lesion in the midline skull base. RESULTS: Seven hundred forty-nine patients underwent endonasal endoscopic surgery. Final pathology in 12 patients (1.6%) revealed metastasis to the sellar or parasellar region. Tumors were located in the sella, suprasellar cistern, clivus, ethmoid sinuses, sphenoid sinus, cavernous sinus, and craniovertebral junction. Breast and lung cancers were the most common primary diagnoses. Gross total resection was achieved in 41.6% of patients. There were no postoperative cerebrospinal fluid leaks. Adjuvant radiation therapy was used in 92% of cases. Median follow-up was 14 months (range, 1-55). Median progression-free and overall survival were 18 and 16 months, respectively. CONCLUSIONS: The range of anterior skull base metastatic lesions that can be managed endonasally has increased with the advent of extended endonasal endoscopic surgical approaches. Favorable results can be obtained with this surgical approach as part of the overall management paradigm for patients with skull base metastases.
Authors: Cinzia Baiano; Teresa Somma; Raduan Ahmed Franca; Marianna Di Costanzo; Maria Rosaria Scala; Pasquale Cretella; Felice Esposito; Luigi Maria Cavallo; Paolo Cappabianca; Domenico Solari Journal: Front Oncol Date: 2022-07-28 Impact factor: 5.738