Complications in Salvage Surgery for Nasal and Paranasal Malignant Tumors Involving the Skull Base.

Objective  Nasal and paranasal malignant tumors invading the skull base are rare and poorly studied. We evaluated postoperative complications in patients undergoing salvage surgery for such tumors. Design  Retrospective study. Setting  Kobe University Hospital. Participants  Among 48 patients who underwent surgery for tumors involving the skull base between 1993 and 2015, 21 patients had squamous cell carcinoma, 13 had olfactory neuroblastoma, 5 had adenocarcinoma, 2 had sarcoma, 2 had adenoid cystic carcinoma, and 1 each had malignant melanoma, poorly differentiated carcinoma, undifferentiated carcinoma, myoepithelial carcinoma, and malignant peripheral nerve sheath tumor. Prior to skull base surgery, radiotherapy, chemoradiotherapy (CRT), particle radiotherapy, chemotherapy, or surgery were applied in 3, 15, 4, 5, and 3 patients, respectively. Main Outcome Measures  Main outcome measures were postoperative complications in patients who underwent skull base surgery after concomitant CRT and/or particle therapy. Results  Major postoperative complications were observed in 14 surgical procedures (29%; 2 patients with cerebral herniation, 3 with cerebrospinal fluid leakages, 3 with meningitis, 1 with hydrocephalus, 6 with epidural abscesses, 2 with local infections, and 2 with partial flap necrosis). Four patients developed ≥2 complications. One patient died of postoperative lung infarction. Three (16.7%) of 18 patients without prior treatment and 9 (50%) of 18 patients who underwent preoperative radiotherapy/CRT had severe postoperative complications. Two (50%) of four patients treated with particle radiotherapy had postoperative complications. Conclusions  CRT or particle radiotherapy were significantly associated with a high risk of severe postoperative complications after skull base surgery. Meticulous care should be taken in patients treated with radiotherapy/particle therapy prior to skull base surgery.