Is There a Role for Craniofacial Surgery in the Treatment of Extensive or Recurrent Head and Neck Tumors Involving the Cranial Base?

PURPOSE: Extensive or recurrent head and neck tumors involving the cranial base are extremely difficult to treat from a surgical perspective. The purposes of this study were to estimate and identify factors associated with overall survival after traditional craniofacial resection in these cases and to discuss the specific indications and treatment outcomes.

MATERIALS AND METHODS: From January 2005 to December 2014, a retrospective cohort study was performed with the analysis of patients diagnosed with extensive or recurrent head and neck tumors extending to the skull base. The clinical records were reviewed for predictor variables regarding demographic characteristics, prior treatment status, pathologic characteristics, tumor sites and sizes, skull base bone or brain parenchyma invasion, reconstructive approaches, surgical margins, and adjuvant therapies. The outcome variable was overall survival. Overall survival was estimated by Kaplan-Meier methods, and risk factors were identified by use of Cox modeling.

RESULTS: The cohort was composed of 119 patients with a mean age of 44.53 years; there were 67 male patients (56.30%). Through-and-through resection of the skull base bones (dural exposure) was performed in 100 patients (84.03%). The overall complication rate for the entire group was 42.86%, and the perioperative mortality rate was 2.52% (n = 3). The mean follow-up period reached 43.88 months. Of the patients without perioperative death (n = 116), 39 had local recurrences. After multivariate analysis, surgical margins (P = .001), pathologic classification (P = .016), and extent of skull base involvement (P = .001) were found to be independent factors affecting overall survival.

CONCLUSIONS: Craniofacial surgery for extensive or recurrent skull base lesions is feasible in well-selected patients.