Abstract
Craniofacial resection is the gold standard for resection of tumors of the paranasal sinuses and anterior skull base. This procedure was described approximately 50 years ago, and despite advances in technique, imaging, and endoscopy, as well as the development of surgical teams, the perioperative complication rate is greater than 30%. To further stratify patients undergoing traditional open craniofacial resection or endoscopic-assisted resection, we attempted to evaluate risk factors associated with peri- and postoperative complications.
We performed a retrospective chart review of 81 consecutive surgeries for benign and malignant disease involving the anterior cranial base between 2001 and 2006 at the University of Pennsylvania Medical Center. Mean age was 55.8 years (range 19–90 years). The cohort involved 58 patients with malignant disease, with stage IV, III, II, and Kadish C lesions found in 34, 15, 4, and 5 patients, respectively. Forty-eight of the 81 patients undergoing surgery (59%) had endoscopic or endoscopic-assisted surgical resection. Thirty-eight patients (47%) had either pre- or postoperative radiation treatment. Forty-one (50.6%) were identified as having at least one comorbidity. We distinguished complications as those of the wound, central nervous system, orbit, or systemic nature.
The complication rate was 27%(22/81). We found no difference in complication rates in those patients who were older or younger than 70 or 80 years of age. Furthermore, we found no significant differences in complications in patients with an identified comorbidity, or in those that underwent chemotherapy or radiation. There were trends toward fewer complications in patients that underwent surgery for benign disease (17% vs. 31%). There was a significant decrease in the rate of complications in those patients who underwent endoscopic-assisted resection compared with open craniofacial resection (15% vs. 45%).
On evaluation of the possible risk factors for perioperative complication, we found the use of endoscopic resection and surgery for benign disease to be associated with fewer complications. Other factors, including elderly age, stage of disease, preoperative identified comorbidity, and patient chemotherapy or radiation, were not statistically associated with changes in complication rates. Further study with larger samples must be performed to further delineate risk factors for those undergoing anterior skull base surgery.