Kawahara Nobutaka, Sasaki Tomio, Asakage Takahiro, Nakao Kazunari, Sugasawa Masashi, Asato Hirotaka, Koshima Isao, Saito Nobuhito
Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
J Neurosurg. 2008 Mar;108(3):501-10. doi: 10.3171/JNS/2008/108/3/0501.
Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations.
Between 1994 and 2006, 17 patients (10 men and 7 women) underwent total or subtotal TBR for primary temporal bone malignancies. Tumors were graded according to the University of Pittsburgh system. The effects of surgical margins and tumor extensions on patient survival were analyzed using the Kaplan-Meier method.
All tumors, except 1, were graded T4 (most advanced). Subtotal TBR was performed in 14 patients, and total TBR was performed in 3. The surgical margin was tumor negative in 10 patients and tumor positive in 7. For large tumors extending into the infratemporal fossa or encroaching on the jugular foramen, orbitozygomatic (3 patients) and posterior transjugular (4 patients) approaches were combined with the standard approach, and en bloc resection with a negative margin was achieved in all cases but 1. The follow-up time ranged from 0.3-11.6 years (mean 3.3 years). The 5-year recurrence-free and disease-specific survival rates were 67.5 and 60.1%, respectively. When a negative surgical margin was achieved, the survival rates improved to 100 and 89%, respectively.
The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.
原发性颞骨恶性肿瘤是一种罕见的肿瘤形式，其治疗策略仍存在争议。在本研究中，作者回顾了他们对这类病变进行根治性颞骨切除术（TBR）的经验，并分析了长期结果以提供治疗建议。
1994年至2006年间，17例患者（10例男性和7例女性）因原发性颞骨恶性肿瘤接受了全颞骨或次全颞骨切除术。肿瘤根据匹兹堡大学系统进行分级。使用Kaplan-Meier方法分析手术切缘和肿瘤扩展对患者生存的影响。
除1例肿瘤外，所有肿瘤均为T4级（最晚期）。14例患者接受了次全颞骨切除术，3例接受了全颞骨切除术。10例患者手术切缘无肿瘤，7例切缘有肿瘤。对于延伸至颞下窝或侵犯颈静脉孔的大型肿瘤，3例患者采用眶颧入路，4例患者采用后经颈静脉入路并结合标准入路，除1例患者外，所有病例均实现了切缘阴性的整块切除。随访时间为0.3至11.6年（平均3.3年）。5年无复发生存率和疾病特异性生存率分别为67.5%和60.1%。当手术切缘阴性时，生存率分别提高到100%和89%。
神经外科颅底技术可提高广泛颞骨恶性肿瘤实现无瘤切缘整块切除的概率，这将治愈一部分患者。神经外科医生的积极参与将改善该领域的患者护理。
