Results and prognostic factors in skull base surgery.

The charts of 81 patients who underwent skull base surgery between 1982 and 1993 were reviewed retrospectively. Data relative to demographic aspects, clinical stage, previous treatment, surgical approach, type of reconstruction, histology, extent of disease, complications, and follow-up were analyzed. The craniofacial approach for the anterior fossa was used in 53% of patients, the lateral skull base approach in 12%, and a combination of both in 17. Malignant tumors were diagnosed in 58 patients (72%), and histologically benign tumors in the remaining 23 (28%). Forty-one patients (51%) had skin cancer. There was dural invasion in 31 patients (38%), and 32 (40%) underwent microsurgical flap reconstruction. From the malignant group, 31 (53%) were alive with no evidence of disease (NED), and 6 (10%) were alive with disease. From the benign group, 19 (83%) were alive NED. The most common complications were cerebrospinal-fluid fistula (10%) and flap necrosis (9%). Statistical analyses of survival showed significantly different rates associated with histologic types (P = 0.0002), type of reconstruction (P = 0.0039), and previous treatment (P = 0.0018).