Bilsky M H, Kraus D H, Strong E W, Harrison L B, Gutin P H, Shah J P
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Am J Surg. 1997 Nov;174(5):565-8. doi: 10.1016/s0002-9610(97)00172-4.
To review our experience with anterior craniofacial resection for malignant neoplasms with intracranial extension. Survival was analyzed in terms of presence of intracranial extension, extent of intradural disease, tumor histology, and histological status of margins.
In a retrospective review made at a tertiary cancer facility, 26 of the 115 consecutive patients undergoing craniofacial resection for malignant lesions of the anterior skull base had intracranial extension, defined as dural and/or brain extension. Survival was evaluated with the Kaplan-Meier product limit method, and comparisons between individual subgroups were performed using the log-rank test.
Patients with intradural extension have a statistically worse disease-specific survival than patients without intracranial extension (P = 0.05). Surgical margins and tumor histology impact on survival. The incidence of local complications was 42% and of systemic complications, 8%.
Anterior craniofacial resection is indicated for patients with resectable disease. The complication rate is comparable with that of patients without intracranial extension. Gross total resection with histologically negative margins portends a better prognosis. Esthesioneuroblastoma has a better prognosis than other tumor types.
回顾我们对伴有颅内侵犯的恶性肿瘤行前颅面切除术的经验。根据颅内侵犯情况、硬脑膜内病变范围、肿瘤组织学类型及切缘组织学状态分析生存率。
在一家三级癌症治疗机构进行的回顾性研究中，115例因前颅底恶性病变接受颅面切除术的连续患者中有26例存在颅内侵犯，定义为硬脑膜和/或脑侵犯。采用Kaplan-Meier乘积限界法评估生存率，并使用对数秩检验对各亚组进行比较。
硬脑膜内侵犯患者的疾病特异性生存率在统计学上低于无颅内侵犯患者（P = 0.05）。手术切缘和肿瘤组织学类型对生存率有影响。局部并发症发生率为42%，全身并发症发生率为8%。
前颅面切除术适用于可切除疾病的患者。并发症发生率与无颅内侵犯患者相当。组织学切缘阴性的根治性全切除预示着更好的预后。嗅神经母细胞瘤的预后优于其他肿瘤类型。
