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J Neurol Surg B Skull Base 2018; 79(05): 419-426
DOI: 10.1055/s-0037-1612617
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Impact of Dural Resection on Sinonasal Malignancies with Skull Base Encroachment or Erosion

Hedyeh Ziai
1   Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
,
Eugene Yu
2   Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
,
Terence Fu
3   Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Nidal Muhanna
4   Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
,
Eric Monteiro
4   Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
,
Allan Vescan
4   Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
,
Gelareh Zadeh
5   Division of Neurosurgery, University of Toronto, Toronto, Canada
,
Ian J. Witterick
4   Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
,
David P. Goldstein
4   Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
,
Fred Gentili
5   Division of Neurosurgery, University of Toronto, Toronto, Canada
,
John R. de Almeida
4   Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada
› Author Affiliations
Further Information

Publication History

07 June 2017

13 November 2017

Publication Date:
29 December 2017 (online)

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Abstract

Objectives (1) To determine the occult rate of dural invasion in patients with tumors extending to and/or eroding the bony anterior skull base but without evidence of dural invasion on preoperative imaging. (2) To determine the impact of dural resection and of skull base erosion on survival outcomes in this group of patients (without evidence of dural invasion upon preoperative imaging).

Study Design Retrospective study.

Setting Tertiary care academic center.

Participants Patients with sinonasal malignancies with anterior skull base encroachment/erosion without dural invasion on preoperative imaging treated surgically.

Main Outcome Measures (1) Histopathologic disease in the dura in patients who had dural resection and (2) Oncologic outcomes (5-year local recurrence, dural recurrence, disease-specific survival, and overall survival) in patients with and without dural resection, and patients with and without skull base erosion.

Results Thirty-seven patients were included. The occult rate of dural invasion was 54%. Patients with dural resection had improved margin control versus those without dural resection (90% vs 56%, p = 0.02). Dural resection improved 5-year overall survival only in patients with esthesioneuroblastoma compared with bony skull base resection alone (100% vs 75%, p = 0.03). Patients with skull base erosion had reduced local control versus those without erosion (63% vs 93%, p = 0.047).

Conclusion This study suggests a substantial rate of occult dural invasion despite no overt imaging findings. Dural resection may be associated with improved margin control, but no oncologic benefit except for esthesioneuroblastomas, although treatment heterogeneity and small sample size may limit conclusions.

Keywords

nose and paranasal sinuses (head and neck) - skull base (head and neck) - radiology - survival

Note

This work was presented at the 26th Annual North American Skull Base Society Meeting in Scottsdale, Arizona, USA, February 14, 2016.


 

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