ANTERIOR CRANIOFACIAL RESECTIONS
Tumors involving the anterior skullbase are not easily accessible to surgical therapy, but it is no longer an impossible task due to constant improvements in diagnostic methods, surgical techniques and cooperation between the different specialists. While this type of surgery earlier had a very low successrate or at the best resulted in massive facial deformities, we see today that tumors often are possible to resect completely and that the patients have an average survivalrate of 50% an only minor permanent deformities of the facial structures.
This is a retrospective study of 13 years of experience with anterior craniofacial resections of diseases involving the anterior skullbase at Rikshospitalet. The material of patients consisted of 22 persons, six women and sixteen men, aged 11 to 73 years at the time of surgery, with a median age of 53,5 years. Twenty patients had malignant tumors, one had a meningeoma and the last patient had an aggressive sinusitis.
Six patients experienced postoperative complications, with infection as the most common complication, in four of the patients. One patient developed a late complication, a subcutaneous hematoma. Six patients developed more or less permanent sequelas, two had osteomyelitis and skinfistulas, and out of the remaining four, one had a visual defect, one a structural damage of the nose, one a permanent enophtalmus and the last one has had a number of serious sinusitis due to that not all of the sinuses were properly resected.
Fourteen of the patients have had radiationtherapy postoperatively, and one has had it preoperatively.
Survivalrates are good, only three patients are dead so far. These three distinguish themselves from the rest of the material. One of them was the only patient with a meningeoma, and the other two were the only ones whose cancer had methastasized to lymphnodes at the time that the disease was recognized.
Discussion; Numbers of mortality and complications seems to be good compared to other similar materials, but this needs to be investigated more thoroughly to get a significant conclusion. One reason why these patients seem to be doing so well, may be because the surgeons at Rikshospitalet spend a few more hours on closing after surgery compared to collegues abroad. But it is difficult to compare these numbers with larger studies, partly because there are so few cases of craniofacial surgery that the studies may reach over two decades, and meanwhile the techniques have improved so much that the groups are not comparable anymore.
Conclusion; Mortality is low and complications few compared to similar materials, and it seems to be due to improved techniques and thorough work.