Outcomes of Surgical Management of Sinonasal Malignancies Involving the Anterior Skull Base

Objective: Sinonasal malignancies involving the anterior skull base frequently require neurosurgical intervention. Surgery, including craniofacial resection of these tumors is often effective, but can carry significant attendant morbidity. Both modern and long-term data are lacking. The present study was performed to better define the utility of surgical management and determine factors related to outcome.

Methods: Patients who underwent surgery between 1993 and 2018 were included in this retrospective, cohort study. Patients with greater than 6 months of clinical and radiologic follow-up were included. Outcome measures included progression, survival, and treatment-related complications.

Results: One hundred ninety-one patients (mean age: 51 years) were included. Mean clinical follow-up was 6.2 years. The most common histology was olfactory neuroblastoma (30%). Overall, metastatic disease and brain invasion were present in 9% and 19% of patients, respectively, at the time of surgery. A lumbar drain was used in 55% of cases. When stratified by decade, higher stage disease at surgery became more frequent over time (21% metastatic disease in the 2010s vs. 5% in the 1990s). Median overall survival (OS) was 10.1 years, which remained stable over time. OS was significantly worse in patients with brain invasion at the time of surgery (p = 0.004). Complications occurred after 30% of operations. Use of a lumbar drain was a significant predictor of complications (p = 0.02). Permanent neurologic deficits were observed after 5% of surgeries (all ophthalmologic). Perioperative mortality was noted in 2 patients (1%, both cardiac complications). Finally, overall complications decreased from 33% in the 1990s to 28% in the 2010s.

Conclusion: Neurosurgical management of sinonasal malignancies with anterior skull base involvement can be effective and is generally safe. Outcomes have remained stable despite more invasive disease at surgery encountered in recent decades. Furthermore, the safety of such surgery has improved over time and may be specifically altered by avoiding the routine use of lumbar drains.