Subkranialer Zugang bei Malignomen mit Beteiligung der Frontobasis

Zusammenfassung

Hintergrund: Überleben und Lebensqualität von Patienten nach chirurgischer Resektion eines Malignoms mit Infiltration der Frontobasis über einen subkranialen Zugang sollten beschrieben werden. Methoden: Die Datenerhebung erfolgte retrospektiv aus den Krankenakten, durch Telefoninterview sowie durch Kontaktaufnahme mit dem Hausarzt. Zur Ermittlung der Lebensqualität wurden der EORTC-QLQ30 und H&N35 eingesetzt. Ergebnisse: Im Zeitraum von 1996 bis 2004 wurden 19 Patienten (mittl. Alter 52 Jahre, 4 weiblich, 15 männlich) über einen subkranialen Zugang behandelt. 15 Patienten hatten ein Karzinom und 3 ein Ästhesioneuroblastom in fortgeschrittenen Stadien. 1 Patient hatte ein Fibrosarkom. 15 Patienten erhielten eine postoperative Strahlentherapie. Im mittleren Nachbeobachtungszeitraum von 44 Monaten (12 - 109 Monate) verstarben 6 Patienten, davon ein Patient tumorunabhängig. Die 5-Jahres-Überlebenswahrscheinlichkeit betrug 50 %, die mittlere Überlebenszeit 72 Monate. Bei 18 der 19 Patienten kam es zur Anosmie. Bei 2 Patienten trat postoperativ ein Spannungpneumozephalus auf, einmal mit letalem Ausgang. Es kam zu 1 Visusminderung und 1 Visusverlust, 1 persistierenden Diplopie, 2 tiefe Wundinfektionen und 2 Liquorfisteln. Die Lebensqualität unterschied sich durchschnittlich 36 Monate nach Abschluss der Therapie nicht wesentlich von der anderer Patienten mit Kopf-Hals-Tumoren. Schlussfolgerung: Malignome mit Infiltration der Frontobasis sind insgesamt selten. Die Therapieempfehlung erfolgt für jeden Patienten individuell. Hierbei ist zu berücksichtigen, dass trotz Infiltration der Frontobasis 5-Jahres-Überlebensraten von ca. 50 % bei annehmbarer Lebensqualität erreicht werden.

Abstract

Background: Survival and quality of life after subcranial resection of malignant tumors infiltrating the anterior skull base should be evaluated. Methods: Data were acquired retrospectively from patient charts and by telephone interview. Quality of life was assessed with the EORTC QLQ30 and H&N35 modules. Results: From 1996 to 2004, 19 patients (mean age 52 years, 4 woman, 15 men) were surgically treated via a subcranial approach. Fifteen patients suffered from advanced carcinoma, 3 from advanced esthesioneuroblastoma, and 1 patient had a fibrosarcoma. Fifteen patients received adjuvant radiotherapy. During the mean follow-up period of 44 months (12 - 109 months), 6 patients died, 1 unrelated to the tumor. The probability to survive 5 years was 50 %, the mean survival time was 72 months. Anosmia was reported by 18 of 19 patients. A tension pneumocephalus was observed in 2 patients, one with lethal outcome, decreased vision in 1 patient, loss of vision in 1, persisting diplopia in 1, deep wound infections in 2, and CSF leak in 2 patients. Quality of life was assessed on the average 36 months following end of therapy and did not differ substantially from other patients with head-neck malignancies. Conclusion: Most, malignant tumors infiltrating the anterior skull base can be treated curatively. The treatment outcome is well comparable to other head and neck tumors of corresponding stage.

Karzinom - Ästhesioneuroblastom - Schädelbasis - Chirurgie - Radiotherapie

Carcinoma - esthesioneuroblastoma - skull base - surgery - radiotherapy

Literatur

• 1 Patel S G, Singh B, Polluri A, Bridger P G, Cantu G, Cheesman A D. et al . Craniofacial surgery for malignant skull base tumors: report of an international collaborative study.  Cancer. 2003;  98 1179-1187
• 2 American Joint Committee on Cancer .Soft tissue sarcoma. In: Greene FL, American Joint Committee on Cancer, American Cancer Society (Hrsg) AJCC cancer staging manual. New York; Springer-Verlag 2002: 193-197
• 3 National Cancer Institute .Paranasal Sinus and Nasal Cavity Cancer (PDQ®): Treatment. http: //www. nci. nih. gov/cancertopics/pdq/treatment/paranasalsinus/ healthprofessional/allpages 2005
• 4 Day T A, Beas R A, Schlosser R J, Woodworth B A, Barredo J, Sharma A K. et al . Management of paranasal sinus malignancy.  Curr Treat Options Oncol. 2005;  6 3-18
• 5 Plinkert P K, Zenner H P. Transfazialer Zugang, kraniofaziale Resektion und Midfacial Degloving bei der Chirurgie bösartiger Tumoren der vorderen Schädelbasis und der angrenzenden Nasennebenhöhlen.  Hno. 1996;  44 192-200
• 6 Lenarz T, Keiner S. Midfacial Degloving: ein alternativer Zugangsweg zur Frontobasis, der Nasenhaupt- und den Nasennebenhöhlen.  Laryngorhinootologie. 1992;  71 381-387
• 7 Raveh J, Laedrach K, Iizuka T, Leibinger F. Subcranial extended anterior approach for skull base tumors: surgical procedure and reconstruction. In: Donald PJ (Hrsg) Surgery of the skull base. Philadelphia; Lippincott-Raven 1998: 239-261
• 8 Bjordal K, De Graeff A, Fayers P M, Hammerlid E, van Pottelsberghe C, Curran D. et al . A 12 country field study of the EORTC QLQ-C30 (version 3. 0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group.  Eur J Cancer. 2000;  36 1796-1807
• 9 Bloching M, Bootz F, Burkert S. HNO-relevante Änderungen in der aktuellen TNM-Klassifikation maligner Tumoren.  HNO. 2004;  52 497-502
• 10 Kadish S, Goodman M, Wang C C. Olfactory neuroblastoma. A clinical analysis of 17 cases.  Cancer. 1976;  37 1571-1576
• 11 Raquet F, Mann W J. Die lumbale Liquordrainage zur Prophylaxe von Liquorfisteln.  Hno. 1993;  41 335-338
• 12 Mann W, Riechelmann H, Gilsbach J. The state of the frontal sinus after craniotomy.  Acta Neurochir. 1989;  100 101-103
• 13 Hjermstad M J, Fayers P M, Bjordal K, Kaasa S. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ = C30 (+ 3).  J Clin Oncol. 1998;  16 1188-1196
• 14 Hawthorne G. The effect of different methods of collecting data: mail, telephone and filter data collection issues in utility measurement.  Qual Life Res. 2003;  12 1081-1088
• 15 Fayers P M, Aaronson N K, Bjordal K, Groenvold M, Curran D, Bottomley A. The EORTC QLQ-C30 Scoring Manual. 3rd Edition. Brüssel; European Organisation for Research and Treatment of Cancer 2001
• 16 Unger F, Haselsberger K, Walch C, Stammberger H, Papaefthymiou G. Combined endoscopic surgery and radiosurgery as treatment modality for olfactory neuroblastoma (esthesioneuroblastoma).  Acta Neurochir (Wien),. 2005; 
• 17 Catalano P J, Hecht C S, Biller H F, Lawson W, Post K D, Sachdev V. et al . Craniofacial resection. An analysis of 73 cases.  Arch Otolaryngol Head Neck Surg. 1994;  120 1203-1208
• 18 Ketcham A S, Wilkins R H, Vanburen J M, Smith R R. A combined intracranial facial approach to the paranasal sinuses.  Am J Surg. 1963;  106 698-703
• 19 Moore C E, Ross D A, Marentette L J. Subcranial approach to tumors of the anterior cranial base: analysis of current and traditional surgical techniques.  Otolaryngol Head Neck Surg. 1999;  120 387-390
• 20 McCutcheon I E, Blacklock J B, Weber R S, DeMonte F, Moser R P, Byers M. et al . Anterior transcranial (craniofacial) resection of tumors of the paranasal sinuses: surgical technique and results.  Neurosurgery. 1996;  38 471-479
• 21 Jackson C G, Netterville J L, Glasscock M Ed, Hampf C R, Carrasco V N, Haynes D S. et al . Defect reconstruction and cerebrospinal fluid management in neurotologic skull base tumors with intracranial extension.  Laryngoscope. 1992;  102 1205-1214
• 22 McCaffrey T V, Olsen K D, Yohanan J M, Lewis J E, Ebersold M J, Piepgras D G. Factors affecting survival of patients with tumors of the anterior skull base.  Laryngoscope. 1994;  104 940-945
• 23 Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux F X. Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure: a clinical review of 1 year.  Neurosurgery. 2004;  54 599-603
• 24 Hochman M. Reconstruction of midfacial and anterior skull-base defects.  Otolaryngol Clin North Am. 1995;  28 1269-1277
• 25 Schliephake H, Schmelzeisen R, Samii M, Sollmann W P. Microvascular reconstruction of the skull base: indications and procedures.  J Oral Maxillofac Surg. 1999;  57 233-239
• 26 Mauriello J A jr, McShane R, Voglino J. Use of Vicryl (polyglactin-910) mesh implant for correcting enophthalmos and hypo-ophthalmos. A study of 16 patients.  Ophthal Plast Reconstr Surg. 1990;  6 247-251
• 27 Katz T S, Mendenhall W M, Morris C G, Amdur R J, Hinerman R W, Villaret D B. Malignant tumors of the nasal cavity and paranasal sinuses.  Head Neck. 2002;  24 821-829
• 28 Blanco A I, Chao K S, Ozyigit G, Adli M, Thorstad W L, Simpson J R. et al . Carcinoma of paranasal sinuses: long-term outcomes with radiotherapy.  Int J Radiat Oncol Biol Phys. 2004;  59 51-58
• 29 Jiang G L, Morrison W H, Garden A S, Geara F, Callender D, Goepfert H. et al . Ethmoid sinus carcinomas: natural history and treatment results.  Radiother Oncol. 1998;  49 21-27
• 30 Levine P A, Gallagher R, Cantrell R W. Esthesioneuroblastoma: reflections of a 21-year experience.  Laryngoscope. 1999;  109 1539-1543
• 31 Francel P C, Bhattacharjee S, Tompkins P. Skull base approaches and gamma knife radiosurgery for multimodality treatment of skull base tumors.  J Neurosurg. 2002;  97 674-676
• 32 Hug E B, Sweeney R A, Nurre P M, Holloway K C, Slater J D, Munzenrider J E. Proton radiotherapy in management of pediatric base of skull tumors.  Int J Radiat Oncol Biol Phys. 2002;  52 1017-1024
• 33 Schulz-Ertner D, Nikoghosyan A, Thilmann C, Haberer T, Jakel O, Karger C. et al . Results of carbon ion radiotherapy in 152 patients.  Int J Radiat Oncol Biol Phys. 2004;  58 631-640
• 34 Bernier J, Cooper J S. Chemoradiation after surgery for high-risk head and neck cancer patients: how strong is the evidence?.  Oncologist. 2005;  10 215-224
• 35 Musy P Y, Reibel J F, Levine P A. Sinonasal undifferentiated carcinoma: the search for a better outcome.  Laryngoscope. 2002;  112 1450-1455
• 36 Samant S, Robbins K T, Vang M, Wan J, Robertson J. Intra-arterial cisplatin and concomitant radiation therapy followed by surgery for advanced paranasal sinus cancer.  Arch Otolaryngol Head Neck Surg. 2004;  130 948-955
• 37 Dulguerov P, Jacobsen M S, Allal A S, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review.  Cancer. 2001;  92 3012-3029
• 38 Euteneuer S, Sudhoff H, Bernal-Sprekelsen M, Theegarten D, Dazert S. Malignome der inneren Nase und der Nasennebenhöhlen, Klinik, Therapie und Prognose verschiedener Tumorentitaten.  Laryngorhinootologie. 2004;  83 33-39
• 39 Hosemann W, Dammer R, Bloss H G, Fietkau R. Therapie maligner Tumoren im Bereich der Nasennebenhöhlen.  Hno. 2002;  50 578-592
• 40 Le Q T, Fu K K, Kaplan M J, Terris D J, Fee W E, Goffinet D R. Lymph node metastasis in maxillary sinus carcinoma.  Int J Radiat Oncol Biol Phys. 2000;  46 541-549
• 41 Van Tuyl R, Gussack G S. Prognostic factors in craniofacial surgery.  Laryngoscope. 1991;  101 240-244
• 42 Suarez C, Llorente J L, Fernandez D L, Maseda E, Lopez A. Prognostic factors in sinonasal tumors involving the anterior skull base.  Head Neck. 2004;  26 136-144
• 43 Hyams V J, Batsakis J G, Michaels L. Tumors of the upper respiratory tract and ear. Washington, D. C.; Armed Forces Institute of Pathology 1988
• 44 Bridger G P, Kwok B, Baldwin M, Williams J R, Smee R I. Craniofacial resection for paranasal sinus cancers.  Head Neck. 2000;  22 772-780
• 45 Kraus D H, Sterman B M, Levine H L, Wood B G, Tucker H M, Lavertu P. Factors influencing survival in ethmoid sinus cancer.  Arch Otolaryngol Head Neck Surg. 1992;  118 367-372
• 46 Osguthorpe J D, Patel S. Craniofacial approaches to sinus malignancy.  Otolaryngol Clin North Am. 1995;  28 1239-1257
• 47 Shah J P, Kraus D H, Bilsky M H, Gutin P H, Harrison L H, Strong E W. Craniofacial resection for malignant tumors involving the anterior skull base.  Arch Otolaryngol Head Neck Surg. 1997;  123 1312-1317
• 48 Kellman R M, Marentette L. The transglabellar/subcranial approach to the anterior skull base: a review of 72 cases.  Arch Otolaryngol Head Neck Surg. 2001;  127 687-690
• 49 Kraus D H, Shah J P, Arbit E, Galicich J H, Strong E W. Complications of craniofacial resection for tumors involving the anterior skull base.  Head Neck. 1994;  16 307-312
• 50 Korinek A M. Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie Hygiene et Prevention.  Neurosurgery. 1997;  41 1073-1079
• 51 Barker F G. Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis.  Neurosurgery. 1994;  35 484-490
• 52 Carrau R L, Snyderman C, Janecka I P, Sekhar L, Sen C, D’Amico F. Antibiotic prophylaxis in cranial base surgery.  Head Neck. 1991;  13 311-317
• 53 Arbit E, Shah J, Bedford R, Carlon G. Tension pneumocephalus: treatment with controlled decompression via a closed water-seal drainage system. Case report.  J Neurosurg. 1991;  74 139-142
• 54 Reasoner D K, Todd M M, Scamman F L, Warner D S. The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air.  Anesthesiology. 1994;  80 1008-1012
• 55 Clevens R A, Marentette L J, Esclamado R M, Wolf G T, Ross D A. Incidence and management of tension pneumocephalus after anterior craniofacial resection: case reports and review of the literature.  Otolaryngol Head Neck Surg. 1999;  120 579-583
• 56 Hayden R E, Strome S E. Anterior skull base: Otolaryngology - head and neck surgery perspective. In: Arriaga MA, Day JD (Hrsg) Neurosurgical issues in otolaryngology - principles and practice of collaboration. Philadelphia; Lippincott Williams & Wilkins 1999: 377-382
• 57 Klopfenstein C E, Forster A, Suter P M. Pneumocephalus. A complication of continuous positive airway pressure after trauma.  Chest. 1980;  78 656-657
• 58 Andersen P E, Kraus D H, Arbit E, Shah J P. Management of the orbit during anterior fossa craniofacial resection.  Arch Otolaryngol Head Neck Surg. 1996;  122 1305-1307