Direct and remote outcome after treatment of tumours involving the central skull base with the extended subfrontal approach.

ABSTRACT

BACKGROUND AND PURPOSE: To present our results of the surgical treatment of central skull base tumours using the extended subfrontal approach (ESA). MATERIAL AND METHODS: Twenty-six patients (8 women, 18 men) with central skull base tumours were included in the study. The neurological and performance status of the patients was assessed before and after surgery as well as at the conclusion of treatment. The approximate volume of the operated tumour, its relation to the large blood vessels, cranial nerves and brainstem, as well as consistency and vascularisation were assessed. RESULTS: The symptom duration ranged from 1.5 to 18 months (mean 8.3 months). Loss of olfaction was the predominant symptom in 38% of patients. Less frequent symptoms were paresis/paralysis of the 6th cranial nerve, psychoorganic syndrome, impaired visual acuity, nasal obstruction and headache. Approximate volume of the tumours ranged from 10 to 105 ml (mean 54.3). The most frequent histological diagnosis was chordoma (19%), meningioma (15%), followed by haemangiopericytoma, fibroma and esthesioneuroblastoma (12%). Total or subtotal resection was achieved in 77% of patients. The postoperative performance status was improved in 39%, unchanged in 27% and impaired in 15% of patients. Five patients died after the surgery. CONCLUSIONS: Extended subfrontal approach is a useful technique for removal of benign tumours expanding along the midline, superiorly and inferiorly to the skull base. For removal of malignant tumours at the same location, ESA is an alternative to a combination of transcranial approach and one of the craniofacial approaches.