The Interdisciplinary Concept in Treating Patients with Malignant Anterior Skull Base Tumors and Outcomes

Objective: Malignant tumors of the anterior skull base are complex lesions that require an understanding of the tumor pathology, principles of resection, and nonsurgical therapeutic modalities. In order to justify a complex interdisciplinary surgical approach, the indications and contraindications for resection should be influenced by prognostic factors and anticipated outcome. Methods: A 10-year retrospective analysis of a heterogenous group of 40 patients with malignant anterior skull base tumors (metastases, intrasellar metastases, ethmoidal adenocarcinomas, sarcomas, chordomas, malignant meningiomas) was performed. Recursive partitioning analysis (RPA) criteria for metastases used for class assignment were Karnofsky performance status (KPS), primary tumor status (PD), presence of extracranial system metastases (SD), and age. Results: Median follow-up was 41 months (range, 3 to 124 mos). Median age at the time of surgery was 63 years (range, 3 to 91 yrs). Median KPS was 70 (range, 60 to 90). The median survival of anterior skull base metastases was 16 months (range, 3 to 48 mos), contrary to intrasellar metastases with 14 months (range, 10 to 19 mos). Median survival of ethmoidal adenocarcinomas was 10 months (range, 8 to 12 mos), sarcomas 10.5 yrs and 5.3 yrs (still under observation), malignant meningiomas 19 months (range, 12 to 25 mos), chordomas 23 months (range, 8 to 51 mos). Conclusions: Carefully selected patients will benefit from surgical treatment. The outcome and survival time are comparable to patients with brain metastases, in our analysis even better. RPA classes are valid for malignant metastatic anterior skull base tumors and may also serve as a basis for historical comparisons.