Long-term outcome following radical temporal bone resection for lateral skull base malignancies: a neurosurgical perspective

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Object

Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations.

Methods

Between 1994 and 2006, 17 patients (10 men and 7 women) underwent total or subtotal TBR for primary temporal bone malignancies. Tumors were graded according to the University of Pittsburgh system. The effects of surgical margins and tumor extensions on patient survival were analyzed using the Kaplan–Meier method.

Results

All tumors, except 1, were graded T4 (most advanced). Subtotal TBR was performed in 14 patients, and total TBR was performed in 3. The surgical margin was tumor negative in 10 patients and tumor positive in 7. For large tumors extending into the infratemporal fossa or encroaching on the jugular foramen, orbitozygomatic (3 patients) and posterior transjugular (4 patients) approaches were combined with the standard approach, and en bloc resection with a negative margin was achieved in all cases but 1. The follow-up time ranged from 0.3–11.6 years (mean 3.3 years). The 5-year recurrence-free and disease-specific survival rates were 67.5 and 60.1%, respectively. When a negative surgical margin was achieved, the survival rates improved to 100 and 89%, respectively.

Conclusions

The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.

Abbreviations used in this paper: CN = cranial nerve; CT = computed tomography; DSS = disease-specific survival; EAC = external auditory canal; ICA = internal carotid artery; IMRT = intensity-modulated radiation therapy; MR = magnetic resonance; RFS = recurrence-free survival; SCC = squamous cell carcinoma; TBR = temporal bone resection.

Article Information

Address correspondence to: Nobutaka Kawahara, M.D., Ph.D., Department of Neurosurgery, Graduate School of Medicine, University of Tokyo 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. email: kawahara-tky@umin.ac.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Drawing illustrating the extent of subtotal TBR for tumors with infratemporal fossa and jugular foramen extension. En bloc resection of the lateral temporal bone can be achieved with a combined orbitozygomatic osteotomy and posterior transjugular approach, which provide anterior and posterior routes to the carotid canal and jugular foramen, respectively. Red indicates the carotid artery, and blue indicates the sigmoid sinus and jugular bulb.

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    Case 15. Photograph obtained after en bloc subtotal TBR via the orbitozygomatic and posterior transjugular approaches, showing complete removal with a tumor-free margin. The maxilla, orbit, jugular bulb, and ICA were all exposed after removal of the lesion. XI = accessory nerve; XII = hypoglossal nerve.

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    Schematics revealing tumor locations and extensions in the temporal bone according to case number. A: Tumors in which a positive surgical margin was verified pathologically. B: Tumors with a negative surgical margin.

  • View in gallery

    Kaplan–Meier curves for RFS (A) and DSS (B). Negative = negative surgical margin; Positive = positive surgical margin.

References

  • 1

    Arriaga MCurtin HTakahashi HHirsch BEKamerer DB: Staging proposal for external auditory meatus carcinoma based on preoperative clinical examination and computed tomography findings. Ann Otol Rhinol Laryngol 99:7147211990

  • 2

    Austin JRStewart KLFawzi N: Squamous cell carcinoma of the external auditory canal. Therapeutic prognosis based on a proposed staging system. Arch Otolaryngol Head Neck Surg 120:122812321994

  • 3

    Bangalore MMatthews SSuntharalingam M: Recent advances in radiation therapy for head and neck cancer. ORL J Otorhinolaryngol Relat Spec 69:1122007

  • 4

    Birzgalis ARKeith AOFarrington WT: Radiotherapy in the treatment of middle ear and mastoid carcinoma. Clin Otolaryngol Allied Sci 17:1131161992

  • 5

    Brisman MHSen CCatalano P: Results of surgery for head and neck tumors that involve the carotid artery at the skull base. J Neurosurg 86:7877921997

  • 6

    Eisbruch AMarsh LHDawson LABradford CRTeknos TNChepeha DB: Recurrences near base of skull after IMRT for head-and-neck cancer: implications for target delineation in high neck and for parotid gland sparing. Int J Radiat Oncol Biol Phys 59:28422004

  • 7

    Fujitsu KKuwabara T: Zygomatic approach for lesions in the interpeduncular cistern. J Neurosurg 62:3403431985

  • 8

    George BLot GTran Ba Huy P: The juxtacondylar approach to the jugular foramen (without petrous bone drilling). Surg Neurol 44:2792841995

  • 9

    Go KGAnnyas AAVermey ARobinson PHBelopavlovic MMehta DM: Evaluation of results of temporal bone resection. Acta Neurochir (Wien) 110:1101151991

  • 10

    Goodwin WJJesse RH: Malignant neoplasms of the external auditory canal and temporal bone. Arch Otolaryngol 106:6756791980

  • 11

    Hakuba AHashi KFujitani KIkuno HNakamura TInoue Y: Jugular foramen neurinomas. Surg Neurol 11:83941979

  • 12

    Hakuba ALiu SNishimura S: The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol 26:2712761986

  • 13

    Hirsch BE: Staging system revision. Arch Otolaryngol Head Neck Surg 128:93942002

  • 14

    Honeybul SNeil-Dwyer GLees PDEvans BTLang DA: The orbitozygomatic infratemporal fossa approach: a quantitative anatomical study. Acta Neurochir (Wien) 138:2552641996

  • 15

    Kawahara NSasaki TNibu KSugasawa MIchimura KNakatsuka T: Dumbbell type jugular foramen meningioma extending both into the posterior cranial fossa and into the para-pharyngeal space: report of 2 cases with vascular reconstruction. Acta Neurochir (Wien) 140:3233301998

  • 16

    Kinney SEWood BG: Malignancies of the external ear canal and temporal bone: surgical techniques and results. Laryngoscope 97:1581641987

  • 17

    Lambert PRJohns MEWinn RH: Infralabyrinthine approach to skull-base lesions. Otolaryngol Head Neck Surg 93:2502581985

  • 18

    Lee JPTsai MSChen YR: Orbitozygomatic infratemporal approach to lateral skull base tumors. Acta Neurol Scand 87:4034091993

  • 19

    Lee NXia PQuivey JMSultanem KPoon IAkazawa C: Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 53:12222002

  • 20

    Lewis JS: Temporal bone resection. Review of 100 cases. Arch Otolaryngol 101:23251975

  • 21

    Manolidis SPappas D JrVon Doersten PJackson CGGlasscock ME 3rd: Temporal bone and lateral skull base malignancy: experience and results with 81 patients. Am J Otol 19:S1S151998

  • 22

    McGrew BMJackson CGRedtfeldt RA: Lateral skull base malignancies. Neurosurg Focus 12:5E82002

  • 23

    Mizoe JETsujii HKamada TMatsuoka YTsuji HOsaka Y: Dose escalation study of carbon ion radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 60:3583642004

  • 24

    Moffat DAWagstaff SAHardy DG: The outcome of radical surgery and postoperative radiotherapy for squamous carcinoma of the temporal bone. Laryngoscope 115:3413472005

  • 25

    Moody SAHirsch BEMyers EN: Squamous cell carcinoma of the external auditory canal: an evaluation of a staging system. Am J Otol 21:5825882000

  • 26

    Nakagawa TKumamoto YNatori YShiratsuchi HToh SKakazu Y: Squamous cell carcinoma of the external auditory canal and middle ear: an operation combined with preoperative chemoradiotherapy and a free surgical margin. Otol Neurotol 27:2422492006

  • 27

    Parsons HLewis JS: Subtotal resection of the temporal bone for cancer of the ear. Cancer 7:99510011954

  • 28

    Pensak MLGleich LLGluckman JLShumrick KA: Temporal bone carcinoma: contemporary perspectives in the skull base surgical era. Laryngoscope 106:123412371996

  • 29

    Pfreundner LSchwager KWillner JBaier KBratengeier KBrunner FX: Carcinoma of the external auditory canal and middle ear. Int J Radiat Oncol Biol Phys 44:7777881999

  • 30

    Prasad SJanecka IP: Efficacy of surgical treatments for squamous cell carcinoma of the temporal bone: a literature review. Otolaryngol Head Neck Surg 110:2702801994

  • 31

    Sasaki TTakakura K: Twelve cases of jugular foramen neurinoma. Skull Base Surg 1:1521601991

  • 32

    Shih LCrabtree JA: Carcinoma of the external auditory canal: an update. Laryngoscope 100:121512181990

  • 33

    Spector JG: Management of temporal bone carcinomas: a therapeutic analysis of two groups of patients and long-term followup. Otolaryngol Head Neck Surg 104:58661991

  • 34

    Stell PMMcCormick MS: Carcinoma of the external auditory meatus and middle ear. Prognostic factors and a suggested staging system. J Laryngol Otol 99:8478501985

  • 35

    Testa JRFukuda YKowalski LP: Prognostic factors in carcinoma of the external auditory canal. Arch Otolaryngol Head Neck Surg 123:7207241997

  • 36

    Tokuuye KAkine YKagei KHata MHashimoto TMizumoto T: Proton therapy for head and neck malignancies at Tsukuba. Strahlenther Onkol 180:961012004

  • 37

    Willging JPPensak ML: Temporal bone resection. Ear Nose Throat J 70:6126171991

  • 38

    Yeung PBridger ASmee RBaldwin MBridger GP: Malignancies of the external auditory canal and temporal bone: a review. ANZ J Surg 72:1141202002

  • 39

    Zhang BTu GXu GTang PHu Y: Squamous cell carcinoma of temporal bone: reported on 33 patients. Head Neck 21:4614661999

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