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

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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.


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.


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.


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.



  • View in gallery

    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.

  • View in gallery

    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.

  • View in gallery

    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.


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