Surgical Decision-Making in Anterior and Middle Skull Base Lesions: A Single-Center Experience with Comparative Outcomes and a Preoperative Predictive Model
The findings suggest that tumor characteristics may play a substantial role in determining outcomes; however, the observational design does not allow independent assessment of the causal effect of the surgical approach.
Abstract
Abstract Introduction Surgical management of anterior and middle skull base (ASB/MSB) lesions requires careful balancing of maximal resection and preservation of neurological function. Although both transcranial (TC) and endoscopic endonasal (EE) approaches are widely used, the extent to which the surgical approach independently influences outcomes remains unclear. Methods We conducted a retrospective, single-center, observational study of adult patients who underwent surgery for ASB/MSB lesions. Demographic, clinical, radiological, and surgical variables were analyzed. Outcomes included extent of resection (EOR), complications, intraoperative blood loss, operative time, and length of hospital stay. Comparative analyses between TC and EE approaches were performed and interpreted as exploratory. A preoperative predictive model for gross total resection (GTR) was developed using Least Absolute Shrinkage and Selection Operator-penalized logistic regression with internal bootstrap validation. Results A total of 84 patients were included. TC approaches were performed in 62 patients (73.8%) and EE in 22 (26.2%). GTR was achieved in 77.4% of cases, with no significant difference between approaches. The EE group showed significantly lower intraoperative blood loss, shorter operative time, and reduced length of hospital stay. Complication rates did not differ significantly between groups. The predictive model demonstrated good apparent discrimination (area under the curve 0.97). Conclusions Our findings suggest that tumor characteristics may play a substantial role in determining outcomes; however, the observational design does not allow independent assessment of the causal effect of the surgical approach. When appropriately selected, both TC and EE strategies achieve comparable effectiveness and safety. At this stage, the proposed model may serve only as an exploratory predictive tool.
INTRODUCTION
Anterior skull base (ASB) tumors are rare and comprise a variety of pathologies. In recent years, the surgical management of ASB tumors has undergone a paradigm shift from open craniofacial resection (CFR) to minimally invasive endoscopic approaches. Endoscopic-assisted (EaCFR) and entirely endoscopic (ECFR) CFR have shown equivalent oncological outcomes without the morbidity of open surgery. This study presents our tertiary center experience and outcomes with endoscopic approaches for ASB tumors.
METHODS
A retrospective review of all patients who underwent EaCFR and ECFR for ASB tumors from January 2010 to December 2024 at Singapore General Hospital was performed. Relevant patient characteristics, histologic diagnoses, treatment protocols, and perioperative data were collected and analyzed to determine complication rates, recurrence, and mortality.
RESULTS
Thirty-seven patients were included in the study, with 22 (59.5%) undergoing ECFR and 15 (40.5%) undergoing EaCFR. The mean age was 51.5 years. The most common presenting symptoms were epistaxis (70.3%) and nasal obstruction (48.6%). The primary histologic diagnoses were olfactory neuroblastoma (62.2%), sarcoma (13.5%), adenocarcinoma (8.1%), and sinonasal carcinoma (8.1%). R0 resection was achieved in 26 (70.3%) cases, and intraoperative hemorrhage necessitating staged surgery occurred in 2 (5.4%) cases. The mean follow-up duration was 4.6 years. There were no cases of perioperative mortality. Eight (21.6%) cases had postoperative complications, including 1 (2.7%) case of cerebrospinal fluid leak after completion of adjuvant radiotherapy. The 5-year recurrence-free, disease-specific, and overall survival rates were 61.8%, 94.2%, and 80.1%, respectively.
CONCLUSION
In appropriately selected patients, EaCFR and ECFR are effective management approaches for ASB tumors.
Joel C I Goh, M. Y. Chen, Kaijun Tay et al.· The Journal of craniofacial...· 0 citations
INTRODUCTION
Anterior skull base (ASB) oncologic resection can create composite defects involving bone, dura, sinonasal cavities, orbit, and soft tissue. Although endoscopic techniques have expanded, open reconstruction remains essential for extensive tumors with intracranial, orbital, or craniofacial involvement. We systematically reviewed techniques and outcomes after open ASB reconstruction following oncologic resection.
METHODS
Following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science were searched through December 2025. Eligible studies included English-language original reports of patients undergoing oncologic tumor resection requiring open ASB reconstruction, with reported reconstructive technique and at least one clinical or surgical outcome. Data were extracted on study characteristics, surgical approach, flap or graft strategy, dural closure, structural support, adjuncts, and outcomes. Complications were categorized using a structured framework.
RESULTS
Twenty-seven studies comprising 554 cases/procedures were included: 17 retrospective studies (13 cohorts and 4 case series) and 10 case reports. Tumor histologies were heterogeneous, with meningioma, esthesioneuroblastoma, and squamous cell carcinoma among the most frequently reported pathologies. Reconstruction strategies included pedicled regional flaps in 12 studies, free (microvascular) flaps in 7, non-vascularized free grafts in 4, a mixed local-and-free-flap strategy in 2, artificial dural grafts in 1, and an autologous fascia-muscle-fat composite in 1. Dural patch grafts were used in 18 studies, while watertight closure was explicitly reported in 12. Bone grafts were used in 12 studies, and titanium mesh in 7. Flap survival was reported in 20 studies, with 9 failures across the series. CSF leak was reported in 26 studies; 17 reported no leaks, while 9 documented leaks, with the highest cohort rate of 11.8%. Revision surgery was reported in 24 studies and occurred in 10. Complications included infectious, CSF-related, flap-related, and donor-site events.
CONCLUSION
Open anterior skull base reconstruction has been reported as feasible across heterogeneous clinical series; however, the predominantly retrospective evidence does not support comparative conclusions regarding reconstructive superiority. Recurring practices included defect-specific multilayer closure, vascularized tissue coverage in compromised fields, and structural reconstruction when required.
L. Cardoso, M. Ferreira, Murtaja Satea et al.· The Journal of craniofacial...· 0 citations
OBJECTIVE
Surgical resection of maxillofacial tumors requires balancing radical resection with functional and esthetic preservation. Endoscopic-assisted and transoral techniques offer minimally invasive alternatives, but each has limitations. This retrospective study evaluates the endoscopic-assisted transoral approach (EATA) for maxillofacial tumor resection, analyzing its technical characteristics, perioperative outcomes, and safety.
METHODS
Patients who underwent tumor resection via EATA at West China Hospital of Stomatology, Sichuan University, between April 2024 and September 2025 were included. They were stratified by tumor anatomical location and pathology. Clinical characteristics, tumor features, operative parameters, postoperative complications, and follow-up findings were collected and analyzed.
RESULTS
A total of 32 patients with a median age of 42.5 years (range, 8-74 years) were included. Tumor distribution was as follows: accessory parotid gland (n = 15), zygomatic/buccal region (n = 9), mandibular functional area (n = 3), infratemporal fossa (n = 3), and parapharyngeal space (n = 2). The median operative time was 50 min (range, 14-304 min), and the median intraoperative blood loss was 10 mL (range, 5-150 mL). Among cases completed via EATA without conversion, no visible external scars were produced, and endoscopic magnification facilitated identification and preservation of critical neurovascular structures. One case with an intraoperative frozen-section diagnosis of mucoepidermoid carcinoma was converted to conventional parotidectomy.
CONCLUSION
EATA appears to be a feasible minimally invasive option for carefully selected maxillofacial tumors in deep or esthetically sensitive anatomical regions. Its application requires strict patient selection, anatomical risk control, and adherence to oncologic principles.
LEVEL OF EVIDENCE: 4
Shuai Chen, Guan-Ru Wang, Heyi Tang et al.· The Laryngoscope· 0 citations
BACKGROUND
Carotid body tumours (CBTs), , are rare neoplasms for which universally accepted diagnostic and management guidelines are lacking. complicating the development of standardized treatment pathways. We present a 22-year single-centre experience that longitudinally evaluates operative strategy, perioperative risk mitigation, and long-term outcomes, and we describe an institutional care bundle derived from this experience.
METHODS
We conducted a retrospective cohort study with prospective follow-up of all patients who underwent open resection for CBT at a tertiary vascular surgery unit between 30th June 2003 and 28th January 2025 according to STROBE criteria. Demographic, imaging, operative, histopathologic, and follow-up data were extracted from electronic medical records. Tumors were staged according to the Shamblin classification. The primary endpoint was assessment of institutional practice with respect to perioperative morbidity (including cranial nerve injury and vascular complications), mortality, recurrence, and long-term oncologic status. Subgroup analyses were also performed to assess differences between early and later period of our practice. Categorical variables were compared using Fisher's exact test. A p-value < 0.05 was considered statistically significant.
RESULTS
Seventy-four patients (81 tumors) (mean age 53 years, range 21-89; 62.2% female) underwent 81 procedures: 77 (95.1%)complete resections, 2 (2.5%) partial resections, and 2 (2.5%) embolization alone. Tumor diameter ranged from 15 to 60 mm (mean 32 mm). By Shamblin grade, 3 tumors (3.7%) were type I, 53 (65.4%) were type II, and 25 (30.9%) were type III. Preoperative embolization was performed in 28 cases (34.6%). Two patients experienced a transient ischemic attack (TIA) during embolization; their resections were deferred by 35 and 47 days, respectively. Internal carotid artery resection with reconstruction was required in two patients., Early postoperative complications occurred in 15 (18.9%) interventions. These comprised dysphagia in 5 patients (6.3%), dysphonia in 5 patients (6.3%), wound hematoma requiring reoperation in 2 patients (2.5%), 2 (2.5%) complete Horner syndrome and one (1.7%) episode of aspiration pneumonia.. Subgroup analyses were also performed to assess differences between early (2003-2013) and later (2014-2025) period of our practice. Reinterventions for bleeding were performed both in the early period but overall, there was no statistical difference between the two period in terms of complications (p=1). Additionally comparative analysis was performed according to the shambling type (Shambling I/II versus III) to detect difference in clinical outcomes but no statical difference were found when comparing overall complications (p=0.723) nor vascular procedures (p=0.698) probably due to the small number of events. There were no perioperative or follow-up deaths. At a mean follow-up of 83.8 months (range 1-271), one local recurrence was documented and managed conservatively, no metastatic disease was identified.
CONCLUSIONS
This series describes temporal changes in preoperative imaging, selective embolization, and dissection techniques and their association with outcomes including nerve morbidity, vascular complications, and oncologic control. In this high-volume tertiary practice, open surgical resection combined with selective preoperative embolization and vascular reconstruction when indicated was associated with low rates of permanent neurologic morbidity and durable oncologic outcomes.
C. Vincenzoni, Teresa Lodico, L. Mangiacotti et al.· Annals of Vascular Surgery· 0 citations
Background: Spinal tumors are associated with significant morbidity, neurological compromise, and reduced quality of life. For decompression and stabilisation, conventional open spinal surgery has been the norm. However, minimally invasive spine surgery (MISS) has become a viable alternative with potential benefits such as less tissue damage, less blood loss, shorter hospital stays, and quicker recovery. While preserving comparable neurological and oncological efficacy, recent systematic studies have revealed that MISS improves perioperative outcomes.
Aim: To compare perioperative, functional, and postoperative outcomes between minimally invasive and conventional open spinal tumor surgery techniques.
Methods: Over the course of two years, this prospective observational study was carried out at Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute. Sixty individuals with either primary or metastatic spinal tumours were included in the study. Thirty patients who underwent minimally invasive procedures were compared to thirty patients who underwent traditional open surgery. Operative time, intraoperative blood loss, hospital stay, postoperative pain scores, neurological improvement, complications, and functional recovery were among the parameters assessed. The independent t-test and chi-square test were used for statistical analysis; p < 0.05 was deemed significant.
Results: The MISS group demonstrated significantly lower intraoperative blood loss (312.4 ± 96.5 mL vs 648.7 ± 142.3 mL; p<0.001), shorter hospital stay (5.8 ± 1.6 days’ vs 9.7 ± 2.8 days; p<0.001), and lower postoperative pain scores (VAS 3.1 ± 1.2 vs 5.6 ± 1.5; p<0.001). Operative time was slightly longer in the MISS group but not statistically significant (p=0.08). Neurological recovery was comparable between groups, whereas functional recovery was significantly better in the MISS group. Postoperative complications were significantly lower in the MISS group (13.3% vs 33.3%; p=0.04).
Conclusion: Minimally invasive spinal tumor surgery provides superior perioperative outcomes with reduced morbidity and shorter recovery compared with conventional open surgery, while maintaining comparable neurological outcomes. MISS may be considered a safe and effective alternative in appropriately selected spinal tumor patients.
Keywords: Minimally invasive, spinal tumor surgery, conventional open surgery, neurological outcomes, spinal tumor patients
Rahul Deo, Anirudha Doshi, Prathamesh Pathrikar· International Journal of Med...· 0 citations
Introduction Stereotactic surgery of predominantly cystic craniopharyngiomas (CC) is a minimally invasive alternative to microsurgical or endoscopic resection. Both cyst aspiration (CA) and internal cyst shunting (CS) have been proposed as stereotactic treatment strategies, yet comparative data remain limited. Research question Do CA and CS differ in clinical, radiological, visual, endocrine, and recurrence outcomes in predominantly cystic craniopharyngiomas? Material and methods A retrospective cohort of patients treated between 2000 and 2025 was analyzed. Volumetric MRI was performed preoperatively and at ≤6 weeks, 4–6 months, and 9–12 months postoperatively. Clinical, radiological, visual, endocrine, and recurrence outcomes were evaluated using uni- and multivariate analyses. Results A total of 42 patients were included (15 CA, 27 CS). Baseline characteristics were largely comparable, although optic nerve sheath dilation was more frequent in the CS group. Preoperative cyst volumes were similar (14.2 ± 10.3 cm3 vs. 16.5 ± 9.7 cm3; p = 0.5), as were final postoperative volumes (3.2 ± 3.4 cm3 vs. 4.2 ± 5.9 cm3; p = 0.6). Both techniques achieved significant and durable cyst reduction (all p < 0.001). Visual outcomes favored CS (85.2% vs. 53.3% without deficit; p = 0.02), whereas corticotropic (p = 0.02), thyreotropic insufficiency, and diabetes insipidus (both p = 0.03) were more frequent. Recurrence correlated with preoperative cyst volume (p = 0.008), independent of treatment modality. Discussion and conclusion Both techniques provide effective cyst decompression. CS may improve visual outcomes but appears associated with higher endocrine risk. Findings support individualized treatment selection and warrant prospective validation.
B. Harapan, A. Wehn, Sabrina V. Kirchleitner et al.· Brain and Spine· 0 citations
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