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BACKGROUND: Skull base metastases (SBM) are rare and have received limited attention in the medical literature. Questions remain regarding the role of surgery, if any, in the management of these tumors.
OBJECTIVE: To report surgical outcomesin a consecutive series of patients with SBM, and to better define the role of surgery in their management.
METHODS: 27 patients with SBM underwent surgery between 1996 and 2009 at M. D. Anderson Cancer Center. A retrospective review of their prospectively collected data was performed after obtaining institutional review board (IRB) approval. Median patient age was 52 years. The most common pathology:renal cell carcinoma (6 patients). Surgical indicationswere worsening neurologic deficit, disfiguring mass and need for diagnosis.
RESULTS: A gross total resection was achieved in 59% of the cases. Median survival was11.4 months. Median progression-free survival was5.8 months. A Karnofskyperformance scale score less than 90, dural invasion and brain invasion were associated with a shorter survival. Seven patients were neurologically intact pre-operatively; all of them remained intact after surgery. Among all patients with pre-operative neurologic deficit, 11 remained stable, 7 improved, and 2 had worsening of their deficit post-operatively.
CONCLUSION: The goal of surgery for SBM disease is to provide symptom relief and to preserve functional status in well selected cases. Patientselection is critical since the surgery is usually palliative and only a minority of patients are surgical candidates. Radiation therapy remains the management option of choice for the majority of patients.
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
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