Comparison of Transnasal Endoscopic and Open Craniofacial Resection for Malignant Tumors of the Anterior Skull Base

Objective/hypothesis: Craniofacial resection (CFR) represents the traditional approach for resection of anterior skull base (ASB) malignancies. However, this past decade has witnessed the emergence of transnasal endoscopic ASB resection (TER) as a feasible alternative. The aim of this study was to compare TER and CFR for ASB malignancy resection.

Methods: Retrospective analysis at a tertiary care medical center on 66 patients undergoing ASB malignant tumor resection between September 1997 and December 2006.

Results: Eighteen patients were treated with TER, whereas 48 patients underwent CFR. The two groups showed no significant difference in complication rate (27.8% for TER and 25.0% for CFR, P > 0.05), survival (94.4% for TER and 83.3% for CFR, P > .05), and metastasis (11.1% for TER and 8.3% for CFR, P > .05). A significant difference was observed in hospital stay with an average of 3.8 days in the TER group compared to 8.1 days in the CFR group (P < .05). Local recurrence approximated significance (5.6% for TER and 29.2% for CFR, P = .051)

Conclusions: TER of ASB malignancy is associated with a decreased hospital stay and faster recovery when compared to open CFR. Lower local recurrence rate in the TER group may reflect a discrepancy in histology and clinical stage. We found no significant differences in survival, metastatic, or complication rates in the two groups, whereas patients in the TER group had the added benefit of a desirable cosmetic outcome. Overall, TER seems to be an excellent alternative to CFR in properly selected cases.