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J Neurol Surg B Skull Base 2013; 74(04): 228-235
DOI: 10.1055/s-0033-1342925
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Survival and Recurrence for Patients Undergoing Surgery of Skull Base Intracranial Metastases

Kaisorn L. Chaichana
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Mariana Flores
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Shami Acharya
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Paul Sampognaro
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Chetan Bettegowda
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Daniele Rigamonti
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Jon D. Weingart
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Alessandro Olivi
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Gary L. Gallia
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Henry Brem
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Michael Lim
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
,
Alfredo Quinones-Hinojosa
1   Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
2   Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
› Author Affiliations
Further Information

Publication History

13 November 2012

28 January 2013

Publication Date:
03 April 2013 (online)

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Abstract

Objective Skull base metastases (SBMs) are rare lesions in close proximity to critical neural and vasculature structures. This rarity and complexity have led many to only offer nonsurgical therapies. The surgical outcomes for patients with SBM therefore remain unknown.

Design Retrospective, comparison analyses.

Setting Johns Hopkins Hospital.

Participants All patients who underwent intracranial metastatic tumor surgery.

Main Outcome Measure Survival and recurrence.

Results Of the 708 patients who underwent intracranial metastatic tumor surgery, 29 (4%) had SBM: 3 (10%) involved the anterior skull base, 7 (24%) the sella, 6 (21%) the orbit, 2 (7%) the sphenoid wing, 3 (10%) the clivus, 4 (14%) the petrous bone, and 4 (14%) the paranasal sinuses. Following surgery, 6 (50%) had improvements in vision and 14 (88%) had improvement and/or maintenance of their cranial nerve symptoms. Three (10%), 0(0%), and 1(3%) developed a new motor, language, and vision deficit, respectively. There were no differences in median survival (10.0 versus 9.2 months, p = 0.48) and local progression-free survival (PFS) (p = 0.52), but there was improved distal PFS (p = 0.04) between patients with and without SBM.

Conclusions Patients with SBM are relatively rare. These patients can tolerate surgery with minimal morbidity and mortality, and they have similar prognoses to patients without SBM.

Keywords

metastatic brain tumor - recurrence - skull base - surgery - survival
 

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