거대 두개저 종양 절제술에 대한 단일 기관 수술 결과

Outcomes of giant skull base tumor after surgical resection in a single-center

Objectives : Giant tumors of the skull base are extremely rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after tumor resection. We report our experience of thirteen patients who had received surgical treatment successfully. Materials and Methods : Surgical approach is selectively perfomed based on the location of the tumor and surrounding anatomical structure. Twelve patients underwent extended translabyrinthectomy with combined anterior and posterior petrosectomy(ETLAPP) and one patient had received subtotal petrosectomy(SP). Tumor resection was achieved in all patients. Two patients underwent gross total removal(GTR) and eleven patients had received subtotal tumor resection(STR). Results : The mean age of the patients was 39 years (ranged from 7 to 60). The male to female ratio was 3:10. The average tumor size was 4.1×3.0×3.0cm. Of the thirteen patients, twelve patients had pre-operative cranial nerve deficits (CN II, III, V, VI, VII, VIII, XII) and another three patients had hemiparesis. Postoperative evaluation was performed for all patients after tumor resection. The new cranial nerve complications after surgery were found in five (38.5%) patient in the following order : facial palsy, hearing loss, extraocular paresis and double vision. The second most common morbidities were motor deficits (15.4%, n=2) in the early opstoperative period. In the pathological findings after surgery, schwannoma(n=5), meningioma(n=4), chondrosarcoma(n=1), pilocytic astrocytoma(n=1), embryonal carcinoma(n=1) and anaplastic oligodendroglioma(n=1) have been reported in excised tumors. Conclusion : Tumor resection is helpful to relatively young age of the patient with giant skull base tumor who do not have improvement in the conservative treatment. We found that the extended trans-labyrinthectomy combined with anterior and posterior petrosectomy are ways to minimize mortality and major morbidity. Further studies are needed to evaluate the effectiveness of the procedure in the future.