Miscellaneous
2
PREFACE J. DAVID OSGUTHORPE, MD Guest Editor Skull base tumors account for less than 5% of head and neck neoplasia. The most common sites of skull base tumors are found in the nose and sinuses in American and European populations and in the nasopharynx in much of the Asian population. Cure rates were poor until the 1960s when the advent of multidisci- plinary surgical teams and in subsequent decades, of better irradiation techniques and equipment began to achieve steady improvements in both cure rates and the quality of patients’lives after therapy.This anatomically complex region comprised of fusion planes of all three embryonic layers and through which course the cra- nial nerves and blood supply to the brain remains a challenge, however. En bloc extirpation, while minimizing disruption of form and vital functions (e.g., speech, swallowing, vision, hearing, olfaction); irradiation to the high doses necessary for cure, yet with close proximity to vital structures (cranial nerves, globe, brain); and chemotherapy across the blood brain interface all present barriers to the treatment team; indeed, there is considerable room for improvements in treatment and much research is ongoing. Cure rates for the more aggressive skull base malignancies, such as squamous cell carcinomas, adenocarcinomas, adenoid cystic carcinomas, and sarcomas have still not yet reached the 50% range. In the majority of patients (64%-91% in the instance of paranasal malignancy), local persistence is the pri- mary cause of death; therefore, en bloc extirpation with clear margins remains highly desirable. Although stereotacticradiosurgery and 3-D planning of conventional irradia- tion ports have improved the ability of irradiation to cure some skull base malignan- cies and to significantly slow the progression of others, the primary responsibility for success usually rests with the surgical team. Clear margins are the primary goal of surgical intervention, but preservation of form and function is increas- ingly integrated into the surgical planning, and reconstructive techniques, often as challenging as the resections, have recently evolved at a faster rate than the extirpative techniques-these involve a range of options from vascularized free flaps to biocompatible reconstructivematerials and osseointegrated prosthodontic rehabilitation. xiii
Transcript of Miscellaneous
PREFACE
J. DAVID OSGUTHORPE, MD Guest Editor
Skull base tumors account for less than 5% of head and neck neoplasia. The most common sites of skull base tumors are found in the nose and sinuses in American and European populations and in the nasopharynx in much of the Asian population. Cure rates were poor until the 1960s when the advent of multidisci- plinary surgical teams and in subsequent decades, of better irradiation techniques and equipment began to achieve steady improvements in both cure rates and the quality of patients’ lives after therapy. This anatomically complex region comprised of fusion planes of all three embryonic layers and through which course the cra- nial nerves and blood supply to the brain remains a challenge, however. En bloc extirpation, while minimizing disruption of form and vital functions (e.g., speech, swallowing, vision, hearing, olfaction); irradiation to the high doses necessary for cure, yet with close proximity to vital structures (cranial nerves, globe, brain); and chemotherapy across the blood brain interface all present barriers to the treatment team; indeed, there is considerable room for improvements in treatment and much research is ongoing. Cure rates for the more aggressive skull base malignancies, such as squamous cell carcinomas, adenocarcinomas, adenoid cystic carcinomas, and sarcomas have still not yet reached the 50% range. In the majority of patients (64%-91% in the instance of paranasal malignancy), local persistence is the pri- mary cause of death; therefore, en bloc extirpation with clear margins remains highly desirable.
Although stereotactic radiosurgery and 3-D planning of conventional irradia- tion ports have improved the ability of irradiation to cure some skull base malignan- cies and to significantly slow the progression of others, the primary responsibility for success usually rests with the surgical team. Clear margins are the primary goal of surgical intervention, but preservation of form and function is increas- ingly integrated into the surgical planning, and reconstructive techniques, often as challenging as the resections, have recently evolved at a faster rate than the extirpative techniques-these involve a range of options from vascularized free flaps to biocompatible reconstructive materials and osseointegrated prosthodontic rehabilitation.
xiii
This issue of Otolaryngologic Clinics of North America provides a succinct overview of the management of skull base tumors, spanning from our under- standing of the pathology, radiographic imaging, and intervention techniques, to radiation oncology, chemotherapy, and the various surgical approaches. Ample current references are provided to direct the interested reader to further study. The authors would like to thank our readers in advance for their attention and interest in this highly complex and evolving subspecialty. It is currently the most technically challenging in otolaryngology and involves a base of knowledge and operative skills from multiple disciplines, including head and neck oncology, neurosurgery, ophthalmology, and facial plastic and reconstructive surgery. It stimulates those involved to seek out and learn from each other, as is demonstrated by the diverse group of authors of this issue of Otoluyngologic Clinics of North America.
J. DAVID OSGUTHORPE, MD Guest Editor
St. Francis Annex, 2nd Floor Medical University of South Carolina 150 Ashley Avenue Charleston, SC 29425
xiv PREFACE
