Objective. Evaluation of the results of surgical treatment of patients with squamous cell carcinoma sinonasal localization, treated in the period from 2009 to 2019.
Material and methods. The present study represents a retrospective analysis of results of surgical treatment of 56 patients with squamous cell carcinoma of the skull base, operated in FGAU “SMRC neurosurgery them. AK. N.N. Burdenko” of the Ministry of health of Russia from 2009 to 2019. The following indicators were analyzed: demographic data, localization and size of the tumor, clinical symptoms and its dynamics in the postoperative period, features and volume of surgery, tumor histology, development of complications, relapse or continued tumor growth, the nature of subsequent treatment.
Results. T he radic alit y was assessed ac c ording to CT and M R I data p er formed in the early and late postop erative periods. In 26 cases, an extended tumor biopsy was performed, in 15 cases the tumor was partially removed, in 12 — subtotally, and in 3 – totally. The average duration of the operation was 130 minutes (70-860 minutes).
In 19 cases, the intracranial fragment was removed, and in 25 it was not. In 20 cases(Figure 6), plastic surgery of the dura mater or frontal sinus was required at the end of surgical treatment.
Dynamics of pain syndrome: regressed in almost all patients for 3 months after surgery. The dynamics of cranial nerve functions also had a positive character over a three-month period. Out of 56 patients, 7 had early postoperative complications in
various combinations. 3 patients had meningitis, which was cured by antibacterial therapy. 2 had an abscess of the surgical site – these were patients after CF resection. In 3 patients, there was a failure of the postoperative
wound. Also, 3 developed nasal liquorrhea. In addition, the 1st patient experiencedrejection of the displaced periosteal flap in the delayed period. In 10 cases, repeated surgical treatment in adelayed period aimed at repeated
removal of the tumor was required. Removal of existing metastases was performed in 4 patients. Four needed a tracheostomy, and one needed gastrostroms. Catamnesis was traced in 50 patients. Its average term was 60.32
months (from 4 to 168 months). Radiation therapy was performed in 44 patients. In 38 cases, chemotherapy was performed before radiation therapy, 13 patients underwent chemotherapy after radiation therapy, and in 5 cases
chemoradiotherapy was performed simultaneously.
Discussion. The presented work is devoted to the analysis of the results of complex treatment of patients with squamous cell carcinoma of the base of the skull. These tumors account for more than 50% of all malignant
neoplasms of sinonasal localization. It is known that factors of the industrial environment, smoking play an important role in the development of RCC of this localization, as well as the presence of human papillomavirus (HPV) in
the development of RCC. The histological picture of RCC is heterogeneous. Epithelial immunohistochemistry is crucial for distinguishing RCC subtypes. This often requires the determination of p63, p40 and cytokeratin. The location of the tumor in the nasal cavity and paranasal sinuses causes the erasure of the clinical picture, which is why the diagnosis of RCC is not established for quite a long time and until the tumor reaches a late stage. Treatment of RCC requires a multidisciplinary approach. Modern treatment strategies usually include a
combination of surgical treatment, radiation and chemotherapy.
Conclusion. Despite the introduction of new surgical techniques, the progress of chemo- and radiation therapy for squamous cell carcinoma remains an urgent problem today. The RCC of the skull base is a multidisciplinary
problem. Most tumors of this localization are removed either by an open method (including craniofacial resection), or using endoscopic technique. To date, the removal of a tumor under the control of an endoscope is an effective
method, with comparable indicators of overall and relapse-free survival, but withfewer complications.
Key words: squamous cell carcinoma, skull base surgery, craniofacial neurosurgery, endonasal endoscopic surgery
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. The research was funded from the authors’ own funds.