AUTHOR=Wang Zhi-Qiang , Tong Xiao-Guang 

TITLE=Clinical effect of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1019400

DOI=10.3389/fsurg.2022.1019400

ISSN=2296-875X

ABSTRACT=Background: To investigate the surgical methods and clinical effects of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement.
Methods: The relationship between skull base tumors and internal carotid artery (ICA), tumor location and size, and extent of tumor invasion were assessed. Preoperative CT perfusion (CTP), magnetic resonance perfusion-weighted imaging (MR-PWI), and digital subtraction angiography (DSA) were performed to evaluate collateral circulation and brain tissue perfusion. Then, craniotomy through the fronto-orbitozygomatic approach was performed, based on which 4 cases received extended middle skull base approach + Dolenc approach + Fukushima bypass type I I, and 6 cases received extended middle skull base approach + Fukushima bypass type III. After surgery, DSA, CT angiogram (CTA) and CTP/PWI were performed to evaluate the patency of the reconstructed vessels and cerebral perfusion, and contrast-enhanced MRI to evaluate the degree of tumor resection. All patients were followed up for 6-12 months. 
Results: Among the 10 cases investigated, gross total resection was achieved in 8 cases, subtotal resection in 1 case, and partial resection in 1 case, as confirmed by CT and enhanced MRI. The patency of revascularization vessels was observed using fluorescein angiography during the operation in all patients and via DSA and CTA postoperatively in 9 patients. One patient underwent ventilator-assisted ventilation due to respiratory failure and failed to undergo DSA and CTA. Regarding postoperative complications, 1 patient developed watershed cerebral infarction on the operated side but no sequelae after drug treatment, 3 patients developed facial numbness, which improved after 3 months, and 2 patients experienced worsening of their diplopia. After 6 to 12 months of follow-up, the Glasgow Outcome Scale (GOS) of 9 evaluable patients was 4-5 after surgery. Additionally, 6-month follow-up results showed that one patient with clival chondrosarcoma developed a recurrence on contrast-enhanced MRI, while no relapse was observed in the other patients.
Conclusion: For skull base tumors with intra- and extra-cranial invasion and involving the ICA, revascularization might improve the total resection rate and reduce the recurrence rate and risk of intraoperative bleeding and postoperative ischemia.