Recurrence of Ventral Skull Base Lesions Attributed to Tumor Seeding: A Systematic Review.

Recurrence of Ventral Skull Base Lesions Attributed to Tumor Seeding: A Systematic Review.

World Neurosurg. 2018 Dec 31;:

Authors: Nguyen B, Blasco M, Svider PF, Lin H, Liu JK, Eloy JA, Folbe AJ

Abstract
OBJECTIVES: Our objective was to evaluate ventral skull base lesion recurrences along surgical access pathways attributed to iatrogenic seeding.
METHODS: A systematic review of the literature was performed, searching for recurrence of ventral skull base lesions attributed to iatrogenic implantation. Studies were assessed for level of evidence. Primary intervention, pathology, and other clinical factors were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
RESULTS: Of 69 patients with recurrent skull base lesions attributed to seeding, the most common pathologies included craniopharyngioma (52.2%), chordoma (33.3%), adenocarcinoma (4.3%), adenoid cystic carcinoma (2.9%) and squamous cell carcinoma (2.9%). Median time to recurrence was 36 months. Time to recurrence was significantly longer for craniopharyngiomas than chordomas (42 vs. 24 months, p ≤ .05). Surgical approaches included: craniotomy (62.0%), transseptal (11.3%), transfacial (12.7%), and transpalatal (4.2%). Mean time to recurrence following craniotomy was 69 months. Only five cases (7.0%) employed endoscopic/endoscopic-assisted approaches. Commonly reported recurrence sites included: subarachnoid (29.6%), Dura (21.1%), incision (12.7%), septum (7.0%), and ethmoid sinuses (4.2%).
CONCLUSION: The potential for iatrogenic tumor seeding exists for numerous skull base lesions, most notably craniopharyngioma and chordomas. Routine surveillance may be necessary due to significant latency intervals to ectopic recurrence. While transnasal endoscopic techniques have been extensively employed in recent decades, only a handful of reported cases involve lesions originally treated with this approach. Further direct comparison of traditional approaches to endoscopic approaches may be invaluable in further elucidating the role of surgical technique in tumor implantation and recurrence.

PMID: 30605757 [PubMed - as supplied by publisher]

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