Over the past 40 years, there has been a significant improvement and enhancement of surgical techniques for the removal of malignant tumors that spread to the base of the skull.
The main indication for surgery at the base of the skull is the presence of both benign and malignant tumors coming from the mucous membrane of the nasal cavity and paranasal sinuses, skin, bone and cartilage structures of the craniofacial region, as well as tumors of the vascular and nervous genesis and formation of the orbit and dura mater.
In order to access the anterior part of the base of the skull, a standard bifrontal craniotomy is used, or the anterior subcranial access. For access to tumors located more laterally used cranio-orbito-occipital access, lesions of the middle cranial fossa requires craniotomy through the main bone and subsequent facial translocation. The modern approach is considered to be the use of endonasal surgery for access to tumor lesions of the central part of the skull base.
Mortality during interventions on the craniofacial area remains significant, with a number of complications approaching 30-40% of cases. In most surgical cases, the mortality rate remains below 10%.
According to most authors, survival rate in tumor lesions of the skull base is 60%. However, the long-term survival rate depends on the histological type of the tumor. Estesioneuroblastoma and malodifferentiated sarcomas show better long-term survival results compared to mucosal melanoma and low differentiated cancer. High-differentiated sarcomas show the worst survival rates. Features such as the spread of the tumor into orbit, or the dura mater are attributed to adverse prognostic factors.
Surgical method remains the main and basic element in the treatment of most solid tumors.
Approximately 70% of patients receiving therapy for head and neck cancer require surgical treatment at an early stage. In turn, the goal and objectives of multi-component cancer treatment are to improve patient longevity, patient recurrence and reduce the risk of developing remote metastases and new primary tumors. In achieving these goals, multicomponent treatment is indisputable. On the other hand, surgery remains the only possible method to treat patients with relapses after previous radiation therapy or chemotherapy.
The role of head and neck surgery adopts synchronous changes in parallel with the development of new advances in multicomponent treatment. The introduction of radiation and chemotherapy in the initial stage of multicomponent treatment has reduced the radicality of surgery, but broad rescue operations are a priority in the treatment of relapse tumors after chemotherapy.
Improvements in imaging and navigation technology, as well as the development of robotics and intracellular radiotherapy have expanded the role of the modern surgeon in the treatment of head and neck tumors. Similarly, minimally invasive surgery is increasingly being used in the treatment of tumors of the parathyroid and thyroid glands. The use of endoscopy has expanded the possibilities of laser removal of laryngeal tumors, as well as endonasal surgery is optimal for access to tumor lesions of the central part of the base of the skull. Improvements in histological analysis using immunohistochemical techniques and genetic markers have resulted in both more accurate diagnosis of the tumor and an assessment of its genesis and choice of treatment tactics.
The role of the surgeon is important throughout the treatment of patients with head and neck tumors. It is important both at the stage of correct diagnosis and choice of treatment method, and is invaluable in the treatment of postoperative complications and further rehabilitation and palliative symptomatic treatment of patients.
Prognostic factors in the choice of tactics for thyroid cancer treatment have been identified in many major studies. Both the patient and the tumor associated factors are distinguished. Patient age and gender are independent parameters influencing the prognosis. Tumor size, histological structure, extrathyroid proliferation, the presence of remote metastases are all tumor factors. Three risk groups were identified based on these prognostic factors. The low risk group includes young patients with favorable tumor associated factors, the high risk group includes elderly patients with unfavorable tumor associated factors. Young patients with favorable tumors associated factors and elderly patients with unfavorable tumors are in the intermediate risk group.