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

Brandon Nguyen; Michael Blasco; Peter F Svider; Ho-Sheng Lin; James K Liu; Jean Anderson Eloy; Adam J Folbe

doi:10.1016/j.wneu.2018.12.104

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

World Neurosurg. 2018 Dec 31:S1878-8750(18)32927-9. doi: 10.1016/j.wneu.2018.12.104. Online ahead of print.

Authors

Brandon Nguyen¹, Michael Blasco², Peter F Svider³, Ho-Sheng Lin⁴, James K Liu⁵, Jean Anderson Eloy⁶, Adam J Folbe⁷

Affiliations

¹ Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA; Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA. Electronic address: bknguyen@oakland.edu.
² Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA; John D. Dingell VA Medical Center, Detroit, Michigan, USA; Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
⁷ Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA; Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.

PMID: 30605757
DOI: 10.1016/j.wneu.2018.12.104

Abstract

Objective: 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 Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: Among 69 patients with recurrent skull base lesions attributed to seeding, the most common pathologies were 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 for chordomas (42 months vs. 24 months, P ≤ 0.05). Surgical approaches included craniotomy (62.0%), transseptal (11.3%), transfacial (12.7%), and transpalatal (4.2%). Mean time to recurrence after craniotomy was 69 months. Endoscopic/endoscopic-assisted approaches were used in 5 cases (7.0%). Commonly reported recurrence sites included subarachnoid (29.6%), dura (21.1%), incision (12.7%), septum (7.0%), and ethmoid sinuses (4.2%).

Conclusions: The potential for iatrogenic tumor seeding exists for numerous skull base lesions, most notably craniopharyngioma and chordomas. Routine surveillance may be necessary owing to significant latency intervals to ectopic recurrence. Although 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 with endoscopic approaches may be invaluable in further elucidating the role of surgical technique in tumor implantation and recurrence.

Keywords: Chordoma; Craniopharyngioma; Ectopic recurrence; Iatrogenic; Sinonasal; Skull base; Tumor seeding.