Impact of Dural and Olfactory Nerve Resection on Sinonasal Malignancies with Skull Base Encroachment
Notice bibliographique
Résumé
Background: The treatment of sinonasal malignancies with anterior cranial base encroachment but without obvious dural invasion varies by institution and surgeon. The need to resect the bony skull base and dura often varies depending on the histopathology, patient functional status, and surgeon preference. Surgeons must balance the risk of microscopic residual disease with the risk of cerebrospinal fluid leak and potential neurologic sequelae. Pre-operative imaging with CT or MRI may predict the extent of invasion, but in cases where the dura is not clearly invaded, there is still uncertainty about the extent of resection. Methods: We performed a retrospective review of patients with nasal cavity or paranasal sinus malignancies treated surgically at University Health Network in Toronto between 2001 and 2014. Patients were included if they had cribriform plate or fovea ethmoidalis encroachment or erosion without any signs of dural invasion on CT or MRI, as determined by a head and neck radiologist. Relevant prognostic features related to demographics, treatment, tumor extent and histopathology were collected. Rates of occult dural invasion in those undergoing dural resection were reported as were dural recurrence rates in patients who underwent dural resection versus those who did not. Survival analyses were completed using Kaplan-Meier methods. Results: Thirty-nine patients (mean age 55.5 years; SD 13.8; 54% male) met our inclusion criteria. Fourteen patients (36%) had esthesioneuroblastoma, six patients (15%) had squamous cell carcinoma and the remaining 19 patients (49%) had other malignancies. Twenty-three patients (59%) had dural resections, of whom only 14 patients (61%) had reporting of whether or not dura was invaded. Of those 14 patients, 7 patients (50%) had dural invasion. Five patients had dural recurrences, two with dural resections (9%), and three (19%) without dural resections. There were no differences in five year dural control, loco-regional control and disease specific survival in the dural resection and no dural resection groups (94% vs 86%, p = 0.25; 84% vs 86%, p = 0.49, 87% vs 68%, p = 0.91). Conclusions: Sinonasal malignancies that encroach the bony anterior skull base, but without overt dural invasion require surgical extirpation with margin control. The risk of microscopic disease of the dura is not clear. This study provides some preliminary evidence that there may be occult dural involvement despite no overt imaging evidence. Dural resection, however, does not seem to be associated with any survival advantage. A surgeon must balance this risk with the added morbidity of dural resection and possible cerebrospinal fluid leak in determining the extent of resection.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».