Impact of Dural and Olfactory Nerve Resection on Sinonasal Malignancies with Skull Base Encroachment
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".