Management And Early Surgical Outcome Of Skull Base Tumours; A 15-Year Single-Center Experience

Abstract

Objectives: Tumors of the skull base (SBT) are complex and challenging to neurosurgeons. This study aims to report the single-center experience with SBT including types, frequency, management, and early outcome. Methods: The retrospective study of SBT managed between 2006 to 2021 in Memfys Hospital, Enugu, Nigeria was retrieved and analyzed including the demographic, laboratory, and radiologic data, surgery, histologic results, and 30-day surgical outcome. Results: A total of 891 central nervous system tumors were seen and SBT accounted for 20.9%. The mean age was 45.01±8.4years with a male preponderance.  Most involved the middle cranial base (73.1%) with pituitary tumors (51.1%), meningioma (25.8%), and craniopharyngioma (10.25%) being the commonest. Giant nonfunctional macroadenoma accounted 66.3% of pituitary tumors and one-third had transsphenoidal adenectomy while 67.4% had improvement in  vision(p<0.05).  All meningioma were CNS WHO grade 1 (fibroblastic histologic subtype commonest 33.3%) with the olfactory groove (30.6%) and sphenoid wing meningioma (33.3%) most frequent. Only 25.1% had Karnofsky performance of ≥60% at presentation and more than two-thirds had Simpson II excision. Vestibular schwannoma (3.2%) and granulomatous lesions (2.9%) were rare. Breast cancer was the commonest cause of metastatic SBT and 5 patients had nasopharyngeal cancer.  New onset neurologic deficits were the commonest morbidity 7.3%. The 30-day mortality was 11.73%. Conclusion: SBT were common among patients with intracranial tumors in our subregion, and nonfunctional pituitary macroadenoma and anterior and middle skull base meningioma were commonest while vestibular schwannoma is rare. The 30-day mortality for SBT was low.

Keywords: skull base tumors, nonfunctional pituitary tumor, meningioma, Memfys Hospital.