The pre- and post-era of ESTTT (Extented SubTemporal Transcavernous Transpetrosal) approach in managing skull base tumour

Abstract

Hugh skull base tumour is always a challenge to neurosurgeon because of its deep location and involvement of important neurological structures and difficult complete excision. Some of them were labeled “inoperable” because of high morbidity and mortality after aggressive excision. In this study, we evaluate the long term clinical outcome, survival and performance status after aggressive microsurgical resection via the Extended SubTemporal Transcavernous Transpetrosal (ESTTT) approach in Queen Mary Hospital since 2007. Within the 37 patients operated between 2007-2011, the mean age was 57 year old. 97% of tumours operated were larger than 2.5cm, within which most of them involved cavernous sinus, cerebellopontine angle and compression of brainstem. We achieved gross total resection in 51% cases and subtotal (>90%) resection in 49%. Only 1 case has permanent new onset cranial nerve palsy, 3 cases with CSF leakage required fistula repair and 1 case having new post-op intracranial haemorrhage. 76% of cases has >24months follow-up duration, and up to 81% of patients has either no residual disease or static residual lesion.