[ XXXX invading the skull base. Apropos of 4 cases and review of the literature].

@entity1 @entity3478 @entity5 @entity2347 @entity458 @entity5516 @entity3
Head and neck @entity2347 may invade the adjacent skull base by bone lysis and/or by perinervous and perivascular spread within the skull base foramina. @entity5516 making is not well defined regarding the extent of @entity5 component removal, as neurosurgical expertise is limited for this peculiar type of @entity5 . The issue is to decide whether a radical supposedly locally curative surgery should be attempted, or if a large non disfigurating surgery is mandatory, keeping in mind the frequency of local recurrences and of distant metastases. Over a 13-year period, four @entity2347 invading the skull base were operated on at our institution: two @entity5 originated in the parotid gland, one in the sphenoid sinus, and one in the ethmoid sinus. Surgical removal was total in one case, subtotal in three cases. Post-operative irradiation was delivered in the four @entity1 (two neutron irradiation, two conventional). One @entity1 with advanced @entity3 was submitted to chemotherapy. Three @entity1 died from @entity5 progression and distant metastases within three years after the @entity5 extension has been diagnosed. The @entity1 with an @entity5 is still alive seven years after surgery without any evidence of @entity5 progression nor distant metastases. Surgery remains the gold standard treatment for @entity2347 invading the skull base. However, in our opinion a @entity3478 , but without sacrifice of cranial nerves, cavernous sinus, internal carotid artery, and of the orbit allows @entity1 survival with an acceptable comfort and absence of @entity458 due to disfigurating surgery nor surgically induced neurological functional deficit. Post-operative irradiation may sometimes stabilize locally the lesions. The place of chemotherapy has, yet, to be determined.
