This is controversial at present. No evidence exists, as yet, that supports the endoscopic "debulking" of tumors followed by radiotherapy. Craniofacial en bloc resection remains the gold standard that has increased life expectancy in skull base tumors (Howard and Lund, 1993). The integrity of the dura is critical in the management of this condition. A tumor invading the dura is associated with a poor prognosis, but thankfully the dura often forms a good barrier.
The endoscopic resection of malignant skull base lesions may have a role in small tumors, where a margin of resection is possible (Fig. 15.54a-c).
The same technique should be used as has been described above (in the section Surgical Approaches for Benign Paranasal and Skull Base Lesions, p. 268) except that every attempt should be made to remove the tumor and its bony base in one piece. However, it is often necessary to debulk a tumor hanging into the airway in order to improve the visibility of its margins and the roof of the sinuses. Powered instrumentation helps, but all material must be collected in a trap, in series with the suction tube, for histological examination.
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