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KUANetal.

TABLE VIII.3 Evidence surrounding the resectability of tumors involving the carotid artery.

Clinical endpoints 1. OS 2. PFS 3. Mortality

Author

Year LOE Study design Study groups

Conclusion

Ferrari et al. 173

ICA resection is feasible with fair outcomes (mean OS 27.2 months,

2022 4

Retrospective case series

10 patients with skull base cancer with ICA invasion treated with surgery Two patients underwent bypass 46 EEA patients with recurrent or persistent ventral cranial base tumors

2-year OS/PFS of 88.9%, 10% perioperative mortality) with properly selected patients

Zhang et al. 169

2021

4

Retrospective case series

Effect of ICA

1. Recommend 5S ICA grading scale and ICA grading strategy to obtain maximum total resection rate 2. Treatment strategy is guided by ICA 3. BOT testing with either bypass (if BOT is failed) or ICA embolization and ligation (if BOT is passed) followed by GTR In experienced hands, high flow bypass for cerebral revascularization may be an option There was a high rate of periprocedural complications and poor patient survival 1. Histologic invasion predicted survival 2. Clinical assessment was as predictive as CT for tumor invasion ICA revascularization prior to malignant skull base tumor extirpation was feasible with 20% risk of vascular complication > 270-degree encasement of the ICA on MRI was 100% specific and 88% sensitive for unresectable disease

related tumor characteristics on ability to achieve GTR

Yanget al. 172

Descriptive

2014 4

Retrospective case series

18 patients with skull base tumors of nonsinonasal origin who underwent 20 high flow bypasses advanced head and neck cancer requiring ICA sacrifice and cerebral revascularization advanced head and neck SCC who underwent carotid artery resection 10 anterior skull base tumor patients with ICA encasement requiring sacrifice 49 patients with head and neck neoplasms and clinical evidence of carotid wall invasion 18 patients with 34 patients with

clinical data

Kalani et al. 170

2013 4

Retrospective case series

1. Adverse events 2. Survival

Yooet al. 167

1. CTand

2000 4

Retrospective case series

histologic findings

2. OS

Lawtonand Spetzler 171

1996 4

Retrospective case series

N/A

Yousem et al. 168

Correlation

1995 4

Retrospective case series

betweenMR imaging findings and tumor resectability

Abbreviations: BOT, balloon occlusion testing; EEA, endoscopic endonasal approach; GTR, gross total resection; OS, overall survival; PFS, progression-free survival; SCC, squamous cell carcinoma; SDH, subdural hemorrhage.

combined approaches) is aimed at addressing both the sinonasal and intracranial aspects of tumors (dural or brain parenchymal components) and is a commonly used modality for addressing SNM with intracranial spread. Ganly et al. analyzed 344 patients undergoing CFR from an international collaborative study and found that 5-year OS decreased from 57.3% to 37.8% with dural involve

ment and decreased to 26.6% with brain involvement ( p < 0.001), while DSS decreased from 64.1% to 45.0% and 28.4%, respectively ( p < 0.001). 174 Despite the staging and survival implications of intracranial involvement, the reviewed studies included patients in which tumor was dissected from the dura and brain parenchymal compo nents without reported independent increases in positive