Abstract

Dr. Jaspreet Singh Badwal* and Mrinal Deka

ABSTRACT

Purpose: The purpose of the study is to investigate the trends in long term outcomes for surgical treatment of temporal bone malignancy and generate guidelines for future benchmark reference, in order to establish a treatment pathway for critical decision making, supported by cumulative evidence gathered over decades of research. Apart from this, the study will aim to answer four key questions in relation to temporal bone malignancy: (1) Has survival for temporal bone malignancy improved over the last few decades (2) Is Total temporal bone resection ever indicated ? (3) How does prognosis change when structures such as the dura mater, brain and internal carotid artery become involved ? What is the feasibility of surgery in these instances ? (4) What is the role of postoperative radiation therapy ? Materials and Methods: A systematic review was conducted to study the long term outcomes of surgical management of temporal bone malignancy. 736 articles had been published till October 2018, which included retrospective studies, prospective studies, SEER Database surveys, Multicenter studies and smaller descriptive studies. References of the selected studies were further searched for relevant articles. Apart from this, a search was conducted over Google Scholar to obtain related articles. Subsequently, a meta-analysis was completed to extrapolate the cumulative survival, hazard rate, survival probability and event rate for surgical management of temporal bone malignancy. Following this, regression analysis was conducted to study the outcomes of primary surgery +/- adjuvant radiotherapy as a treatment protocol for temporal bone malignancy. Results: The long term outcomes for surgical management of temporal bone malignancy have improved over the last few decades. Also, outcomes for surgical management of advanced stage disease show a favourable trend. Further clinical trials and multicentre studies should be carried out to strengthen the results for this separate clinical cohort. Primary surgery +/- adjuvant radiotherapy has commendable long term clinical outcomes in the contemporary skull base era. Conclusion: Long term outcomes for surgical management of temporal bone malignancy show slow but persistent improvements resulting from the parallel consistent development of skull base surgical techniques.