Combined Transpetrosal Approach for Salvage Surgery in the Treatment of Recurrent and Advanced Nasopharyngeal Carcinoma: A Case Report.

Abstract

A 45-year-old female patient was diagnosed with nasopharyngeal carcinoma (NPC). She previously underwent chemotherapy and radiotherapy but now presents with multiple craniopathies and persistent severe headaches that significantly impair her daily activities due to local tumor progression. Notably, she had not been offered prior surgical intervention. Salvage surgical therapy following maximal chemotherapy and radiotherapy is a viable option for patients with local tumor progression and signs of brain compression, aiming to relieve increased intracranial pressure through tumor debulking. In this case report, we advocate for a multi-corridor approach - combining anterior and posterior petrosectomy with a retrosigmoid craniotomy - to optimize tumor resection. The choice of surgical approach is tailored to the extent of tumor invasion within the skull base, with the primary goal of achieving a safe and maximal resection. By utilizing multiple surgical corridors, extradural and intradural tumor burden can be effectively reduced. Mastery of various skull base approaches is essential to develop a comprehensive surgical repertoire, allowing for strategic combinations that optimize resection. Additionally, continuous monitoring and postoperative multidisciplinary care are crucial in guiding the next steps for these highly morbid conditions. In this case, the patient was discharged with a significant reduction in headache and no new neurological deficits. Salvage surgery remains a viable palliative option that can enhance the patient's quality of life.