Invasive Giant Cell Tumor of the Lateral Skull Base: A Systematic Review, Meta-Analysis, and Case Illustration

• Published in: World neurosurgery Vol. 96; pp. 47 - 57
• Main Authors: Freeman, Jacob L., Oushy, Soliman, Schowinsky, Jeffrey, Sillau, Stefan, Youssef, A. Samy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2016
• Subjects: Adult; Cranial Fossa, Middle - diagnostic imaging; Cranial Fossa, Middle - surgery; Frontal Bone - diagnostic imaging; Frontal Bone - surgery; Giant cell tumor; Giant Cell Tumor of Bone - diagnostic imaging; Giant Cell Tumor of Bone - surgery; Humans; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local - epidemiology; Neoplasm, Residual; Neurosurgery; Occipital Bone - diagnostic imaging; Occipital Bone - surgery; Odds Ratio; Radiotherapy, Adjuvant; Skull base; Skull Base Neoplasms - diagnostic imaging; Skull Base Neoplasms - surgery; Sphenoid bone; Sphenoid Bone - diagnostic imaging; Sphenoid Bone - surgery; Tegmen reconstruction; Temporal bone; Temporal Bone - diagnostic imaging; Temporal Bone - surgery; Temporomandibular Joint - diagnostic imaging; Temporomandibular Joint - surgery; Tomography, X-Ray Computed; RANKL; RT; Temporal bone; OR; Skull base; GTR; MRI; CI; Sphenoid bone; STR; CT; Giant cell tumor; Tegmen reconstruction; GCT; receptor activator of nuclear factor kappa-β ligand; giant cell tumor of bone; magnetic resonance imaging; urokinase type plasminogen activator receptor; creatine kinase isoenzyme BB; RANK; odds ratio; interleukin-6; tegmen reconstruction; receptor activator of nuclear factor kappa-β; temporomandibular joint; CK-BB; giant cell reparative granuloma; computed tomography; temporal bone; gross total resection; u-PAI; sphenoid bone; skull base; GCTB; IL-6; u-PAR; GCRG; TMJ; sub total resection; urokinase type plasminogen activator; radiation therapy; u-PA; urokinase type plasminogen activator and inhibitor genes
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.05.086

The current literature regarding cranial giant cell tumor (GCT) management includes scattered case reports and small case series. We present a comprehensive literature review and meta-analysis on this subject, along with a case report describing our management of a patient with temporal GCT. A systematic literature review of all reports on GCTs of the skull was performed, followed by a meta-analysis examining the effect of radiation and degree of resection on tumor recurrence. Fifty-nine abstracts published between 1945 and 2015, reporting 110 cases of GCT, were reviewed. After exclusions were applied, 31 reports, covering 67 patients, were selected for meta-analysis. Average patient age was 33.7 years, and the male:female ratio was roughly 1:1. Tumor locations were temporal in 37 patients, sphenoid in 20 patients, occipital in 6 patients, frontal in 2 patients, and the temporomandibular joint in 2 patients. Treatments were surgery plus radiation in 25 patients, surgery alone in 41 patients, and radiation alone in 1 patient. In the 66 patients who underwent surgery, the degree of resection was gross total resection (GTR) in 34 patients, subtotal resection (STR) in 31 patients, and not recorded in 1 patient. The mean follow-up time was 36 months. Recurrence occurred in 8.8% of patients in the GTR group and in 32.3% of those in the STR group (odds ratio, 0.203; 95% confidence interval, 0.033–0.937; P = 0.018). The odds ratio for STR alone compared with STR plus radiation was 14.01 (P = 0.0038). GCTs of the skull commonly affect young adults, with an equal sex distribution, and are most often centered in temporal bone. GTR is associated with the lowest recurrence rate and should be the goal of treatment. If GTR cannot be achieved, the combination of STR and radiation results in a similar recurrence rate. With the advent of denosumab, there is now a role for chemotherapy in the treatment of GCTs.