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Ziv Gil, MD, PhD; Diane L. Carlson, MD; Amar Gupta, MD; Nancy Lee, MD; Bradford Hoppe, MD; Jatin P. Shah, MD; Dennis H. Kraus, MD

Arch Otolaryngol Head Neck Surg. 2009;135(2):173-179.

Objective  To characterize the incidence and pattern of neural invasion (NI) in patients with cancers of the paranasal sinuses and anterior skull base.

Design  Retrospective study.

Setting  A tertiary referral cancer center.

Patients  The study included 208 patients with cancer of the paranasal sinuses. Patients with brain invasion or neurogenic tumors were excluded.

Main Outcome Measure  Analysis of clinical and pathologic data on patients with cancer of the paranasal sinuses.

Results  Forty-one specimens (20%) had evidence of NI. Sinonasal undifferentiated, adenoid cystic, and squamous cell carcinoma had a high propensity for NI, whereas melanoma and sarcoma rarely invaded nerves. Intraneural invasion was found in 32% of these cases, and 34% invaded more than 1 cm distal to the tumor. Neural invasion was associated with a high rate of positive margins, maxillary origin, and previous surgical treatment (P < .04) but not with stage, orbital invasion, or dural invasion. Patients with NI were more likely to undergo adjuvant radiotherapy (P = .003), which significantly improved survival in patients with minor salivary gland carcinomas (P = .04). Multivariate analysis showed that pathologic evidence of NI was not an independent predictor of outcome.

Conclusions  Paranasal carcinomas have high propensity for NI, whereas melanoma and sarcoma rarely invade nerves. Patterns of NI include both perineural and intraneural invasion. Neural invasion is associated with positive margins, maxillary origin, and previous surgery.

Author Affiliations: Departments of Surgery (Drs Gil, Gupta, Shah, and Kraus), Pathology (Dr Carlson) and Radiation Oncology (Drs Lee and Hoppe), Memorial Sloan-Kettering Cancer Center, New York, New York. Dr Gil is now with the Department of Otolaryngology–Head and Neck Surgery, Skull Base Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

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