1. A uniform staging system is mandatory before an accurate analysis of treatment modalities can be made.

2. The best staging system at present is that presented by Curtin et al.7 in 1990 with the modification by Clark et al.8 to subdivide Curtin's T4 to reflect the difference in prognosis between anterior soft tissue extension and posterior and medial extension into dura and brain.

3. Different histologic malignancies and sites of origin should be differentiated when cure rates and survival rates are calculated inasmuch as different tumors have different biologic patterns of behavior.

4. Technological advances in imaging have enhanced adequate evaluation of the extent of disease and more realistic preoperative planning.

5. The advent of skull base surgery and free tissue transfers has extended the scope of surgery to include previously unresectable tumors, made surgery safer, decreased severe complication (CSF leaks, meningitis), and has rendered the concept of piecemeal removal obsolete and indefensible.

6. Postoperative radiotherapy is mandatory after temporal bone resection, but it is beneficial for local control only if the tumor has been totally resected with clear margins.

7. Forty-four years ago, Parsons and Lewis9 presented their landmark contribution on subtotal temporal bone resections. Since then, many advances in surgery have extended our surgical ability to perform this surgery more safely.

It is my opinion we have reached the pinnacle of our surgical ability in treating carcinoma of the temporal bone and must now devote our energies to adjunctive modalities either after or in conjunction with surgery. Temporal bone resection is the cornerstone in the treatment of malignancies of the temporal bone.


Arena—CHAPTER 54

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