Esthesioneuroblastoma: endoscopic nasal and anterior craniotomy resection

Abstract

Objectives/hypothesis: The objective was to illustrate the use of endoscopic techniques as an evolving surgical modality in excision of esthesioneuroblastoma. The authors advocate this method with excision with anterior craniotomy for removal of cribriform plate or anterior cranial fossa tumor extension.

Study design: A retrospective chart review of patients with esthesioneuroblastoma treated surgically at a tertiary care institution from 1991 to 2002 using this surgical paradigm.

Methods: Patients were excluded for nonsurgical treatment or nasal and sinus tumor excision by nonendoscopic techniques. Patient demographics, tumor histological findings, presenting signs and symptoms, staging (Kadish and Dulguerov), postoperative complications, adjunct therapy, and recurrence were examined.

Results: Seven of 13 patients with esthesioneuroblastoma met all inclusion criteria. The average patient age was 47 years, with a male-to-female distribution of 4 to 3. Patients were grouped by tumor stage using Kadish (stages A, B, and C included three, one, and three patients, respectively) and Dulguerov (stages T1, T2, and T4 included three, two, and two patients, respectively) methods. Average follow-up was 62.3 months. All patients had an endoscopic excision of the nasal and sinus component with anterior craniotomy. The most common postoperative complication was temporary mental status change, which was seen in two patients. There were no postoperative deaths. All patients received radiation therapy, and one also received chemotherapy. Two of the seven patients had recurrences. At last follow-up, six patients had no evidence of disease and one was alive with disease.

Conclusion: Endoscopic excision of the nasal and sinus component with anterior craniotomy for cribriform or anterior cranial fossa extension is an effective treatment of esthesioneuroblastoma.