Endonasal endoscopic sinus surgery with rhinobasis resection due to esthesioneuroblastoma: case report (original) (raw)

Combined endoscopic surgery and radiosurgery as treatment modality for olfactory neuroblastoma (esthesioneuroblastoma)

Acta Neurochirurgica, 2005

Object. Treatment of esthesioneuroblastoma (olfactory neuroblastoma) has been considerably improved by microsurgical techniques. Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and Gamma Knife radiosurgery is presented here. Taking into account the rarity of the disease the present study comprises a relatively large series of patients treated in a similar manner. Methods. 14 patients (8 males, 6 females) aged 27-75 years (median 38) were treated between May 1993 and December 2003. This series comprises 12 newly diagnosed esthesioneuroblastomas. Two more patients had already previously undergone surgery (24=39 months earlier). Paranasal and nasal endoscopic sinus surgery was performed. Marginal irradiation doses ranging from 15-34 Gy were given to the residual tumours by means of radiosurgery (Gamma Knife) involving 1-7 isocentres within 3 months after surgery. Median follow-up is 58 months (range 13-128). Results. There was no mortality. In all patients tumour control was achieved within the treated area. 4 patients underwent a second radiosurgical procedure 6-79 months (median 34 months) after initial radiosurgery. One patients had to undergo an additional craniotomy because of extensive neoplastic infiltration, 1 developed postoperative liquorrhea, 1 case was complicated by bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. Karnovsky Index-preoperatively ranging from 80%-100%-remained stable in 12 patients, an improvement was observed in 2 cases. Conclusions. Based on the favourable results recorded so far, the combination of endoscopic sinus surgery and radiosurgery can be considered a promising treatment option for esthesioneuroblastoma that merits further consideration.

Olfactory Neuroblastoma Treated by Minimally Invasive Endoscopic Resection and Postoperative Adjuvant Radiotherapy: A Representative Case and an Updated Review of the Literature

Journal of Cancer Therapy, 2012

This paper presents a case of an olfactory neuroblastoma, treated with minimally invasive endoscopic resection, followed by adjuvant radiotherapy and critically reviews the current literature with regard to diagnosis and management of such malignancies. Olfactory neuroblastoma is considered to be an uncommon malignancy of the nasal cavity. The tumor arises from the specialized sensory epithelial olfactory cells, normally situated at the upper part of the nasal cavity, including the superior nasal concha, the roof of the nose and the cribriform plate. The imaging modality of choice is computed tomography and magnetic resonance imaging. Combination of surgery and radiotherapy is considered to be the standard of care for primary site disease by the majority of researchers. Combined transfacial and neurosurgical conventional approaches are adopted in most cases, mainly due to the endocranial extension and the close anatomic relationship of esthesioneuroblastomas with the ethmoid roof and cribriform plate. However, recent literature supports that endoscopic resection correlates with similar oncologic control rates, compared with open surgery, when basic oncologic surgical principles are maintained.

Long-Term Prognostic Analysis after Endoscopic Endonasal Surgery for Olfactory Neuroblastoma: A Retrospective Study of 13 Cases

PloS one, 2016

To summarize the characteristics and long-term outcomes of olfactory neuroblastoma through the analysis of 13 cases in single institution, with the assessment of treatment modality, prognostic factors. A retrospective study of thirteen cases diagnosed as olfactory neuroblastoma and underwent combined treatments during the period 2000-2010. Statistical analysis was performed to search for prognostic factors and compared different treatment modalities. 13 patients were enrolled in this study, including 8 male and 5 female, ranging from 15 to 69 (median 43) years old. One patient at stage A was only treated with endoscopic endonasal surgery (EES). Seven patients were treated with preoperative radiotherapy and EES, two with EES and postoperative radiotherapy, and the other three with combined radiotherapy and chemotherapy. The range of follow-up time varied from 23 to 116 months (median 65 months). The 5-year overall survival rate was 46.2% (6/13). To date, these thirteen patients have ...

The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment

The …, 2000

Objectives: To describe a new treatment modality of olfactory neuroblastoma consisting of endoscopic nasal and paranasal sinus surgery and stereotactic radiosurgery. Study Design: Retrospective review of three patients suffering from olfactory neuroblastoma. Methods: Review of the charts, the computed tomography, and magnetic resonance imaging scans, the operation reports, radiosurgical data, and followup. Results: All three patients remained free of disease with excellent quality of life in respective follow-up periods of 71, 50, and 39 months. Conclusion: The combination of two minimally invasive therapies, endoscopic sinus surgery and stereotactic radiosurgery, provide a reliable new approach to the treatment of a series of olfactory neuroblastomas that offers excellent quality of life, less injury to the patient, fewer side-effects, and fewer long-term effects than other treatment strategies.

Endonasal Endoscopic Treatment of Esthesioneuroblastoma

Otolaryngology open access journal, 2024

Introduction: Esthesioneuroblastoma is a malignant neoplasm that originates from the olfactory epithelium. Treatment is established according to its extension and the histological degree of atypia and may include surgery, surgery more radiotherapy or more chemoradiation therapy. Different surgical approaches have been used, including facial incisions and craniotomy, but with the greater experience acquired with endoscopic sinus surgery and teamwork with the neurosurgeon, endonasal techniques have been developed that make it possible to perform oncological resections in selected patients, with less morbidity, brief hospitalization and without compromising local control of the disease. Objectives: To determine the rate of local control in patients treated for esthesioneuroblastomas by the endonasal approach with endoscopes or through an endonasal approach with bifrontal craniotomy. Methods: A review of the electronic medical records of patients who were treated for esthesioneuroblastomas in the ENT Department of the Italiano Hospital of Buenos Aires between March 2005 and May 2022 was carried out. Results: Five patients were treated with an endonasal approach with endoscopes. Two patients with an endonasal approach only (Kadish B and C) and three with an endonasal approach combined with bifrontal craneotomy (Kadish C and one D). In four cases, chemotherapy-radiotherapy or radiotherapy was also used. Local control in the treated group was 80% (4/5) and specific survival was 60% (3/5). Conclusions: The local control that we obtained in patients treated for esthesioneuroblastomas through a single endonasal approach or combined with bifrontal craniotomy and adjuvant treatments was 80% and survival without local, regional or distant disease was 60%.

Multicenter assessment of exclusive endoscopic endonasal approach for the treatment of 53 olfactory neuroblastomas

Head & neck, 2018

Given the particularities of olfactory neuroblastoma (ONB) and the lack of studies on the subject, a multicenter collaborative study was conducted to assess treatment strategy. Fifty-three patients with ONB were included from the French Rare Head and Neck Cancer Expert Network (REFCOR) database: 16T1, 8T2, 19T3, and 10T4. All cases were treated endoscopically with skull base removal and repair in 26 cases (49%) and without external craniotomy. The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 87% and 71%, respectively, with mean follow-up of 45.4 ± 26.5 months. The complication rate was 18.8% with 4 cases of meningitis. Pathological analysis showed positive margins in 26.8%, notably on the dura-mater and periorbita, without impairment of OS or DFS. Forty-eight patients received adjuvant radiotherapy on T ± N. Ten patients had a recurrence (18.9%). Six patients died of their disease. Prophylactic neck irradiation seemed to reduce the recurrence rate. Exc...

Endoscopy skull-base resection for ethmoid adenocarcinoma and olfactory neuroblastoma

Rhinology, 2011

Olfactory neuroblastoma (ON) and ethmoid adenocarcinoma (AC) are rare sinonasal malignancies that often involve the skull base. Standard surgical treatment is craniofacial resection (CFR), which allows for efficient removal but entails significant morbidity and mortality. Because expanded endoscopy nasal approaches are newly developed, we aimed to describe the procedure in patients with ON and AC and compare it with CFR in terms of efficiency and morbidity. This work reports on a retrospective series of 16 patients with AC and ON treated endoscopically with anterior skull-base resection in a single institution over 9 years. Invasion of the frontal sinus, massive extension to the cerebral parenchyma, spread of the tumour above the orbits or lysis of anterior facial skeleton were contraindications for endoscopy resection. Of the 16 patients, 11 had AC and 5 ON. In total, 37.5% (6) exhibited skull-base invasion. All patients had postoperative radiotherapy. In the early postoperative pe...

Endoscopic-Assisted Excision of Esthesioneuroblastoma

Journal of Craniofacial Surgery, 2007

The purpose of this article is to report a case of esthesioneuroblastoma involving the bilateral paranasal sinuses, which was excised using an endoscopic-assisted transfacial approach. A patient presented with nasal swelling and left-sided nasal obstruction, epistaxis, and diplopia. Examination revealed broadening of the nasal dorsum with a fleshy pink mass in both nasal cavities. Computed tomographic scan showed a mass involving the nasal cavity and paranasal sinuses on both sides. The tumor was diagnosed as group C esthesioneuroblastoma. The mass was excised by bilateral medial maxillectomy and bilateral frontoethmoidectomy. Using a 0 degrees endoscope, the attachment of the tumor to the cribriform plate was identified and resected using a motordrill. On Waroff staining, Hispathology slides suggested esthesioneuroblastoma. The patient was asymptomatic for 1 year, following which he developed infection of the nasal cavity for which he had no form of treatment. He subsequently developed maggots in the nasal cavity after which he died. An endoscopic resection of the cribriform plate from the nasal cavity without a formal craniofacial resection can be safely performed with oncologic safety.