Transnasal, transfacial, anterior skull base resection of olfactory neuroblastoma

• Published in: American journal of otolaryngology 2011-07, Vol.32 (4), p.279-285
• Main Authors: Nabili, Vishad, MD, Kelly, Daniel F., MD, Fatemi, Nassrin, MD, St. John, Maie, MD, PhD, Calcaterra, Thomas C., MD, Abemayor, Elliot, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; California - epidemiology; Craniotomy; Endoscopy - methods; Esthesioneuroblastoma, Olfactory - diagnosis; Esthesioneuroblastoma, Olfactory - mortality; Esthesioneuroblastoma, Olfactory - surgery; Face - surgery; Female; Follow-Up Studies; Hospitalization; Humans; Male; Medical imaging; Medical sciences; Middle Aged; Mortality; Nasal Cavity - surgery; Neoplasm Staging; Nose; Nose Neoplasms - diagnosis; Nose Neoplasms - mortality; Nose Neoplasms - surgery; Otolaryngology; Otorhinolaryngologic Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Retrospective Studies; Skull Base - surgery; Surgery; Survival Rate; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Young Adult
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2010.05.003

Abstract Purpose Using a transnasal, transfacial, anterior skull base approach, we have removed olfactory neuroblastomas (OFN) obviating the need for a frontal craniotomy. The objectives were to present our surgical approach in achieving clear margins, to assess patient survival, and to recommend eligibility criteria. Materials and methods A retrospective chart review was done to identify patients diagnosed with OFN who underwent this surgical approach. Thirteen patients were identified who underwent our pictorially described approach. Postoperative assessment of pathologic margins, patient survival, and limitations of surgical approach was determined. Results Of the 13 patients, 12 (92%) had clear postsurgical margins. One patient had residual intracranial disease due to coagulopathy preventing further resection. Twelve patients remain alive with 10 patients remaining disease-free (follow-up ranging from 11 to 64 months). Three patients presented with recurrent disease initially, with 2 having had subsequent repeat local and regional recurrences, respectively; one of whom died recently of the rerecurrent disease. One patient had a postoperative cerebrospinal fluid leak repaired via the original surgical approach. Conclusions Although craniofacial resection remains an accepted approach for surgical treatment of OFN, we have adopted a transnasal, transfacial approach eliminating the need for a frontal craniotomy. This approach allows for adequate exposure of the cribriform plate, dura, and anterior skull base. Our technique minimizes dural defects and prevents many craniotomy-associated complications, including frontal lobe retraction. Long-term follow-up is needed to compare survival using this approach; however, our results to date are quite promising.