Outcomes of Endoscopic Endonasal Resection of Esthesioneuroblastoma

Objectives: Evaluate the outcomes of the endoscopic endonasal resection for esthesioneuroblastoma.

Methods: A retrospective analysis was conducted of 35 patients who underwent endoscopic endonasal resection of esthesioneuroblastoma at UPMC in a period of 9 years. The mean age at the time of the surgery was 48 years (range, 16–79 years), and 63% were men. The Kadish classification, reconstruction, lumbar drain, postoperative complications, adjuvant treatment, and outcomes were analyzed.

Results: The majority of patients were Kadish B (75%); 16% were Kadish C, 6% Kadish A, and 3% Kadish D. The reconstruction was done with septal flap in 54%, pericranial flap in 11%, and grafts in 17%. In 18%, no reconstruction was done as dural resection was not needed. Lumbar drain was used in only one patient (3%). Postoperative complications occurred in 21% of the patients including: diplopia (6%), CSF leak/meningitis (3%), epistaxis (3%), intracranial hematoma (3%), orbital emphysema (3%), and depression in the glabella from the bone window drilled for the pericranial flap (3%). Radiation was done in 63% and chemotherapy in 14%. Local recurrence occurred in one patient (3%) treated with multiple surgeries. The mean follow-up period was 35 months (range, 1–110 months), and 100% were NED after surgical salvage.

Conclusions: Endoscopic endonasal resection seems to be an effective surgical modality to treat esthesioneuroblastoma with low complications and good outcomes. The low frequency of postoperative CSF leak demonstrates the efficacy of the endoscopic technique for reconstruction of the anterior cranial base defect.