Preservation of Olfactory Function Following Endoscopic Resection of Select Malignancies of the Nasal Vault

Objective: The purpose of this study is to elucidate the feasibility of preserving olfactory function in patients undergoing oncologic anterior skull base resection via an endoscopic approach.

Method: This is a retrospective case series. All patients underwent a standardized smell identification test.

Results: From January 2002 to July 20011, we attempted to preserve olfactory function in nine patients, who required endoscopic resection of various malignancies involving the ipsilateral anterior skull base (six esthesioneuroblastomas, one squamous cell carcinoma, one adenocarcinoma, and one hemangiopericytoma). In seven patients, the resection included a unilateral endoscopic craniectomy that preserved the contralateral middle and superior turbinates. Two patients underwent resection of the ipsilateral olfactory epithelium as the superior margin of resection. Six patients received adjuvant radiotherapy. Postoperatively, olfaction was documented in seven patients (three normosmic, four microsmic). All patients are free of recurrence at the original site at a mean follow-up period of 55.7 months (range, 21–101 months). One patient developed metastatic esthesioneuroblastoma to the cervical lymph nodes 4 years after surgery.

Conclusion: In select patients, it is feasible to preserve olfactory function without apparent compromise of oncologic outcomes. The success rate depends largely on the extent of the resection, which, in turn, is dictated by the extent of the tumor.