Oncological Results of Endoscopic Endonasal Resection of Esthesioneuroblastoma

Objective: To evaluate the oncological results of endoscopic endonasal resection of esthesioneuroblastoma.

Methods: A retrospective analysis of 35 patients who underwent endoscopic endonasal resection of esthesioneuroblastoma at UPMC over a 9-year period was performed. The Kadish classification, reconstruction, postoperative complications, adjuvant treatment, and outcomes were analyzed.

Results: The mean age at the time of surgery was 48 years (range, 16–79 years), and 60% were male. The majority of patients were Kadish C (63%), 34% were Kadish B, 3% Kadish A, and 0% Kadish D. Two patients required a combined open and endoscopic approach. The majority of reconstructions were done with a septal flap (57%) and/or pericranial flap (17%). In 14%, no reconstruction was done as dural resection was not needed. Lumbar drainage was used in five patients (14%). Postoperative complications occurred in 21% of the patients, including diplopia (6%), CSF leak/meningitis (3%), epistaxis (3%), intracranial hematoma (3%), orbital emphysema (3%), and cosmetic deformity from a pericranial flap (3%). Postoperatively, 63% received radiation therapy and 14% received chemotherapy. Negative margins were achieved in 94% of patients. Local recurrence occurred in one patient (3%) treated with surgical salvage. There were no regional recurrences. The mean follow-up period was 35 months (range, 1–110 months), and 100% are currently disease free after surgical salvage.

Conclusions: Endoscopic endonasal resection is an effective surgical modality for the treatment of esthesioneuroblastoma with minimal morbidity. The low frequency of postoperative CSF leak demonstrates the efficacy of the endoscopic technique for reconstruction of the anterior cranial base defect. With limited follow-up, oncological outcomes are encouraging.