Endoscopic Endonasal Management of Esthesioneuroblastoma
Esthesioneuroblastoma is a rare sinonasal malignancy arising from the olfactory epithelium. Classically, craniofacial resection represented the gold standard for management of these tumors. With the advent and evolution of extended endoscopic endonasal techniques, sole endoscopic management of esthesioneuroblastoma has become a viable option. We retrospectively analyzed patients with esthesioneuroblastoma who underwent sole endoscopic resection at the University of Texas Southwestern between 2010 and 2013. We identified 10 patients with esthesioneuroblastoma, seven males and three females. Nine patients were treated for primary disease and one patient was treated following subtotal resection at an outside facility. Kadish staging revealed three patients (30%) with stage B, five patients (50%) with stage C and two patients (20%) with stage D disease. All patients had a complete resection with negative intraoperative margins. On review of the final pathology, one patient was noted to have a positive posterior dural margin and subsequently underwent adjuvant chemotherapy and radiation. One patient had a CSF leak evidenced by symptomatic, worsening pneumocephalus and required an endoscopic revision. Two patients received neoadjuvant chemotherapy and radiation. Five patients received adjuvant chemotherapy and radiation. Three patients (Kadish stage B) received post-operative radiation alone with one patient electing to halt radiation treatment following administration of 2150 cGy via intensity modulated radiation therapy. One patient died (Kadish stage D) during the follow-up period. We have a mean follow-up period of 14.8 months with no evidence of recurrent disease including a Kadish stage D patient 33 months out from surgery and adjuvant chemotherapy and radiation. There is a growing body of literature suggesting outcomes from a purely endonasal approach is equivalent with the traditional craniofacial approach and outcomes may be better in patients with smaller tumors via an extended endonasal approach. As the majority of the patients in our series are Kadish stage C and D, a longer follow-up period will be valuable and may further influence the shift toward pure endoscopic management of esthesioneuroblastoma.