Abstract
Introduction Advanced Kadish stage esthesioneuroblastoma requires more extensive resections and
aggressive adjuvant therapy to obtain adequate disease-free control, which can lead
to higher complication rates. We describe the case of a patient with Kadish D esthesioneuroblastoma
who underwent multiple surgeries for infectious, neurologic, and wound complications,
highlighting potential preventative and salvage techniques.
Case Presentation A 61-year-old man who presented with a large left-sided esthesioneuroblastoma, extending
into the orbit, frontal lobe, and parapharyngeal nodes. He underwent margin-free endoscopic-assisted
craniofacial resection with adjuvant craniofacial and cervical radiotherapy and concomitant
chemotherapy. He then returned with breakdown of his skull base reconstruction and
subsequent frontal infections and ultimately received 10 surgical procedures with
surgeries for infection-related issues including craniectomy and abscess evacuation.
He also had surgeries for skull base reconstruction and CSF leak, repaired with vascularized
and free autologous grafts and flaps, synthetic tissues, and CSF diversion.
Discussion Extensive, high Kadish stage tumors necessitate radical surgical resection, radiation,
and chemotherapy, which can lead to complications. Ultimately, there are several options
available to surgeons, and although precautions should be taken whenever possible,
risk of wound breakdown, leak, or infection should not preclude radical surgical resection
and aggressive adjuvant therapies in the treatment of esthesioneuroblastoma.
Keywords
esthesioneuroblastoma - olfactory neuroblastoma - skull base reconstruction - cerebrospinal
fluid leak - pneumocephalus - sinonasal malignancy - complications
