Esthesioneuroblastoma: Approach, Analysis, and Staging Proposal

Introduction: The purpose of this study is to evaluate the advantages of the subcranial approach enabling a broad exposure under direct vision in comparison to the recommended craniofacial (CFR) techniques. A clinically more relevant staging will be proposed.

Material and Methods: Since 1990, 15 patients were all managed in a prospective manner by the subcranial approach enabling en bloc resection, avoiding the CFR and the related frontal lobe retraction combined with transfacial procedures. All cases had postoperative radiotherapy. The reconstruction of complex defects will be described.

Results: Complete surgical resection was achieved in 83%, sparing adjacent vital structures. The reduction of complications and morbidity including a shorter ICU and hospitalization will be emphasized. The high incidence of extensive tumor spread and high Hyams grading with bone destruction effacing the carotid, optic nerve/chiasm, including cavernous sinus, intracranial/brain, orbital and retromaxillary involvement, which should have prognostic significance, prevented adequate assignment to the categories of existing classification systems, thus implying the need for a modified proposal. The mean follow-up was 56.6 months and overall survival 66.6%. The detailed evaluation of the survival in correlation to our staging proposal and grading, including Kaplan graphs, will be analyzed.

Conclusions: The subcranial concept is less invasive than the CFR, obviating the related combined transfrontal and transfacial approaches. The staging system was modified with the hope of defining a more useful system enabling a better interseries comparison.