Our Experience with Surgical Treatment of Esthesioneuroblastomas

Purpose: In this paper we present our experience with management of patients suffering from esthesioneuroblastomas (ENB). ENB is a malignant tumor of the nasal cavity, originating from basal cells of the olfactory epithelium. It is relatively rare, representing only about 3% of intranasal neoplasms, and therefore experience with its management is relatively small. The tumor often spreads into the surroundings of the nose, including the cranium and brain.

Method: For surgical treatment we performed bifrontal craniotomy with drilling of anterior fossa in all of the cases. This approach enables very good exposure for a total removal of the tumor intradurally and from nasal and paranasal cavities. Involved dura mater was excised and patched with epicranial flap. Postoperatively we do not observe cerebrospinal fluid leakage in any of the cases.

Result: Patients were periodically evaluated by means of MR, endoscopic-endonasal techniques, and neurological examinations. One man with a huge intracranial tumor died 1 year after the operation. One woman with delayed radiotherapy (after removing a metastasized ENB located in the right orbit) died 5 years after the first intracranial operation. The next four patients with follow-up of 2.5 to 10 years (mean, 6 yrs) have no sign of recurrency or metastasis.

Conclusion: According to our experience and the literature review, the best management is early complete surgical removal followed by radiotherapy.