Endoscopic endonasal compared with anterior craniofacial and combined cranionasal resection of esthesioneuroblastomas

World Neurosurg. 2013 Jul-Aug;80(1-2):148-59. doi: 10.1016/j.wneu.2012.12.003. Epub 2012 Dec 7.


Objective: Esthesioneuroblastomas represent a surgical challenge because of their anatomical location, the necessity of achieving negative margins, and the often-cosmetically disfiguring transfacial approaches needed. Recently, expanded endonasal endoscopic approaches have been developed, either alone or in combination with a craniotomy. We conducted a systematic review of case series and case reports to compare outcomes between these various surgical approaches.

Methods: A MEDLINE search was conducted of the modern literature (1985-2010) to identify open and endoscopic surgical series. Tumor and patient characteristics, Kadish stage, extent of resection, and progression-free and overall survival were recorded and analyzed by approach. Kaplan-Meier analysis was used to assess overall survival and progression-free survival.

Results: Forty-seven studies comprising 453 patients were included. The endoscopic cohort had a greater proportion of Kadish Stage A tumors compared with the craniofacial group. Gross total resection was achieved in 98.1% of patients who underwent an endoscopic approach compared with 81.3% for the craniofacial and 100% for the cranionasal cohorts. Local recurrence occurred in 8.0% of patients in the endoscopic group compared with 22.1% in the craniofacial and 16.7% in the cranionasal cohorts.

Conclusion: In well-selected cases, cranionasal and endonasal approaches can be safe and effective. An ongoing evaluation of the benefits and limitations are necessary to better define the ideal patient population and patient-specific risk factors for the use of these minimal access techniques.

Keywords: CFR; CN; CSF; Cerebrospinal fluid; Craniofacial resection; Cranionasal; EE; Endonasal; Endoscopic; Endoscopic endonasal; Esthesioneuroblastoma; Minimal access; RT; Radiotherapy; Skull base; Surgery; Systematic review.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Craniotomy
  • Data Interpretation, Statistical
  • Endoscopy / methods*
  • Esthesioneuroblastoma, Olfactory / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Nasal Cavity / surgery*
  • Neoplasm Recurrence, Local
  • Neurosurgical Procedures / methods*
  • Nose Neoplasms / surgery*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Treatment Outcome