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J Neurol Surg Rep 2014; 75(01): e149-e153
DOI: 10.1055/s-0034-1376427
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Preservation of Olfaction after Unilateral Endoscopic Approach for Resection of Esthesioneuroblastoma

Aaron Wessell
1   School of Medicine, The George Washington University Medical Center, Washington, District of Columbia, United States
,
Ameet Singh
2   Department of Surgery, Division of Otolaryngology, The George Washington University Medical Center, Washington, District of Columbia, United States
,
Zachary Litvack
3   Department of Neurosurgery, The George Washington University Medical Center, Washington, District of Columbia, United States
› Author Affiliations
Further Information

Publication History

29 January 2014

03 April 2014

Publication Date:
24 June 2014 (online)

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Abstract

Objectives We present a case of olfactory preservation after a unilateral transcribriform transethmoidal endoscopic resection of esthesioneuroblastoma. We also discuss the oncologic results of endoscopic and transcranial approaches and describe the potential benefits and limitations of an endoscopic approach.

Setting Single academic medical center.

Participant and Design The clinical course of a 28-year-old patient who underwent endoscopic en bloc resection of esthesioneuroblastoma through a unilateral transcribriform transethmoidal approach was reviewed.

Results Imaging demonstrated a left-sided nasal mass with cribriform plate involvement (Kadish C). Intraoperatively, the left olfactory bulb and epithelium were sacrificed. Negative frozen sections were obtained from the right olfactory epithelium and dura surrounding the right olfactory bulb. Reconstruction was performed using a multilayered closure of fascia, rigid buttress, and nasoseptal flap. Histology was consistent with esthesioneuroblastoma. Postoperative clinical evaluation, endoscopy, and magnetic resonance imaging demonstrated no evidence of residual or recurrent tumor at 18 months. The UPSIT smell testing revealed normal olfaction preoperatively, moderate microsomia at 3 months postoperatively, and mild microsomia at 18 months postoperatively.

Conclusions Endoscopic resection of esthesioneuroblastoma has demonstrated similar oncologic control while reducing postoperative morbidity and mortality over transcranial approaches. This case reveals the potential to preserve olfaction while achieving en bloc endoscopic resection of early stage esthesioneuroblastoma.

Keywords

endoscopy - esthesioneuroblastoma - skull-base - olfactory preservation - craniofacial
 

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