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Patel R, Masys T, Baridi R. Exploring the Impact of Artificial Intelligence and Machine Learning in the Diagnosis and Management of Esthesioneuroblastomas: A Comprehensive Review. Cureus 2024; 16:e62683. [PMID: 39036183 PMCID: PMC11258942 DOI: 10.7759/cureus.62683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
Esthesioneuroblastomas (ENBs) present unique diagnostic and therapeutic challenges due to their rare and complex clinical presentation. In recent years, artificial intelligence (AI) and machine learning (ML) have emerged as promising tools in various medical specialties, revolutionizing diagnostic accuracy, treatment planning, and patient outcomes. However, their application in ENBs remains relatively unexplored. This comprehensive literature review aims to evaluate the current state of AI and ML technologies in ENB diagnosis, radiological and histopathological imaging, and treatment planning. By synthesizing existing evidence and identifying gaps in knowledge, this review aims to showcase the potential benefits, limitations, and future directions of integrating AI and ML into the multidisciplinary management of ENBs.
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Affiliation(s)
- Raj Patel
- Otolaryngology - Head and Neck Surgery, Loyola University Chicago Stritch School of Medicine, Chicago, USA
| | - Tadas Masys
- Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, USA
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Zamarud A, Yener U, Sayed R, Chang SD, Meola A. CyberKnife Radiosurgery for Spinal Leptomeningeal Metastases Secondary to Esthesioneuroblastoma: A Clinical Case Report. Cureus 2023; 15:e39791. [PMID: 37398775 PMCID: PMC10313237 DOI: 10.7759/cureus.39791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant tumor of neuroectodermal origin that arises from the olfactory epithelium. We present a case of ENB metastasizing through the leptomeningeal route to the spinal dura, which was treated with CyberKnife (CK) stereotactic radiosurgery (SRS), and aim to assess the safety and effectiveness of SRS in such cases. To the best of our knowledge, this is the first case report in the literature that discusses ENB spinal leptomeningeal metastases treated with CK radiosurgery. We retrospectively review the clinical and radiological outcomes in a 70-year-old female with ENB metastasis to the spine. Progression-free survival (PFS), overall survival (OS), and local tumor control (LTC) are investigated. In our patient, ENB had been diagnosed at the age of 58 years and spinal metastases had been first noted at the age of 65 years. A total of six spinal lesions received CK SRS. Lesions were present at the level of C1, C2, C3, C6-C7, T5, and T10-11. The median target volume was 0.72 cc (range: 0.32-2.54). A median marginal dose of 24 Gy was delivered to the tumors with a median of three fractions to a median isodose line of 80% (range: 78-81). LTC at the 24-month follow-up was 100%. PFS and OS were 27 months and 40 months, respectively. No adverse radiation effects were reported. Even though the treated spinal lesions remained stable, the number of new metastatic lesions had increased with progressive osseous and dural metastatic lesions within the cervical, thoracic, and lumbar spine at the last follow-up. SRS provides relatively good LTC for patients with ENB metastasizing to the spine, with no radiation-induced adverse events.
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Affiliation(s)
- Aroosa Zamarud
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Ulas Yener
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Rahman Sayed
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
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Brahmbhatt P, Kumar T, Bhatt AA, Vibhute P, Patel V, Desai A, Gupta V, Agarwal A. Sinonasal Schwannomas: Imaging Findings and Review of Literature. EAR, NOSE & THROAT JOURNAL 2023:1455613221150573. [PMID: 36775665 DOI: 10.1177/01455613221150573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE Schwannomas are common nerve sheath tumors and may occur anywhere in the body. 4% of head and neck schwannomas occur in the sinonasal cavity, and fewer yet have an intracranial component, making these presentations extremely rare. Furthermore, schwannomas present with nonspecific imaging signs and can only be definitively differentiated via histopathologic review, leading to misdiagnosis as various nasal tumors. We aim to conduct a review of published literature on sinonasal schwannomas with and without intracranial extension and provide additional case representations. METHODS A literature review was conducted using the PubMed Database with the terms "sinonasal schwannoma," "intracranial," "anterior skull base," and "schwannoma." Results were reviewed, and additional cases identified were referenced and included in the study. Inclusion criteria were any case with intracranial extension of the schwannoma. There were no exclusion criteria. Review data was compiled into Excel and used for data analysis and comparison. Additionally, a search was done within our institution to identify additional cases of sinonasal schwannoma. RESULTS We identified 17 cases of sinonasal schwannoma with intracranial extension, five from our institution and twelve from literature. Analysis revealed: 8 females (47%), 9 males (53%), 9 patients presented with headaches (53%), 6 patients presented with anosmia (35%), 4 patients presented with nasal obstruction (24%), and 2 patients with no symptoms (12%). Mean age and median were 39.4 ± 10.1 and 40, respectively. For treatment, 4 patients underwent endoscopic resection (24%), 11 underwent craniotomy (65%), and data was unavailable for 2 patients. Post-treatment complications occurred in 6 patients, 5 had CSF leaks (29%) and 1 had a hematoma (6%). CONCLUSION We identified and discussed 17 cases of sinonasal schwannoma with intracranial extension. We hope our review provides insight for clinicians to maintain schwannoma as a potential differential when evaluating nasal and anterior skull base masses.
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Affiliation(s)
| | - Tushar Kumar
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Alok A Bhatt
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Vishal Patel
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Amit Desai
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Vivek Gupta
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Amit Agarwal
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
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Mozaffari K, Pradhan A, Yang I, Patel K, Vivas AC. Metastatic esthesioneuroblastoma recurrence after 19 years of remission: A systematic review with case illustration. J Neurol Sci 2022; 442:120406. [PMID: 36081302 DOI: 10.1016/j.jns.2022.120406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 08/28/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Esthesioneuroblastoma (ENB) is a rare malignant neoplasm of the olfactory epithelium with an estimated incidence of 0.4/million. It can directly extend along the cribriform plate in order to metastasize to the central nervous system. However, non-contiguous intracranial involvement without recurrence at the primary site is extremely uncommon. In this report, the authors review the literature and present a case of non-contiguous intracranial metastasis of ENB without recurrence at the primary site. To the best of our knowledge, this case presents the longest disease-free interval reported in the literature. METHODS A systematic review of literature was conducted in accordance with the PRISMA guidelines. Additionally, the presentation, surgical management, and post-operative outcomes of an 82-year-old female with non-contiguous intracranial metastasis of ENB after 19 years of remission are described. RESULTS A total of 137 deduplicated works were identified after the search. Of these, 6 papers satisfied our inclusion criteria for our systematic review. Average age at presentation was 50.8 years (range: 26-66) and 52.6% of patients were female. A majority of cases achieved gross-total resection and received adjuvant radiotherapy for initial treatment. The median interval to intracranial metastasis was 6 years from the time of primary tumor presentation. The median overall survival from ENB recurrence with non-contiguous intracranial metastasis was 11.5 months. CONCLUSIONS ENB is a highly recurrent tumor and harbors the potential to involve the intracranial space even years after remission. Intracranial involvement entails poor overall survival. Lifetime radiographic follow-up should be considered in all patients with ENB.
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Affiliation(s)
- Khashayar Mozaffari
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Anjali Pradhan
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Isaac Yang
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States of America; Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Orthopedic Surgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, United States of America; Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, United States of America; Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, United States of America.
| | - Kunal Patel
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Andrew C Vivas
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States of America; Orthopedic Surgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America; Department of Surgery and Perioperative Services, Greater Los Angeles VA Medical Center, United States of America
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Maurer R, Henry A, Maurer T, Staity G, Williams N, Goyal N, Zacharia B. Heavily Calcified Esthesioneuroblastoma in a 72-year-old. Cureus 2019; 11:e4298. [PMID: 31183279 PMCID: PMC6538117 DOI: 10.7759/cureus.4298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 72-year-old female presented with the complaint of declining vision. Workup included magnetic resonance imaging (MRI) which revealed a large enhancing mass extending into the nasal cavity, nasopharynx, and anterior cranial fossa. Computed tomography (CT) imaging revealed extensive calcification. Subsequent endonasal biopsy revealed the tumor to be an unusually calcified esthesioneuroblastoma (ENB). The patient elected for palliative measures. The case provides a basis for a discussion on rare esthesioneuroblastomas and highlights the possibility of extensive calcification on such tumors.
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Affiliation(s)
- Robert Maurer
- Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - April Henry
- Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Timothy Maurer
- Osteopathy, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Ghazal Staity
- Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Nicole Williams
- Pathology, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Neerav Goyal
- Otolaryngology, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Brad Zacharia
- Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
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Cante D, Piva C, Sciacero P, Franco P, Petrucci E, Casanova Borca V, Marola F, Tubino L, Vellani G, La Porta MR. Olfactory neuroblastoma treated with minimally invasive surgery and adjuvant radiotherapy: a case report and review of the literature. BJR Case Rep 2018; 4:20170077. [PMID: 30363190 PMCID: PMC6159119 DOI: 10.1259/bjrcr.20170077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/17/2017] [Accepted: 11/28/2017] [Indexed: 01/20/2023] Open
Abstract
Olfactory neuroblastoma (ON) is a rare tumour of the olfactory neuroepithelium that is characterized by a pattern of slow growth and local recurrences. Combination of surgery and radiotherapy, with or without chemotherapy, is considered to be the standard of care for primary site disease. Recent literature supports the view that endoscopic resection followed by adjuvant radiotherapy correlates with better outcome. In this short communication, we present a case report of olfactory neuroblastoma arising in the right nasal sinus in a 34-year-old male. This patient was treated with endoscopic resection and external beam radiotherapy to the right nasal sinus with intensity-modulated radiation therapy (IMRT) technique. After 2 years follow-up, the patient is free of tumour without any late effect related to therapies. We believe that, in such patients, a treatment strategy including endoscopic resection followed by adjuvant radiotherapy may be effective and feasible and should be considered the gold standard of care.
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Affiliation(s)
- Domenico Cante
- Department of Radiation Oncology, Ivrea Community Hospital, Ivrea, Italy
| | - Cristina Piva
- Department of Radiation Oncology, Ivrea Community Hospital, Ivrea, Italy
| | - Piera Sciacero
- Department of Radiation Oncology, Ivrea Community Hospital, Ivrea, Italy
| | | | - Edoardo Petrucci
- Department of Medical Physics, Ivrea Community Hospital, Ivrea, Italy
| | | | - Fabrizio Marola
- Department of Otolaryngology, Chivasso Hospital, Chivasso, Italy
| | - Libero Tubino
- Department of Otolaryngology, Chivasso Hospital, Chivasso, Italy
| | - Giorgio Vellani
- Department of Medical Oncology, Chivasso Hospital, Chivasso, Italy
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Akgul MH, Gezen F, Uzunlar AK. Esthesioneuroblastoma located in the thoracic extradural space: Case report. Int J Surg Case Rep 2016; 27:70-73. [PMID: 27552033 PMCID: PMC4995531 DOI: 10.1016/j.ijscr.2016.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022] Open
Abstract
Objective Esthesioneuroblastoma accounted for only 6% of the malignant nasal cavity neoplasms (ENB) is a rare tumor which originates from the olfactory epithelium. ENB’s are locally agresive and can metastasize by lymphatic and hematogenous routes. A patient with the mass on the nasal dorsum was reported in this article. Case history A 52–year-old-man admitted to the hospital with a 3 months history of progressive nasal obstruction, epistaxis and mass on the nasal dorsum. On rhinoscopy, a polypoid mass was seen in the both nasal cavity and intranasal biopsy with local anesthesia was performed. Histopathologic diagnosis of the tumor was Kadish stage B esthesioneuroblastoma. Tumor was excised by using bilateral endoscopic endonasal resection and lateral rhinotomy approach and paranasal radiotherapy performed postoperatively. Ten months after surgery, neck metastasis was occured and patient was underwent neck dissection. Twenteeth months after initial treatment, distant metastasis was identified on the T 10 vertebra and following the cranial and spinal radiotherapy to the neck he was free of local recurrence at follow up 13 months after surgery. Conclusion It has been known that the metastasis of the ENB to the spinal cord is an uncommon event, and it occurs often years after initial diagnosis. MRI scan is helpful for making the diagnosis, and surgery is the treatment of choice for obtaining diagnostic tissue and debulking the tumor. Radiotherapy is also a mainstay of postoperative treatment.
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Affiliation(s)
- Mehmet Hüseyin Akgul
- Kırıkkale University Medical Faculty, Department of Neurosurgery, Kirikkale, Turkey.
| | - Ferruh Gezen
- Medeniyet University Medical Faculty Department of Neurosurgery, Istanbul, Turkey.
| | - Ali Kemal Uzunlar
- Duzce University Medical Faculty, Department of Pathology, Düzce, Turkey.
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Sivakumar W, Oh N, Cutler A, Colman H, Couldwell WT. Cranial and spinal leptomeningeal dissemination in esthesioneuroblastoma: Two reports of distant central nervous system metastasis and rationale for treatment. Surg Neurol Int 2015; 6:S628-32. [PMID: 26682087 PMCID: PMC4672577 DOI: 10.4103/2152-7806.170464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/08/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Esthesioneuroblastoma is a locally aggressive cancer of the nasal cavity. While systemic metastasis can occur in 10-30% of patients, there are only six reported cases of distal metastasis from leptomeningeal dissemination. CASE DESCRIPTION The authors report two cases of esthesioneuroblastoma treated previously with multimodal therapy in which distal metastatic recurrence was found and describe their treatment protocol, which has resulted in long-term success. CONCLUSION Understanding the drivers of leptomeningeal dissemination in more prevalent primary neuroectodermal tumors may hold the key to developing successful treatment algorithms for this disease.
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Affiliation(s)
- Walavan Sivakumar
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Nathan Oh
- Department of Neurosurgery, Loma Linda University, Loma Linda, California 92354, USA
| | - Aaron Cutler
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Howard Colman
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
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Su SY, Bell D, Hanna EY. Esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma: differentiation in diagnosis and treatment. Int Arch Otorhinolaryngol 2015; 18:S149-56. [PMID: 25992139 PMCID: PMC4399581 DOI: 10.1055/s-0034-1390014] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Introduction Malignant sinonasal tumors comprise less than 1% of all neoplasms. A wide variety of tumors occurring primarily in this site can present with an undifferentiated or poorly differentiated morphology. Among them are esthesioneuroblastomas, sinonasal undifferentiated carcinomas, and neuroendocrine carcinomas. Objectives We will discuss diagnostic strategies, recent advances in immunohistochemistry and molecular diagnosis, and treatment strategies. Data Synthesis These lesions are diagnostically challenging, and up to 30% of sinonasal malignancies referred to the University of Texas MD Anderson Cancer Center are given a different diagnosis on review of pathology. Correct classification is vital, as these tumors are significantly different in biological behavior and response to treatment. The past decade has witnessed advances in diagnosis and therapeutic modalities leading to improvements in survival. However, the optimal treatment for esthesioneuroblastoma, sinonasal undifferentiated carcinoma, and neuroendocrine carcinoma remain debated. We discuss advances in immunohistochemistry and molecular diagnosis, diagnostic strategies, and treatment selection. Conclusions There are significant differences in prognosis and treatment for esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma. Recent advances have the potential to improve oncologic outcomes but further investigation in needed.
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Affiliation(s)
- Shirley Y Su
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Diana Bell
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Prognostic utility of Hyams histological grading and Kadish-Morita staging systems for esthesioneuroblastoma outcomes. Head Neck Pathol 2014; 9:51-9. [PMID: 24806334 PMCID: PMC4382491 DOI: 10.1007/s12105-014-0547-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
Esthesioneuroblastoma (ENB) is derived from the specialized olfactory neuroepithelium. Hyams grading and Kadish staging have been used to prognosticate and to guide treatment decisions. In this study, we sought to validate the prognostic utility of these systems in a large ENB cohort. We retrospectively analyzed the records of patients with ENB who had been evaluated and treated at our institution. The association of grade and stage with prognostic outcome was assessed; the Kaplan-Meier estimator was used to generate 5-year OS and DFS curves. Out of 124 cases we identified, 121 were assessed for grading and 109 for staging. Review of the tissue samples revealed that 62 % of tumors were low grade (I/II) and 21 % were high grade (III/IV); 17 % of tumors were metastasis. The OS rate was 75 % at 5 years. The DFS was 60 % at 5 years. The OS was significantly worse for metastatic ENB (low-grade ENB vs metastatic ENB p = 0.01598); the DFS was significantly worse for high grade versus low grade ENB. Of the 109 cases that had been staged, 16 % were stage A, 33 % stage B, 43 % stage C, and 8 % stage D. In the A, B, and C groups, there were no significant differences between recurrence, distant metastasis, or 5-year survival rates. Statistical significance was not reached with the T, N, M and overall staging system. Age cutoff of 65 years reliably predicted OS. High grade of ENB was significantly associated with poor outcome, while advanced stage was not associated with poor outcome in this large cohort. Grading should certainly be considered in prognostication and treatment decisions for ENB.
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Kamal E, El-Fattah AMA, Emam H, Kassem M, Elashry M, Abd Elwahab AEM, Tawfik A. Esthesioneuroblastoma: Mansoura University Hospitals’ experience with multimodality therapy in 10years. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ejenta.2012.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Esthesioneuroblastoma is a rare malignant neoplasm in the olfactory region of the nasal cavity and anterior skull base. Diagnosis and staging require anatomic imaging and careful pathologic assessment. Standard treatment is anterior craniofacial resection with postoperative irradiation. The role for chemotherapy is not defined, but is generally for the most advanced cases and used in the neoadjuvant setting and/or postoperatively with irradiation. Prognosis is favorable; however, metastasis rates remain relatively high. Regional and distant metastasis portends a poor outcome. Intensity-modulated radiation treatment and endoscopic surgery have reduced morbidity, but outcomes with these techniques must be fully evaluated.
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Affiliation(s)
- Thomas J Ow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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13
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with anterior craniofacial and combined cranionasal resection of esthesioneuroblastomas. World Neurosurg 2012; 80:148-59. [PMID: 23228365 DOI: 10.1016/j.wneu.2012.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 08/19/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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14
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Rao AJ, Gultekin SH, Neuwelt EA, Cintrón-Colón HR, Ragel BT. Late occurrence of drop metastasis to the spine in a case of esthesioneuroblastoma. J Neurosurg Spine 2011; 15:571-5. [DOI: 10.3171/2011.6.spine11157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Esthesioneuroblastoma is an aggressive neuroectodermal tumor that originates from the olfactory mucosa and often recurs locally. Distant metastasis of esthesioneuroblastoma has been described, but there are few reports of drop metastasis to the spinal cord. Here, we report a case of multiple drop metastases to the cervical, thoracic, and lumbar regions of the spinal cord that occurred 18 years after resection and radiotherapy of the original anterior cranial fossa lesion. There was no evidence of local recurrence. The symptomatic lesion was treated with resection and adjuvant chemotherapy. The options available for treatment of this disease are summarized with a review of the few reported cases of spinal metastasis of esthesioneuroblastoma.
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Affiliation(s)
| | | | - Edward A. Neuwelt
- 1Departments of Neurological Surgery,
- 3Neurology, Oregon Health & Science University, Portland, Oregon
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Noh OK, Lee SW, Yoon SM, Kim SB, Kim SY, Kim CJ, Jo KJ, Choi EK, Song SY, Kim JH, Ahn SD. Radiotherapy for esthesioneuroblastoma: is elective nodal irradiation warranted in the multimodality treatment approach? Int J Radiat Oncol Biol Phys 2010; 79:443-9. [PMID: 20421144 DOI: 10.1016/j.ijrobp.2009.10.067] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 10/26/2009] [Accepted: 10/30/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. METHODS AND MATERIALS Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. RESULTS Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. CONCLUSIONS ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy.
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Affiliation(s)
- O Kyu Noh
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kodama S, Kawano T, Suzuki M. Endoscopic transnasal resection of ectopic esthesioneuroblastoma in the pterygopalatine fossa: technical case report. Neurosurgery 2010; 65:E112-3; discussion E113. [PMID: 19935009 DOI: 10.1227/01.neu.0000346268.69786.88] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Esthesioneuroblastoma is a rare, malignant neoplasm arising from the olfactory neuroepithelium in the upper nasal cavity. Even more rare is ectopic esthesioneuroblastoma developing from the region outside the olfactory epithelium. In addition, tumors occurring in the pterygopalatine fossa (PPF) are uncommon, and the endoscopic transnasal approach for the resection of malignant tumors in this region is also uncommon. CLINICAL PRESENTATION We describe an esthesioneuroblastoma arising from the left maxillary sinus and PPF. The tumor was resected using the endoscopic transnasal approach, followed by treatment with radiotherapy. The patient showed no evidence of recurrence 12 months postoperatively. TECHNIQUE The endoscopic transnasal approach could be successfully used for the complete removal of malignant tumors in the PPF. CONCLUSION The PPF is an anatomic area that is difficult to access. The endoscopic transnasal approach improves access and visualization; it also has the potential to reduce complications compared with the open approach. The endoscopic transnasal approach might become the treatment of choice for malignant tumors in the PPF.
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Affiliation(s)
- Satoru Kodama
- Department of Otolaryngology, Oita University Faculty of Medicine, Oita, Japan.
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Abstract
Esthesioneuroblastoma is a rare neuroectodermal tumor of the nasal vault with an aggressive biological behavior that is characterized by local recurrence, atypical distant metastasis, and poor long-term prognosis. The treatment regimen consists of surgical resection, radiation therapy, and chemotherapy in various, mainly stage-dependent, combinations. We report two cases of primary metastatic and locally recurrent disease, which were treated with computed tomography-guided interstitial high-dose-rate brachytherapy in palliative and curative intent, respectively. Computed tomography-guided interstitial high-dose-rate brachytherapy should be considered as a feasible treatment option for advanced esthesioneuroblastoma.
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Pagni F, Di Bella C, Bono F, Zoldan MC, Faravelli A. A 37-year-old woman with epistaxis [corrected] and unilateral nasal obstruction. Neuropathology 2008; 27:609-11. [PMID: 18021385 DOI: 10.1111/j.1440-1789.2007.00840.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fabio Pagni
- Department of Pathology, Azienda Ospedaliera Ospedale Civile di Vimercate- Presidio di Desio, Desio, Unversità degli Studi di Milano Bicocca, Italy.
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Brown SR. Esthesioneuroblastoma. Otolaryngol Head Neck Surg 2007; 137:835-6. [PMID: 17967657 DOI: 10.1016/j.otohns.2007.06.718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 05/21/2007] [Accepted: 06/07/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Sheldon R Brown
- Department of Surgery, Section of Ear, Nose, and Throat, Carl T Hayden Veterans Affairs Medical Center, Phoenix, AZ 85012, USA.
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