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Dharmarajan H, Choby G, Abi Hachem R, Kuan EC, Levine CG, Sanusi O, Schuman T, Tang D, Yim M, Geltzeiler M. Treatment of unilateral olfactory neuroblastoma: Appropriate extent of surgical resection and potential for olfactory preservation. Int Forum Allergy Rhinol 2024; 14:881-886. [PMID: 38526915 DOI: 10.1002/alr.23345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
Historically, comprehensive surgical resection for olfactory neuroblastoma has included the bilateral olfactory epithelium, cribriform plate, overlying dura, olfactory bulbs and tracts. This results in postoperative anosmia that may significantly impact a patient's quality of life without definitive added benefit in survival. The prevalence of occult intracranial disease is low, especially for Hyams grade I and II tumors. A unilateral approach sparing the contralateral cribriform plate and olfactory system can be considered for select cases of early stage, low-grade tumors when the disease does not cross midline to involve the contralateral olfactory cleft or septal mucosa and when midline dural margins can be cleared with frozen pathology. Approximately half of patients who undergo unilateral resection may have residual olfaction even with adjuvant unilateral radiation. Early data suggest favorable disease-free survival and overall survival for patients who underwent the unilateral approach; however, larger sample studies are needed to confirm comparability to bilateral resections regarding oncologic outcomes.
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Affiliation(s)
- Harish Dharmarajan
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA
| | - Garret Choby
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Edward C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Olabisi Sanusi
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Theodore Schuman
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dennis Tang
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai, Los Angeles, California, USA
| | - Michael Yim
- Department of Otolaryngology-Head and Neck Surgery, LSU Health, Shreveport, Louisiana, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA
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Tsutsumi Y, Omura K, Kijima Y, Kobayashi M, Fukasawa N, Takeda T, Ebihara T, Aoki S, Otori N, Kojima H, Aoki M. The impact of multidisciplinary approaches on the outcomes of olfactory neuroblastoma treated with postoperative radiotherapy. Cancer Med 2024; 13:e6943. [PMID: 38497548 PMCID: PMC10945880 DOI: 10.1002/cam4.6943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/30/2023] [Accepted: 01/06/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND We investigated the outcomes of postoperative radiation therapy for olfactory neuroblastoma (ONB) and our cross-departmental collaboration to enhance the effectiveness of cancer treatment. METHODS We retrospectively evaluated 22 patients with ONB who underwent postoperative radiotherapy after tumor resection. En bloc resection was performed; pathology specimens were prepared in coronal sections; and irradiation fields were determined after discussion with radiation oncologists, head and neck surgeons, and pathologists. RESULTS The overall survival and local control rates were 95.5% and 100%, respectively, at a median 37-month follow-up. The 3- and 5-year disease-free survival (DFS) rates were 64.4% and 56.3%, respectively. Of the 22 patients, 9 (8 Kadish C and 1 Kadish B) had disease recurrence. Of the nine patients, five had positive margins and two had closed margins; cervical lymph node recurrence occurred in six, and distant metastasis with or without cervical lymph node recurrence occurred in three. DFS analysis of risk factors showed no statistically significant differences, but positive margins were a significant recurrence factor in multivariate analysis. CONCLUSIONS The local control rate of ONB treated with postoperative radiation therapy was 100%. This may be attributed to cross-departmental cooperation between head and neck surgeons, pathologists, and radiation oncologists, which resulted in accurate matching of CT images for treatment planning with the location of the tumor and positive margins. Longer follow-up periods are required to evaluate the effectiveness of our strategy.
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Affiliation(s)
- Yuki Tsutsumi
- Department of Radiation Oncology, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Yoshikazu Kijima
- Department of Radiation Oncology, Jikei University School of Medicine, Tokyo, Japan
| | - Masao Kobayashi
- Department of Radiation Oncology, Jikei University School of Medicine, Tokyo, Japan
| | - Nei Fukasawa
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Takeda
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Teru Ebihara
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Aoki
- Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Aoki
- Department of Radiation Oncology, Jikei University School of Medicine, Tokyo, Japan
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Suzuki H, Haimoto S, Inaba Y, Tachibana H, Takanari K, Ando M, Yoshizawa K, Hanai N. Peptide Receptor Radionuclide Therapy for Recurrent Olfactory Neuroblastoma After Cranioplasty for Surgical Infection: A Case Report. Anticancer Res 2023; 43:5723-5728. [PMID: 38030203 DOI: 10.21873/anticanres.16778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Peputide receptor radionuclide therapy with 177Lu for midgut neuroendocrine metastasis has been clinically approved as a safe treatment. Unresectable metastases of olfactory neuroblastoma have shorter survival due to insufficient effective systemic treatment. CASE REPORT Herein, we report a patient treated with peputide receptor radionuclide therapy for unresectable recurrent olfactory neusroblastoma following a rare cranial metastasectomy infection. A 50-year-old female patient with olfactory neuroblastoma of Kadish C was initially treated by skull base surgery plus postoperative radiotherapy following chemotherapy. Recurrent disease with neck and intracranial metastases was treated by four salvage surgeries. Surgical site infection following intracranial metastasectomy was treated with debridement and delayed cranioplasty. Peputide receptor radionuclide therapy was performed for unresectable multiple metastases after cranioplasty. Successful therapy using four cycles of peputide receptor radionuclide had neither grade 3 nor grade 4 adverse events. The patient was followed at an outpatient clinic. CONCLUSION Further case accrual of peputide receptor radionuclide therapy is required to develop a treatment for unresectable olfactory neuroblastoma.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan;
| | - Shoichi Haimoto
- Department of Neurosurgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masashi Ando
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Koichi Yoshizawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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Zamarud A, Yener U, Yoo KH, Park DJ, Marianayagam NJ, Ho QA, Pollom E, Soltys S, Wang L, Chang SD, Meola A. Stereotactic radiosurgery for distant brain metastases secondary to esthesioneuroblastoma: a single-institution series. Neurosurg Focus 2023; 55:E6. [PMID: 37527675 DOI: 10.3171/2023.5.focus23216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare, malignant tumor of neuroectodermal origin that arises from the olfactory neuroepithelium. In this study the authors present the first series in the literature on distant brain metastases (BMs) secondary to ENB that were treated with stereotactic radiosurgery (SRS), to evaluate the safety and effectiveness of SRS for this indication. METHODS A retrospective analysis of clinical and radiological outcomes of patients with ENB who underwent CyberKnife (CK) SRS at a single center was conducted. The clinical and radiological outcomes of patients, including progression-free survival, overall survival, and local tumor control (LTC) were reported. RESULTS Between 2003 and 2022, 32 distant BMs in 8 patients were treated with CK SRS at Stanford University. The median patient age at BM diagnosis was 62 years (range 47-75 years). Among 32 lesions, 2 (6%) had previously been treated with surgery, whereas for all other lesions (30 [94%]), CK SRS was used as their primary treatment modality. The median target volume was 1.5 cm3 (range 0.09-21.54 cm3). CK SRS was delivered by a median marginal dose of 23 Gy (range 15-30 Gy) and a median of 3 fractions (range 1-5 fractions) to a median isodose line of 77% (range 70%-88%). The median biologically effective dose was 48 Gy (range 21-99.9 Gy) and the median follow-up was 30 months (range 3-95 months). The LTC at 1-, 2-, and 3-year follow-up was 86%, 65%, and 50%, respectively. The median progression-free survival and overall survival were 29 months (range 11-79 months) and 51 months (range 15-79 months), respectively. None of the patients presented adverse radiation effects. CONCLUSIONS In the authors' experience, SRS provided excellent LTC without any adverse radiation effects for BMs secondary to ENB.
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Affiliation(s)
| | | | | | | | | | - Quoc-Anh Ho
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Erqi Pollom
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Scott Soltys
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Lei Wang
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
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5
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McAvoy M, Satyanarayan Shenoy V, Miller C, Feroze A, Moe KS, Sekhar LN. Operative Technique and Complication Management in a Case of Giant Esthesioneuroblastoma Resected by a Combined Transcranial and Endonasal Endoscopic Approach: Technical Case Report. Oper Neurosurg (Hagerstown) 2023; 24:e449-e453. [PMID: 36804514 DOI: 10.1227/ons.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Esthesioneuroblastoma (ENB) is a rare anterior skull base tumor derived from olfactory epithelium. There are very few operative videos in the literature demonstrating the surgical resection techniques for giant ENB because of their rarity and complexity. In this technical report, we demonstrate the microsurgical resection of a very large and complex high-grade ENB, initially deemed unresectable, through a bifrontal craniotomy and extended subfrontal approach combined with an endonasal endoscopic approach. CLINICAL PRESENTATION A 34-year-old woman presented with headaches, nasal congestion, and bloody nasal drainage. MRI showed a large nasal cavity mass with extension into the anterior cranial fossa and bifrontal lobes. There was significant bifrontal edema causing headaches and abutting the optic nerves. Initial management with surgical resection was offered to the patient for local tumor control and to preserve her vision. A combined bifrontal craniotomy and endonasal transsphenoidal approach was used for resecting this giant tumor. After achieving gross total resection, we reconstructed the anterior skull base in layers. She developed several postoperative complications which were appropriately managed. CONCLUSION We demonstrate the surgical resection of a giant ENB through a combined transcranial and endonasal endoscopic approach. We discuss the several postoperative complications in this complex case and the lessons learned.
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Affiliation(s)
- Malia McAvoy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Varadaraya Satyanarayan Shenoy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Innovation Commercialization, Co-Motion, University of Washington, Seattle, Washington, USA
| | - Charles Miller
- Department of Neurosurgery, Walter Reed National Military Medical Center, Washington, District of Columbia, USA
| | - Abdullah Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Kris S Moe
- Department of Otolaryngology, University of Washington, Seattle, Washington, USA
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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Narang A, Aggarwal V, Jain R, Maheshwari C, Ramesh A, Singh G. Nasoethmoidal Schwannoma as a Mimicar of Esthesioneuroblastoma: A Case Report and Literature Review. Neurol India 2022; 70:784-787. [PMID: 35532661 DOI: 10.4103/0028-3886.344679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nasoethmoidal schwannomas are rare lesions and their presentation with intracranial extension is even rarer. Here, a patient presenting with rhinorrhea, epistaxis, and proptosis of left eye was diagnosed with giant nasoethmoidal schwannoma extending to frontal lobe and orbit, which was managed with bifrontal craniotomy with endoscopic transnasal gross total excision. This being predominantly a benign lesion has good prognosis if total excision is achieved.
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Affiliation(s)
- Amit Narang
- Department of Neurosurgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Varun Aggarwal
- Department of Neurosurgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Rahul Jain
- Department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Chandni Maheshwari
- Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Athira Ramesh
- Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Gurbax Singh
- Department of Otorhinolaryngology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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7
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Turri-Zanoni M, Gravante G, Dalfino G, Antognoni P, Locatelli D, Battaglia P, Castelnuovo P. Ectopic Primary Olfactory Neuroblastoma: Case Series and Literature Review. World Neurosurg 2021; 158:e645-e653. [PMID: 34785363 DOI: 10.1016/j.wneu.2021.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Olfactory neuroblastoma (ONB) is a rare malignant tumor arising in the upper nasal cleft. Rarely, ONB may originate in ectopic sites and the impact of this on prognosis and treatment strategies continues to be debated. METHODS A retrospective analysis was undertaken of patients with ectopic ONB treated between 2000 and 2020 in a tertiary-care referral center for skull base tumors. Three patients were included in this analysis: a 37-year-old woman with ONB arising from the bulla ethmoidalis; a 28-year-old man with inappropriate secretion of antidiuretic hormone caused by a maxillary sinus ONB; and a 41-year-old man with lacrimal sac ONB. Preoperative workup, surgical approach, adjuvant treatments and postoperative surveillance were analyzed. Relevant literature published between 2000 and January 2021 was fully reviewed to investigate oncologic outcomes and delineate the standard of care for such rare tumors. RESULTS All patients were treated via endoscopic endonasal resection with radical intent, followed by adjuvant treatments when required. No recurrences of disease were observed after a mean follow-up time of 32 months (range, 12-60 months). Data emerging from the literature suggest that a multidisciplinary treatment approach, including free-margins surgical resection followed by adjuvant radiotherapy or radiochemotherapy, is recommended. Olfactory bulb and dura preservation should be attempted whenever feasible. CONCLUSIONS Endoscopic endonasal surgery should be preferred, when possible, to achieve complete excision to minimize patients' morbidity. The ectopic site of origin affects prognosis and should be considered when selecting the appropriate multimodal treatment strategy.
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Affiliation(s)
- Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giacomo Gravante
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Fischer-Szatmári T, Fülöp B, Szakács L, Gyura E, Bella Z, Barzó P. Combined Simultaneous Multiportal Approach via Minimally Invasive Transciliary and Endoscopic Endonasal Approaches for Tumors Invading Both the Skull Base and the Sinonasal Area. World Neurosurg 2021; 148:70-79. [PMID: 33418120 DOI: 10.1016/j.wneu.2020.12.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND A combined transcranial and transfacial approach has long been the gold standard for surgical management of large tumors with sinonasal and skull base involvement. The extended endoscopic endonasal approach for such pathologies has its advantages, but it has flaws as well, such as anatomic limitations and more ponderous skull base reconstruction and thus higher risk of postoperative complications. Our primary technique for surgical treatment of these pathologies has been a combination of transfacial and minimally invasive transciliary supraorbital keyhole approaches. With the aim to further minimize invasiveness, potential complications, and unsatisfactory aesthetic outcomes during surgical treatment of large tumors invading both the sinonasal area and the skull base, we abandoned the transfacial approach and simultaneously combined the transciliary supraorbital keyhole approach with the endoscopic endonasal approach. METHODS The well-known microscope-assisted minimally invasive approach via a transciliary supraorbital keyhole craniotomy was combined with the endoscopic endonasal approach. RESULTS Six patients with different histologic types of tumors affecting the sinonasal area and the skull base were operated on. The mean operative time was 3 hours, there were no unexpected intraoperative or postoperative complications, and total tumor removal was achieved in each patient. None of the patients experienced complications associated with the surgery during follow-up. CONCLUSIONS Our combined simultaneous multiportal approach enables total tumor eradication with reduced operative time and is associated with minimal intraoperative and postoperative complications, low mortality rate, and excellent cosmetic results.
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Affiliation(s)
- Tamás Fischer-Szatmári
- Department of Neurosurgery, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
| | - Béla Fülöp
- Department of Neurosurgery, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - László Szakács
- Department of Otorhinolaryngology and Head and Neck Surgery, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Erika Gyura
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsolt Bella
- Department of Otorhinolaryngology and Head and Neck Surgery, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Pál Barzó
- Department of Neurosurgery, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Wong E, Choroomi S, Palme CE, Singh NP. Isolated primary maxillary sinus esthesioneuroblastoma presenting as idiopathic syndrome of inappropriate antidiuretic hormone. BMJ Case Rep 2019; 12:e228666. [PMID: 31142486 PMCID: PMC6557341 DOI: 10.1136/bcr-2018-228666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 11/03/2022] Open
Abstract
Esthesioneuroblastoma is an uncommon tumour, and isolated primary involvement of the maxillary sinus is exceedingly rare. Esthesioneuroblastoma has infrequently been reported as a source of paraneoplastic ectopic hormone production. We report a case of isolated primary maxillary esthesioneuroblastoma, presenting as idiopathic syndrome of inappropriate antidiuretic hormone (SIADH). A 17-year-old girl presented with symptoms consistent with SIADH and no sino-nasal symptoms. MRI to exclude pituitary tumour revealed an isolated lesion of the right maxillary sinus. Biopsy demonstrated esthesioneuroblastoma. The lesion was removed endoscopically as a single en bloc specimen. Following resection, the sodium level returned to normal. This is only the third report in the literature of a primary maxillary esthesioneuroblastoma presenting as SIADH.
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Affiliation(s)
- Eugene Wong
- Department of Otolaryngology, University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Siamak Choroomi
- Department of Otolaryngology, University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Otolaryngology, University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Narinder Pal Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
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10
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Huang Y, Qiu QH, Zhang SX. Endoscopic surgery for primary sinonasal malignancies: Treatment outcomes and prognostic factors. Ear Nose Throat J 2018; 97:E24-E30. [PMID: 30036420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
We retrospectively reviewed the cases of 85 patients with primary sinonasal malignancies who had undergone endoscopic surgery with curative intent achieved by "regional resection." Our goal was to assess the efficacy of endoscopic surgical treatment vis-à-vis traditional open surgery. Kaplan-Meier data analysis revealed that the 1-, 3-, and 5-year disease-specific survival rates were 82, 60, and 49%, respectively. Multivariate Cox model survival analysis revealed that male sex, certain pathologic types of cancer (i.e., undifferentiated carcinoma, olfactory neuroblastoma, and rhabdomyosarcoma), and T3/T4 category negatively impacted survival (adjusted hazard ratios: 3.601, 0.012, 0.287, 0.068, and 0.339, respectively; p < 0.05 for all). We also performed a separate analysis of 47 patients who had category T3 or T4 cancer to determine if the type of surgical approach is a prognostic factor. For this, we identified 20 new patients who had undergone open resection, and we compared them to 27 of our endoscopically treated patients who had similar clinical characteristics. We found that the type of surgical approach did not appear to be a prognostic factor (p > 0.10), although those patients who had undergone endoscopic resection had significantly shorter hospital stays (p < 0.001). We conclude that patients with primary sinonasal malignancies who are treated with endoscopic surgery have acceptable survival rates and therefore endoscopic surgery is justified in the hands of highly experienced surgeons in selected cases.
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Affiliation(s)
- Yan Huang
- Department of Otorhinolaryngology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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11
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Batacchi Z, Andeen NK, Trikudanathan S. An unusual manifestation of olfactory neuroblastoma. BMJ Case Rep 2018. [PMID: 29535093 DOI: 10.1136/bcr-2017-221661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 62-year-old woman presented with an 11-month history of worsening nasal symptoms of rhinorrhoea, anosmia, nasal congestion and intermittent epistaxis. MRI revealed a large mass in the upper nasal vault. Biopsy of the mass revealed an olfactory neuroblastoma. While waiting resection, she acutely developed severe proximal muscle weakness, lethargy and lower extremity oedema. Blood glucose was elevated, and hypokalaemic metabolic alkalosis was noted. Elevated serum cortisol level of 95.7 µg/dL (8.7-22.4 µg/dL) and markedly elevated 24-hour urinary cortisol level of 6962.3 µg/24 hours (4.0-50.0 µg/24 hours) with concurrent adrenocorticotropic hormone (ACTH) level of 171 pg/mL (6-58 pg/mL) were suggestive of an ACTH-dependent source of hypercortisolism. A subsequent positive high-dose dexamethasone suppression test was consistent with ectopic ACTH production. She underwent near-total resection of the right nasal mass followed by radiotherapy, resulting in complete resolution of signs and symptoms of cortisol excess.
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Affiliation(s)
- Zona Batacchi
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Nicole K Andeen
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Subbulaxmi Trikudanathan
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
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12
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Mehta GU, Hanna EY, DeMonte F, Raza SM. Endoscopic endonasal resection of sinonasal/anterior skull base malignancy (Kadish C esthesioneuroblastoma). Acta Neurochir (Wien) 2018; 160:361-366. [PMID: 29277853 DOI: 10.1007/s00701-017-3437-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The surgical management of anterior skull base malignancies requires the full complement of open and endoscopic skull base approaches. Due to the evolution of endoscopic techniques, endoscopic approaches are now being employed for complex skull base tumors. METHODS We present our technique for endoscopic management for an advanced (T4) anterior skull base malignancy that provides a systematic approach to resection, margin assessment, and reconstruction. CONCLUSION Our surgical strategy provides a systematic approach by which an oncologic resection can be performed within the context of a spectrum of surgical strategies necessary to manage skull base malignancies.
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Affiliation(s)
- Gautam U Mehta
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA
| | - Shaan M Raza
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 442, Houston, TX, 77030-4009, USA.
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13
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Zhang L, Niu K, Zhu K, Xia C, Yan J, Zhao W, Wei J, Duan M, Zheng G. Long-Term Prognostic Analysis after Endoscopic Endonasal Surgery for Olfactory Neuroblastoma: A Retrospective Study of 13 Cases. PLoS One 2016; 11:e0166046. [PMID: 27806104 PMCID: PMC5091887 DOI: 10.1371/journal.pone.0166046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022] Open
Abstract
Objectives To summarize the characteristics and long–term outcomes of olfactory neuroblastoma through the analysis of 13 cases in single institution, with the assessment of treatment modality, prognostic factors. Method A retrospective study of thirteen cases diagnosed as olfactory neuroblastoma and underwent combined treatments during the period 2000–2010. Statistical analysis was performed to search for prognostic factors and compared different treatment modalities. Results 13 patients were enrolled in this study, including 8 male and 5 female, ranging from 15 to 69 (median 43) years old. One patient at stage A was only treated with endoscopic endonasal surgery (EES). Seven patients were treated with preoperative radiotherapy and EES, two with EES and postoperative radiotherapy, and the other three with combined radiotherapy and chemotherapy. The range of follow-up time varied from 23 to 116 months (median 65 months). The 5-year overall survival rate was 46.2% (6/13). To date, these thirteen patients have not suffered local recurrences while two patients had lymph node recurrences and one had distant metastasis in the bone marrow. In 13 patients, 61.5% were diagnosed as late T stage (T3/4), 69.2% late Kadish stage (C/D) and 53.8% were high Hyams grade (I/ II), which indicated poor prognosis. Related prognostic factors were the TNM stage (T stage P = 0.028, N stage P = 0.000, M stage P = 0.007), Kadish stage (P = 0.025) and treatment modality (P = 0.015). Conclusion Late stage of TNM and Kadish staging system indicated a poor prognosis. Combined treatment modality, including endoscopic endonasal surgery, achieved a better outcome than non-surgical approach.
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Affiliation(s)
- Luyao Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi, China
| | - Kai Niu
- Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
- Department of Otorhinolaryngology Head and Neck Surgery, the No.1 Affiliated Hospital of Jilin University, Changchun, Jilin, China
| | - Kang Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi, China
| | - Cui Xia
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi, China
| | - Jing Yan
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi, China
| | - Wei Zhao
- Department of Otorhinolaryngology, Shangluo Central Hospital, Shangluo, Shaanxi, China
| | - Junrong Wei
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi, China
| | - Maoli Duan
- Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
- * E-mail: (GZ); (MD)
| | - Guoxi Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi, China
- * E-mail: (GZ); (MD)
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14
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Abstract
Esthesioneuroblastoma is a rare malignant tumor of sinonasal origin. These tumors typically present with unilateral nasal obstruction and epistaxis, and diagnosis is confirmed on biopsy. Over the past 15 years, significant advances have been made in endoscopic technology and techniques that have made this tumor amenable to expanded endonasal resection. There is growing evidence supporting the feasibility of safe and effective resection of esthesioneuroblastoma via an expanded endonasal approach. This article outlines a technique for endoscopic resection of esthesioneuroblastoma and reviews the current literature on esthesioneuroblastoma with emphasis on outcomes after endoscopic resection of these malignant tumors.
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Affiliation(s)
- Christopher R Roxbury
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps Building, Room 101, Baltimore, MD 21287, USA
| | - Douglas D Reh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA.
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15
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Abstract
Objective To review our favorable experience with maxillofacial disassembly for exposure and resection of tumors of the skull base. Patients and Methods This is a retrospective review of 31 patients from 1997 to 2005 treated by maxillofacial disassembly and includes 22 patients with midface disassembly and 9 patients with mandible with or without midface disassembly. Results Follow-up ranges from 2 weeks to 7 years: 23 of 31 patients are alive and disease free; 3 patients are alive with disease; 3 patients have died of distant metastasis. There were 14 complications in 12 (38.7%) patients; 13 of 14 complications were minor. One major complication (cardiovascular accident) resulted in the single postoperative mortality in this series. Conclusion Our technique of maxillofacial disassembly allows for tailored exposure of all regions of the anterolateral skull base with acceptable perioperative morbidity in appropriately selected patients. EBM rating: C-4
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Affiliation(s)
- Vladimir Zuzukin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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16
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Abstract
INTRODUCTION Curative resection of malignant tumours of the skull base is increasingly undertaken endoscopically. Hitherto the diverse histology, rarity and long natural history have made it difficult to accrue statistically robust cohorts for comparison with conventional craniofacial resection. It is now possible to make such a comparison in a large personal cohort. METHOD Data on all cases of sinonasal malignancy undergoing endoscopic resection with curative intent over an eighteen year period were collected prospectively and analysed for survival and prognostic factors. RESULTS There were 140 cases, 68 men and 72 women, aged 20-92 years (mean 63 yrs). Follow-up ranged from 6-184 months (mean 60 months). Eighteen different histopathologies were represented with olfactory neuroblastoma (36), malignant melanoma (33) and adenocarcinoma (19) being the commonest. Additional radiotherapy was given in 95 cases and chemotherapy in 49. Overall survival is 84% at 5 years and 69% at 10 years. Overall disease-free survival was 77% at 5 years and 56% at ten. Overall and disease-free survival at 5 (and 10) years is, respectively, 97% and 90% for olfactory neuroblastoma, 79% and 68% for adenocarcinoma and 56% and 39% for malignant melanoma. CONCLUSION These results show that endoscopic resection is an alternative to conventional craniofacial resection in selected cases.
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Chang CF, Chiu SC, Yeh SY, Chen MK, Wen YS. Minimally invasive resection of olfactory neuroblastoma by transnasal endoscopy. Ear Nose Throat J 2015; 94:E30-E36. [PMID: 26322455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Olfactory neuroblastoma is rare. We conducted a retrospective study to review our experience with minimally invasive resection of olfactory neuroblastomas via a transnasal endoscopic technique, including an analysis of surgical outcomes. Our series included 5 patients-3 men and 2 women, aged 29 to 75 years (mean: 48). Surgical outcomes were evaluated on the basis of each patient's preoperative Dulguerov classification and postoperative evaluation on computed tomography and magnetic resonance imaging. One patient was treated with surgery alone, 3 with surgery plus radiotherapy, and 1 with surgery, radiotherapy, and chemotherapy. During follow-up of 18 to 115 months, all 5 patients remained alive and disease-free. We found that endoscopic resection of olfactory neuroblastoma is a feasible and effective procedure, even in patients with more aggressive stages of disease. We also believe that the Dulguerov classification is more useful than other classifications for clinical management and surgical planning. Long-term follow-up is necessary to look for late recurrence.
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Affiliation(s)
- Chin-Fang Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhua Christian Hospital, #135 Nanhsiau St., Changhua 500, Taiwan
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18
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Ye Y, Qiu Q, Zhang S, Huang Y, Zhan J, Xu M. [The long-term clinical efficacy of endoscopic surgery of primary sinonasal malignant neoplasms]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:1105-1110. [PMID: 26514003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the long-term clinical efficacy of endoscopic surgery of primary sinonasal malignant neoplasms and find out the potential postoperative prognostic factors. METHOD Forty-three clinical cases of primary sinonasal malignant neoplasms treated under endoscopy were analyzed retrospectively. RESULT Fifteen patients died. The 1-year, 2-year, 3-year and 5-year survival rates were 83. 7% (36/43), 74. 4% (32/43), 69. 8% (30/43) and 65. 1% (28/43), respectively. Kaplan-Meier single-variable analysis showed that gender, T grade, TNM stage and pathological types of olfactory neuroblastoma were statistically significant prognostic factors (P< 0. 05). COX Pro-Portional hazard models showed that TNM stage was an independent prognostic factors. CONCLUSION Endoscopic surgery for primary sinonasal malignant neoplasms is a safe and effective minimally invasive surgical treatment, and it is an important supplement to the traditional surgery. Gender, T grade, TNM stage and pathological types of olfactory neuroblastoma might be significant prognostic factors.
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19
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De Bonnecaze G, Chaput B, Al Hawat A, Filleron T, Vairel B, Serrano E, Vergez S. Long-term oncological outcome after endoscopic surgery for olfactory esthesioneuroblastoma. Acta Otolaryngol 2014; 134:1259-64. [PMID: 25399885 DOI: 10.3109/00016489.2014.944271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Endoscopic techniques seem to be safe approaches for the treatment of esthesioneuroblastomas (ENBs). However, they are intended for selected patients and require extensive experience in base of the skull surgery. OBJECTIVES ENB is a rare tumor of the nasal cavity. The craniofacial approaches remain the gold standard of treatment in multiple centers. Endoscopic endonasal approaches were progressively developed. The main objective of this work was to study the overall survival and recurrence-free period for patients with ENB who underwent endoscopic resection. METHODS We performed a retrospective study from 1996 to 2014, reviewing the patients treated by endonasal endoscopic surgery for ENB. RESULTS Eight patients benefited from endoscopic surgical resection. According to the Kadish classification, one patient was stage A, three patients were stage B, and four patients were stage C. According to the Dulguerov classification, one patient was stage T1, five patients were stage T2, and two were stage T4. Reconstruction of the base of the skull was performed in three patients. No postoperative complications were noted. The mean follow-up period was 95 months. The 5-year overall survival was 87.5% and the 5-year recurrence-free survival was 75%. To date, there have been no local recurrences but two patients had lymph node recurrences. Seven patients are disease-free and one is deceased.
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Affiliation(s)
- Guillaume De Bonnecaze
- Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey , Toulouse , France
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20
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Squillaci S. Olfactory neuroblastoma with focal ganglioneuroblastic differentiation: a case report with literature review. Pathologica 2014; 106:61-66. [PMID: 25291869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Olfactory neuroblastoma (ONB) is a rare malignant neuroectodermal tumour, with clearly defined histologic and immunohistochemical features, that typically arises in the superior nasal cavity. Although the classical clinicopathological features leave little room for misinterpretation, the wide variability in this tumour, including occasional divergent differentiation, may cause diagnostic difficulty. Herein, an unusual case of ONB with focal ganglioneuroblastic differentiation in an 81-year-old woman arising from the anterior ethmoid, filling the upper portion of the left nasal cavity and sparing the sinus cavities, is described. Histologically, the tumour was composed of atypical monotonous round cells that were positive for NSE, CD56, chromogranin, synaptophysin, neurofilament and calretinin and exhibited an irregular lobulated and nested growth pattern and sparse mitotic figures (3 to 4 mitoses per 10 HPF). Focally, the histology changed to ganglioneuroblastic differentiation consisting of large ganglion and spindle cells, positively staining for S-100, GFAP, CD99, neurofilament, calretinin, chromogranin and synaptophysin. Neuroblastomas, occurring in the nasal cavity, in analogy to other sites, tend to have an aggressive biologic behaviour and can histologically mimic other undifferentiated malignant neoplasms of the sinonasal tract. Differential diagnostic problems are discussed; a comprehensive review of the literature has also been performed with a focus on survival.
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21
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Gabbay U, Leider-Trejo L, Marshak G, Gabbay M, Fliss DM. A case and a series of published cases of esthesioneuroblastoma (ENB) in which long-standing paraneoplastic SIADH had preceded ENB diagnosis. Ear Nose Throat J 2013; 92:E6. [PMID: 24170477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Esthesioneuroblastoma (ENB) is a rare tumor of the olfactory mucosa. We treated a 50-year-old man with an ENB in the right ethmoid sinus who had been diagnosed 16 years earlier with syndrome of inappropriate antidiuretic hormone secretion (SIADH) of unknown cause. When the ENB was surgically removed, the patient's osmoregulation returned to normal-that is, his SIADH resolved completely, which suggested that the SIADH was paraneoplastic in nature. These events prompted us to review the literature to determine if there is an association between our patient's ENB and his SIADH in general and between long-standing SIADH that precedes ENB in particular. Based on our review and an extrapolation of data, we have estimated that 1,300 cases of ENB have occurred since it was first described in 1924. Of these cases, SIADH was reported in 26 cases, including ours, which represents an estimated prevalence of 2% (although we believe this is actually an underestimation of the true prevalence). Of the 26 cases, SIADH had already been present in 14 patients (54%) prior to their diagnosis of EBN for a median duration of 3.5 years. We recommend that patients with newly diagnosed EBN be evaluated for SIADH. In those who are SIADH-positive, a resolution of SIADH should be expected once the ENB has been removed. If this does not occur, one should suspect that the ENB was not completely removed. If SIADH resolves but later recurs during follow-up, then a relapse should be suspected. In long-standing SIADH of unknown etiology, nasal sinus imaging should be considered.
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Affiliation(s)
- Uri Gabbay
- Section of Epidemiology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
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22
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Johnson MD, Piech K, Emandian S. Radiation-associated meningioma in the elderly: development of meningioma with olfactory neuroblastoma recurrence 10 years after irradiation. Ann Clin Lab Sci 2013; 43:460-463. [PMID: 24247807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The pathogenesis of meningiomas is not established [1,2]. However, intracranial irradiation in childhood is a risk factor for the development of meningiomas later in life [2-6]. Children treated with irradiation for tinea capitis of the scalp showed an almost ten-fold increase in development of meningiomas relative to age-matched controls [2,3]. In a study of almost 18,000 children who survived for at least five years after receiving external beam radiation, 2.3% developed meningiomas within 17 years of follow-up [5]. Notably, meningioma formation after radiation therapy (RT) occurs almost exclusively in patients irradiated as children or young adults. Development of a radiation-associated meningioma (RAM) in patients who received RT in the sixth or seventh decade is very rare. For example, in studies including a total of 58 adults receiving RT, only two cases of RAM occurred in patients 50 years old or older [8,9].
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Affiliation(s)
- Mahlon D Johnson
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave. Box 626, Rochester, NY 14642, USA; phone: 585 276 3087; fax: 585 273 1027; e mail:
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23
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Gallia GL, Reh DD, Lane AP, Higgins TS, Koch W, Ishii M. Endoscopic resection of esthesioneuroblastoma. J Clin Neurosci 2012; 19:1478-82. [PMID: 22995757 DOI: 10.1016/j.jocn.2012.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 03/10/2012] [Indexed: 11/19/2022]
Abstract
Esthesioneuroblastoma, or olfactory neuroblastoma, is an uncommon malignant tumor arising in the upper nasal cavity. Surgical approaches to this and other sinonasal malignancies involving the anterior skull base have traditionally involved craniofacial resections. Over the past 10 years to 15 years, there have been advances in endoscopic approaches to skull base pathologies, including malignant tumors. In this study, we review our experience with purely endoscopic approaches to esthesioneuroblastomas. Between January 2005 and February 2012, 11 patients (seven men and four women, average age 53.3 years) with esthesioneuroblastoma were treated endoscopically. Nine patients presented with newly diagnosed disease and two were treated for tumor recurrence. The modified Kadish staging was: A, two patients (18.2%); B, two patients (18.2%); C, five patients (45.5%); and D, two patients (18.2%). All patients had a complete resection with negative intraoperative margins. Three patients had 2-deoxy-2-((18)F)fluoro-d-glucose avid neck nodes on their preoperative positron emission tomography-CT scan. These patients underwent neck dissections; two had positive neck nodes. Perioperative complications included an intraoperative hypertensive urgency and pneumocephalus in two different patients. Mean follow-up was over 28 months and all patients were free of disease. This series adds to the growing experience of purely endoscopic surgical approaches in the treatment of skull base tumors including esthesioneuroblastoma. Longer follow-up on larger numbers of patients is required to clarify the utility of purely endoscopic approaches in the management of this malignant tumor.
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Affiliation(s)
- Gary L Gallia
- Department of Neurosurgery, Phipps Building, Room 101, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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24
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Niazi SA. Olfactory neuroblastoma presenting as bleeding polyp. J Ayub Med Coll Abbottabad 2012; 24:208-209. [PMID: 24669656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Malignant tumours of the nasal cavity are rare. Olfactory neuroblastomas (esthesioneuroblastomas) account for only 6% of these neoplasms. Fewer than 1,000 cases have been reported in the literature since this tumour was first described more than 75 years ago. A 13 year old girl presented with bleeding nasal polyp to ENT Department. She was operated as there were no signs of tumour the histopathology report revealed it to be olfactory neuroblastoma. As there was no intracranial extension she was given postoperative radiotherapy.
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Guo T, Sun J, Wang Y, Sun J. [Endoscopic endonasal surgery for cranial base tumor]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 26:644-646. [PMID: 23156808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore the application of endoscopic endonasal approach in surgery for skull base tumor. METHOD From August 2000 to February 2009, retrospective analyses were performed on clinical data of 21 patients with skull base lesions treated by endoscopic endonasal surgery. There were 3 chordoma, 6 olfactory neuroblastoma, 4 squamous cancer, 5 malignant melanoma, 1 mucoepidermoid carcinoma, 2 sphenoidal malignant adenoma. RESULT Total tumor removal was obtained in 21 cases,subtotal removal in 2 cases. With follow up of 24 to 108 months, 4 cases were recurred, 5 cases were dead. The complications included cerebrospinal fluid (CSF) leak in 2 patients, intracranial infection after the endoscopic surgery in 1 patient. In the two patients with CSF leak, one case cured by internal medicine and another cured by endoscopic surgery. CONCLUSION The endoscopic endonasal surgery could provide sufficient treatment for skull base tumor, and is a safe, minimally invasive and efficient procedure, but indication should be exactitude selected.
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Affiliation(s)
- Tao Guo
- Department of Otorhinolaryngology-Head and Neck Surgery, Anhui Provineial Hospital, Hefei, 230001, China
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26
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Nabili V, Kelly DF, Fatemi N, St John M, Calcaterra TC, Abemayor E. Transnasal, transfacial, anterior skull base resection of olfactory neuroblastoma. Am J Otolaryngol 2011; 32:279-85. [PMID: 20728963 DOI: 10.1016/j.amjoto.2010.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 05/17/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE Using a transnasal, transfacial, anterior skull base approach, we have removed olfactory neuroblastomas (OFN) obviating the need for a frontal craniotomy. The objectives were to present our surgical approach in achieving clear margins, to assess patient survival, and to recommend eligibility criteria. MATERIALS AND METHODS A retrospective chart review was done to identify patients diagnosed with OFN who underwent this surgical approach. Thirteen patients were identified who underwent our pictorially described approach. Postoperative assessment of pathologic margins, patient survival, and limitations of surgical approach was determined. RESULTS Of the 13 patients, 12 (92%) had clear postsurgical margins. One patient had residual intracranial disease due to coagulopathy preventing further resection. Twelve patients remain alive with 10 patients remaining disease-free (follow-up ranging from 11 to 64 months). Three patients presented with recurrent disease initially, with 2 having had subsequent repeat local and regional recurrences, respectively; one of whom died recently of the re-recurrent disease. One patient had a postoperative cerebrospinal fluid leak repaired via the original surgical approach. CONCLUSIONS Although craniofacial resection remains an accepted approach for surgical treatment of OFN, we have adopted a transnasal, transfacial approach eliminating the need for a frontal craniotomy. This approach allows for adequate exposure of the cribriform plate, dura, and anterior skull base. Our technique minimizes dural defects and prevents many craniotomy-associated complications, including frontal lobe retraction. Long-term follow-up is needed to compare survival using this approach; however, our results to date are quite promising.
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Affiliation(s)
- Vishad Nabili
- Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 10833 LeConte Avenue, Los Angeles, CA 90095, USA.
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27
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Albu S, St Florian I, Szabo I, Băciuţ G, Băciuţ M, Mitre I. Craniofacial resection for malignant tumors of the paranasal sinuses. Chirurgia (Bucur) 2011; 106:219-225. [PMID: 21696064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To review the experience with craniofacial resection for malignant tumors of the anterior skull base and analyze prognostic factors for survival. MATERIAL AND METHODS Between 1996 and 2008, 64 consecutive patients with malignant tumors of the anterior skull base underwent craniofacial resection. Different parameters were analyzed to study their relationship with survival: age, sex, pathology, orbital involvement, dural involvement, status of the surgical margins, adjuvant radiotherapy, and whether the treatment was done before or after surgery. Survival analysis was carried out with the Kaplan-Meier product limit method and comparison between groups was performed by the log-rank test. Factors identified in the univariate analysis were then entered in the multivariate analysis using the Cox regression model in order to identify predictive factors of survival. RESULTS For the entire group survival rates were 47% at 5 years. The highest survival was observed in patients with estesioneuroblastoma and the lowest in melanoma cases. Dural involvement and orbital clearance are predictors of poor survival. CONCLUSION The improved survival and minimal morbidity associated with craniofacial resection make it the approach of choice for anterior skull base tumors.
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Affiliation(s)
- S Albu
- Department of Otorhinolaryngology, CF Hospital, University of Medicine and Pharmacy I. Hatieganu, Cluj-Napoca, Romania.
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Chen YF, Yang AK, Zhang Q, Ouyang D, Chen WK, Chen FJ. [Clinical analysis of 53 cases of esthesioneuroblastoma]. Ai Zheng 2009; 28:308-311. [PMID: 19619448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE The prognosis of esthesioneuroblastoma (ENB) patients is poor. This study was to analyze prognostic factors and explore a rational treatment for ENB. METHODS Clinical data of 53 ENB patients, treated at Sun Yat-sen University Cancer Center from 1980 to 2003, were analyzed retrospectively. The correlation of prognostic factors to clinical features and treatment approaches were analyzed using the Kaplan-Meier method. Efficacy of different treatment modalities was compared. RESULTS The five-year overall survival (OS) was 41% of all ENB patients. The five-year OS of the surgery group, radiotherapy group, chemotherapy group, surgery combined with radiotherapy and (or) chemotherapy group, chemoradiotherapy were 42%, 38%, 0, 56%, 0, respectively, which were statistically significant (p<0.05). The five-year OS of Kadish stage A, B, C patients were 100%, 37%, 31%, respectively, which were statistically significant among these three subgroups which (p<0.05). The recurrence rate over the entire period was 51%. The five-year OS of the recurrence group and recurrence-free group were 42% and 48%, respectively, without significant differences (p>0.05). CONCLUSIONS ENB is a malignant tumor with high rates of locoregional recurrence and distant metastasis. Surgery-based multimodality is a relatively reasonable method. The prognosis of ENB is associated with the clinical stage and treatment modalities.
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Affiliation(s)
- Yan-Feng Chen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P. R. China
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Ladziński P, Majchrzak H, Kaspera W, Maliszewski M, Majchrzak K, Tymowski M, Adamczyk P. Direct and remote outcome after treatment of tumours involving the central skull base with the extended subfrontal approach. Neurol Neurochir Pol 2009; 43:22-35. [PMID: 19353441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND PURPOSE To present our results of the surgical treatment of central skull base tumours using the extended subfrontal approach (ESA). MATERIAL AND METHODS Twenty-six patients (8 women, 18 men) with central skull base tumours were included in the study. The neurological and performance status of the patients was assessed before and after surgery as well as at the conclusion of treatment. The approximate volume of the operated tumour, its relation to the large blood vessels, cranial nerves and brainstem, as well as consistency and vascularisation were assessed. RESULTS The symptom duration ranged from 1.5 to 18 months (mean: 8.3 months). Loss of olfaction was the predominant symptom in 38% of patients. Less frequent symptoms were: paresis/paralysis of the 6th cranial nerve, psychoorganic syndrome, impaired visual acuity, nasal obstruction and headache. Approximate volume of the tumours ranged from 10 to 105 ml (mean: 54.3). The most frequent histological diagnosis was chordoma (19%), meningioma (15%), followed by haemangiopericytoma, fibroma and esthesioneuroblastoma (12%). Total or subtotal resection was achieved in 77% of patients. The postoperative performance status was improved in 39%, unchanged in 27% and impaired in 15% of patients. Five patients died after the surgery. CONCLUSIONS Extended subfrontal approach is a useful technique for removal of benign tumours expanding along the midline, superiorly and inferiorly to the skull base. For removal of malignant tumours at the same location, ESA is an alternative to a combination of transcranial approach and one of the craniofacial approaches.
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Affiliation(s)
- Piotr Ladziński
- Katedra i Oddzia(3) Kliniczny Neurochirurgii, OEl(1)ski Uniwersytet Medyczny w Katowicach, Wojewódzki Szpital Specjalistyczny nr 5 im. oew. Barbary, Pl. Medyków 1, 41-200 Sosnowiec, Poland.
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Wang HL, Fan GK, Lin ZH. [Clinical analysis of 10 cases of olfactory neuroblastoma]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2009; 38:103-106. [PMID: 19253437 DOI: 10.3785/j.issn.1008-9292.2009.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To review the diagnosis, treatment and prognosis of olfactory neuroblastoma. METHODS Clinical data were retrospectively reviewed in 10 cases of olfactory neuroblastoma admitted from 1998 to 2002, including data of transmission electron microscopic (TEM) observation in 4 cases. According to Kadish's classification, 2 cases were in stage A, 4 in stage B and 4 in stage C. Three patients were treated with surgery alone, 7 with combined surgery and radiation. RESULT Among 10 cases, the overall 5-year survival rate was 60 %(6/10); 3 patients died from local recurrence, 1 lost follow-up. TEM demonstrated granules in the cytoplasm of 3 patients. CONCLUSION The combined surgery and radiation can achieve excellent local control. Transmission electron microscope is important for its diagnosis.
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Affiliation(s)
- Hua-Lin Wang
- Department of Otolaryngology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
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31
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Issing PR. ["Nodules" in the oral cavity. The dental prosthesis does not fit anymore]. MMW Fortschr Med 2008; 150:5. [PMID: 19055217 DOI: 10.1007/bf03365647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Peter R Issing
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- Hals- u. plastische Gesichtschirurgie, Klinikum Bad Hersfeld GmbH, Seilerweg 29, D-36251 Bad Hersfeld
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Li G, Zhou J, Xiao X, Wang J. [Clinical analysis of 19 cases of esthesioneuroblastoma under classic surgical approaches and surgical approaches with the assistant of nose endoscope]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 22:498-503. [PMID: 18727518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To summarize the curative effect and esthesioneuroblastoma (ENB) by classic surgical approaches and surgical approaches with the assistant of nose endoscope. METHOD A retrospective review was conducted in 19 cases treated from 1980 to 2000. Ten cases were treated by classical surgical approaches. Tumors in 4 patients (According to the Kadish system, stage A, 3 cases; stage B, 1 case) were removed via a transnasal approach, 6 patients (stage B, 5 cases; stage C, 1 case) were performed by lateral rhinotomy. After 1995, 9 cases (stageA, 2 case; stageB, 5 cases; stageC, 2 cases) received surgical resection with nasale endoscope. All of the patients were conducted radiation after operation. RESULT The 5-year survival rate for the classic procedure and the surgical procedure with the assistant of endoscope were 50.0%, 88.9%, respectively. And the local recurrence rates were 50.0%, 33.3%, respectively (had no statistical significance). And the mean recurrent time were 5.2 months, 16 months, respectively. With the assistant of endoscope, the recurrent time was significant retarded. CONCLUSION There are better illumination and better operation field during the surgical operation with the assistant of endoscope. And the tumors are more likely resected entirely and the tumor recurrent time could be deferred.
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Affiliation(s)
- Gaoxin Li
- Department of Otolaryngology-Head and Neck Surgery, Hunan Provincial People's Hospital, Changsha 410002, China
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Li LY, Chen L, Wang RG, Han DY, Huang DL, Yang WY. [Investigation of surgical managements of olfactory neuroblastoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 43:89-91. [PMID: 18510210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of transnasal endoscopic resection and craniofacial resection through an external approach for olfactory neuroblastoma (ONB). METHODS Thirty two patients with ONB treated between 1987 and 2006 were retrospectively reviewed. RESULTS The patients were followed up for 8-135 months, the median follow-up time was 20 months. The longest follow-up time of patients treated by endoscope was 79 months, and patients treated by combined endoscope and transcranial surgery was 87 months. At Kadish stage B the 3-year survival rate of patients with transnasal endoscopic resection was 78.8% and at Kadish stage C it was 50.0%. At Kadish stage B the 3-year survival rate of patients with craniofacial resection through an external approach was 60.0% and at Kadish stage C it was 44.4%. The bleeding amounts in above two approaches were 140 ml and 450 ml. The average length of stay in hospital in transnasal endoscopic resection approach was markedly reduced (P < 0. 01). CONCLUSIONS Olfactory neuroblastoma can be safely and effectively excised and reconstructed endoscopically with comparable degrees of tissue removal as with external approaches. The time of stay in hospital can be reduced and the surgical trauma can be diminished.
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Affiliation(s)
- Liang-Yu Li
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
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Aoyagi M, Kishimoto S, Iida H, Tamaki M, Tsunoda A, Ohno K. [Multidisciplinary surgical approach to the cranial base and mid-facial pathology]. No Shinkei Geka 2008; 36:135-145. [PMID: 18265696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Masaru Aoyagi
- Department of Neurosurgery, Graduate School, Tokyo Medical and Dental University, Japan
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Abstract
BACKGROUND The relative importance of surgery within multimodality regimens commonly used to treat advanced sinonasal malignancies remains unknown. METHODS One hundred two patients with locally advanced sinonasal cancers treated with proton beam radiation therapy with or without surgery were retrospectively reviewed. Extent of surgery and outcome variables of local control, disease-free survival, and overall survival were evaluated. Patterns of failure were also assessed. RESULTS Extent of surgery correlated with disease-free survival and overall survival rates. Local control rate, however, was independent of the degree of surgical resection achieved. Overall, treatment failure most commonly resulted from distant metastases, which occurred in 30% of patients and also correlated with extent of surgical resection. Tumor type-specific outcomes reveal differences associated with the extent of surgery achieved. CONCLUSION High-dose radiotherapy with proton beam resulted in excellent local control rates in patients with locally advanced sinonasal cancer, irrespective of the extent of surgery. Complete resection, however, was predictive of improved disease-free survival and decreased rate of distant metastasis.
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Affiliation(s)
- Vicente A Resto
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Kutluhan A, Yilmaz N, Yakut F, Yurttaş V, Uğraş S. [Treatment of olfactory neuroblastoma via subfrontal and midfacial degloving approaches: a case report]. Kulak Burun Bogaz Ihtis Derg 2008; 18:56-58. [PMID: 18443406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 12-year-old girl presented with complaints of nasal obstruction and a right infraorbital swelling. A biopsy obtained from the right nasal passage revealed olfactory neuroblastoma. The tumor was completely excised via subfrontal craniofacial and midfacial degloving approaches. No recurrence was observed during a three-year follow-up.
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Affiliation(s)
- Ahmet Kutluhan
- Department of Otolaryngology, Medicine Faculty of Yüzüncü Yil University, Van, Turkey.
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Abstract
The purpose of this article is to report a case of esthesioneuroblastoma involving the bilateral paranasal sinuses, which was excised using an endoscopic-assisted transfacial approach. A patient presented with nasal swelling and left-sided nasal obstruction, epistaxis, and diplopia. Examination revealed broadening of the nasal dorsum with a fleshy pink mass in both nasal cavities. Computed tomographic scan showed a mass involving the nasal cavity and paranasal sinuses on both sides. The tumor was diagnosed as group C esthesioneuroblastoma. The mass was excised by bilateral medial maxillectomy and bilateral frontoethmoidectomy. Using a 0 degrees endoscope, the attachment of the tumor to the cribriform plate was identified and resected using a motordrill. On Waroff staining, Hispathology slides suggested esthesioneuroblastoma. The patient was asymptomatic for 1 year, following which he developed infection of the nasal cavity for which he had no form of treatment. He subsequently developed maggots in the nasal cavity after which he died. An endoscopic resection of the cribriform plate from the nasal cavity without a formal craniofacial resection can be safely performed with oncologic safety.
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Affiliation(s)
- Kishore Chandra Prasad
- Department of Otolaryngology-Head & Neck Surgery, Kasturba Medical College & Affiliated Hospitals Mangalore, Karnataka State, India.
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Castelnuovo P, Bignami M, Delù G, Battaglia P, Bignardi M, Dallan I. Endonasal endoscopic resection and radiotherapy in olfactory neuroblastoma: our experience. Head Neck 2007; 29:845-50. [PMID: 17427966 DOI: 10.1002/hed.20610] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Our aim was to evaluate the efficacy of a bimodal method of treatment consisting in endoscopic resection followed by radiotherapy in patients with olfactory neuroblastoma (ON). METHODS This is a retrospective review on 10 patients with ON treated at a tertiary referral center. All the patients were treated with endonasal endoscopic resection, and 1 refused postoperative radiotherapy. RESULTS No mortality was observed. Local tumor control was obtained in all the patients. Follow-up ranged from 15 to 79 months (median, 37 months). One patient developed a regional recurrence and for this was treated with bilateral, modified type III radical neck dissection plus radiotherapy on the neck. All patients regained a good quality of life after the treatment. CONCLUSIONS This method of treatment causes minimal injury to the patients, reduces side effects, and improves the quality of life of those with olfactory neuroblastoma.
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Affiliation(s)
- Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Azienda Ospedaliero Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Xie MQ, Li ZH, Liu X, Li Y, Xu G. [Retrospective analysis of the effect of intranasal endoscopic resection of olfactory neuroblastoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2007; 42:669-672. [PMID: 18051565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate the effectiveness of intranasal endoscopic resection of olfactory neuroblastoma and the significance of assistant radiotherapy. METHODS Six patients (4 men and 2 women) ranging in age from 9-68 years (median age, 48 years) with olfactory neuroblastoma treated endoscopically at the Third Affiliated Hospital of SUN Yat-sen University between August 2001 and September 2005 were retrospectively analyzed. The Kadish clinical stage was determined for all six cases, two cases with stage B, and 4 with stage C. The duration of endoscopic follow-up ranged from fourteen months to sixty three months. RESULTS The tumor in five patients was completely excised including one case underwent craniotomy firstly and one case underwent neck dissection and the another case had her tumor subtotally resected. Five cases underwent assistant radiotherapy after operation without any evidence of recurrence so far, while the other one (Kadish stage B, tumor totally resection), who had no radiotherapy after first procedure, died from local recurrence and cerebellar metastasis 31 months after operation. The medium survival duration was 44.5 months. CONCLUSIONS With simple approach, excellent visualization, a less operative invasiveness and no scar on face, the endoscopic approach appears to be the method of choice for the treatment of olfactory neuroblastoma. But it was necessary for good prognosis to combine with radiotherapy after operation.
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Affiliation(s)
- Min-qiang Xie
- Department of Otorhinolaryngology Head and Neck Surgery, The Third Affiliated Hospital of SUN Yat-sen University, Guangzhuo 510630, China.
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Dave SP, Bared A, Casiano RR. Surgical outcomes and safety of transnasal endoscopic resection for anterior skull tumors. Otolaryngol Head Neck Surg 2007; 136:920-7. [PMID: 17547980 DOI: 10.1016/j.otohns.2007.01.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 01/08/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report the surgical outcomes and safety of transnasal endoscopic resection (TER) for anterior skull base (ASB) tumors. STUDY DESIGN AND SETTING A retrospective chart review to identify patients undergoing TER for ASB tumors at a tertiary care medical center between September 1997 and June 2006. RESULTS Nineteen patients underwent TER for ASB tumors without open craniotomy. There were 17 malignant and two benign lesions. Olfactory neuroblastoma was the most common pathology, occurring in 53 percent of patients. One patient recurred locally, resulting in an overall local control rate of 94.7 percent for all neoplasms and 94.1 percent for malignant disease. It should be noted that the tumor control rate may be premature given the small sample size and limited follow-up. Overall, there were 16 complications, but only two of these, an orbital hematoma and a frontal lobe abscess, were considered major complications directly attributable to surgery. CONCLUSIONS TER for ASB tumors appears to be safe in properly selected patients. In light of the small sample size and limited follow-up, the major complication rate directly attributable to surgery was 11 percent, and the overall local control rate was 95 percent. A larger multi-institutional series with longer follow-up is warranted.
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Affiliation(s)
- Sandeep P Dave
- Department of Otolaryngology-Head and Neck Surgery, Jackson Memorial Medical Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
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41
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Cunningham MJ, Lin DT, Curry WT, Ebb DH, Yock TI, Curtin HD, Faquin WC. Case records of the Massachusetts General Hospital. Case 20-2007. An 11-year-old boy with a calcified mass in the nose. N Engl J Med 2007; 356:2721-30. [PMID: 17596608 DOI: 10.1056/nejmcpc079014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
BACKGROUND Craniofacial resection (CFR) for patients over 70 years of age is uncommon. This study examines a cohort of 36 patients who had CFR at a single institution with the aim of reporting mortality, complications, and outcome. METHODS Thirty-six patients 70 years of age and older were identified from a prospective database of 234 patients who had CFR at a single institution. The median age was 72 years (range, 70-87). Seventeen (47%) patients had had prior single-modality or combined treatment, which included surgery in 14 (40%), radiation in 13 (36%), and chemotherapy in 2 (6%). Thirty-five patients had a malignant tumor and 1 patient a benign tumor; 15 (42%) had high-grade, 17 (47%) intermediate-grade, and 4 (11%) low-grade pathology. The margins of resection were close or microscopically positive in 18 (50%). Adjuvant radiotherapy was given in 15 (42%) and chemotherapy in 1 (3%). Complications were classified into overall, local, central nervous system (CNS), systemic, and orbital. Overall survival (OS) and disease-specific survival (DSS) were determined using the Kaplan-Meier method. Outcomes were compared with patients less than 70 years of age. RESULTS Postoperative mortality occurred in 6 (17%) patients and postoperative complications occurred in 23 (64%) patients. Local wound complications occurred in 11 (30%), CNS in 12 (33%), systemic in 6 (17%), and orbital in 1 (3%). Postoperative mortality and complications were significantly higher in patients 70 years of age and older compared with patients less than 70 years of age (17% versus 1.5%, p = .0005; 64% versus 36%, p = .003, respectively). With a median follow-up of 27 months (range, 1-237), the 3 year OS and DSS were significantly poorer than patients less than 70 years of age (OS: 53% versus 69%, p = .0004; DSS: 61% versus 70%, p = .01) due to increased medical comorbidity (53% versus 24%, p = .001) and poorer histology (high-, intermediate-, low-grade histology: 42%, 47%, 11% versus 26%, 47%, 27%, p = .05, respectively) in patients over 70 years of age. CONCLUSION CFR in patients 70 years of age and older is associated with increased mortality, increased incidence of complications, and a poorer overall and disease-specific 3-year survival, compared with patients less than 70 years of age. The survival was likely due to increased medical comorbidity and adverse histology. These factors must be taken into account when considering an elderly patient for craniofacial resection.
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Affiliation(s)
- Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Almubaslat M, Africk C. Cerebral vasospasm after resection of an esthesioneuroblastoma: case report and literature review. ACTA ACUST UNITED AC 2007; 68:322-8; discussion 328. [PMID: 17586013 DOI: 10.1016/j.surneu.2006.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Accepted: 09/27/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the last 40 years, there were several reports of symptomatic cerebral vasospasm occurring after resection of brain neoplasms. In most cases, delay in recognition of this complication leads to significant neurologic deterioration postoperatively, regardless of the outcome of surgery. We illustrate in this report a case of cerebral vasospasm after resection of an esthesioneuroblastoma in an adult patient. This is the first report of vasospasm after resection of this neoplasm. CASE DESCRIPTION A 41-year-old woman presented with complaints of headache, dizziness, visual blurring, and diplopia of several-day duration. Funduscopic examination revealed papilledema. Radiological studies revealed a large frontal lobe mass extending through the cribriform plate into the ethmoid sinus with accompanying brain edema. The patient underwent a craniotomy for resection of the neoplasm. Pathological findings were consistent with a high-grade esthesioneuroblastoma. Eleven days postoperatively, the patient's neurologic status declined. Diffusion-weighted MRI of the brain showed an infarct involving mainly the left PCA as well as branches of the left anterior and middle cerebral arteries. Angiography revealed narrowing of the corresponding cerebral vessels consistent with vasospasm. Hypervolemic, hypertensive therapy with nimodipine and corticosteroids were instituted. The patient initially improved but was left with a right homonymous hemianopsia upon discharge 23 days postoperatively. CONCLUSIONS Delayed neurologic deficit from vasospasm after tumor resection is a complication that is being reported in increasing numbers. These cases involved tumors in or adjacent to the basal cisterns, or surgical approaches that increase the propensity of blood to accumulate intraoperatively or postoperatively in a specific pattern in the basal subarachnoid space. A high index of suspicion for vasospasm should be maintained in patients who develop delayed neurologic deficit, especially when there is evidence of profuse intraoperative bleeding or postoperative blood in the basal cisterns. Early recognition of this phenomenon and early institution of proper therapy can reverse some or all of the neurologic deficit and improve the overall outcome for these patients.
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Vergani F, Pirola E, Fiori L, Pagni F, Parmigiani F, Sganzerla EP. Combined transcranial and endoscopic nasal resection for esthesioneuroblastoma. Technical note. J Neurosurg Sci 2007; 51:99-102. [PMID: 17571044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Esthesioneuroblastoma is a rare malignant neoplasm arising in the nasal cavity. Huge esthesioneuroblastomas, extending into the ethmoid roof and the cribriform plate, or invading the anterior cranial fossa, have traditionally been treated by craniofacial resection. Because of the invasiveness and potentially disfiguring results of a transfacial approach, a new technique has been proposed, combining endoscopic nasal and anterior craniotomy resection. We describe the case of a young male presenting with a large esthesioneuroblastoma involving the nasal cavity and the anterior cranial fossa, causing a huge skull base destruction. A combined transcranial and endoscopic nasal resection resulted in a macroscopically total removal of the tumor. The operative technique is reviewed in detail, along with the method used for the reconstruction of the anterior skull base defect.
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Affiliation(s)
- F Vergani
- Department of Neurosurgery, University of Milano-Bicocca, Monza, Italy.
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Kim HJ, Kim CH, Lee BJ, Chung YS, Kim JK, Choi YS, Yoon JH. Surgical treatment versus concurrent chemoradiotherapy as an initial treatment modality in advanced olfactory neuroblastoma. Auris Nasus Larynx 2007; 34:493-8. [PMID: 17499464 DOI: 10.1016/j.anl.2007.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 01/23/2007] [Accepted: 02/18/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Olfactory neuroblastomas are very aggressive tumors with a high locoregional recurrence rate and distant metastasis. Surgical treatment, including craniofacial resection, has been the main treatment modality, but treatment outcomes of concurrent chemoradiotherapy remain unclear. We present our experiences regarding the treatment outcome of patients with advanced olfactory neuroblastoma undergoing surgical treatment and concurrent chemoradiotherapy. METHODS We retrospectively analyzed 16 patients treated for advanced olfactory neuroblastoma within the past 10 years. RESULTS The disease-free 5-year survival rate of the patients (n = 10) who underwent surgical treatment was 68%. The survival rate for patients (n = 6) who received concurrent chemoradiotherapy was 42%. The difference in the survival rate was not statistically significant, and no difference in the recurrence rate between the two groups. In the group having surgical treatment, post-operative radiotherapy and salvage therapy were important to increase the survival rate. In the group having concurrent chemoradiotherapy, no patient experienced primary tumor progression. CONCLUSION Complete surgical resection, including craniofacial resection (CFR), and post-operative radiotherapy seem to be essential in the treatment of advanced olfactory neuroblastoma. However, concurrent chemoradiotherapy may be another primary treatment modality.
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Affiliation(s)
- Hyun Jik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Republic of Korea
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Mori R, Sakai H, Kato M, Hida T, Nakajima M, Fukuda T, Fukunaga M, Abe T. [Olfactory neuroblastoma with spinal metastasis: case report]. No Shinkei Geka 2007; 35:503-8. [PMID: 17491347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Olfactory neuroblastoma is a rare tumor of the nasal cavity. It is a locally aggressive tumor with local recurrence, and distant metastasis occurs in 22-40% of patients. We report a case of olfactory neuroblastoma with cauda equina metastases. A 49-year old male had undergone surgery twice previously; the first for olfactory neuroblastoma in October, 1990, and the second for its intracranial and orbital metastasis in September, 1999. He complained of lumbago in autumn, 2005 and MRI showed two enhanced lesions in the cauda equina. The mass was partially removed and histologically diagnosed as olfactory neuroblastoma metastasis. Whole-spine irradiation of 32 Gy and lumber-spine irradiation of 10 Gy were performed. The mass at L2/3 was disappeared after the irradiation although the mass at L4/5 was not changed in size. The patient was discharged without neurological deficit and is now kept under observation as an outpatient. Olfactory neuroblastoma with spinal metastasis is rare and only 11 cases have been reported in the literature. A very poor prognosis was observed in the patients of olfactory neuroblastoma with spinal metastasis. Olfactory neuroblastoma is a radiosensitive tumor, and radiotherapy for spinal metastasis was reported to be effective. However, effectiveness of chemotherapy was still uncertain. The patient with olfactory neuroblastoma should be observed carefully even though no local recurrence had been detected over 10 years. Radiotherapy and further treatment including chemotherapy should be considered in case of spinal metastasis.
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Affiliation(s)
- Ryosuke Mori
- Department of Neurosurgery, Jikei University School of Medicine, Daisan Hospital, Izumihoncho, Komae-shi, Tokyo, Japan
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Podboj J, Smid L. Endoscopic surgery with curative intent for malignant tumors of the nose and paranasal sinuses. Eur J Surg Oncol 2007; 33:1081-6. [PMID: 17329065 DOI: 10.1016/j.ejso.2007.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 01/11/2007] [Indexed: 11/21/2022] Open
Abstract
AIM To assess the efficacy of endoscopic surgical treatment in patients with nasal and paranasal sinus malignancies. PATIENTS AND METHODS During the period 1991-2006, 16 patients with nasal and paranasal sinus malignancies underwent endoscopic surgery with curative intent. The lesions included 11 carcinomas, two malignant melanomas, one olfactory neuroblastoma, one hondrosarcoma and one leiomyosarcoma. Tumors originated from the ethmoids in eight, and from the nasal cavity in another eight patients. Oncologic radicality of resection was verified by intraoperative frozen-section examination of biopsy specimens from the margins of the defect site. RESULTS Radical resection was accomplished in 15 out of 16 operated patients. There were no major intra- or postoperative complications. Ten patients were postoperatively irradiated. Follow up of the treated patients ranged from 15 to 178 months (median 67 months). One patient with malignant melanoma died of generalized disease nine months after treatment, another with malignant melanoma recurred locally 30 months and again 49 months after first operation and is at the time of evaluation disease free and one died 21 months after operation without evidence of disease. CONCLUSIONS It seems that in selected cases, endoscopic surgery with curative intent for removal of malignant tumors of the nasal and paranasal cavities in the hands of highly experienced surgeon is justified.
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Affiliation(s)
- J Podboj
- Clinical Center, University Department of Otorhinolaryngology and Cervicofacial Surgery, Zaloska 2, 1525 Ljubljana, Slovenia.
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Suriano M, De Vincentiis M, Colli A, Benfari G, Mascelli A, Gallo A. Endoscopic treatment of esthesioneuroblastoma: a minimally invasive approach combined with radiation therapy. Otolaryngol Head Neck Surg 2007; 136:104-7. [PMID: 17210343 DOI: 10.1016/j.otohns.2006.04.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 04/26/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In a retrospective analysis we discuss our experience in the treatment of olfactory neuroblastoma (ON), a rare tumor of the sinonasal tract. STUDY DESIGN AND SETTING Nine patients with olfactory neuroblastoma were treated at the Bolognini Hospital of Seriate and at the Department of Otolaryngology of "La Sapienza" University of Rome combining endoscopic surgery and postoperative radiation therapy. All patients were staged according to Kadish criteria. No chemotherapy was administered in any cases. Local radiation therapy was started postoperatively in all the cases. RESULTS All patients, over an average follow-up which ranged from 26 through 60 months, are actually alive with non evidence of disease (NED). CONCLUSIONS Despite the short follow-up in this small series of patients, we suggest endoscopic surgery combined with postoperative radiation therapy as an alternative to the conventional modalities of treatment for esthesioneuroblastoma in selected cases.
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Affiliation(s)
- Maria Suriano
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Bolognini, Seriate, Italy.
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Zhang LW, Zhang MS, Qi J, Zhang JT, Li GL, Luo L, Wang ZC. Management of intracranial invasive olfactory neuroblastoma. Chin Med J (Engl) 2007; 120:224-7. [PMID: 17355826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Olfactory neuroblastoma (ONB) is a rare tumor that often arise from the nasal cavity. The aim of this study was to investigate the clinical characteristics and treatments of intracranial invasive ONB. METHODS Between July 2001 and August 2005, 5 patients with intracranial invasive ONB were treated in our department. Their clinical features, radiological and pathological characteristics, and surgical treatments were analyzed. Among the 5 patients, 1 received transnasal biopsy, and 4 were operated through the transfrontal or extended bifrontal approaches to reconstruct the skull base. After the operation, all the patients received radiotherapy, and one received chemotherapy. They were followed up for 6 to 45 months. RESULTS The ONB was resected totally in the 4 patients. In all the patients, nasal obstruction was alleviated without cerebrospinal fluid leakage. The visual acuity was improved in 3 patients, who had a decreased visual acuity before the operation. Two patients had metastasis into the lumbosacral spinal canal 6 and 8 months after the operation, one of them received a second operation and the other died. CONCLUSION ONB has no specific symptoms. Intracranial ONB should be resected as far as possible, and treated by radiotherapy after the operation.
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Affiliation(s)
- Li-wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
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Dahabreh I, Janinis D, Stamatelopoulos AG, Bontozoglou N, Dahabreh J. Surgical resection of esthesioneuroblastoma metastasis to the chest wall. J Thorac Oncol 2007; 2:93-5. [PMID: 17410019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A 51-year-old female patient was evaluated for a painful chest wall mass causing atelectasis of the right lung, pleural effusion, and dyspnea. The patient's history was significant for esthesioneuroblastoma at the age of 24; multiple recurrences of the tumor had been treated with surgery, radiotherapy, and chemotherapy. Surgical resection of the chest wall mass relieved her symptoms and improved her quality of life. Histologic examination confirmed metastatic esthesioneuroblastoma. The patient developed generalized disease and finally died 2 years after surgery. This case demonstrates the long natural history of this rare neoplasm and the need for close follow-up of patients so that they can be treated early.
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Affiliation(s)
- Issa Dahabreh
- Department of Thoracic Surgery, Athens Medical Center, Marousi, Greece.
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