Abstract
Objective: To illustrate an transnasal approach (endoscopic assisted transnasal-craniectomy) used for olfactory neuroblatoma treatment and to advocate this method of management followed by radiation therapy for selected cases, based on the Stamm-Kennedy (SK) stage system.
Method: A retrospective chart review was performed with 16 patients harboring olfactory neuroblastomas. Patients were categorized secondary to SK staging system. Twelve patients underwent the endoscopic assisted transnasal craniectomy (EATNC) approach, and 4 were submitted to hybrid approach (cranio-endoscopic) between 2000 and 2011 at a tertiary referral center.
Results: Seven SK-IVa, 5 SK-II, 2 SK-IVb, 1 SK-I, and 1 SK-V patients, aged 10 to 67 years (9 females and 7 males), were identified. In 10 cases the tumor was bilateral, and in six cases the tumor was unilateral. Twelve patients were submitted to EATNC, 4 patients were submitted to hybrid approach (cranio-endoscopic), and 1 was submitted to endonasal approach without craniectomy. Gross total resection was achieved in 12, and near total was achieved in 4 patients. Twelve patients were submitted to radiotherapy (75%). Four cases needed posterior surgery. Fourteen patients were disease free 5 to 72 months postresection, and 2 patients were lost during follow-up. Only 4 patients preserved olfactory function (unilateral cases treated without radiotherapy).
Conclusion: The EATNC is a promising approach for olfactory neuroblastoma treatment, even for those tumors with intradural extension. Most patients require radiation therapy, and in these cases there is no olfaction preservation.
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