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How I do it: endonasal transcribriform approach for resection of esthesioneuroblastoma

  • How I Do it - Tumor - Other
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Abstract

Background

Olfactory neuroblastoma, also known as esthesioneuroblastoma, accounts for only 3–6% of sinonasal malignancies but confers a 40% 5-year overall survival.

Method

The authors describe techniques for the endonasal, minimally invasive resection of an esthesioneuroblastoma in a 69-year-old man who presented with headaches and anosmia and describe surgical nuances and their effect on adjuvant therapy planning.

Conclusion

This approach, along with microsurgical techniques, helped increase tumor visualization, improved marginal resection, and reduced surgical risk, which may improve patient outcomes. Multilayered reconstruction with a synthetic dural substitute and creation of a nasoseptal flap were performed to reduce postoperative cerebrospinal fluid leak.

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References

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Acknowledgements

Figure 1 was created using the scientific digital animation platform bioRENDER. We thank Kristin Kraus, MSc, for editorial assistance.

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Authors and Affiliations

  1. College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    J. Curran Henson

  2. Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA

    Amarbir Gill & Jeremiah Alt

  3. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA

    Michael J. Karsy

Authors
  1. J. Curran Henson
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  2. Amarbir Gill
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  3. Jeremiah Alt
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  4. Michael J. Karsy
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Contributions

Conceptualization (Michael Karsy), writing – original draft preparation (J. Curran Henson), writing – reviewing and editing (All), supervision (Michael Karsy, Jeremiah Alt).

Corresponding author

Correspondence to Michael J. Karsy.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the (place name of institution and/or national research committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Patient consent for procedures, data collection, and review was obtained based on institutional guidelines.

Consent for publication

This study was performed in compliance with Institutional Review Board (IRB) and Health Insurance Portability and Accountability Act regulations. Patient consent for publication was not obtained because it is waived per institutional guidelines.

Conflict of interest

Michael Karsy receives royalties from Thieme Medical Publishing. The other authors report no conflicts of interest.

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Key Points

• Endonasal approaches can improve visualization and resection of tumor margins for sinonasal malignancies, further influencing adjuvant treatment.

• Combing endoscopic and open surgical approaches can help with improving resection margins.

• Early coagulation of the anterior ethmoidal artery, located approximately 24 mm posterior to the lacrimal crest, and the posterior ethmoidal artery, located 12 mm posterior to the anterior ethmoidal artery, helps to reduce tumor blood supply and improve resection.

• Identifying the lateral bony margins along the lamina papyracea, the anterior margins at the frontal outflow tract, and the posterior margins at the planum before bone removal helps to ensure adequate tumor visualization and removal.

• Use of the Aquamantys electrocautery can assist with tumor hemostasis and is safe if not placed directly on neurovascular structures.

• Resection of the anterior falcine margin and olfactory bulb helps to ensure clean tumor margins.

• Early creation of a large nasoseptal flap and establishment of clean margins is important for later reconstruction.

• Multilayer closure for prevention of cerebrospinal fluid leak is critical.

• Perioperative and operative management by an interdisciplinary team with experience in surgical and nonsurgical treatment approaches for sinonasal malignancies can achieve better patient outcomes.

• Adjuvant treatment, including radiation and/or chemotherapy, may be necessary for olfactory neuroblastomas with positive margins or for patients with metastatic disease.

This article is part of the Topical Collection on Tumor - Other

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Henson, J.C., Gill, A., Alt, J. et al. How I do it: endonasal transcribriform approach for resection of esthesioneuroblastoma. Acta Neurochir 164, 1949–1952 (2022). https://doi.org/10.1007/s00701-022-05178-x

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  • DOI: https://doi.org/10.1007/s00701-022-05178-x

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