Transnasal, transfacial, anterior skull base resection of olfactory neuroblastoma

Nabili, Vishad; Kelly, Daniel F.; Fatemi, Nassrin; St. John, Maie; Calcaterra, Thomas C.; Abemayor, Elliot

doi:10.1016/j.amjoto.2010.05.003

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 32, Issue 4 , Pages 279-285, July 2011

Transnasal, transfacial, anterior skull base resection of olfactory neuroblastoma☆

Vishad Nabili, MD
- Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Corresponding author. Division of Head and Neck Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, RM 62-132 CHS, Los Angeles, CA 90095-1624. Tel.: +1 310 206 9568; fax: +1 310 206 1393.
Daniel F. Kelly, MD
- Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA
Nassrin Fatemi, MD
- Department of Neurological Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Maie St. John, MD, PhD
- Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Thomas C. Calcaterra, MD
- Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Elliot Abemayor, MD, PhD
- Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Received 19 January 2010 published online 23 August 2010.

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 rerecurrent 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.