Minim Invasive Neurosurg 2003; 46(5): 310-315
DOI: 10.1055/s-2003-44452
Technical Note
© Georg Thieme Verlag Stuttgart · New York

Endoscopic-Assisted Craniofacial Resection of Esthesioneuroblastoma: Minimizing Facial Incisions - Technical Note and Report of 3 Cases

J.  K.  Liu1 , B.  O’Neill1 , R.  R.  Orlandi2 , A.  L.  Moscatello3 , R.  L.  Jensen1 , W.  T.  Couldwell1
  • 1Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
  • 2Division of Otolaryngology - Head and Neck Surgery,
  • 3Department of Otolaryngology, New York Medical College, Valhalla and New York, New York, USA
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Publikationsdatum:
19. November 2003 (online)

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Abstract

The surgical management of esthesioneuroblastoma with anterior skull base involvement has traditionally been craniofacial resection, which combines a bifrontal craniotomy with a transfacial approach. The latter usually involves a disfiguring facial incision, mid-facial degloving, lateral rhinotomy, and/or extensive facial osteotomies, which may be cosmetically displeasing to the patient. The advent of angled endoscopes has provided excellent magnification and illumination for surgeons to remove tumors using minimally invasive techniques. The authors describe their experience with three cases of esthesioneuroblastoma, which were surgically removed using a transnasal endoscopic approach, avoiding transfacial incisions. Preoperative radiographs were reviewed and tumors were staged according to the Kadish staging system. One patient had a recurrent esthesioneuroblastoma (Kadish stage B), which was removed entirely through a transnasal endoscopic approach. Two patients had intracranial extension (Kadish stage C), which were resected with a combined approach, endoscopically from below and a bifrontal craniotomy from above, to remove intracranial disease. All patients underwent reconstruction of the anterior skull base. Esthesioneuroblastomas confined to the nasal and paranasal cavities (Kadish stage A and B) were readily accessible through the transnasal endoscopic approach. If there was significant intracranial disease (Kadish stage C), adding a bifrontal craniotomy provided excellent exposure for complete resection of involved tumor. All patients underwent complete tumor resection with negative margins. None developed a cerebrospinal fluid (CSF) leak. The endoscopic-assisted craniofacial approach for the surgical management of esthesioneuroblastomas provides excellent exposure, adequate visualization, and the cosmetic benefit of avoiding an external facial incision.

References

William T. Couldwell,M.D. Ph.D 

Department of Neurosurgery · University of Utah Health Sciences Center

50 North Medical Drive

Salt Lake City, Utah 84132 · USA

Telefon: +1-801-581-6908

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eMail: william.couldwell@hsc.utah.edu