Commentary

The authors present their series of eight patients treated for olfactory neuroblastoma with isolated transcranial resections. The traditional approach to these tumors has involved a combined approach using transfacial and transcranial routes. The authors eliminated the facial approach in an attempt to improve postoperative cosmesis by avoiding potentially disfiguring facial incisions. For carefully selected patients, they demonstrated that this approach is feasible and provides an appropriate en bloc oncological resection. The small size of the study prevents significant conclusions about this approach, but it demonstrates that further study and patient accrual are warranted. The authors appropriately explain that this approach is limited to tumors that do not extensively involve the orbit, maxillary antrum, nasal floor, or oropharynx. However, in patients with tumors lacking these features, the transcranial approach alone may provide long-term results equivalent to those of the traditional combined transfacial and transcranial approaches, while eliminating potentially disfiguring facial incisions.