Minim Invasive Neurosurg 2001; 44(2): 79-84
DOI: 10.1055/s-2001-16000
ORIGINAL PAPER
Georg Thieme Verlag Stuttgart · New York

Olfactory Neuroblastoma (Esthesioneuroblastoma): Report of Six Cases Treated by a Novel Combination of Endoscopic Surgery and Radiosurgery

F. Unger1 , C. Walch2 , H. Stammberger2 , G. Papaefthymiou1 , K. Haselsberger1 , G. Pendl1
  • 1Department of Neurosurgery, Karl-Franzens University, Graz, Austria
  • 2Department Ears-Nose-Throat Diseases, Karl-Franzens University, Graz, Austria
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Microsurgical techniques have considerably improved the results of surgical treatment for esthesioneuroblastoma (olfactory neuroblastoma). Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and radiosurgery (gamma knife) is presented here. Six patients (3 males, 3 females) aged between 27 and 75 years (median 38 years) were treated between August 1993 and July 1999. Following paranasal and nasal endoscopic sinus surgery, marginal irradiation doses ranging from 16 to 34 Gy were applied radiosurgically involving up to 7 isocentres. At present, the median follow-up period is 57 months (range: 9 - 79 months). Without mortality, tumour control was achieved in all patients. One patient, who had to undergo additional craniotomy because of extensive neoplastic infiltration, developed postoperative liquorrhea. In another case the clinical course was complicated by a bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. However, a preoperative Karnovsky Index ranging from 80 to 100 % remained stable in four patients whereas an improvement was observed in two patients. Based on the favourable results observed so far, the combination of endoscopic sinus surgery and radiosurgery can be considered as promising new option for the treatment of esthesioneuroblastoma that merits further investigation.

References

  • 1 Berger L, Luc R. L'esthesioneuroepitheliome olfactif.  Bull Assoc Fr Etude Cancer. 1924;  13 410-421
  • 2 Dulguerov P, Calcaterra T. Esthesioneuroblastoma: the UCLA experience 1970 - 1990.  Laryngoscope. 1992;  102 843-849
  • 3 Kempf H-G, Becker G, Weber B P, Ruck P. Diagnostik und Therapie des Olfaktoriusneuroblastoms.  HNO. 1994;  42 422-428
  • 4 Kadish S, Goodman M, Wang C C. Olfactory neuroblastoma. A clinical analysis of 17 cases.  Cancer. 1976;  37 1571-1576
  • 5 Hyams V J. Tumors of the upper respiratory tract and ear. In: Hyams VJ, Batsakis JG, Michaels L (eds.): Atlas of Tumor Pathology, Second Series, Fascicle 25 Washington: Armed Forces Institute of Pathology 1988: 240-248
  • 6 Koka V N, Julieron M, Bourhis J, Janot F, Le Ridant A M, Marandas P, Luboinski B, Schwaab G. Aesthesioneuroblastoma.  J Laryngol Otol. 1998;  112 628-633
  • 7 Draf W, Samii M. Chirurgische Behandlung von bösartigen Tumoren der Nasennebenhöhlen mit Schädelbasisbeteiligung.  Strahlentherapie und Onkologie. 1989;  165 474-477
  • 8 Broich G, Pagliari A, Ottaviani F. Esthesioneuroblastoma: a general review of the cases published since the discovery of the tumour in 1924.  Anticancer Res. 1997;  17 2683-2706
  • 9 Schwaab G, Micheau C, Le Guillou C, Pacheco L, Marandas P, Domenge C, Richard J M, Wibault P. Olfactory esthesioneuroblastoma: a report of 40 cases.  Laryngoscope. 1988;  98 872-876
  • 10 Levine P A, McLean W C, Cantrell R W. Esthesioneuroblastoma: The University of Virginia experience 1960 - 1985.  Laryngoscope. 1986;  96 742-746
  • 11 Morita A, Ebersold M J, Olsen K D, Foote R L, Lewis J E, Quast L M. Esthesioneuroblastoma: prognosis and management.  Neurosurgery. 1993;  32 706-715
  • 12 Polin R S, Sheehan J P, Chenelle A G, Munoz E, Larner J, Phillips C D, Cantrell R W, Laws Jr E R, Newman S A, Levine P A, Jane J A, Shah J P, Gutin P H, Adler J R, Piepmeier J M. The role of preoperative adjuvant treatment in the management of esthesioneuroblastoma: the University of Virginia experience.  Neurosurgery. 1998;  42 1029-1037
  • 13 Ebersold M J, Olsen K D, Foote R L, Buckner J C, Quast L M. Esthesioneuroblastoma. In: Kaye AH, Laws ER Jr (eds.): Brain Tumours: An Encyclopedic Approach New York: Churchill Livingstone 1995: 825-838
  • 14 McElroy Jr E A, Buckner C J, Lewis J E. Chemotherapy for advanced esthesioneuroblastoma: the Mayo Clinic experience.  Neurosurgery. 1998;  42 1023-1028
  • 15 Han-Soo C, Nihei H. Theoretical comparison of surgery and radiosurgery in cerebral arteriovenous malformations.  J Neurosurg. 1999;  90 709-719
  • 16 Ling S M, Linzer D, Lu J, Raub W, Villalobos H, Ting J, Wu X, Landy H, Berti A, Markkoe A M. Local control of large primary brain tumors or metastasis treated by Leksell Gamma knife stereotactic radiosurgery: An analysis of dose-volume considerations, local control and complications.  J Radiosurg. 1999;  2 141-152
  • 17 Muacevic A, Kreth F W, Horstmann G A, Schmid-Elsaesser R, Wowra B, Steiger H J, Reulen H J. Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter.  J Neurosurg. 1999;  91 35-43
  • 18 Leber K A, Berglöff J, Pendl G. Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery.  J Neurosurg. 1998;  88 43-50
  • 19 Slevin N J, Irvin C JR, Banerjee S S, Gupta N K, Farrington W T. Olfactory neural tumours - the role of external beam radiotherapy.  J Laryngol Otol. 1996;  110 1012-1016
  • 20 Baron S H. Brain radiation necrosis following treatment of an esthesioneuroblastoma (olfactory neurocytoma).  Laryngoscope. 1979;  89 214-223
  • 21 Biller H F, Lawson W, Sachdev V P, Som P. Esthesioneuroblastoma: surgical treatment without radiation.  Laryngoscope. 1990;  100 1195-1201
  • 22 Anderhuber W, Stammberger H, Walch C, Fock C, Regauer S, Luxenberger W, Gotschuli A. Rigid endoscopy in minimally invasive therapy of tumours of the paranasal sinuses and skull base.  Min Invas Ther & Allied Technol. 1999;  8 25-32

Corresponding Author

F Unger, M.D 

Department of Neurosurgery
Karl-Franzens University

Auenbruggerplatz 29
8036 Graz
Austria

Phone: Phone:+43-316-3852708

Fax: Fax:+43-316-3853368

Email: E-mail:frank.unger@lkh-graz.or.at