Endoscopic endonasal compared with anterior craniofacial and combined cranionasal resection of esthesioneuroblastomas

Ricardo J. Komotar, Robert M. Starke, Daniel M.S. Raper, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalReview articlepeer-review

42 Scopus citations

Abstract

Objective: Esthesioneuroblastomas represent a surgical challenge because of their anatomical location, the necessity of achieving negative margins, and the often-cosmetically disfiguring transfacial approaches needed. Recently, expanded endonasal endoscopic approaches have been developed, either alone or in combination with a craniotomy. We conducted a systematic review of case series and case reports to compare outcomes between these various surgical approaches. Methods: A MEDLINE search was conducted of the modern literature (1985-2010) to identify open and endoscopic surgical series. Tumor and patient characteristics, Kadish stage, extent of resection, and progression-free and overall survival were recorded and analyzed by approach. Kaplan-Meier analysis was used to assess overall survival and progression-free survival. Results: Forty-seven studies comprising 453 patients were included. The endoscopic cohort had a greater proportion of Kadish Stage A tumors compared with the craniofacial group. Gross total resection was achieved in 98.1% of patients who underwent an endoscopic approach compared with 81.3% for the craniofacial and 100% for the cranionasal cohorts. Local recurrence occurred in 8.0% of patients in the endoscopic group compared with 22.1% in the craniofacial and 16.7% in the cranionasal cohorts. Conclusion: In well-selected cases, cranionasal and endonasal approaches can be safe and effective. An ongoing evaluation of the benefits and limitations are necessary to better define the ideal patient population and patient-specific risk factors for the use of these minimal access techniques.

Original languageEnglish (US)
Pages (from-to)148-159
Number of pages12
JournalWorld neurosurgery
Volume80
Issue number1-2
DOIs
StatePublished - Jul 1 2013

Keywords

  • Endonasal
  • Endoscopic
  • Esthesioneuroblastoma
  • Minimal access
  • Skull base
  • Surgery
  • Systematic review

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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