Exclusively endoscopic surgical resection of esthesioneuroblastoma: A systematic review

Abstract

Background Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long‐term and large scale outcomes data. Objective The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery. Methods In accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas. Results Forty‐four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy‐two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6–83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5‐year follow‐up, reported overall survival was 91.1%. Conclusion Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5‐year survival is 91.1%.

Treatment of unilateral olfactory neuroblastoma: Appropriate extent of surgical resection and potential for olfactory preservation

“…Postoperative CSF leak was estimated at 1% and meningitis at approximately 1.8% in a review of 399 endoscopic ONB resections. 18 Furthermore, removing mucosa along the olfactory cleft may worsen postoperative olfaction even though the ipsilateral olfactory bulb and tract are preserved. Unilateral ONB resection including the cribriform plate, dura, and olfactory bulb and tract may be considered for cases under the following circumstances: (1) tumors not involving the contralateral septal mucosa or olfactory cleft and (2) adequate clearance of midline dural margins with intraoperative frozen pathology (Figure 1).…”

“…However, the risk of such complications is generally infrequent, especially with the use of vascularized flaps. Postoperative CSF leak was estimated at 1% and meningitis at approximately 1.8% in a review of 399 endoscopic ONB resections 18 . Furthermore, removing mucosa along the olfactory cleft may worsen postoperative olfaction even though the ipsilateral olfactory bulb and tract are preserved.…”

Olfactory neuroblastoma: diagnosis, management, and current treatment options

“…Spielman DB et al., reported on 339 ONB patients undergoing ES for different stages and grades of disease. Negative margins have been achieved in 86.9% of cases with an overall recurrence rate of 10.3% and 5‐year survival of 91.1% ( 28 ). On the other hand, Patel et al.…”

“…Spielman DB et al, reported on 339 ONB patients undergoing ES for different stages and grades of disease. Negative margins have been achieved in 86.9% of cases with an overall recurrence rate of 10.3% and 5-year survival of 91.1% (28). On the other hand, Patel et al reported on 151 patients from 17 institutions who underwent TS, of these 77% of tumors with Kadish stage C. Overall 60% had received treatment before TS, radiation therapy or chemotherapy.…”