Craniopharyngiomas
March 13, 2019Esthesioneuroblastoma or Olfactory Neuroblastoma
Esthesioneuroblastoma or Olfactory Neuroblastoma
Esthesioneuroblastoma is an infrequent malignant skull base tumor located in the anterior skull base that originates in the olfactory neuroepithelial cells. Its origin is extracranial and extends through the lamina cribrosa to the endocranium. It is characterized by local aggressiveness and it first spreads to the cervical lymph nodes.
Clinically it is accompanied by sinusitis, facial pain, nasal obstruction, alterations in the sense of smell, bleeding, ocular proptosis, etc.
The ideal treatment is total resection with tumor-free margins, followed by an evaluation of the possibiltiy of radiation therapy. It is considered to generally have a better prognosis than other kinds of tumors which can occur in nasal passages.
Our team prioritizes endoscopic endonasal treatment for extracranial and intracranial tumors when it is possible to completely remove the tumor. Otherwise a cranio-endoscopic approach is performed to meet the objective of treating the cancer effectively.
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- an intra-extra cranial esthesioneuroblastoma with displacement of the left orbital wall.
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- In this patient, a total endoscopic endonasal resection was performed without the need for a craniotomy and subsequent radiation therapy.
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- Endoscopic endonasal view showing the posterior wall of the frontal sinus and tumor in the roof of the nasal cavity which is invading the skull base.
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- Panoramic view of the tumor in the roof of the nasal cavity.
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- After the resection of the extracranial tumor, we can observe dura mater which had been invaded by the tumor.
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- We resect the dura invaded by the tumor and the brain begins to be exposed from the nasal passages. Both frontal lobes and both olfactory bulbs can be observed. Note how the tumor extends through the patient’s left olfactory nerve.
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- Final image of the complete resection. We observe a large defect in dura mater and a tumor free brain.
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- The reconstruction of the dura mater was performed with a synthetic dural patch.
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- We can observe the nasoseptal pedicled flap described by Dr. Hadad* and used for the reconstruction of the skull base.
Gustavo Hadad, MD; Luis Bassagaisteguy, MD; Ricardo L. Carrau, MD; Juan C. Mataza, MD; Amin Kassam, MD; Carl H. Snyder- man, MD; Arlan Mintz, MSc, MD. A Novel Reconstructive Tech- nique After Endoscopic Expanded Endonasal Approaches: Vascular Pedicle Nasoseptal Flap. Laryngoscope, 116:1882–1886, 2006.
