Esthesioneuroblastomas with intracranial invasion (Kadish C): neurosurgical management

Abstract

Esthesioneuroblastomas are only 3% of endonasal tumors. The importance in our area is its high tendency to invade the skull base and adjacent structures; the negative impact over the life of the patient requires handle immediately after diagnosis. Objectives: to establish the best surgical approach in the management of this disease, evaluate the type of treatment, prognostic factors and to compare them with the world literature. Methods: a retrospective, descriptive and longitudinal study of five patients with diagnosis of esthesioneuroblastomas Kadish C managed in our department, with an analysis of prognostic factors, the importance of the surgical technique, results and evolution. Results: 2 women (40 %) and 3 men (60 %) were treated; according to Kadish, five were type C. Histological outcome as rated by Hyams was 3 cases in grade I, 1 grade II case and 1 case in grade IV. One bifrontal approach was performed combined with facial degloving in 5 cases, achieving a 100 % tumor resection in 80% with check resection by endonasal endoscopy. Of these, five patients received radiotherapy management; 80% (4 cases) are alive free of disease. Conclusions: the bifrontal approach with facial degloving in Kadish stage C supported by endonasal endoscopy in all cases we believe is still the first choice of surgical treatment. Radiation therapy is an adjunct in all cases and chemotherapy in selected cases. The only well-documented prognostic factor in our series is grade Hyams .