phenylephrine-hydrochloride and Esthesioneuroblastoma--Olfactory

Esthesioneuroblastoma is a rare malignant tumor of sinonasal origin. These tumors typically present with unilateral nasal obstruction and epistaxis, and diagnosis is confirmed on biopsy. Over the past 15 years, significant advances have been made in endoscopic technology and techniques that have made this tumor amenable to expanded endonasal resection. There is growing evidence supporting the feasibility of safe and effective resection of esthesioneuroblastoma via an expanded endonasal approach. This article outlines a technique for endoscopic resection of esthesioneuroblastoma and reviews the current literature on esthesioneuroblastoma with emphasis on outcomes after endoscopic resection of these malignant tumors.

Topics: Endoscopy; Esthesioneuroblastoma, Olfactory; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Neurosurgical Procedures; Nose; Postoperative Complications; Skull Base Neoplasms; Tomography, X-Ray Computed; Treatment Outcome

The advances in endoscopy have revolutionized the management of sinonasal and skull base lesions. Many complex cancers that traditionally required open approaches are now amenable to purely endoscopic endonasal resection, providing less invasive surgery with lower morbidity but with comparable oncologic outcomes in terms of survival rates. This article discusses the current evidence for the multimodal management of sinonasal and anterior skull base cancers focusing on the different treatment protocols driven by histologic subtypes.

Topics: Adenocarcinoma; Carcinoma; Carcinoma, Adenoid Cystic; Carcinoma, Neuroendocrine; Carcinoma, Squamous Cell; Disease Management; Endoscopy; Esthesioneuroblastoma, Olfactory; Hemangiopericytoma; Humans; Maxillary Sinus Neoplasms; Nose; Professional Corporations; Skull Base; Skull Base Neoplasms; Survival Rate

Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and cerebrospinal fluid (CSF) fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature.. A literature search was performed in the electronic database Ovid MEDLINE (1950 to August 25, 2015) with the search item "([Anterior] AND Skull base surgery) AND endoscopic.". We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0%-68.0%) and a mortality rate of 0.4% (0%-10.0%) were demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0%-40.0%) with meningiomas and clival lesions having the greatest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumor was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a greater rate of meningitis compared with studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed.. The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease rates of complications.

Topics: Adenoma; Cerebrospinal Fluid Leak; Esthesioneuroblastoma, Olfactory; Fistula; Humans; Meningeal Neoplasms; Meningioma; Meningitis; Mortality; Nasal Cavity; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Nose; Nose Neoplasms; Pituitary Neoplasms; Postoperative Complications; Skull Base; Skull Base Neoplasms

Advanced-stage olfactory neuroblastoma requires multimodal therapy for optimal outcomes. Debate exists over endoscopic endonasal surgery in this situation. Stage-matched open and endoscopic surgical therapy were compared.. Patients from 6 cancer institutions were assessed. Stratification included dural involvement, Kadish stage, nodal disease, Hyams' grade, approach, and margin status. At follow-up, local control, nodal status, and evidence of distant metastases were recorded with any subsequent therapy. Statistical analyses to identify risk factors for developing recurrence and survival differences were performed.. One hundred nine patients were assessed (age 49.2 ± 13.0 years; 46% women) representing Kadish A stage (10%), Kadish B stage (25%), and Kadish C stage (65%). The majority of the patients (61.5%) underwent endoscopic resection, 53.5% within Kadish C stage. Within-stage survival analysis favored endoscopic subgroup for Kadish C stage (log-rank P = .017) nonsignificant for Kadish B stage (log-rank P = .39).. Stage-matched survival was better for the endoscopically treated group compared to the open surgery group, with high negative margin resections obtained.

Topics: Adult; Cohort Studies; Databases, Factual; Disease-Free Survival; Endoscopy; Esthesioneuroblastoma, Olfactory; Humans; Internationality; Kaplan-Meier Estimate; Middle Aged; Nasal Cavity; Neoplasm Invasiveness; Neoplasm Staging; Nose; Nose Neoplasms; Otorhinolaryngologic Surgical Procedures; Prognosis; Propensity Score; Retrospective Studies; Risk Assessment; Survival Analysis; Treatment Outcome

The purpose of this study is to demonstrate the potential contribution of positron emission tomography (PET)/computed tomography (CT) to help differentiate olfactory neuroblastoma (ONB) from sinonasal undifferentiated carcinoma (SNUC).. Following approval by the institutional review board at the Wexner Medical Center at the Ohio State University, Columbus, Ohio, a pilot study with retrospective review of patients with biopsy-proven diagnosis of ONB s and SNUC s was conducted. Staging PET/CT scans were reviewed to document the maximum standardized uptake value (SUVmax). A statistical comparison of SUVmax was performed.. 4. Laryngoscope, 2016 127:321-324, 2017.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma; Diagnosis, Differential; Esthesioneuroblastoma, Olfactory; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Pilot Projects; Positron Emission Tomography Computed Tomography

Dural and anterior cranial base reconstruction is essential in the surgical resection of a craniofacial tumor that extends from the paranasal sinuses to the subdural space. Watertight reconstruction of vascularized tissue is essential to prevent postoperative liquorrhea, especially under conditions that prevent wound healing (e.g., postoperative irradiation therapy).. We successfully treated two cases of olfactory neuroblastoma by endoscopic-assisted craniotomy with primary dural closure and anterior cranial base reconstruction using a multi-layered flap technique. Dural defects were closed using temporal fascia or fascia lata in a conventional fashion, immediately after detaching the subdural tumor, in order to isolate and prevent contamination of subdural components and cerebrospinal fluid (CSF) from the tumor and nasal sinuses. Tumor removal and anterior cranial base reconstruction were performed without any concern of CSF contamination after dural closure by craniotomy and endoscopic endonasal approach (EEA). Vascularized pericranial flaps (PCF) and nasoseptal flaps (NSF) were used simultaneously as doubled-over layers for reconstruction.. The tumor was completely removed macroscopically and the anterior cranial base was reconstructed in both cases. CSF leak and postoperative meningitis were absent. Postoperative and irradiation therapy courses were successful and uneventful.. This multi-layered anterior cranial base reconstruction consisted of three layers: a fascia for dural plasty and double-layered PCF and NSF. This surgical reconstruction technique is suitable to treat craniofacial tumors extending into the subdural space through the anterior cranial base dura mater.

Topics: Craniotomy; Dura Mater; Esthesioneuroblastoma, Olfactory; Humans; Nose; Plastic Surgery Procedures; Skull Base; Skull Base Neoplasms; Surgical Flaps; Video-Assisted Surgery

To explore the application of endoscopic endonasal approach in surgery for skull base tumor.. From August 2000 to February 2009, retrospective analyses were performed on clinical data of 21 patients with skull base lesions treated by endoscopic endonasal surgery. There were 3 chordoma, 6 olfactory neuroblastoma, 4 squamous cancer, 5 malignant melanoma, 1 mucoepidermoid carcinoma, 2 sphenoidal malignant adenoma.. Total tumor removal was obtained in 21 cases,subtotal removal in 2 cases. With follow up of 24 to 108 months, 4 cases were recurred, 5 cases were dead. The complications included cerebrospinal fluid (CSF) leak in 2 patients, intracranial infection after the endoscopic surgery in 1 patient. In the two patients with CSF leak, one case cured by internal medicine and another cured by endoscopic surgery.. The endoscopic endonasal surgery could provide sufficient treatment for skull base tumor, and is a safe, minimally invasive and efficient procedure, but indication should be exactitude selected.

Topics: Adult; Aged; Chordoma; Endoscopy; Esthesioneuroblastoma, Olfactory; Female; Humans; Male; Middle Aged; Nose; Retrospective Studies; Skull Base Neoplasms

The diagnostic workup on esthesioneuroblastoma is more extensive than ever before. We have investigated whether improvements in diagnosis of sinonasal neuroectodermal tumors, including esthesioneuroblastomas (ENB), sinonasal neuroendocrine carcinomas (SNEC) and sinonasal undifferentiated carcinomas (SNUC), have had an impact on treatment and outcome.. 11 ENB, 7 SNEC and 1 SNUC in 13 men and 6 women (average age 52.9 years (range 26-82)), diagnosed between 1986 and 2001, were analyzed with regard to histopathologic and clinical diagnosis as well as outcome. Our results were compared with the available literature.. According to the Morita classification considering endoscopy, CT and MRI scans, 2 tumors were staged D, 14 were found to be stage C, 2 were stage B and 1 was stage A. Lightmicroscopically only 4 of 19 showed higher differentiation and rosette-like structures, the others were poorly differentiated. 18 of 19 tumors were examined immunohistochemically. Neuronal markers (NSE, synaptophysin, chromogranin, S-100 and neurofilaments) were heterogeneously expressed in both ENB and NEC, only NSE stained all but 2 tumors. Coexpression of neuronal markers and cytokeratins was proven in all NEC and 5 of 11 ENB. Some tumors expressed atypical markers. Despite extensive diagnostic steps it was not possible to exclude a different histopathological diagnosis in 10 of 19 cases.. For sinonasal neuroectodermal tumors no pathognomonic antigenic profiles are known. Immunohistochemical markers lack specificity and sensitivity. Nevertheless, in many sinonasal neuroectodermal tumors a panel of differentiation markers allows to specify the light-microscopic diagnosis. Until now no therapeutic consequence arises from a more extensive diagnostic workup. However, the histopathologic identification of subtypes (SNUC) and proliferation markers may help to identify patients with poor prognosis.

Topics: Adult; Aged; Biomarkers, Tumor; Biopsy; Combined Modality Therapy; Diagnosis, Differential; Diagnostic Imaging; Endoscopy; Esthesioneuroblastoma, Olfactory; Female; Humans; Male; Middle Aged; Neoplasm Staging; Neuroectodermal Tumors; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Survival Rate

Esthesioneuroblastoma is a rare tumor, which in many cases is diagnosed at an advanced stage with an high recurrence rate and incidence of metastases. Regionary metastases predict a poor prognosis. There is no standard therapy approach for these tumors. The most widly accepted primary therapy is radical craniofacial enbloc resection followed by radiation therapy. Today chemotherapy is getting more important and is administered with curative intention. Multidisciplinary management results in significantly longer survival in advanced tumor stages and recurrence. A clinical staging system as well as histopathological grading according of Hyams could be from importance for selection and timing of the different therapeutic modalities. We present a case of a 34-year-old female patient who was diagnosed with an advanced olfactory neuroblastoma of the upper nasal cavity with bilateral cervical lymph node metastasis (modified Kadish-stage D). Craniofacial resection and bilateral neck dissection was performed, followed by postoperative radiotherapy. Reviewing the recent literature the different therapeutic approaches are compared and discussed.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Esthesioneuroblastoma, Olfactory; Female; Humans; Lymphatic Irradiation; Lymphatic Metastasis; Magnetic Resonance Imaging; Neck Dissection; Neoplasm Invasiveness; Neoplasm Staging; Nose; Nose Neoplasms; Patient Care Team; Radiotherapy, Adjuvant; Tomography, X-Ray Computed

To determine whether the MR finding of cysts along the intracranial margin of sinonasal esthesioneuroblastomas can be considered to suggest this tumor.. MR scans of 54 patients who had sinonasal lesions with intracranial extension were examined specifically for cysts along the intracranial margins of the lesions.. Only 3 of the 54 patients had these cysts, and all 3 of these patients had esthesioneuroblastoma. Surgical pathologic findings of one specimen showed the cyst to be marginally located within the tumor.. If cysts are seen on MR along the intracranial margin of a sinonasal mass, this finding highly suggests esthesioneuroblastoma.

Topics: Biopsy; Brain; Brain Neoplasms; Cysts; Diagnosis, Differential; Esthesioneuroblastoma, Olfactory; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses