Transnasal Endoscopic Craniectomy For Esthesioneuroblastoma

Esthesioneuroblastoma (ENB) is a rare malignant neoplasm originating from neurosecretory cells of the olfactory mucosa. Staging the disease makes treatment decisions and prognostic information more accurate. Once the diagnosis of olfactory neuroblastomas is clinically and radiologically suspected, several staging systems can be used, but no single system has become universally accepted.The "gold-standard" treatment for ENB is still under investigation. The best management of ENB usually involves a combination of surgery and radiotherapy, associated or not with chemotherapy. A classic craniofacial resection (CFR) has been the most accepted surgical modality for the treatment of ENB. In the past two decades, however, expanded endonasal approach (EEA) has gained a highlight position in the management of selected tumors.For those tumors located unilaterally, that do not involve the crista galli or the dura on the other side, a unilateral transcribriform endoscopic approach might be performed. This procedure has the main advantage of permitting the preservation of olfaction, without impacting on long-term survival rates. For those cases in which the tumor crosses the midline, affects the crista galli, and/or infiltrates the dura on both sides, a classical bilateral transcribriform endoscopic approach must be performed.