Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 10833 LeConte Avenue, Los Angeles, CA 90095, USA.
Am J Otolaryngol. 2011 Jul-Aug;32(4):279-85. doi: 10.1016/j.amjoto.2010.05.003. Epub 2010 Aug 21.
Using a transnasal, transfacial, anterior skull base approach, we have removed olfactory neuroblastomas (OFN) obviating the need for a frontal craniotomy. The objectives were to present our surgical approach in achieving clear margins, to assess patient survival, and to recommend eligibility criteria.
A retrospective chart review was done to identify patients diagnosed with OFN who underwent this surgical approach. Thirteen patients were identified who underwent our pictorially described approach. Postoperative assessment of pathologic margins, patient survival, and limitations of surgical approach was determined.
Of the 13 patients, 12 (92%) had clear postsurgical margins. One patient had residual intracranial disease due to coagulopathy preventing further resection. Twelve patients remain alive with 10 patients remaining disease-free (follow-up ranging from 11 to 64 months). Three patients presented with recurrent disease initially, with 2 having had subsequent repeat local and regional recurrences, respectively; one of whom died recently of the re-recurrent disease. One patient had a postoperative cerebrospinal fluid leak repaired via the original surgical approach.
Although craniofacial resection remains an accepted approach for surgical treatment of OFN, we have adopted a transnasal, transfacial approach eliminating the need for a frontal craniotomy. This approach allows for adequate exposure of the cribriform plate, dura, and anterior skull base. Our technique minimizes dural defects and prevents many craniotomy-associated complications, including frontal lobe retraction. Long-term follow-up is needed to compare survival using this approach; however, our results to date are quite promising.
通过经鼻、经面、前颅底入路，我们已经成功切除了嗅神经母细胞瘤（olfactory neuroblastoma，OFN），避免了开颅手术。本研究旨在介绍我们的手术方法以获得清晰的切缘，评估患者的生存率，并提出手术适应证。
对经鼻、经面、前颅底入路治疗 OFN 的患者进行回顾性病例分析。共纳入 13 例接受该手术入路的患者。评估术后病理切缘、患者生存率以及手术方法的局限性。
13 例患者中，12 例（92%）术后切缘清晰。1 例患者因凝血功能障碍无法进一步切除而残留颅内病变。12 例患者存活，10 例患者无瘤生存（随访时间 11~64 个月）。3 例患者最初出现复发性疾病，其中 2 例分别发生局部和区域复发，1 例最近因复发性疾病死亡。1 例患者术后发生脑脊液漏，通过原手术入路进行修复。
尽管颅面联合切除术仍然是 OFN 手术治疗的一种可接受的方法，但我们已经采用了经鼻、经面入路，避免了开颅手术。该方法可充分暴露筛板、硬脑膜和前颅底。我们的技术最大限度地减少了硬脑膜缺损，预防了许多开颅术相关并发症，包括额叶牵拉。需要长期随访来比较使用该方法的生存率，但我们目前的结果非常有希望。
