Manthuruthil Christine, Lewis Jeremy, McLean Caitlin, Batra Pete S, Barnett Samuel L
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Neurological Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
World Neurosurg. 2016 Jun;90:1-5. doi: 10.1016/j.wneu.2016.02.035. Epub 2016 Feb 16.
Anterior craniofacial resection has served as the traditional surgical treatment of olfactory neuroblastoma (ON). With the development of extended endonasal approaches, the opportunity exists for using minimal access techniques for management of select tumors. This study assesses the impact of endoscopic resection on ON and patient outcomes and quality of life.
A retrospective review identified 10 patients with ON (3 women, 7 men; mean age 49.1 years) who underwent endoscopic resection during the period 2010-2013. Modified Kadish staging divided the cohort into 3 stage B patients (30%), 5 stage C patients (50%), and 2 stage D patients (20%). Outcome measures included extent of resection, complications, recurrence, and preoperative and postoperative Sino-Nasal Outcome Test-20 scores.
Gross total resection was achieved in all patients, with negative margins in 9 patients. One patient had negative frozen section pathology but was noted to have a positive posterior dural margin on final pathology. There was a 20% complication rate (pneumocephalus, ethmoid meningoencephalocele). Neoadjuvant chemotherapy and radiation were performed in 2 patients (Kadish stage C and D). Adjuvant chemotherapy and radiation were performed in 5 patients (4 Kadish stage C and 1 stage D). Postoperative radiation alone was administered in 3 patients (Kadish stage B). Analysis of postoperative Sino-Nasal Outcome Test-20 scores demonstrated no significant change relative to preoperative Sino-Nasal Outcome Test-20 scores. At the most recent follow-up examination, there was no evidence of recurrent disease in patients who underwent endoscopic resection. One patient (Kadish stage D) died during the follow-up period. Mean follow-up duration was 21.1 months.
This series adds to the growing body of literature that suggests equivalent or improved outcomes of purely endonasal resection for select patients. Given the advanced Kadish stage of most of our patients, longer follow-up is required to determine the full applicability of purely endoscopic approaches to the treatment of ON.
前颅面切除术一直是嗅神经母细胞瘤（ON）的传统外科治疗方法。随着扩大经鼻入路技术的发展，存在使用微创技术治疗特定肿瘤的机会。本研究评估了内镜切除术对ON以及患者预后和生活质量的影响。
一项回顾性研究确定了10例在2010年至2013年期间接受内镜切除术的ON患者（3例女性，7例男性；平均年龄49.1岁）。改良Kadish分期将该队列分为3例B期患者（30%）、5例C期患者（50%）和2例D期患者（20%）。观察指标包括切除范围、并发症、复发情况以及术前和术后的鼻窦结局测试-20评分。
所有患者均实现了大体全切，9例患者切缘阴性。1例患者冰冻切片病理阴性，但最终病理显示硬脑膜后缘阳性。并发症发生率为20%（气颅、筛窦脑膜脑膨出）。2例患者（Kadish C期和D期）接受了新辅助化疗和放疗。5例患者（4例Kadish C期和1例D期）接受了辅助化疗和放疗。3例患者（Kadish B期）仅接受了术后放疗。术后鼻窦结局测试-20评分分析显示，与术前鼻窦结局测试-20评分相比无显著变化。在最近的随访检查中，接受内镜切除术的患者没有复发疾病的证据。1例患者（Kadish D期）在随访期间死亡。平均随访时间为21.1个月。
本系列研究增加了越来越多的文献证据，表明对于特定患者，单纯经鼻内镜切除术的预后相当或有所改善。鉴于我们大多数患者的Kadish分期较晚，需要更长时间的随访来确定单纯内镜方法在ON治疗中的全面适用性。
