Nakagawa Takayuki, Kodama Satoru, Kobayashi Masayoshi, Sanuki Tetsuji, Tanaka Shuho, Hanai Nobuhiro, Hanazawa Toyoyuki, Monobe Hiroko, Yokoi Hidenori, Suzuki Motohiko, Yamashita Masaru, Omori Koichi
Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Otolaryngology-Head and Neck Surgery, Oita University Faculty of Medicine, Yufu, Japan.
Auris Nasus Larynx. 2018 Apr;45(2):281-285. doi: 10.1016/j.anl.2017.05.001. Epub 2017 Jun 5.
The aim of the present study was to illustrate the safety and utility of the endoscopic endonasal approach (EEA) for the treatment of esthesioneuroblastomas (ENB).
We retrospectively reviewed patients with a diagnosis of ENB between March 2008 and February 2016 at 10 tertiary referral hospitals in Japan, and assessed demographic data, stage of disease, surgical approach, outcomes and postoperative complications.
A total of 22 patients (10 males and 12 females; mean age at presentation, 49.0 years) underwent endoscopic endonasal resection of newly diagnosed ENBs. Dulguerov staging at presentation was T1, 6 patients; T2, 9 patients; T3, 5 patients; and T4, 2 patients. As surgical procedures, unilateral resection via EEA was performed in 12 patients aiming preservation of the contralateral olfactory system, and bilateral resection via EEA was done in 10 patients. Post-operative radiotherapy was done in 20 patients. Pathological margin studies revealed margin-free resections in 21 patients (95.5%). The mean period of follow-up was 44 months. Local recurrence was observed in one T2 patient 12 months after bilateral resection. All patients were alive at the last follow-up, and 21 patients showed no evidence of disease. No post-operative complications including bleeding, CSF leak and meningitis were identified. Preservation of olfactory function was achieved in 11 patients (91.7%).
The results of the present study indicate the safety and utility of multilayer resection using EEA for treatment of ENBs.
本研究旨在阐明鼻内镜鼻内入路（EEA）治疗嗅神经母细胞瘤（ENB）的安全性和实用性。
我们回顾性分析了2008年3月至2016年2月期间日本10家三级转诊医院诊断为ENB的患者，评估了人口统计学数据、疾病分期、手术入路、治疗结果及术后并发症。
共有22例患者（男性10例，女性12例；就诊时平均年龄49.0岁）接受了新诊断ENB的鼻内镜鼻内切除术。就诊时Dulguerov分期为T1期6例；T2期9例；T3期5例；T4期2例。手术方式上，12例患者采用EEA单侧切除术以保留对侧嗅觉系统，10例患者采用EEA双侧切除术。20例患者术后接受了放疗。病理切缘检查显示21例患者（95.5%）切缘阴性。平均随访时间为44个月。1例T2期患者在双侧切除术后12个月出现局部复发。最后一次随访时所有患者均存活，21例患者无疾病证据。未发现包括出血、脑脊液漏和脑膜炎在内的术后并发症。11例患者（91.7%）实现了嗅觉功能保留。
本研究结果表明，使用EEA进行多层切除术治疗ENB具有安全性和实用性。
