Klironomos Georgios, Gonen Lior, Au Karolyn, Monteiro Eric, Mansouri Alireza, Turel Mazda Keki, Witterick Ian, Vescan Alan, Zadeh Gelareh, Gentili Fred
Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
J Clin Neurosci. 2018 Dec;58:117-123. doi: 10.1016/j.jocn.2018.09.011. Epub 2018 Oct 16.
During the last two decades evolution of the endoscopic endonasal approaches (EEA) has offered the option of minimally invasive techniques in the management of esthesioneuroblastomas (ENB), either as endoscope assisted cranial resection or as pure endoscopic procedures. This study presents the use of pure EEA in the management of ENB in our center, along with a literature review. We retrospectively reviewed the clinical, radiology and pathology records of patients with ENB treated during the period July 2006 to January 2016. During the above period, ten patients with ENB were treated using pure EEA. The mean age was 47.5 years. The gender distribution was: eight males, two females. The most common presenting symptoms were nasal obstruction and discharge or epistaxis (8/10). The mean duration of symptoms was 1.5 years. All patients had preoperative confirmation of ENB by biopsy. Five patients received neoadjuvant radiation and four underwent postoperative radiation. One patient did not receive any radiotherapy and no patient received chemotherapy. Gross total resection was achieved in all patients and intraoperative microscopically negative surgical margins achieved in 9/10 (90%). No major intraoperative complications occurred. The most common postoperative complication was nasal infection. Cerebrospinal fluid leak was noted in one patient. During the follow-up period of 6-120 months (mean 74.8) two cases of neck lymph node recurrence were observed. No deaths due to the disease occurred during the follow-up period. Pure EEA offer excellent results in the management of ENB. Neoadjuvant radiation treatment is promising although more studies need to establish its role.
在过去二十年中，鼻内镜鼻内入路（EEA）的发展为嗅神经母细胞瘤（ENB）的治疗提供了微创技术选择，既可以是内镜辅助的颅底切除术，也可以是单纯的内镜手术。本研究介绍了我们中心在ENB治疗中使用单纯EEA的情况，并进行了文献综述。我们回顾性分析了2006年7月至2016年1月期间接受治疗的ENB患者的临床、放射学和病理学记录。在此期间，10例ENB患者接受了单纯EEA治疗。平均年龄为47.5岁。性别分布为：8例男性，2例女性。最常见的症状是鼻塞、流涕或鼻出血（8/10）。症状的平均持续时间为1.5年。所有患者术前均通过活检确诊为ENB。5例患者接受了新辅助放疗，4例接受了术后放疗。1例患者未接受任何放疗，无患者接受化疗。所有患者均实现了肿瘤全切除，9/10（90%）的患者术中显微镜下切缘阴性。术中未发生重大并发症。最常见的术后并发症是鼻腔感染。1例患者出现脑脊液漏。在6至120个月（平均74.8个月）的随访期内，观察到2例颈部淋巴结复发。随访期间无因疾病死亡的病例。单纯EEA在ENB的治疗中取得了优异的效果。新辅助放疗前景良好，尽管需要更多研究来确定其作用。
