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DOI: 10.1055/s-0037-1601877
Complex Skull Base Reconstructions in Kadish D Esthesioneuroblastoma: Case Report
Publication History
11 November 2016
04 March 2017
Publication Date:
04 May 2017 (online)
![](https://www.thieme-connect.de/media/jnlsr/201702/lookinside/thumbnails/10-1055-s-0037-1601877_160063-1.jpg)
Abstract
Introduction Advanced Kadish stage esthesioneuroblastoma requires more extensive resections and aggressive adjuvant therapy to obtain adequate disease-free control, which can lead to higher complication rates. We describe the case of a patient with Kadish D esthesioneuroblastoma who underwent multiple surgeries for infectious, neurologic, and wound complications, highlighting potential preventative and salvage techniques.
Case Presentation A 61-year-old man who presented with a large left-sided esthesioneuroblastoma, extending into the orbit, frontal lobe, and parapharyngeal nodes. He underwent margin-free endoscopic-assisted craniofacial resection with adjuvant craniofacial and cervical radiotherapy and concomitant chemotherapy. He then returned with breakdown of his skull base reconstruction and subsequent frontal infections and ultimately received 10 surgical procedures with surgeries for infection-related issues including craniectomy and abscess evacuation. He also had surgeries for skull base reconstruction and CSF leak, repaired with vascularized and free autologous grafts and flaps, synthetic tissues, and CSF diversion.
Discussion Extensive, high Kadish stage tumors necessitate radical surgical resection, radiation, and chemotherapy, which can lead to complications. Ultimately, there are several options available to surgeons, and although precautions should be taken whenever possible, risk of wound breakdown, leak, or infection should not preclude radical surgical resection and aggressive adjuvant therapies in the treatment of esthesioneuroblastoma.
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References
- 1 Berger L, Luc R, Richard D. L'esthesioneuroepitheliome olfactif. Bull Assoc Fr Etud Cancer 1924; 13: 410-421
- 2 Liu JK, O'Neill B, Orlandi RR, Moscatello AL, Jensen RL, Couldwell WT. Endoscopic-assisted craniofacial resection of esthesioneuroblastoma: minimizing facial incisions—technical note and report of 3 cases. Minim Invasive Neurosurg 2003; 46 (05) 310-315
- 3 Ferlito A, Rinaldo A, Rhys-Evans PH. Contemporary clinical commentary: esthesioneuroblastoma: an update on management of the neck. Laryngoscope 2003; 113 (11) 1935-1938
- 4 Koka VN, Julieron M, Bourhis J. , et al. Aesthesioneuroblastoma. J Laryngol Otol 1998; 112 (07) 628-633
- 5 Loy AH, Reibel JF, Read PW. , et al. Esthesioneuroblastoma: continued follow-up of a single institution's experience. Arch Otolaryngol Head Neck Surg 2006; 132 (02) 134-138
- 6 Monroe AT, Hinerman RW, Amdur RJ, Morris CG, Mendenhall WM. Radiation therapy for esthesioneuroblastoma: rationale for elective neck irradiation. Head Neck 2003; 25 (07) 529-534
- 7 Zafereo ME, Fakhri S, Prayson R. , et al. Esthesioneuroblastoma: 25-year experience at a single institution. Otolaryngol Head Neck Surg 2008; 138 (04) 452-458
- 8 Tajudeen BA, Arshi A, Suh JD. , et al. Esthesioneuroblastoma: an update on the UCLA experience, 2002–2013. J Neurol Surg B Skull Base 2015; 76 (01) 43-49
- 9 Herr MW, Sethi RKV, Chan A. , et al. Esthesioneuroblastoma: an update on the Massachusetts eye and ear infirmary and Massachusetts general hospital experience with craniofacial resection. J Neurol Surg B Skull Base 2014; 1 (212) 58-64
- 10 Folbe A, Herzallah I, Duvvuri U. , et al. Endoscopic endonasal resection of esthesioneuroblastoma: a multicenter study. Am J Rhinol Allergy 2009; 23 (01) 91-94
- 11 Polin RS, Sheehan JP, Chenelle AG. , et al. The role of preoperative adjuvant treatment in the management of esthesioneuroblastoma: the University of Virginia experience. Neurosurgery 1998; 42 (05) 1029-1037
- 12 Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with anterior craniofacial and combined cranionasal resection of esthesioneuroblastomas. World Neurosurg 2013; 80 (1-2): 148-159
- 13 Hollen TR, Morris CG, Kirwan JM. , et al. Esthesioneuroblastoma of the nasal cavity. Vestn Otorinolaringol 2015; 38: 84
- 14 Levine PA, McLean WC, Cantrell RW. Esthesioneuroblastoma: the University of Virginia experience 1960–1985. Laryngoscope 1986; 96 (07) 742-746
- 15 McLean JN, Nunley SR, Klass C, Moore C, Müller S, Johnstone PA. Combined modality therapy of esthesioneuroblastoma. Otolaryngol Head Neck Surg 2007; 136 (06) 998-1002
- 16 Devaiah AK, Andreoli MT. Treatment of esthesioneuroblastoma: a 16-year meta-analysis of 361 patients. Laryngoscope 2009; 119 (07) 1412-1416
- 17 Miyamoto RC, Gleich LL, Biddinger PW, Gluckman JL. Esthesioneuroblastoma and sinonasal undifferentiated carcinoma: impact of histological grading and clinical staging on survival and prognosis. Laryngoscope 2000; 110 (08) 1262-1265
- 18 Gruber G, Laedrach K, Baumert B, Caversaccio M, Raveh J, Greiner R. Esthesioneuroblastoma: irradiation alone and surgery alone are not enough. Int J Radiat Oncol Biol Phys 2002; 54 (02) 486-491
- 19 Foote RL, Morita A, Ebersold MJ. , et al. Esthesioneuroblastoma: the role of adjuvant radiation therapy. Int J Radiat Oncol Biol Phys 1993; 27 (04) 835-842
- 20 Dulguerov P, Allal AS, Calcaterra TC. Esthesioneuroblastoma: a meta-analysis and review. Lancet Oncol 2001; 2 (11) 683-690
- 21 Song CM, Won TB, Lee CH, Kim DY, Rhee CS. Treatment modalities and outcomes of olfactory neuroblastoma. Laryngoscope 2012; 122 (11) 2389-2395
- 22 Levine PA, Gallagher R, Cantrell RW. Esthesioneuroblastoma: reflections of a 21-year experience. Laryngoscope 1999; 109 (10) 1539-1543
- 23 Resto VA, Eisele DW, Forastiere A, Zahurak M, Lee DJ, Westra WH. Esthesioneuroblastoma: the Johns Hopkins experience. Head Neck 2000; 22 (06) 550-558
- 24 Eich HT, Müller RP, Micke O, Kocher M, Berthold F, Hero B. Esthesioneuroblastoma in childhood and adolescence. Better prognosis with multimodal treatment?. Strahlenther Onkol 2005; 181 (06) 378-384
- 25 Manthuruthil C, Lewis J, McLean C, Batra PS, Barnett SL. Endoscopic endonasal management of olfactory neuroblastoma: a retrospective analysis of 10 patients with quality of life measures. World Neurosurg 2016; 90: 1-5
- 26 Petruzzelli GJ, Howell JB, Pederson A. , et al. Multidisciplinary treatment of olfactory neuroblastoma: patterns of failure and management of recurrence. Am J Otolaryngol 2015; 36 (04) 547-553
- 27 Kadish S, Goodman M, Wang CC. Olfactory neuroblastoma. A clinical analysis of 17 cases. Cancer 1976; 37 (03) 1571-1576
- 28 Patel SG, Singh B, Polluri A. , et al. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 2003; 98 (06) 1179-1187
- 29 Dias FL, Sá GM, Kligerman J. , et al. Complications of anterior craniofacial resection. Head Neck 1999; 21 (01) 12-20
- 30 Ganly I, Patel SG, Singh B. , et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27 (06) 445-451
- 31 Thorp BD, Sreenath SB, Ebert CS, Zanation AM. Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak. Neurosurg Focus 2014; 37 (04) E4
- 32 Schmalbach CE, Webb DE, Weitzel EK. Anterior skull base reconstruction: a review of current techniques. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (04) 238-243
- 33 Chang DW, Langstein HN, Gupta A. , et al. Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 2001; 107 (06) 1346-1355 , discussion 1356–1357
- 34 Nameki H, Kato T, Nameki I, Ajimi Y. Selective reconstructive options for the anterior skull base. Int J Clin Oncol 2005; 10 (04) 223-228