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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2017; 78(02): e86-e92
DOI: 10.1055/s-0037-1601877
Case Report
Georg Thieme Verlag KG Stuttgart • New York

Complex Skull Base Reconstructions in Kadish D Esthesioneuroblastoma: Case Report

Sheri K. Palejwala
1   Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, United States
,
Saurabh Sharma
2   Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
,
Christopher H. Le
2   Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
,
Eugene Chang
2   Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
,
Audrey B. Erman
2   Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States
,
G. Michael Lemole Jr
1   Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, United States
› Author Affiliations
Further Information

Publication History

11 November 2016

04 March 2017

Publication Date:
04 May 2017 (online)

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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.

Keywords

esthesioneuroblastoma - olfactory neuroblastoma - skull base reconstruction - cerebrospinal fluid leak - pneumocephalus - sinonasal malignancy - complications
 

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