Available online 7 December 2012
Publication year: 2012
Source:World Neurosurgery
Objective Esthesioneuroblastomas represent a surgical challenge due to their anatomical location, the necessity to achieve negative margins and often cosmetically disfiguring transfacial approaches. Recently, expanded endonasal endoscopic approaches have been developed, either alone or in combination with a craniotomy. We conducted a systematic review of case series and case reports to compare outcomes between these various surgical approaches. Methods MEDLINE search of the modern literature (1985-2010) to identify open and endoscopic surgical series. Tumor and patient characteristics, Kadish stage, extent of resection, and progression-free and overall survival were recorded and analyzed by approach. Kaplan-Meier analysis was used to assess overall survival and progression-free survival. Results Forty seven studies, involving 453 patients, were included. The endoscopic cohort had a higher proportion of Kadish Stage A tumors compared with the craniofacial group. Gross total resection was achieved in 98.1% of patients undergoing an endoscopic approach, compared with 81.3% for the craniofacial and 100% for the cranionasal cohorts. Local recurrence occurred in 8.0% of patients in the endoscopic group, compared with 22.1% in the craniofacial and 16.7% in the cranionasal cohorts. Conclusion In well-selected cases, cranionasal and endonasal approaches can be safe and effective. Ongoing evaluation of the benefits and limitations are necessary to better define the ideal patient population and patient-specific risk factors for the use of these minimal access techniques.
Júlio Leonardo B. Pereira
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