Esthesioneuroblastoma with intracranial invasion, surgical management by double approach: craniotomy and craniofacial. case report

Introduction: Esthesioneuroblastoma, or olfactory neuroblastoma, is a rare malignant neoplasm of the sinonasal tract that originates in the olfactory neuroepithelium with neuroblastic differentiation. It occurs most frequently in the upper nasal cavity. It is a locally aggressive neoplasm and metastasizes both hematogenously and lymphatic. A multimodal approach, which can combine surgery, chemotherapy, and radiotherapy, is essential for the management of these tumors. Clinical Case: A 56-year-old female patient with an 18-month illness, characterized by loss of smell, shortness of breath, and frontal headache. Brain tomography showed an extensive tumor in the nasopharynx with intracranial involvement and destruction of the anterior skull base. She was diagnosed with Esthesioneuroblastoma by endonasal endoscopic biopsy. A combined approach was planned first by Neurosurgery, through a bifrontal craniotomy in which the resection of the intracranial portion and the reconstruction of the skull base were achieved. Then, Head and Neck Surgery perform the resection of the tumor in the nasal cavity through right lateral rhinotomy. The patient evolved favorably in the postoperative period without presenting neurological deficit, so she was discharged in the following days after the removal of the tracheostomy cannula. She subsequently received adjuvant chemotherapy and radiation therapy. Conclusion: In an Esthesioneuroblastoma, obtaining an extensive resection, total, if possible, is a very important factor in the prognosis of a patient, so it is recommended to use the combination of several surgical techniques to achieve this goal. Keywords: Esthesioneuroblastoma, Olfactory, Craniotomy, Nasal Cavity, Skull Base (source: MeSH NLM)