Endoscopic versus Open Craniofacial Resection of Esthesioneuroblastoma: What Is the Evidence?

Background

Esthesioneuroblastoma is a malignant neoplasm originating from the specialized neuroepithelium of the olfactory cleft. Surgical resection through an open craniofacial approach has been the accepted treatment modality for decades, together with adjuvant radiotherapy and sometimes chemotherapy. Over the last 10 to 15 years, surgical techniques for esthesioneuroblastomas have evolved to include endoscopically assisted craniofacial resections and, more recently, purely endoscopic skull base resections. However, the introduction of these newer techniques has not been without significant debate. This controversy stems largely from important limitations in the currently available published literature.

Best Practice

The optimal treatment of esthesioneuroblastoma involves complete surgical resection followed in most instances by radiotherapy. Definitive prospective studies comparing open craniofacial resection with purely endoscopic techniques will probably never be available, owing to the relative rarity of esthesioneuroblastomas and their proclivity for late recurrence. The currently available evidence suggests that equivalent short-term outcomes can be achieved with both techniques, with purely endoscopic techniques more likely to be performed in lower-stage tumors and open techniques in higher-stage cases. The completeness of the surgical resection is probably more important than the specific surgical technique used to achieve negative margins. The best practice for cases of esthesioneuroblastoma would thus be for the individual surgeon to use the technique that is most likely to result in complete tumor removal, whether it is a traditional open procedure, endoscopically assisted, or purely endoscopic. With this paradigm, the specific surgical technique would be expected to vary based on tumor stage and the individual surgeon’s training/preference. Read the full article in The Laryngoscope.