Olfactory Neuroblastoma (Esthesioneuroblastoma): Report of Six Cases Treated by a Novel Combination of Endoscopic Surgery and Radiosurgery

F. Unger, C. Walch, Heinz Stammberger, G. Papaefthymiou, K. Haselsberger, G. Pendl
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引用次数: 57

Abstract

Microsurgical techniques have considerably improved the results of surgical treatment for esthesioneuroblastoma (olfactory neuroblastoma). Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and radiosurgery (gamma knife) is presented here. Six patients (3 males, 3 females) aged between 27 and 75 years (median 38 years) were treated between August 1993 and July 1999. Following paranasal and nasal endoscopic sinus surgery, marginal irradiation doses ranging from 16 to 34 Gy were applied radiosurgically involving up to 7 isocentres. At present, the median follow-up period is 57 months (range: 9 - 79 months). Without mortality, tumour control was achieved in all patients. One patient, who had to undergo additional craniotomy because of extensive neoplastic infiltration, developed postoperative liquorrhea. In another case the clinical course was complicated by a bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. However, a preoperative Karnovsky Index ranging from 80 to 100 % remained stable in four patients whereas an improvement was observed in two patients. Based on the favourable results observed so far, the combination of endoscopic sinus surgery and radiosurgery can be considered as promising new option for the treatment of esthesioneuroblastoma that merits further investigation.
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嗅觉神经母细胞瘤(感觉神经母细胞瘤):内窥镜手术与放射手术结合治疗6例报告
显微外科技术大大提高了嗅觉神经母细胞瘤的手术治疗效果。然而,这些罕见的额颅底肿瘤仍然与肿瘤复发率和死亡率高有关,因此即使对经验丰富的外科医生来说,仍然是一个挑战。本文提出了一种结合内窥镜鼻窦手术和放射手术(伽玛刀)的新型治疗方法。6例患者(男3例,女3例)于1993年8月至1999年7月间接受治疗,年龄27 ~ 75岁,中位年龄38岁。在鼻翼和鼻内窥镜鼻窦手术后,放射外科应用16至34 Gy的边缘照射剂量,涉及多达7个等中心。目前,中位随访期为57个月(范围:9 - 79个月)。所有患者均无死亡,肿瘤得到控制。一名患者因肿瘤广泛浸润而不得不接受额外的开颅手术,术后出现了脓口。在另一个病例的临床过程是复杂的双侧额窦炎。所有患者均有鼻溢液和结痂。然而,术前Karnovsky指数在80 - 100%范围内的4例患者保持稳定,而2例患者观察到改善。基于目前观察到的良好结果,内窥镜鼻窦手术和放射手术相结合可以被认为是治疗感觉神经母细胞瘤的有希望的新选择,值得进一步研究。
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Minimally Invasive Neurosurgery
Minimally Invasive Neurosurgery 医学-临床神经学
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We would like to thank the following persons who reviewed MIN manuscripts for their expertise and support in the year 2010: Reply to the comment of R. Härtl: The Future of “Minimally Invasive Neurosurgery” Simultaneous Treatment of a Pituitary Adenoma and an Internal Carotid Artery Aneurysm Through a Supraorbital Keyhole Approach Endoscopic Fenestration of Symptomatic Septum Pellucidum Cysts: Three Case Reports with Discussion on the Approaches and Technique
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