[Management of esthesioneuroblastoma of the Fulda surgical concept]

To summaries the treatment strategy of esthesioneuroblastoma (ENB).

Between 1988 and 2001, 17 patients with ENB were treated at the Department of Otorhinolaryngology of the Klinikum Fulda. All patients were monitored on an outpatient basis after completed therapy with a median follow-up of 44 months. In a retrospective review, the patients' charts, the computed tomography, and magnetic resonance imaging scans, the operation reports, and the follow-up data were analyzed, particularly with respect to the surgical approaches.

All tumors were staged according to Morita. One patient was classified as stage A, six stage B, nine stage C, and one stage D. All patients received surgical resection. Ten patients were disease free for at least 2 years, whereas 6 patients died because of ENB and one due to other disease. Of 10 patients who were free of disease, the tumors were removed via a transnasal approach in 6 patients using the microscope in combination with the endoscope. These tumors resected endonasally were staged as A (1 case) and B (5 cases). In ENB of stage C a craniofacial resection was performed using a subfrontal approach or the midfacial degloving. The lateral rhinotomy was applied only in cases in which an exenteration orbitae had to be carried out.

ENB is best managed by complete surgical resection followed by adjuvant stereotactic radiation therapy. The Fulda surgical concept in management of anterior skull base tumors is also forwarded to resection of ENB. It classifies the following indications: 1) Endonasal approach in cases without tumor infiltration of the orbit and/or the brain; 2) Subfrontal approach in cases with extended tumor infiltration of the intradural space or the brain; 3) Midfacial degloving in cases with far lateral tumor spread, particularly fossa pterygoidea or pterygopalatina; 4) Lateral rhinotomy in all cases where an exenterative orbita is needed.