Transcranial resection of olfactory neuroblastoma

From February 1995 to August 2004 at Chang Gung Memorial Hospital and Chang Gung University, eight patients with an olfactory neuroblastoma underwent transcranial resection alone. The transcranial surgical technique consisted of a bicoronal incision, followed by a standard frontal craniotomy with or without a separated orbital bar osteotomy. The tumor could be removed en bloc transcranially after the cranial base osteotomy according to the tumor extent delineated by preoperative magnetic resonance imaging and intraoperative findings. The defect in the floor of the anterior cranial fossa was reconstructed with a galeopericranial flap. Sinoscopy should compensate rather than compete with the transcranial approach. With thorough knowledge of the basic topographic anatomy of the anterior cranial base, transcranial resection can provide adequate surgical exposure to facilitate oncologically sound resection and to execute reliable skull base reconstruction in selected patients with an olfactory neuroblastoma. A transcranial approach alone may further decrease the rate of surgical morbidity by omitting the facial incision and osteotomy.