Complex Skull Base Reconstructions in Kadish D Esthesioneuroblastoma: Case Report

Area of Science:

• Head and Neck Surgery
• Neuro-oncology
• Skull Base Surgery

Background:

• Advanced Kadish stage esthesioneuroblastoma necessitates aggressive multimodal treatment, including extensive resection and adjuvant therapies.
• High-stage esthesioneuroblastoma treatment is associated with significant complication rates, impacting patient outcomes.
• Management of complex cases requires a thorough understanding of potential surgical and oncologic challenges.

Observation:

• A 61-year-old male presented with a large, advanced Kadish D esthesioneuroblastoma involving the orbit, frontal lobe, and parapharyngeal nodes.
• Initial treatment involved endoscopic-assisted craniofacial resection, radiotherapy, and chemotherapy.
• The patient experienced multiple complications, including skull base reconstruction failure, frontal infections, and cerebrospinal fluid (CSF) leak, requiring 10 subsequent surgical procedures.

Findings:

• Surgical interventions for complications included craniectomy, abscess evacuation, skull base reconstruction with various grafts and synthetic materials, and CSF diversion.
• The case demonstrates the complexity of managing infectious, neurologic, and wound-healing issues post-treatment for advanced esthesioneuroblastoma.
• Successful salvage and reconstruction techniques were employed to address severe post-operative complications.

Implications:

• Aggressive surgical resection and adjuvant therapies are crucial for disease control in advanced esthesioneuroblastoma, despite potential risks.
• Surgeons must be prepared to manage a spectrum of complications, employing diverse reconstructive and salvage techniques.
• Preventative strategies and prompt management of complications are vital for optimizing outcomes in patients with extensive esthesioneuroblastoma.