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Olfaction Preservation and Long-Term Outcomes in Patients with Unilateral Endoscopic Resection of Olfactory
Alejandra Rodas1, Leonardo Tariciotti2, Youssef M Zohdy3
1Department of Otolaryngology and Head & Neck Surgery, Emory University, Atlanta, Georgia, USA.
Background:
Endoscopic endonasal surgical resection is an effective therapeutic approach for olfactory neuroblastoma (ONB). Unilateral excision of ONBs with limited extension has been reported with the purpose of preserving olfactory function. We aimed to review implications of surgical management, olfactory preservation feasibility, and survival outcomes in patients who underwent endoscopic unilateral resection of ONB.
Methods:
A systematic literature review was conducted using the search terms [("Olfactory neuroblastoma") OR ("Esthesioneuroblastoma")] AND [("Unilateral resection") OR ("Olfaction preservation")]. Studies reporting cases of unilateral ONB endoscopic resection with postoperative olfaction assessment were included. Concurrently, records of patients who met inclusion criteria at our institution were reviewed retrospectively. The survival and olfactory outcomes were analyzed in both cohorts.
Results:
Thirty-three patients were identified in the published literature. Twenty-three (69.7%) reported postoperative olfaction preservation. Olfactory function after surgery did not show an association with Kadish stage (P = 0.128). No evidence of disease was observed at the latest follow-up in this group of patients. Nine patients who met inclusion criteria were identified at our institution. The extent of resection influenced the level of olfaction preservation when cribriform plate and nasal septum resection coexisted (P = 0.05). A single patient at our institution developed recurrence after being lost to follow-up for 22 months.
Conclusions:
Olfaction preservation can be achieved in patients who undergo endoscopic unilateral resection and adjuvant radiotherapy. The extent of resection should aim for negative margins, particularly in the midline. Larger studies are required to assess the risk of contralateral microscopic disease, and, hence, close follow-up is advised.
Insights
Endoscopic unilateral resection for olfactory neuroblastoma (ONB) can preserve olfaction. Careful surgical planning and adjuvant radiotherapy are key for successful outcomes and disease control in ONB patients.
Area of Science:
- Otolaryngology
- Neurosurgery
- Oncology
Background:
- Olfactory neuroblastoma (ONB) is a rare malignancy.
- Endoscopic endonasal resection is a primary treatment modality for ONB.
- Unilateral resection aims to preserve olfactory function.
Purpose of the Study:
- To review surgical management implications for ONB.
- To assess olfactory preservation feasibility after unilateral resection.
- To evaluate survival outcomes in ONB patients undergoing unilateral resection.
Main Methods:
- Systematic literature review of unilateral ONB resection.
- Inclusion of studies with postoperative olfaction assessment.
- Retrospective review of institutional patient records.
Main Results:
- Olfaction preservation reported in 69.7% of published cases.
- No association between olfaction and Kadish stage.
- Extent of resection impacted olfaction preservation when involving cribriform plate and nasal septum.
Conclusions:
- Olfaction preservation is achievable with endoscopic unilateral resection and adjuvant radiotherapy.
- Achieving negative margins is crucial, especially in the midline.
- Close follow-up is advised due to potential contralateral microscopic disease.
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