Transnasal, transfacial, anterior skull base resection of
Vishad Nabili, MD
, Daniel F. Kelly, MD
, Nassrin Fatemi, MD
, Maie St. John, MD, PhD
Thomas C. Calcaterra, MD
, Elliot Abemayor, MD, PhD
Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA
Department of Neurological Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Received 19 January 2010
Abstract Purpose: Using a transnasal, transfacial, anterior skull base approach, we have removed olfactory
neuroblastomas (OFN) obviating the need for a frontal craniotomy. The objectives were to present
our surgical approach in achieving clear margins, to assess patient survival, and to recommend
Materials and methods: A retrospective chart review was done to identify patients diagnosed with
OFN who underwent this surgical approach. Thirteen patients were identified who underwent our
pictorially described approach. Postoperative assessment of pathologic margins, patient survival, and
limitations of surgical approach was determined.
Results: Of the 13 patients, 12 (92%) had clear postsurgical margins. One patient had residual
intracranial disease due to coagulopathy preventing further resection. Twelve patients remain alive
with 10 patients remaining disease-free (follow-up ranging from 11 to 64 months). Three patients
presented with recurrent disease initially, with 2 having had subsequent repeat local and regional
recurrences, respectively; one of whom died recently of the rerecurrent disease. One patient had a
postoperative cerebrospinal fluid leak repaired via the original surgical approach.
Conclusions: Although craniofacial resection remains an accepted approach for surgical treatment of
OFN, we have adopted a transnasal, transfacial approach eliminating the need for a frontal
craniotomy. This approach allows for adequate exposure of the cribriform plate, dura, and anterior
skull base. Our technique minimizes dural defects and prevents many craniotomy-associated
complications, including frontal lobe retraction. Long-term follow-up is needed to compare survival
using this approach; however, our results to date are quite promising.
© 2011 Elsevier Inc. All rights reserved.
Olfactory neuroblastoma (OFN), or esthesioneuroblas-
toma, is an uncommon malignant tumor of the nasal cavity
that was first described in 1924 . These tumors are thought
to arise from the basal cells of the olfactory epithelium that
can be located in the cribriform plate, superior and middle
turbinates, and nasal septum . OFN can be locally
aggressive, and given its location, skull base involvement
can often occur .
With less than 1000 cases reported in the literature, the
surgical approaches for managing this tumor have slowly
evolved . Since the 1970s, the “gold standard” surgical
approach for treating OFN has been craniofacial resection
(CFR) combined with postoperative radiotherapy .
However, significant morbidity and perioperative mortality
associated with CFRs has led to less invasive approaches
incorporating the endoscope in various ways [6-10]. With
Available online at www.sciencedirect.com
American Journal of Otolaryngology–Head and Neck Medicine and Surgery 32 (2011) 279 – 285
Presented at the American Head and Neck Society Annual Meeting at
COSM, April 28, 2007.
Corresponding author. Division of Head and Neck Surgery,
Department of Surgery, David Geffen School of Medicine at UCLA,
10833 LeConte Avenue, RM 62-132 CHS, Los Angeles, CA 90095-1624.
Tel.: +1 310 206 9568; fax: +1 310 206 1393.
E-mail address: firstname.lastname@example.org (V. Nabili).
0196-0709/$ – see front matter © 2011 Elsevier Inc. All rights reserved.