title: Endoscopic endonasal compared with anterior craniofacial and combined cranionasal resection of esthesioneuroblastomas.
abstract: OBJECTIVE
  Esthesioneuroblastomas represent a surgical challenge because of their anatomical location, the necessity of achieving negative margins, and the often-cosmetically disfiguring transfacial approaches needed. Recently, expanded endonasal endoscopic approaches have been developed, either alone or in combination with a craniotomy. We conducted a systematic review of case series and case reports to compare outcomes between these various surgical approaches.
  
  
  METHODS
  A MEDLINE search was conducted of the modern literature (1985-2010) to identify open and endoscopic surgical series. Tumor and patient characteristics, Kadish stage, extent of resection, and progression-free and overall survival were recorded and analyzed by approach. Kaplan-Meier analysis was used to assess overall survival and progression-free survival.
  
  
  RESULTS
  Forty-seven studies comprising 453 patients were included. The endoscopic cohort had a greater proportion of Kadish Stage A tumors compared with the craniofacial group. Gross total resection was achieved in 98.1% of patients who underwent an endoscopic approach compared with 81.3% for the craniofacial and 100% for the cranionasal cohorts. Local recurrence occurred in 8.0% of patients in the endoscopic group compared with 22.1% in the craniofacial and 16.7% in the cranionasal cohorts.
  
  
  CONCLUSIONS
  In well-selected cases, cranionasal and endonasal approaches can be safe and effective. An ongoing evaluation of the benefits and limitations are necessary to better define the ideal patient population and patient-specific risk factors for the use of these minimal access techniques.
authors.affiliation: Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Daniel M S
authors.initials: DM
authors.lastname: Raper
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003399:Craniotomy; D003627:Data Interpretation, Statistical; D004724:Endoscopy / Q000379:methods*; D018304:Esthesioneuroblastoma, Olfactory / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009296:Nasal Cavity / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D009669:Nose Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome