Olfactory Neuroblastoma (Esthesioneuroblastoma) Treated by Combined Extensive Transbasal and Transfacial Approach

Introduction: Esthesioneuroblastoma is an uncommon tumor arising from the olfactory epithelium of the nasal cavity. Most cases present clinically with nonspecific findings, such as unilateral nasal obstruction and intermittent epistaxis, and diagnosis can often be directed toward other diseases of the nasal cavity. Case Presentation: A 57-year-old woman presented with a year-long history of breathing difficulty, behavioral changes, and gait disturbance. Clinical examination revealed anosmia, left hemiparesis, apathy, and aboulia and gait apraxia. Magnetic resonance imaging depicted a 2 × 2.5-cm intracranial extraparenchymal mass of the anterior fossa extending into the nasal cavity up to level of the inferior turbinate bilaterally. Within 2 weeks, the patient demonstrated clinical deterioration. The new radiological examination revealed a significant increase of the tumor size (intracranial part 6 × 5 × 4 cm). The patient underwent a combined extensive transbasal and transfacial (modified Altemir) approach. The postoperative course was uneventful, and she was discharged the fourteenth postoperative day with marked improvement of the motor and cognitive functions. Discussion: The aggressive nature of esthesioneuroblastoma is evidenced by frequent local recurrences and occasional distant metastasis. Rarely, the intracranial component is of significant size. In this case, the best treatment was a combined multidisciplinary approach by neurosurgeons, ENT, and plastic surgeons. Meticulous preoperative surgical planning is of utmost importance when dealing with these tumors. Conclusion: Esthesioneuroblastomas are rare and may present a diagnostic and therapeutic challenge. Aggressive surgical excision by a combined transbasal and transfacial approach may be required for tumors extending well into the anterior fossa.