Preservation of olfactory function following endoscopic resection of select malignancies of the nasal vault

Abstract

Preservation of olfactory function during anterior skull base surgery has been previously described. However, its feasibility during oncological resection remains undefined. The aim of this study was to clarify the feasibility of preserving olfactory function in select patients undergoing oncological anterior skull base resection via endonasal endoscopic approach. This is a retrospective case series study. Postoperatively, all patients underwent a standardized smell identification test (Sensonics Inc., Haddon, NJ, USA). From January 2002 to December 2009, we attempted to preserve olfactory function in 9 patients who required an endoscopic resection involving the anterior skull base for treatment of various malignancies presenting unilateral extension. These included: esthesioneuroblastoma (n=6), squamous cell carcinoma (n=1), adenocarcinoma (n=1) and hemangiopericytoma (n=1). In 7 patients, resection included a unilateral endoscopic craniectomy with preservation of the contralateral middle and superior turbinates. Two patients underwent resection of the entire lateral nasal wall and the olfactory epithelium as the superior limit of tumor resection. Six patients received adjuvant radiotherapy. Postoperatively, olfaction was documented in 7 patients (3 normosmic, 4 microsmic). All patients are free of recurrence at the original site at a mean follow-up period of 55.7 months (range 21-101 months). One patient with an esthesioneuroblastoma developed a cervical lymph node recurrence four years after surgery. In selected cases, it is feasible to preserve olfactory function without apparent compromise of oncological outcomes. The success rate depends largely on the extent of the resection, which, in turn, is dictated, by the extent of the tumor.

Keywords

• olfaction, endoscopic surgery, skull base, olfaction testing, sinonasal cancer.