Olfactory neuroblastoma (esthesioneuroblastoma): towards minimally invasive surgery and multi-modality treatment strategies - an updated critical review of the current literature

Olfactory neuroblastoma (esthesioneuroblastoma) was first described by Berger and Luc in 1924. It is considered to be an uncommon malignancy of the nasal cavity. The tumor arises from the specialized sensory epithelial olfactory cells, normally situated at the upper part of the nasal cavity, including the superior nasal concha, the roof of the nose and the cribriform plate. The imaging modalities of choice are computed tomography (CT) and magnetic resonance imaging (MRI). Combination of surgery and radiotherapy (either conventional radiotherapy or stereotactic radiosurgery), with or without chemotherapy is considered to be the standard of care for primary site disease by the majority of researchers. Combined transfacial and neurosurgical conventional approaches are also adopted in many reported cases, mainly due to the endocranial extension and the close anatomic relationship of esthesioneuroblastomas with the ethmoid roof and cribriform plate. Recent literature supports that endoscopic resection correlates with similar oncologic control rates compared with conventional open surgery, provided that basic oncologic surgical principles with clearance of margins and intradural dissection (when required) are completely maintained.