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Olfactory Neuroblastoma or Esthesioneuroblastoma

Background

Olfactory neuroblastomas, also known as esthesioneuroblastomas  are malignant tumors that arise from the olfactory (smelling) nerves and extend into the nasal cavity and brain. They can often invade the sinuses and eye sockets. Lymph node and metastatic spread are rare, so achieving local control of the tumor is critical.

 

Evaluation

 

Symptoms

Olfactory neuroblastomas typically cause loss of sense of smell, nose bleeds, nasal congestion and headache. When they involve the brain, seizures and disorientation can occur.

Imaging

Olfactory neuroblastomas are defined on magnetic resonance imaging (MRI) of the brain. Bony invasion is deliniated on computer tomography (CT) scans of the brain and paranasal sinuses. Pre-operative angiography and tumor embolization is often helpful in the treatment of larger tumors.

Treatment

The aggressive nature and location of olfactory neuroblastomas usually requires surgery and radiation. Chemotherapy can sometimes be useful. Many olfactory neuroblastomas can now be removed via an Endonasal Endoscopic Approach, including those with intradural extension. For some very large tumors with intracranial extension, a combined cranio-facial approach may still be needed.

For small tumors, recurrent tumors or for small residual tumor after surgery, Cyberknife radiosurgery can be used.