EENT Hospital of Fudan University Shanghai, United States
Introduction: The esthesioneuroblastoma (ENB) often exhibits aggressive growing mode. Although many grading system has been established, the criterion for judging whether intracranial space is invaded and the pathway of invasion have not been reported.
Methods: The preoperative magnetic resonance and computed tomography (CT) scanning images were reviewed. The coronal T2 images and T1 enhanced images and the coronal CT images are the main basis. The degree of offending intracranial cavity is divided into four grades based on the extent to which tumor invades bilateral olfactory cisterns and brain tissues. Grade 0 represents no offending and Grade 3 represents true invading into the brain tissues. The intraoperative videos and records were reviewed to verify the grading system.
Results: From June 2014 to August 2021, 114 patients were included in this research. The grading results were consisted of left and right side. The higher grading score was recorded as the final score. Grade 0, 1, 2, 3 were found respectively in 48, 18, 14, 34 cases. In some indistinguishable cases between grade 0 and 1, the height of the cribriform plate and the original shape of the olfactory cistern were the key clue to determine the result. The All the imaging grading results were consistent with the intraoperative findings. In 5 grading 1 cases, the dura mater was not opened, the intracranial lesions were presented in postoperative images but vanished after chemotherapy and/or radiotherapy.
Conclusions: The olfactory cistern, as an obviously identified cistern in anterior skull base, is a good basis to judge whether ENB has invaded intracranial space. The grading system can provide the basis for the operation plan, which is conducive to the preparation of patients before surgery and the formulation of postoperative recovery plan. There was no pathway of intracranial invasion beyond the olfactory cisterns in our cohort.
