A superior nasal-vault tumour crosses the cribriform plate with limited dural involvement but no brain invasion or distant disease. Histology confirms olfactory neuroblastoma. What is the best treatment principle?
Resectability, grade, margins, dural extension and nodal status guide multimodal treatment; limited dural disease does not mandate an open approach in expert hands.
A. Combined endoscopic craniofacial resection with negative dural margins followed by risk-adapted radiotherapy: Selected limited intracranial extension can be resected endoscopically in an expert skull-base MDT; margin control and adjuvant therapy are central.
B. Polypectomy alone: This fails to address skull-base and dural disease.
C. Elective total laryngectomy: This has no anatomical role.
D. Chemotherapy alone for all localised tumours: Systemic therapy may be used in selected high-grade or advanced disease but is not universal definitive monotherapy.
E. Observe after biopsy because the tumour is slow-growing: Even indolent lesions can invade intracranially and metastasise.
If unresectable brain or cavernous-sinus invasion were present, induction/systemic therapy and definitive chemoradiation would be considered instead.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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