Expanded Endoscopic Endonasal Approach for Esthesioneuroblastomas: The Toronto Western Hospital Experience
Bibliographic record
Abstract
Introduction: Esthesioneuroblastoma (ENB) is a rare tumor of neuroectodermal origin arising from the olfactory epithelium in the upper nasal cavity and constituting 1 to 5% of all nasal tumors. Surgery plays a central role in the management of these tumors while radiation and chemotherapy are administered in adjuvant settings. We present our experience with a pure endonasal endoscopic approach for these lesions. Methods: Nine consecutive patients with biopsy-confirmed ENB were operated between 2006 and 2008 (mean age, 36 years). The ENB were staged according to Kadish (two grade A, six grade B, one grade C) and Dulguerov (two T1, three T2, three T3, and one T4) grading systems. Eight patients had received preoperative radiotherapy. Results: A total resection with free margins was possible in all patients except one. In one patient a transcranial approach was felt necessary after the initial endoscopic approach to achieve a complete tumor resection. There was no CSF leak and no infection postoperatively. No recurrence was observed at a mean follow-up of 13 months. Conclusions: Despite a relatively short follow-up, our series shows that the expanded endoscopic endonasal approach is a low-morbidity minimally invasive procedure which permits adequate resection in carefully selected ENB patients. Tumors with significant lateral and anterior (frontal sinus) extension or brain invasion are best addressed transcranially. As these lesions have a tendency to recur, long-term follow-up is mandatory to determine if this approach will improve the overall survival in these patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".