A 48-year-old woman presented with a large sinonasal mass with extensive intracranial extension through the cribriform plate into the anterior cranial fossa []. Tumor was noted in the right orbit and maxillary and sphenoid sinuses and there was lymphatic spread to a retropharyngeal lymph node. She underwent radical resection of the Kadish stage D esthesioneuroblastoma with a right orbital exenteration and upper neck dissection followed by adjuvant radiation therapy. Yearly surveillance imaging was stable until a 6-year follow-up MRI revealed 1 cm of patchy enhancement in the right frontal lobe and the dura overlying the resection cavity. Follow-up imaging 6 months later showed mildly increased dural enhancement and interval development of a new dural-based lesion in the posterior fossa.\nSpinal imaging revealed multiple dural-based enhancing lesions in the cervical, thoracic, and lumbar spine with possible osseous involvement, consistent with drop metastasis []. The patient underwent a suboccipital craniectomy for resection of the posterior fossa lesion. Intraoperatively, the neoplasm was deep to the dura but above the arachnoid membrane; it was carefully dissected and removed en bloc. Two days later, the patient underwent T8–T10 laminectomies, left T9 costotransversectomy, and ligation of the nerve root for resection of a large dural-based mass displacing the thoracic cord and effacing the neural foramen. Pathological analysis of both lesions affirmed a diagnosis of recurrent esthesioneuroblastoma with leptomeningeal spread [].\nThe patient initially began a course of systemic carboplatin, vincristine, and lomustine, as well as intrathecal methotrexate. She ultimately completed the intrathecal methotrexate with carboplatin, etoposide, and cyclophosphamide. Follow-up imaging 16 months after the initiation of chemotherapy revealed resolution of the metastatic lesions and no radiographic appearance of residual disease, 9 years after her original diagnosis. She continues to receive surveillance for the recurrent disease by evaluation of her cerebrospinal fluid (CSF) every 3 months.
A 48-year-old man was referred to our clinic for evaluation of a new dural-based lesion 6 years after excision, skin flap repair, and bone graft placement for a skull-base esthesioneuroblastoma followed by adjuvant radiation. His posttreatment course was complicated by externalization of the bone flap requiring a second skull-base bone flap resection. After 5 years of no radiographic evidence of residual disease, a routine follow-up magnetic resonance imaging (MRI) scan at 6 years revealed an enhancing dural lesion over the right frontal lobes [].\nThe patient underwent a right frontotemporal craniotomy for resection of the enhancing dura and tumor, which was found to be partially invading the brain parenchyma. Pathological analysis indicated the lesion was consistent with recurrent metastatic esthesioneuroblastoma. The patient received adjuvant stereotactic radiosurgery. His follow-up MRIs approximately every 6 months remained negative until additional dural-based lesions along the frontal sinus, right temporal lobe, and right sphenoid wing were observed at 3 years []. Follow-up imaging 5 months later revealed progressive interval growth of the dural-based lesions. Treatment with cisplatin and etoposide was stopped after one cycle because of intractable nausea and vomiting. Approximately 1 year later, the patient restarted treatment with sunitinib, but the tumor showed clear progression 12 months later and the drug was discontinued. The patient succumbed to the disease 6 months later, 11 years after his initial diagnosis.