Endoscopic transnasal management of sinonasal malignancies - our initial experience.

Abstract

IntroductionMalignant tumors of the paranasal sinuses are traditionally managed through external approaches. Advances in endoscopic transnasal surgery have allowed for the endoscopic treatment of some of these tumors.AimTo present the results of treatment of a series of patients with paranasal sinus malignancies treated with an endoscopic approach at a single institution.Material and methodsThe data on tumor type, operative technique, perioperative complications and postoperative course were analyzed.ResultsEleven patients meeting the inclusion criteria were identified. The histopathology was as follows: malignant melanoma in 3 patients, squamous cell carcinoma in 2, adenocarcinoma in 2, poorly differentiated carcinoma in 1, hemangiopericytoma in 1, adenoid cystic carcinoma in 1 and fibrosarcoma in 1. There were no severe perioperative complications with the exception of 1 case of cerebrospinal fluid leak, which was successfully closed. The mean observation period was 13.5 months. One of the patients died of disease, another was lost to follow-up, and one was reoperated on due to recurrence. The remaining 8 patients are alive with no signs of recurrence.ConclusionsOur initial experience seems to confirm results obtained by other authors indicating that in selected cases endoscopic surgery of sinonasal malignancies is similarly effective as external approach surgery.

Comparing endoscopic resection and open resection for management of sinonasal mucosal melanoma

“…Critics of the use of endoscopic surgery for SMM argue that the utilization of piecemeal resection is oncologically inferior to an en bloc resection, the latter being easier to achieve with an open surgical approach . Although concerns regarding the endoscopic approach still remain, our study demonstrates that it is an efficacious and reliable alternative for the surgical treatment of SMM.…”

“…Although highly dependent on anatomic location, patients with sinonasal mucosal melanoma (SMM) typically present with epistaxis, nasal obstruction, and reduced sense of smell . Because of the nonspecific nature of these symptoms, most patients are not diagnosed until they reach advanced stages …”

Minimally invasive transnasal approach for primary ectopic meningioma of the paranasal sinuses.

“…It has become a standard therapeutic procedure not only in patients with rhinosinusitis but also in the case of tumours of the nose and paranasal sinuses such as juvenile angiofibroma or inverted papilloma [ 9 , 10 ]. In the last few years we can observe widening scope of indications for endonasal surgery, nowadays including surgery of selected malignancies or surgery of the skull base [ 11 – 13 ]. Also the big size or abundant vascularity of the neoplasm is no longer a contraindication for the transnasal approach.…”

Rare benign pleomorphic adenoma of the nose: short study and literature review.

“…Radiological diagnostics is necessary before surgery, and it could be useful to establish the diagnosis. Computed tomography scans revealed the tumor involvement location (septum or lateral nasal wall) and could suggest an aggressive type if destruction of bone is seen [ 2 , 3 , 7 – 11 ]. Nuclear magnetic resonance imaging usually showed a heterogeneous mass, isointense to brain on T1-weighted images.…”

“…The method of surgical approach depends on the size of the tumor and its location. If there is a low rate of recurrence and relatively small size up to 2.5 cm in diameter, as in our material, endoscopic resection is appropriate [ 2 , 7 , 11 ].…”