Endoscopic Surgery for Malignant Tumors of the Sinonasal Tract and Adjacent Skull Base: A 10-year Experience

TLDR

Transnasal endoscopic surgery expertise has expanded to include management of sinonasal malignancies. This retrospective study reports on 184 patients with nasoethmoidal malignancies treated by exclusive endoscopic or cranioendoscopic approaches from 1996 to 2006. The cohort comprised 134 patients undergoing exclusive endoscopic approach and 50 undergoing cranioendoscopic approach, with a mean follow‑up of 34.1 months. Histotypes were diverse, 46.7% received adjuvant therapy, and 5‑year disease‑specific survival was 91.4% for EEA versus 58.8% for CEA, suggesting endoscopic surgery is a viable alternative.

Abstract

The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base.A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy.One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 +/- 3.9% and 58.8 +/- 8.6% (p = 0.0004) for the EEA and CEA group, respectively.To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.