Endoscopic removal of sinonasal tumors

Abstract

Objectives: To evaluate the efficacy of endoscopic surgery for sinonasal tumors.Patients and Methods: Clinical records of 20 patients’ 10 males, 10 females; mean age 34; range 12 to 63 years who underwent endoscopic tumor resection with diagnosis of sinonasal tumor between January 1998 and August 2004 were retrospectively reviewed. Patients who were operated by transnasal endoscopic surgery or by combined endo­ scopic or external surgical methods were included in the study. Patients were reviewed for age, sex, pathologic diag­ nosis and tumor location, surgical techniques, need for additional surgery, complications, recurrence and follow-up periods.Results: There were five osteoms, one fibrous dysplasia, one ossifying fibroma, seven inverted papillomas, one oncocitic papilloma, three angiofibromas, one schwanno- ma and one esthesioneuroblastoma. The patients’ follow up period ranged between 6 months and 6 years mean 26 months . The fibrous dysplasia involving the posterior ethmoid sinuses was subtotally resected due to its close proximity to the optic nerve. One of the inverted papilloma of maxillary sinüs was resected by a combined endoscop­ ic and Caldwell-Luc approach. A combined endoscopic intranasal and external frontoethmoidectomy approach was performed for the removal of frontal sinüs schwannoma. Recurrence was observed in one of the inverted papilloma cases. Total removal of the tumors was achieved in ali other cases without any complication or recurrences.Conclusion: Low recurrence rates in our series showed that the endoscopic resection of nasal-paranasal sinüs tumors in selected cases may be an appropriate method as solely or combined with other surgical techniques for experienced surgeons.

Keywords

• Nasal Cavity, paranasal sinüs neoplasms, endo­ scopic surgical procedures, recurrence

Endoskopik sinonazal tümör rezeksiyonu

Abstract

Amaç: Sinonazal tümörlerde endoskopik cerrahinin etkinliği değerlendirildi.Hastalar ve Yöntemler: Ocak 1998-Ağustos 2004 tarihleriarasında sinonazal tümör tanısıyla endoskopik tümör rezeksiyonu yapılan 20 hastanın kayıtları retrospektif olarak incelendi. Sadece transnazal endoskopik cerrahi yapılan veya kombine endoskopik ve eksternal cerrahi yöntemler uygulananhastalar çalışmaya alındı. Hastaların yaşları, cinsiyetleri, tümörün patolojik tanısı, yerleşimi, ek cerrahi girişim gereksinimi, uygulanan cerrahi tedavi modalitesi, komplikasyonları, rekürrens gelişimi ve takip süreleri belirlenerek elde edilen sonuçlar değerlendirildi.Bulgular: Olguların beşi osteom, biri fibröz displazi, biri ossifying fibrom, yedisi inverted papillom, biri onkositik papillom,üçü anjiofibrom, biri schwannom, biri estesionöroblastomdu.Hastaların takip süresi 6 ay-6 yıl arasındaydı ort. 26 ay .Posterior etmoid kaynaklı fibröz displazili olguda optik sinireyakın komşuluk nedeniyle endoskopik subtotal rezeksiyonyapıldı. Nazal pasaj ve maksiller sinüsü tutan inverted papillomlu bir hastaya kombine endoskopik ve Caldwell-Luc yaklaşımla tümör rezeksiyonu yapıldı. İnverted papillom tanısıyla endoskopik olarak ameliyat edilen bir olguda cerrahi sonrası nüks gelişti. Frontal sinüse yerleşmiş schwannom olgusunda kombine endoskopik ve eksternal frontoetmoidektomiyaklaşımıyla tümör rezeke edildi. İnverted papillomlu bir hastada rekürrens izlendi. Diğer tüm olgularda komplikasyonsuzolarak total endoskopik tümör eksizyonu yapıldı, bu hastalarda takipte nüks görülmedi.Sonuç: Çalışmamızdaki düşük rekürrens oranları, seçilmişolgularda, özellikle de deneyimli ellerde, endoskopik yaklaşımla tümör rezeksiyonunun tek başına ya da diğer yaklaşımlarla kombine edilerek, düşük morbiditeyle ve güvenle uygulanabilecek bir yöntem olabileceğini göstermektedir

Keywords

• Nazal kavite, paranazal sinüs neoplazileri,endoskopik sinüs cerrahisi, rekürrens

References

1. London SD, Schlosser RJ, Gross CW. Endoscopic man- agement of benign sinonasal tumors: a decade of expe- rience. Am J Rhinol 2002;16:221-7.
2. Pasquini E, Sciarretta V, Frank G, Cantaroni C, Modugno GC, Mazzatenta D, et al. Endoscopic treat- ment of benign tumors of the nose and paranasal sinuses. Otolaryngol Head Neck Surg 2004;131:180-6.
3. Cakmak O, Yavuz H, Yucel T. Nasal and paranasal sinus schwannomas. Eur Arch Otorhinolaryngol 2003;260:195-7.
4. Caylakli F, Buyuklu F, Cakmak O, Ozdemir H, Ozluoglu L. Ossifying fibroma of the middle turbinate: a case report. Am J Otolaryngol 2004;25:377-8.
5. Wolfe SG, Schlosser RJ, Bolger WE, Lanza DC, Kennedy DW. Endoscopic and endoscope-assisted resections of inverted sinonasal papillomas. Otolaryngol Head Neck Surg 2004;131:174-9.
6. Tufano RP, Mokadam NA, Montone KT, Weinstein GS, Chalian AA, Wolf PF, et al. Malignant tumors of the nose and paranasal sinuses: hospital of the University of Pennsylvania experience 1990-1997. Am J Rhinol 1999;13:117-23.
7. Cakmak O, Ergin NT, Aydin MV. Isolated sphenoid sinus adenocarcinoma: a case report. Eur Arch Otorhinolaryngol 2002;259:266-8.
8. Cakmak O, Ergin NT, Yilmazer C, Kayaselcuk F, Barutcu O. Endoscopic removal of esthesioneuroblas- toma. Int J Pediatr Otorhinolaryngol 2002;64:233-8.

9. Goffart Y, Jorissen M, Daele J, Vander Poorten V, Born J, Deneufbourg JM, et al. Minimally invasive endo- scopic management of malignant sinonasal tumours. Acta Otorhinolaryngol Belg 2000;54:221-32.
10. Maniglia AJ, Phillips DA. Midfacial degloving for the management of nasal, sinus, and skull-base neo- plasms. Otolaryngol Clin North Am 1995;28:1127-43.
11. Wei WI, Ho CM, Yuen PW, Fung CF, Sham JS, Lam KH. Maxillary swing approach for resection of tumors in and around the nasopharynx. Arch Otolaryngol Head Neck Surg 1995;121:638-42.
12. McCutcheon IE, Blacklock JB, Weber RS, DeMonte F, Moser RP, Byers M, et al. Anterior transcranial (cranio- facial) resection of tumors of the paranasal sinuses: surgical technique and results. Neurosurgery 1996;38:471-9; discussion 479-80.
13. Namdar I, Edelstein DR, Huo J, Lazar A, Kimmelman CP, Soletic R. Management of osteomas of the paranasal sinuses. Am J Rhinol 1998;12:393-8.
14. Savic DL, Djeric DR. Indications for the surgical treat- ment of osteomas of the frontal and ethmoid sinuses. Clin Otolaryngol Allied Sci 1990;15:397-404.
15. Schick B, Steigerwald C, el Rahman el Tahan A, Draf W. The role of endonasal surgery in the management of frontoethmoidal osteomas. Rhinology 2001;39:66-70.
16. Brodish BN, Morgan CE, Sillers MJ. Endoscopic resec- tion of fibro-osseous lesions of the paranasal sinuses. Am J Rhinol 1999;13:111-6.
17. Buyuklu F, Tarhan E, Cakmak O, Ozgirgin N, Arikan U. Isolated fibrous dysplasia of the sphenoid sinus. Rhinology 2005;43:309-12.
18. Margo CE, Weiss A, Habal MB. Psammomatoid ossify- ing fibroma. Arch Ophthalmol 1986;104:1347-51.
19. Shanmugaratnam K, Sobin LH. Histological typing of tumours of the upper respiratory tract and ear. 2nd ed. Berlin: Springer Verlag 1991.
20. Winter M, Rauer RA, Gode U, Waitz G, Wigand ME. Inverted papilloma of the nose and paranasal sinuses. Long-term outcome of endoscopic endonasal resec- tion. HNO 2000;48:568-72. [Abstract]
21. Waitz G, Wigand ME. Results of endoscopic sinus surgery for the treatment of inverted papillomas. Laryngoscope 1992;102:917-22.
22. Sadeghi N, Al-Dhahri S, Manoukian JJ. Transnasal endoscopic medial maxillectomy for inverting papillo- ma. Laryngoscope 2003;113:749-53.
23. Stankiewicz JA, Girgis SJ. Endoscopic surgical treat- ment of nasal and paranasal sinus inverted papilloma. Otolaryngol Head Neck Surg 1993;109:988-95.
24. Keles N, Deger K. Endonasal endoscopic surgical treatment of paranasal sinus inverted papilloma--first experiences. Rhinology 2001;39:156-9.
25. Lawson W, Kaufman MR, Biller HF. Treatment out- comes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope 2003;113:1548-56.
26. Tomenzoli D, Castelnuovo P, Pagella F, Berlucchi M, Pianta L, Delu G, et al. Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience with 47 patients. Laryngoscope 2004;114:193-200.
27. Tseng HZ, Chao WY. Transnasal endoscopic approach for juvenile nasopharyngeal angiofibroma. Am J Otolaryngol 1997;18:151-4.
28. Schick B, el Rahman el Tahan A, Brors D, Kahle G, Draf W. Experiences with endonasal surgery in angiofibro- ma. Rhinology 1999;37:80-5.
29. Nicolai P, Berlucchi M, Tomenzoli D, Cappiello J, Trimarchi M, Maroldi R, et al. Endoscopic surgery for juvenile angiofibroma: when and how. Laryngoscope 2003;113:775-82.
30. Onerci TM, Yucel OT, Ogretmenoglu O. Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol 2003;67:1219-25.
31. Radkowski D, McGill T, Healy GB, Ohlms L, Jones DT. Angiofibroma. Changes in staging and treatment. Arch Otolaryngol Head Neck Surg 1996;122:122-9.
32. Pasquini E, Sciarretta V, Farneti G, Ippolito A, Mazzatenta D, Frank G. Endoscopic endonasal approach for the treatment of benign schwannoma of the sinonasal tract and pterygopalatine fossa. Am J Rhinol 2002;16:113-8.
33. Facon F, Forman C, Paris J, Chapon F, Moulin G, Dessi P. A case of nasal septum schwannoma: endoscopic resection. Ann Otolaryngol Chir Cervicofac 2004;121:179-83. [Abstract]
34. Morita A, Ebersold MJ, Olsen KD, Foote RL, Lewis JE, Quast LM. Esthesioneuroblastoma: prognosis and management. Neurosurgery 1993;32:706-14.
35. Casiano RR, Numa WA, Falquez AM. Endoscopic resection of esthesioneuroblastoma. Am J Rhinol 2001;15:271-9.
36. Liu JK, O’Neill B, Orlandi RR, Moscatello AL, Jensen RL, Couldwell WT. Endoscopic-assisted craniofacial resection of esthesioneuroblastoma: minimizing facial incisions-technical note and report of 3 cases. Minim Invasive Neurosurg 2003;46:310-5.
37. Walch C, Stammberger H, Anderhuber W, Unger F, Kole W, Feichtinger K. The minimally invasive approach to olfactory neuroblastoma: combined endo- scopic and stereotactic treatment. Laryngoscope 2000;110:635-40.
38. Anderhuber W, Stammberger H, Walch C, Fock C, Regauer S, Luxenberger W, et al. A. Rigid endoscopy in minimally invasive therapy of tumours of the paranasal sinuses and skull base. Min Invas Ther Allied Technol 1999;8:25-32.
39. Stammberger H, Anderhuber W, Walch C, Papaefthymiou G. Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies. Acta Otorhinolaryngol Belg 1999;53:199- 205.