Challenges in the management of sphenoid inverted papilloma

Rhinology and Sinonasal Surgery, University of Texas Medical School, Houston, Texas, USA.
American Journal of Rhinology (Impact Factor: 1.36). 03/2005; 19(2):207-13.
Source: PubMed


Inverted papilloma (IP) arising in the sphenoid sinus is extremely rare. Management of sphenoid sinus IP is especially challenging because of the paucity of sinonasal symptoms on presentation and the inherent surgical risks associated with the anatomic location of the sphenoid sinus.
We performed a retrospective review of medical records of all patients with IP arising within the sphenoid sinus.
A total of five patients were identified. All patients were managed with endoscopic resection. The most common presenting symptom was headache (three patients). The mean follow-up period was 37.6 months (range, 10-79 months). Two patients with erosive skull base lesions adjacent to the internal carotid artery were managed with a staged endoscopic resection. Only one patient developed a recurrence after 38 months and underwent revision endoscopic resection.
Endoscopic management of sphenoid IP allows maximal resection with minimal morbidity and facilitates endoscopic postoperative surveillance. Complete preoperative radiological assessment of tumor extent is essential. Preoperative medical therapy can help normalize inflamed mucosa and minimize intraoperative bleeding. For large erosive IP, surgical risks may be minimized by considering a staged resection and using computer-aided surgery.

5 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the diagnosis and management of isolated sphenoid sinus disease by using the current rhinologic standard of care. Retrospective chart review. Fifty sequential, symptomatic patients were studied. Presenting symptoms included headache or facial pain (88%), rhinorrhea (46%), and nasal congestion (26%). All patients underwent CT imaging, demonstrating bony changes or dehiscences (42%), a mass (24%), or complete opacification of the sphenoid sinus (22%). Eighty percent required surgical intervention. The most frequent diagnoses were as follows: sinusitis (38%), fungal ball (20%), neoplasm (16%), and mucocele (12%). Treatment resulted in clinical or endoscopic improvement or resolution in 87% of the patients. The presenting symptoms of isolated sphenoid sinus disease can be nonspecific and may result in an inordinate delay in diagnosis. Nasal endoscopy and radiologic imaging are central to making an accurate and timely diagnosis. Medical treatment or minimally invasive surgical techniques can successfully manage the majority of patients with persistent or refractory symptoms.
    Otolaryngology Head and Neck Surgery 11/2005; 133(4):544-50. DOI:10.1016/j.otohns.2005.04.023 · 2.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To review our experience with transnasal endoscopic resection of clival lesions. Because of the surrounding vital structures and the difficulties in achieving wide surgical exposure, the treatment of clival lesions is challenging. In an effort to overcome these obstacles, many centers use facial incisions and osteotomies to approach clival lesions. Minimally invasive endoscopic techniques have the potential to minimize morbidity while yielding similar surgical results. Retrospective chart analysis. Patients with tumors involving the clivus that underwent endoscopic resection between 2000 and 2004 were identified. Charts were reviewed for clinical characteristics, previous therapies, diagnosis, tumor extent, management modalities, length of hospital stay, complications, and outcome. A total of six patients were identified. There were four males and two females with a mean age of 50 years, ranging from 29 to 66 years. The most common presenting symptoms were visual disturbances. Three patients had prior craniotomy with subtotal tumor resection. The pathology included three clival chordomas, and one each of meningioma, adenoid cystic carcinoma, and sinonasal undifferentiated carcinoma. All patients were managed with computer-aided transnasal endoscopic tumor resection with neurosurgical standby or involvement. None of the patients required additional craniotomies. The mean follow-up was 13 (range, 8-24) months. Intensity-modulated radiation therapy was used in three patients, and two patients are currently undergoing proton beam radiation therapy (PBRT). The average length of hospital stay was 2 (range, 2-3) days. There were no major postoperative complications. At the last follow-up, five patients were alive with two patients being free of disease. Two patients with residual disease are currently undergoing PBRT, and one patient developed distant metastasis. One patient died of unrelated causes. This preliminary report suggests that transnasal endoscopic management of clival lesions is a viable option to traditional open approaches with acceptable morbidity and mortality. The use of computer-aided surgery further minimizes surgical risks while maximizing tumor resection.
    The Laryngoscope 12/2005; 115(11):1917-22. DOI:10.1097/01.mlg.0000172070.93173.92 · 2.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Inverted papillomas are uncommon benign tumors that may occur in the sinonasal tract. Because of their tendency towards recurrence and their potential for malignant transformation, complete en bloc resection has been the standard treatment modality. With the application of minimally invasive surgical techniques in the management of sinonasal disease processes, transnasal endoscopic removal of inverted papillomas is gaining in acceptance. The following represents a review of the current literature regarding sinonasal inverted papilloma and its clinical management. The recent literature has further refined the technique of endoscopic resection of inverted papillomas by delineating essential principles and applying new technologies, such as image guidance and angled endoscopic drills. Modified approaches and methodology have been described to address tumors originating in particular anatomic locations. At the same time, new information relevant to the diagnosis and surveillance of inverted papillomas has been published, regarding the role of imaging, serum tumor markers, and human papillomavirus. Growth in experience with the endoscopic management of inverted papillomas has led to evolving technical improvements and innovations. In most tumor locations, the completeness of resection achieved by a skilled endoscopic surgeon is equivalent, if not superior, to that attained with an open approach. In some instances, an endoscopic exploration with tumor resection may help define the site of tumor attachment and direct adjunctive open procedures when indicated. Long-term outcomes studies with sizeable patient cohorts will be needed to define the role of various surgical strategies in the optimal management of inverted papilloma.
    Current Opinion in Otolaryngology & Head and Neck Surgery 03/2006; 14(1):14-8. DOI:10.1097/01.moo.0000193175.54450.1f · 1.84 Impact Factor
Show more

Similar Publications