Endonasal Endoscopic Management of Fibrous Dysplasia Involving Sphenoid Sinus and Optic Nerve: Postoperative Outcomes

Objective: To evaluate success of endonasal endoscopic surgery in removing fibrous dysplasia (FD) lesions involving sphenoid sinuses at areas close to important structures and to assess its effectiveness in management of patient symptoms and possible complications.

Methods: Retrospective analysis of all patients operated between 2007 and 2015 at our tertiary care unit with sinonasal FD effecting sphenoid sinuses. Open or combined surgeries were excluded. Clinical examination results, radiological studies, operative findings and treatment outcomes were evaluated.

Results: Ten patients with optic nerve encasement in 7 (70%) were included. All had headache which completely vanished in all postoperatively. Preoperative visual changes were detected only in 5 (50%) patients from whom symptoms have resolved completely in 2 (40%) and improved in 3 (60%) after surgery. No patients had postoperative additional visual deficit. During surgery there were no major bleedings, but in 2 (20%) cases CSF leakage was inevitable, which were recognized and repaired immediately. Postoperative imaging showed total resection in 7 (70%), gross total resection in 2 (20%) patients. One patient had only optic nerve decompression due to diffuse skull disease. In a mean follow-up time of 38 months, no recurrences or growth were detected except last mentioned patient.

Conclusion: For removal of FD involving sphenoid sinuses, endonasal endoscopic approach reveals a viable technique with acceptable morbidity. Decision of surgery should be made carefully by evaluating radiological evidence for possible complications and by analyzing tumor growth and symptoms of the patients. For reducing recurrences total or gross total excision should be aimed which is achievable with this approach.