Endoscopic Resection of Sinonasal and Anterior Skull Base Malignancies: Analysis of 78 Cases

Background: Craniofacial resection followed by radiotherapy is considered to be the gold standard in the treatment of malignancies of the sinonasal tract. After 20 years of experience in the treatment of sinonasal tract lesions, such as inflammatory disorders, benign tumors, and duraplasty procedures, the endoscopic technique has reached a high degree of refinement to provide the endosurgeon with the necessary skills and dexterity to treat such malignancies. This technique allows removal of sinonasal neoplasms respecting the criterion of oncological radicality (free margins).

Objectives: To describe and analyze outcomes of “multilayer centripetal technique” in the treatment of malignancies of the sinonasal tract. This procedure is based on two main steps consisting in central debulking of the lesion followed by its removal in a multilayer fashion (piecemeal removal until reaching anatomical structures free from disease).

Methods: From June 1997 to October 2006, 78 patients with malignant tumors of the sinonasal tract underwent a sole endoscopic endonasal treatment. The follow-up lasted from 3 to 115 months. AJCC-UICC staging was as follows: T1 = 26, T2 = 8, T3 = 12, T4a = 10, T4b = 9. Patients affected by esthesioneuroblastoma were staged according to Kadish: 3 = A, 5 = B, 5 = C. All patients underwent surgery but with different therapeutic intent: curative, salvage, or palliative.

Results: Statistical analysis showed a 2-year survival rate higher than 80% in all histological types of tumors except for melanomas. Such findings were in accordance with others' experiences in the literature. In this preliminary study endoscopic technique, in selected cases, seems to be an effective method in the treatment of sinonasal tumors. The management of malignancies through these approaches should be carried out only by surgeons with substantial experience in these techniques in highly specialized centers.