The Selective Role of Open and Endoscopic Approaches for Sinonasal Malignant Tumours

Abstract

Endoscopic endonasal surgery has been demonstrated to be effective in the treatment of selected cases of sinonasal cancers. However, in cases of locally advanced neoplasms, as well as recurrences, the most appropriate approach is still debated. The present review aims to summarize the current state of knowledge on the utility of open approaches to resect sinonasal malignant tumours. Published comparative studies and meta-analyses suggest comparable oncological results with lower morbidity for the endoscopic approaches, but selection biases cannot be excluded. After a critical analysis of the available literature, it can be concluded that endoscopic surgery for selected lesions allows for oncologically safe resections with decreased morbidity. However, when endoscopic endonasal surgery is contraindicated and definitive chemoradiotherapy is not appropriate, craniofacial and transfacial approaches remain the best therapeutic option.

Progress and emerging strategies to preserve function in the treatment of sinonasal cancer

“…Indeed, following endoscopic removal of the bulk of the tumor, the superior identification of the site of tumor origin facilitates a more precise complete excision than traditionally achieved with the open approaches 5,7 . Consequently, the endoscopic access has become the preferred surgical exposure for SNC that encompasses structures amenable to minimally invasive approaches 8 . In a recent retrospective review of 239 patients, 70% had a transnasal endoscopic approach alone, whereas 30% had a combined endoscopic and external approach.…”

“…5,7 Consequently, the endoscopic access has become the preferred surgical exposure for SNC that encompasses structures amenable to minimally invasive approaches. 8 In a recent retrospective review of 239 patients, 70% had a transnasal endoscopic approach alone, whereas 30% had a combined endoscopic and external approach. Postoperative cerebrospinal fluid (CSF) leakage occurred in 5.9% of patients and negative margins were achieved in 87.4% of patients.…”

Poorly differentiated sinonasal neuroendocrine carcinoma with skull base invasion: A case report

“…In the case of intracranial extension of potentially aggressive tumors, like in this case, the exclusive endoscopic approach is associated with limited morbidity, but a frontal craniotomy provides better control of surgical margins in locally advanced neoplasms and recurrence. [ 5 , 12 ] It has been proposed that for lesions that invade the rectus gyrus and medial orbital gyrus, the open approach should be chosen; however, the adequate postoperative outcome of our patient was completely matched by a pure endoscopic approach, reducing hemorrhagic, ophthalmologic, and infectious complications found in the open surgery. Regarding the treatment of persistent high-grade lesions, salvage resection has been shown to be a potentially curative option; one cohort demonstrated a disease-free survival of 60% following salvage surgery.…”

“…Orbital invasion and intracranial extension of the sinonasal tumor are recognized as the worst prognostic factors due to the difficulty in obtaining negative surgical margins, and the high risk of systemic dissemination through dural infiltration. [ 1 , 12 ] Accordingly, achieving free margins is the primary objective, regardless of the technique used to reach it. Novel endonasal techniques focus on creating an optimal surgical corridor for a wider scope of visualization through lamina papyracea removal, and drilling crista galli, among other techniques that allow a better inspection of the sinus and improve surgical margins.…”

Endoscopic endonasal anterior skull base surgery

“…Alles in allem bestätigt die aktuelle Literatur, dass die EEES in vielen Fällen eine gleichwertige Alternative zu einem offenen Zugang ist und vielversprechende Ergebnisse in Bezug auf das Gesamtüberleben und die Reduktion der Lokalrezidivrate zeigt [ 7 ]. Doch trotz der stetigen Erweiterung des Indikationsprofils endoskopischer Zugänge und ihrer klaren Vorteile bleiben weiterhin viele Indikationen für eine offene Technik bestehen [ 22 ]. Für die Erzielung gleichwertiger onkologischer Ergebnisse bedarf es somit einer sorgfältigen Patient:innenselektion [ 17 , 21 ], da das wichtigste prognostische Kriterium bei Malignomen eine realisierbare R0-Resektionssituation ist [ 4 ].…”