xRead - Nasal Obstruction (September 2024) Full Articles

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ingfully compare outcomes between surgical approaches, only studies with at least 20 total subjects were included.

Intervention CT and MRI remain the conventional

imaging modalities. Hybrid PET or other full-body imaging should be considered in the investigation of regional and distant metastases in SNM. Presence of enlarged RPLNs should always be evaluated on CT orMRI.

A Squamous cell carcinoma Current data investigating open versus EEA of sinonasal SCC are limited to retrospective studies (Table X.1). Kilic et al. queried the NCDB for cases of sinonasal SCC with out metastases treated surgically between 2010 and 2014. 135 They found that using open approaches was associated with longer hospital LOS (open 4.7 vs. EEA 2.5 mean days; p < 0.0001). Five-year OS was not significantly dif ferent between the two approaches (OS: open 56.5% vs. EEA46.0%; p = 0.953). The findings were confirmed using propensity score-matched cohorts ( n = 326 in each group). In these cohorts, the 5-year OS was not significantly dif ferent between the open and EEA groups (56% vs. 51%; p = 0.850). Mortality at 30 and 90 days did not differ signif icantly between the groups. 246 The authors concluded that EEA is an effective alternative to open surgery, even after accounting for confounding factors, and is also associated with a shorter hospital LOS. Torabi et al. queried the NCDB and found that EEA was not associated with an increased rate of positive margins in 2968 cases of sinonasal SCC. 241 Additionally, Karligkiotis et al. found that, in 34 patients treated for SCC arising from IP, OS, DFS, and RFS rates were comparable to traditional open approaches. 247 B Olfactory neuroblastoma A number of studies have compared outcomes between EEA and open approaches for anterior skull base (ASB) resection of ONB, though most studies examined small retrospective cohorts (Table X.2). 246,248–254 One of the ear liest studies comparing open versus EEA was a systematic review by Devaiah et al. in 2009 demonstrating signifi cantly improved OS in the EEA group. Since then, two systematic reviews, containing primarily level 4 stud ies, showed no significant difference in rate of GTR or complication rates between open and EEA. 255–257 Fu et al., in another systematic review, showed that EEA was associated with improved OS regardless of stage or grade ( p = 0.001), and in patients with Kadish C or D tumors ( p = 0.04) or with Hyams grade III/IV disease ( p = 0.001). 258 Additionally, the rates of distant metas tasis, cause-specific mortality, and overall mortality were significantly lower in EEA. Barinsky et al. presented a large ONB cohort study of 533 cases comparing 267 open approaches to 257 EEA. 254 Cases denoted as endoscopic converted to open were included in the open approach cohort. There were no differences between the cohorts in

X SURGICAL APPROACH Over the past two decades, the approach to treating SNM has transitioned from radical open surgeries to more min imally invasive approaches. 30,232 In 1963, Ketcham et al. introduced the transfacial and transcranial (CFR) proce dures to address SNM. 233,234 The approach was found to improve survival, and CFR was subsequently deemed the gold standard for SNM treatment. 22 While CFR has tradi tionally allowed for en bloc GTR of tumors, this approach was associated with a high rate of complications includ ing CSF leaks, increased hospital length of stay (LOS), poor cosmesis, and perioperative mortality. 174 Endoscopic endonasal sinus surgery was introduced in 1986 as a means to treat chronic sinusitis. 235 Proponents found that it offered better visualization, reduced recovery times, and precluded the need for external incisions. 236,237 Over time, adaptation of endoscopic techniques to EEA was successfully used to address benign sinonasal lesions. Bolstered by early retrospective cases series indicating sim ilar survival and decreased morbidity using EEA for SNM as compared to published rates for open approaches, 238,239 EEA began gaining traction as a main approach to address SNM. An important concern with EEA was increased risk for recurrence. 239 En bloc GTR was the gold standard for resection of malignant tumors. Alternatively, EEA utilizes progressive resection, moving from the distal aspects of the mass proximally toward its site of origin/attachment, with the goal of resecting the tumor pedicle en bloc with wide margins. 240 Frozen sections are used to assess margin sta tus. Early studies showed no association between positive margin status and type of surgical approach. 241–243 Fur thermore, the development of the nasoseptal flap (NSF) for more effective skull base reconstruction led to increased use of EEA to address SNM. 244,245 The efficacy of EEA as compared to open approaches to address SNM is still debated, especially for locally advanced and recurrent neoplasms. Additionally, the rare nature and heterogeneity of these tumors make random ized, adequately powered studies difficult to perform. This section reviewed the available literature to com pare outcomes after EEA, endoscopic-assisted, and open procedures for the surgical resection of SNM. To mean