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146

KUANetal.

TABLE XVI.4 Evidence surrounding the role of skull base bony resection.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Tilak et al. 359

Periorbital suspension provided excellent endoscopic access for curative resection with low recurrence (0/11, 0.0%) and complications (0/11, 0.0%) Management of IP involving the frontal sinus should tailor surgical technique to its site of attachment and extension and the anatomical conformation of each frontal sinus in order to achieve low recurrence (2/47, 4.3%) and complications (1/47, 2.1%) Aggressive endoscopic resection of skull base IP was effective at producing durable cure rates (0/4, 0.0% recurrence) with acceptable complication rates (1/4, 25.0%) Aggressive endoscopic resection of skull base IP was effective at producing durable cure rates (0/49, 0.0% recurrence) with acceptable complication rates (5/49, 10.2%) Aggressive endoscopic resection of skull base IP was effective at producing durable cure rates (0/5, 0.0% recurrence) Bony resection reduced recurrence rates when skull base involvement was suspected (2/15, 13.3% vs. 7/17, 41.2%)

1. Recurrence 2.

2021

4

Retrospective case series

Patients undergoing periorbital suspension during EEA( n = 29; n = 11 with IP) Patients undergoing EEA or combined EEA and open approaches for IP

Complications

Pietrobon et al. 692

2019 4

Retrospective case series

1. Recurrence 2.

Complications

involving the frontal sinus ( n = 47)

Albathi et al. 691

1. Recurrence 2.

2018 4

Retrospective case series

Patients with IP

involving the lateral frontal sinus undergoing EEA and Draf IIB or Draf III sinusotomy ( n = 4)

Complications

Grayson et al. 673 2016 4

Retrospective case series

Patients with skull

1. Recurrence 2.

base IP resected via EEA( n = 49)

Complications

Gras-Cabrerizo et al. 689

Recurrence

2013 4

Retrospective case series

Patients with varying skull base lesions resected via EEA ( n = 72; n = 5with IP) Patients with sinonasal IP resected via EEA and/or open approaches ( n = 24; n = 15 with bony resection)

Endoet al. 688

2008 4

Retrospective case series

Recurrence

Abbreviations: EEA, endoscopic endonasal approach; IP, inverted papilloma.

rence, and the leading causes of incomplete removal are improper approaches and mismanagement of the attachment site. 715–718 Debulking of tumor to attach ment site, resection of diseased and partially healthy mucosa underlying attachment site, cauterizing the bone and mucosa underlying the attachment site, and/or drilling/resecting the bone underlying the attachment site is a generalized approach commonly employed for IP resection. In one systematic review, there does not appear to be significant advantage of tumor recurrence rates with any specific approach but rather the surgeon can use discretion when employing one or more of these techniques. 138

When IP lesion attachment sites are in problematic areas such as the sphenoid sinus, anterior wall of the maxil lary sinus, frontal sinus, or hidden behind large bulky disease, the literature base is clear that surgeons must prioritize access to the pedicle and may need to utilize extended endoscopic surgical approaches such as Draf III, bilateral sphenoidotomy with or without a sphenoid drill out, transseptal access with crossing multiple incisions (TACMI), prelacrimal approaches, modified endoscopic medial maxillectomy, or Denker’s approaches. 303,706,719–725 Multifocal attachment of IP was more commonly seen in recurrent lesions and conferred a 3.5-fold increased risk of recurrence when present. 726 Some studies reported