Preoperative Staging and Surgical Approaches for Sinonasal Inverted Papilloma

2007 ◽  
Vol 116 (9) ◽  
pp. 674-680 ◽  
Author(s):  
Keita Oikawa ◽  
Yasushi Furuta ◽  
Yuji Nakamaru ◽  
Nobuhiko Oridate ◽  
Satoshi Fukuda
Keyword(s):  
Preoperative Staging ◽  
Staging System ◽  
Endoscopic Approach ◽  
Sinus Surgery ◽  
Surgical Approaches ◽  
External Approach ◽  
Sinonasal Inverted Papilloma ◽  
Mri Staging ◽  
First Choice ◽  
Magnetic Resonance Imaging Mri

Objectives: We sought to determine the value of preoperative staging by magnetic resonance imaging (MRI) assessment in the surgical management of sinonasal inverted papillomas (IPs). Methods: Preoperative MRI staging was used to assess 22 patients with IPs. In addition to the Krouse staging system, T3 cases were categorized as subgroup T3-B if tumors extended into the frontal sinus or the supraorbital recess; otherwise, they were categorized as T3-A. Standard endoscopic sinus surgery (ESS) was the first choice for T1 and T2 cases. Endoscopic approaches, including ESS combined with endoscope-assisted transantral approach and endoscopic medial maxillectomy, were considered in T3-A cases, and external approaches were considered in T3-B cases. Patients were followed for a minimum of 1 year after surgery. Results: Preoperative MRI staging and postoperative staging were coincident in 21 of the 22 patients (95%). All 8 T2 cases were treated by an endoscopic approach. Of 10 T3-A cases, 9 (90%) were treated by an endoscopic approach and 1 (residual case) was treated by an external approach. All 3 of the T3-B cases underwent an external approach. One T4 case with malignant transformation underwent an external approach followed by radiotherapy. After a median follow-up period of 22 months, none of the 22 patients had had a recurrence. No major complications were observed after endoscopic approaches, but epiphora or hemorrhage requiring transfusion occurred in 3 of the 5 patients (60%) who underwent external approaches. Conclusions: Preoperative staging of IP by MRI is useful for selecting cases that can be managed by endoscopic approaches, resulting in lower rates of tumor recurrence and morbidity.

scholarly journals The comparison of endoscopic and external surgical approaches for sinonasal inverted papilloma and their impact on tumour recurrence

2019 ◽  
Vol 8 (4) ◽  
pp. 90-95
Author(s):  
Zuzanna Nowinka ◽  
Shadaba Ahmed
Keyword(s):  
Recurrence Rate ◽  
Endoscopic Surgery ◽  
Surgical Complications ◽  
Inverted Papilloma ◽  
Endoscopic Approach ◽  
High Rate ◽  
Surgical Approaches ◽  
Tumour Resection ◽  
External Approach ◽  
Sinonasal Inverted Papilloma

Introduction: Sinonasal inverted papilloma (SNIP) is a rare, benign tumour originating from the mucosal lining of the sinonasal cavity. The treatment is aimed at complete tumour resection. Current resection methods include external excision, endoscopic surgery and a combined approach. The high rate of SNIP recurrence poses a challenge for the ear nose and throat (ENT) specialist. There is a debate about which method provides the best outcomes. In this study, the most recent literature is analysed to evaluate the effectiveness of each surgical approach in terms of recurrence rate and surgical complications. Results: The literature search yielded data for 941 patients from ten studies. The analysis showed a recurrence rate of 13.5% for the endoscopic approach, 34% for combined and 36.7% for the external. The lowest recurrence rate (0%-3.6%) was reported when novel endoscopic approaches, such as prelacrimal recess or ‘TuNa’ saving, were used. However, the comparison of surgical complications was challenging due to inconsistent reporting. Discussion: The external approach previously considered a ‘gold standard’ is now becoming replaced by endoscopic surgery. The advantages of an endoscopic approach are a lower recurrence rate, better visualisation of the tumour and a more precise excision. Moreover, this approach preserves the surrounding tissues, reducing the amount of complications and recovery time. However, the external approach should still be employed when SNIP is widespread or in proximity with vital structures. Careful pre-operative planning is needed as the primary surgery has the best chances of eliminating the disease. Each revision surgery subsequently increases the risk of SNIP recurrence. Furthermore, there is a need for agreement on minimal surveillance time after SNIP resection. Conclusion: The endoscopic approach should be a mainstay of SNIP treatment due to low recurrence rate and better patient outcomes. Nevertheless, ENT specialists should keep in mind that for more advanced disease, external an combined methods may be more appropriate.

Endoscopic approaches to benign sphenoid sinus lesions: development of an algorithm based on 13 years of experience

2014 ◽  
Vol 128 (9) ◽  
pp. 791-796 ◽  
Author(s):  
A S Elhamshary ◽  
H E Romeh ◽  
M F Abdel-Aziz ◽  
S M Ragab
Keyword(s):  
Revision Surgery ◽  
Sphenoid Sinus ◽  
Inflammatory Diseases ◽  
Endoscopic Approach ◽  
Surgical Approaches ◽  
Transnasal Approach ◽  
First Choice ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractObjective:To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions.Methods:Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted.Results:A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively.Conclusion:Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.

S278 – Management Strategies for Sinonasal Inverted Papilloma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P168-P168
Author(s):  
Michael Hoa ◽  
Gruber Bianca ◽  
John H Krouse
Keyword(s):  
Intraoperative Complications ◽  
Management Strategies ◽  
Preoperative Staging ◽  
Retrospective Chart Review ◽  
Inverted Papilloma ◽  
Sinus Surgery ◽  
Disease Stage ◽  
Secondary Outcome ◽  
Recurrence Rates ◽  
Sinonasal Inverted Papilloma

Objectives 1) To compare endoscopic and external approaches in the management of sinonasal inverted papilloma at our institution. 2) To discuss the relationship of these management strategies to disease stage and malignancy. Methods Retrospective chart review of 18 patients who had operations performed to remove sinonasal inverted papilloma. Demographic, imaging and intraoperative data were collected from clinic charts. All patients had a definitive procedure performed between 2001 and 2007, with preoperative staging by CT, MRI or both. The primary outcome measure was recurrence and secondary outcome measures included association with malignancy and intraoperative complications. Results CT and MRI scanning were utilized for staging in 88% and 53% of cases, respectively. Mean follow-up was 16.3 months. All T1 lesions were managed by functional endoscopic sinus surgery (FESS). 71% of T3 lesions were managed by transnasal endoscopic medial maxillectomy (TEMM). 33% and 67% of large T3 and T4 lesions were managed with external procedures and TEMM, respectively. Recurrence rates for T1, T3, and T4 lesions were 0%, 16.7%, and 100%, respectively. Recurrence by surgical method were 0%, 18% (1 T3 and 1 T4), and 0% for FESS, TEMM and external approaches, respectively. Conclusions Inverted papilloma tended to present at more advanced stage. T1 and T3 lesions were generally managed by FESS and TEMM, respectively. Large T3 and T4 lesions were generally managed via external approaches or required further definitive management via an external approach. MRI, especially with frontal disease, may augment CT scanning, identifying true tumor mass, and thus provide indications for or against supplementary procedures.

A Surgical Staging System for Chronic Sinusitis

1992 ◽  
Vol 6 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Ralph E. Gaskins
Keyword(s):  
Paranasal Sinus ◽  
New Technology ◽  
Preoperative Staging ◽  
Staging System ◽  
Clinical Results ◽  
Endoscopic Examination ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Clinical Criteria ◽  
Paranasal Sinus Surgery

The application of new technology over the past decade has brought a considerable increase in the volume of paranasal sinus surgery, especially for ethmoid sinus disease. Most literature reports have included patients with widely disparate clinical problems, which makes interpretation and/or prediction of clinical results less meaningful. A set of clinical criteria is proposed to provide a preoperative staging system for patients with paranasal sinus disease. This is backed by clinical results of several hundred patients who have undergone various sinus surgical procedures. Clinical factors used in staging include the anatomic extent of the sinus/nasal disease (as determined both by endoscopic examination and radiographic studies), previous sinus surgical history, presence and extent of polyps (again determined both by endoscopic examination and radiographic studies), presence and severity of immunologic disease (including allergic rhinitis), and the state of control of infection within the sinuses. This staging system can be used to guide procedure selection and in preoperative discussions of likely results. Use of such a system can also promote better scientific analysis of variations in technique.

scholarly journals Endoscopic Modified Medial Maxillectomy for Resection of an Inverted Papilloma Originating from the Entire Circumference of the Maxillary Sinus

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Kota Wada ◽  
Takashi Ishigaki ◽  
Yutaro Ida ◽  
Yuki Yamada ◽  
Sachiko Hosono ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Surgical Approach ◽  
Staging System ◽  
Inferior Turbinate ◽  
Nasolacrimal Duct ◽  
Inverted Papilloma ◽  
Sinonasal Inverted Papilloma ◽  
Medial Maxillectomy ◽  
Magnetic Resonance Imaging Mri ◽  
Modified Medial Maxillectomy

For treatment of a sinonasal inverted papilloma (IP), it is essential to have a definite diagnosis, to identify its origin by computed tomography (CT) and magnetic resonance imaging (MRI), and to select the appropriate surgical approach based on the staging system proposed by Krouse. Recently, a new surgical approach named endoscopic modified medial maxillectomy (EMMM) was proposed. This approach can preserve the inferior turbinate and nasolacrimal duct. We successfully treated sinonasal IP with EMMM in a 71-year-old female patient. In this patient, the sinonasal IP originated from the entire circumference of the maxillary sinus. EMMM is not a difficult procedure and provides good visibility of the operative field. Lacrimation and empty nose syndrome do not occur postoperatively as the nasolacrimal duct and inferior turbinate are preserved. EMMM is considered to be a very favorable approach for treatment of sinonasal IP.

scholarly journals Origin site‐based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery

Head & Neck ◽  
2018 ◽  
Vol 41 (2) ◽  
pp. 440-447 ◽  
Author(s):  
Yifan Meng ◽  
Gaoli Fang ◽  
Xiangdong Wang ◽  
Xiaohong Song ◽  
Kuiji Wang ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Staging System ◽  
Inverted Papilloma ◽  
Sinus Surgery ◽  
Sinonasal Inverted Papilloma

Pediatric Hyperacute Arterial Ischemic Stroke Pathways at Canadian Tertiary Care Hospitals

2021 ◽  
pp. 1-8
Author(s):  
Maria Gladkikh ◽  
Hugh J. McMillan ◽  
Andrea Andrade ◽  
Cyrus Boelman ◽  
Ishvinder Bhathal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Tertiary Care ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Pediatric Hospitals ◽  
First Choice ◽  
Similarities And Differences ◽  
Pre Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Iv Tpa

ABSTRACT: Background: Childhood acute arterial ischemic stroke (AIS) is diagnosed at a median of 23 hours post-symptom onset, delaying treatment. Pediatric stroke pathways can expedite diagnosis. Our goal was to understand the similarities and differences between Canadian pediatric stroke protocols with the aim of optimizing AIS management. Methods: We contacted neurologists at all 16 Canadian pediatric hospitals regarding AIS management. Established protocols were analyzed for similarities and differences in eight domains. Results: Response rate was 100%. Seven (44%) centers have an established AIS protocol and two (13%) have a protocol under development. Seven centers do not have a protocol; two redirect patients to adult neurology, five rely on a case-by-case approach for management. Analysis of the seven protocols revealed differences in: 1) IV-tPA dosage: age-dependent 0.75–0.9 mg/kg (N = 1) versus age-independent 0.9 mg/kg (N = 6), with maximum doses of 75 mg (N = 1) or 90 mg (N = 6); 2) IV-tPA lower age cut-off: 2 years (N = 5) versus 3 or 10 years (each N = 1); 3) IV-tPA exclusion criteria: PedNIHSS score <4 (N = 3), <5 (N = 1), <6 (N = 3); 4) first choice of pre-treatment neuroimaging: computed tomography (CT) (N = 3), magnetic resonance imaging (MRI) (N = 2) or either (N = 2); 5) intra-arterial tPA use (N = 3) and; 6) mechanical thrombectomy timeframe: <6 hour (N = 3), <24 hour (N = 2), unspecified (N = 2). Conclusions: Although 44% of Canadian pediatric hospitals have established AIS management pathways, several differences remain among centers. Some criteria (dosage, imaging) reflect adult AIS literature. Canadian expert consensus regarding IV-tPA and endovascular treatment should be established to standardize and implement AIS protocols across Canada.

Endoscopic Septal Spur Resection

1993 ◽  
Vol 7 (5) ◽  
pp. 213-216 ◽  
Author(s):  
Donald C. Lanza ◽  
Deborah Farb Rosin ◽  
David W. Kennedy
Keyword(s):  
Surgical Technique ◽  
Endoscopic Sinus Surgery ◽  
Chronic Sinusitis ◽  
Sinus Surgery ◽  
Surgical Approaches ◽  
Postoperative Results ◽  
Valuable Alternative ◽  
Perioperative Morbidity ◽  
The Past ◽  
Septal Spur

A variety of surgical approaches exists for the management of nasal septal spurs in patients who undergo endoscopic sinus surgery (ESS). Treatment of septal spurs in the past has been frequently addressed by septoplasty which can result in increased bleeding and length of surgical procedure as well as mandate postoperative nasal packing. Individually each of these problems can jeopardize the success of endoscopic sinus surgery. An endoscopic approach, which targets the septal spur alone, can minimize perioperative morbidity. The purpose of this paper is to demonstrate the effectiveness of endoscopic septal spur resection (ESSR) for the management of significant septal spurs in 8 patients who underwent concurrent ESSR during ESS for chronic sinusitis. Surgical technique and postoperative results are discussed and suggest that ESSR is a valuable alternative to more traditional techniques.

New Staging System for Sinonasal Inverted Papilloma in the Endoscopic Era

2007 ◽  
Vol 117 (7) ◽  
pp. 1283-1287 ◽  
Author(s):  
Steven B. Cannady ◽  
Pete S. Batra ◽  
Nathan B. Sautter ◽  
Hwan-Jung Roh ◽  
Martin J. Citardi
Keyword(s):  
Staging System ◽  
Inverted Papilloma ◽  
Sinonasal Inverted Papilloma

Biological therapy of chronic rhinosinusitis

2021 ◽  
Vol 70 (2) ◽  
pp. 109-114
Author(s):  
Zuzana Balatková ◽  
Zdeněk Knížek ◽  
Jan Vodička ◽  
Jan Plzák
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Biological Therapy ◽  
Immunoglobulin E ◽  
Sinus Surgery ◽  
Therapeutic Choice ◽  
First Choice ◽  
Intranasal Steroids

The aim of this paper is to present an up-to-date information about therapeutical options in chronic rhinosinusitis with nasal polyps. First choice therapy is a long term regular application of intranasal steroids in combination with salinic solution douches. If this treatment is not eff ective enough, then the pulses of systemic steroids are indicated. If the sufficient control of the disease is not achieved, then surgery is a therapeutic choice; it means functional endoscopic sinus surgery in the extent corresponding to the extension of the sinus disease. However, there remains a certain group of patients in whom the results with this treatment are not optimal. The type 2 immunopathological response affects relevantly the course of the disease. Nowadays, the research is done in this field. Specific agents, which are able to block circulating inflammatory mediators or bind receptors for these mediators are developed and studied. The results of the studies having been completed by now are promising. Keywords: biological therapy – chronic rhinosinusitis – nasal polyps – dupilumab – immunoglobulin E – interleukin

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