Rui Peng, Andrew Thamboo, Garret Choby, Yifei Ma, Bing Zhou, Peter H Hwang
Outcomes of sinonasal inverted papilloma resection by surgical approach: an updated systematic review and meta-analysis.
Int Forum Allergy Rhinol. 2019 Jun;9(6):573-581. doi: 10.1002/alr.22305. Epub 2019 Feb 12.
Abstract/Text
BACKGROUND: Selecting the optimal surgical approach for resection of sinonasal inverted papilloma (SIP) remains a challenge, with endoscopic, external, and combined approaches being utilized. This systematic review was conducted as an update to a 2006 systematic review to determine the preferred surgical approach for tumor control.
METHODS: The study protocol was developed a priori following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process. Data were collected and outcomes were analyzed according to surgical approach and sites of tumor involvement.
RESULTS: A total of 96 papers and 4134 SIP patients were included. The overall recurrence rate was 12.80% (322/2515) for the endoscopic approach group, 16.58% (182/1098) for the external approach group, and 12.60% (65/516) for the combined approach group. Meta-analysis by random effects model showed that the summarized risk ratio (RR) of recurrence was 0.61 (95% confidence interval [CI], 0.44 to 0.85, p = 0.003), I2 = 37.95% for the endoscopic vs external approach; 0.98 (95% CI, 0.69 to 1.39, p = 0.901), I2 = 9.06% for the endoscopic vs combined approach; 1.61 (95% CI, 1.06 to 2.43, p = 0.025), I2 = 0.00% for the external vs combined approach. After adjusting for publication bias, the adjusted RRs were 0.66 (p = 0.014) for endoscopic vs external; 0.99 (p = 0.955) for endoscopic vs combined; and 1.33 (p = 0.224) for external vs combined.
CONCLUSION: An enlarging and maturing body of literature continues to indicate that endoscopic approaches result in significantly lower recurrence rates than open approaches for surgical resection of SIP.
© 2019 ARS-AAOA, LLC.
Kazuhiro Omura, Kazuhiro Nomura, Ryosuke Mori, Yudo Ishii, Satoshi Aoki, Teppei Takeda, Kosuke Tochigi, Yasuhiro Tanaka, Nobuyoshi Otori, Hiromi Kojima
Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360° Suturing Technique.
Oper Neurosurg (Hagerstown). 2022 Jan 1;22(1):e1-e6. doi: 10.1227/ONS.0000000000000013.
Abstract/Text
BACKGROUND: Advances in technique and instrumentation have improved outcomes after resection of anterior skull base tumors. However, cerebrospinal fluid (CSF) leak occurs in 4%-20% of patients. To reduce the risk of CSF leak, we have developed a novel reconstruction technique that consists of a 4-layered graft with patchwork suturing and hard material.
OBJECTIVE: To evaluate the effectiveness of this reconstruction technique when used for resection of anterior skull base tumors.
METHODS: This case series included 59 patients with anterior skull base tumors in whom the 4-layered closure technique was used. The main outcome measures were complications, including CSF leak, meningitis, postoperative bleeding, and infection.
RESULTS: There were no CSF leak cases or serious complications after closure of the anterior skull base using the 4-layered technique.
CONCLUSION: Closure of the anterior skull base in 4 layers prevented CSF leak and was not associated with any serious complications. However, further studies in larger numbers of patients are needed to confirm our outcomes using this closure method.
Copyright © Congress of Neurological Surgeons 2021. All rights reserved.
Ashley C Mays, Diana Bell, Renata Ferrarotto, Jack Phan, Dianna Roberts, Clifton D Fuller, Steven J Frank, Shaan M Raza, Michael E Kupferman, Franco DeMonte, Ehab Y Hanna, Shirley Y Su
Early Stage olfactory neuroblastoma and the impact of resecting dura and olfactory bulb.
Laryngoscope. 2018 Jun;128(6):1274-1280. doi: 10.1002/lary.26908. Epub 2017 Dec 11.
Abstract/Text
OBJECTIVE: Compare outcomes of patients with olfactory neuroblastoma (ONB) without skull base involvement treated with and without resection of the dura and olfactory bulb.
METHODS: Retrospective review of ONB patients treated from 1992 to 2013 at the MD Anderson Cancer Center (The University of Texas, Houston, Texas, U.S.A.). Primary outcomes were overall and disease-free survival.
RESULTS: Thirty-five patients were identified. Most patients had Kadish A/B. tumors (97%), Hyams grade 2 (70%), with unilateral involvement (91%), and arising from the nasal cavity (68%). Tumor involved the mucosa abutting the skull base in 42% of patients. Twenty-five patients (71%) received surgery and radiation, whereas the remainder had surgery alone. Five patients (14%) had bony skull base resection, and eight patients (23%) had resection of bony skull base, dura, and olfactory bulb. Surgical margins were grossly positive in one patient (3%) and microscopically positive in four patients (12%). The 5- and 10-year overall survival were 93% and 81%, respectively. The 5- and 10-year disease-free survival (DFS) were 89% and 78%, respectively. Bony cribriform plate resection was associated with better DFS (P = 0.05), but dura and olfactory bulb resection was not (P = 0.11). There was a trend toward improved DFS in patients with negative resection margins (P = 0.19). Surgical modality (open vs. endoscopic) and postoperative radiotherapy did not impact DFS.
CONCLUSION: Most Kadish A/B ONB tumors have low Hyams grade, unilateral involvement, and favorable survival outcomes. Resection of the dura and olfactory bulb is not oncologically advantageous in patients without skull base involvement who are surgically treated with negative resection margins and cribriform resection.
LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1274-1280, 2018.
© 2017 The American Laryngological, Rhinological and Otological Society, Inc.
J H Krouse
Development of a staging system for inverted papilloma.
Laryngoscope. 2000 Jun;110(6):965-8. doi: 10.1097/00005537-200006000-00015.
Abstract/Text
OBJECTIVES: Inverted papillomas of the nose and sinuses are uncommon neoplasms. In the past decade there has been a trend toward the use of endoscopic surgical techniques in the management of these tumors, in contrast to the extensive open procedures recommended previously. This trend has not been without controversy, given the association of inverted papillomas with malignancy. It has been difficult to compare surgical approaches to these neoplasms, because of the absence of a uniformly applied staging system representing the extent of disease. It was the purpose of this study to develop such a system that could be easily applied in outcomes research.
STUDY DESIGN: This study involved an integrated literature review and a synthesis of findings from a number of studies.
METHODS: Previous and current clinical studies examining the treatment of inverted papilloma were reviewed. Findings were organized, and a staging system was framed based on this review.
RESULTS: A simple, easily applied staging system was developed based on the extent of tumor involvement noted on endoscopic examination of the nasal cavity and computed tomography (CT) scan evaluation.
CONCLUSIONS: Stage I disease is limited to the nasal cavity alone. Stage II disease is limited to the ethmoid sinuses and medial and superior portions of the maxillary sinuses. Stage III disease involves the lateral or inferior aspects of the maxillary sinuses or extension into the frontal or sphenoid sinuses. Stage IV disease involves tumor spread outside the confines of the nose and sinuses, as well as any malignancy.
