Shah Ravi R, Maina Ivy W, Patel Neil N, Triantafillou Vasiliki, Workman Alan D, Kuan Edward C, Tong Charles C L, Kohanski Michael A, O'Malley Bert W, Adappa Nithin D, Palmer James N
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA.
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA.
Int Forum Allergy Rhinol. 2020 Apr;10(4):521-525. doi: 10.1002/alr.22486. Epub 2020 Feb 27.
Patients undergoing endoscopic resection of neoplasms with both sinonasal and skull base involvement can develop chronic rhinosinusitis (CRS) after treatment and may occasionally benefit from additional endoscopic sinus surgery (ESS). We investigate risk factors and outcomes associated with revision ESS (rESS) after endoscopic skull-base surgery (SBS) for neoplasms with combined sinonasal and skull base involvement.
A retrospective review of patients with neoplasms with both sinonasal and skull base involvement who underwent endoscopic resection at a single tertiary care academic institution from 2004 through 2017 was performed. Eighty-three patients were included. Main outcome measures included incidence and timing of revision surgery, Lund-Mackay (LM) scores, and 22-item Sino-Nasal Outcome Test (SNOT-22) scores.
rESS was performed in 21 (25%) cases, 15 (18%) of which were due to CRS. Time between initial resection and rESS was an average of 42 months (range, 6 to 142 months). Pre-SBS and post-SBS LM scores were not significantly different (5.0 vs 4.7, p = 0.640), although pre-SBS and post-SBS SNOT-22 scores showed significant improvement (32.6 vs 24.5, p = 0.030). Malignant pathology correlated with need for rESS (odds ratio [OR] 5.07, p = 0.04), as well as treatment including chemotherapy (OR 5.10, p = 0.003) and radiation (OR 4.15, p = 0.013).
A significant proportion of patients develop clinically significant sinusitis after endoscopic SBS for neoplasms with combined sinonasal and skull base involvement and may benefit from rESS. Intervention occurred, on average, 3.5 years after initial tumor resection. Malignant pathology, radiation therapy, and chemotherapy correlate with need for rESS.
接受内镜下切除累及鼻窦和颅底肿瘤的患者在治疗后可能会发生慢性鼻窦炎（CRS），偶尔可能受益于额外的内镜鼻窦手术（ESS）。我们调查了内镜颅底手术（SBS）治疗累及鼻窦和颅底的肿瘤后行翻修性ESS（rESS）的危险因素和结果。
对2004年至2017年在一家三级医疗学术机构接受内镜切除的累及鼻窦和颅底肿瘤患者进行回顾性研究。纳入83例患者。主要观察指标包括翻修手术的发生率和时间、Lund-Mackay（LM）评分和22项鼻窦结局测试（SNOT-22）评分。
21例（25%）患者接受了rESS，其中15例（18%）是由于CRS。初次切除与rESS之间的时间平均为42个月（范围6至142个月）。SBS术前和术后LM评分无显著差异（5.0对4.7，p = 0.640），尽管SBS术前和术后SNOT-22评分有显著改善（32.6对24.5，p = 0.030）。恶性病理与rESS需求相关（优势比[OR]5.07，p = 0.04），以及包括化疗（OR 5.10，p = 0.003）和放疗（OR 4.15，p = 0.013）在内的治疗。
相当一部分累及鼻窦和颅底肿瘤患者在内镜SBS治疗后发生具有临床意义的鼻窦炎，可能受益于rESS。干预平均在初次肿瘤切除后3.5年进行。恶性病理、放疗和化疗与rESS需求相关。
