Clinical Rhinology

Register      Login

VOLUME 14 , ISSUE 1--3 ( January-December, 2023 ) > List of Articles


Endonasal Endoscopic Excision of Sinonasal Malignancies: An Overview

Pookamala Sathasivam

Keywords : CSF leak, CSF leak repair, Endoscopic endonasal, Endoscopic excision, Endoscopic nasal surgeries, Endonasal transsphenoidal approach, Sinonasal malignancy, Squamous cell carcinoma

Citation Information : Sathasivam P. Endonasal Endoscopic Excision of Sinonasal Malignancies: An Overview. Clin Rhinol An Int J 2023; 14 (1--3):8-14.

DOI: 10.5005/jp-journals-10013-1385

License: CC BY-NC 4.0

Published Online: 21-03-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Sinonasal malignancies are relatively an uncommon entity and squamous cell carcinoma is the commonest malignancy. Tumor mainly arises from the mucosa of nasal cavity or maxillary sinus. Primary tumor from the frontal and sphenoid sinuses are very rare. Patients often present with advanced disease, as the initial symptoms of tumor, such as nasal block, nasal bleeding, and nasal discharge mimic those of common nasal pathology such as rhinitis/sinusitis. The ideal treatment for sinonasal malignancy is surgery, followed by postoperative radiotherapy. Traditionally, such tumors were treated with open surgical excision or combined craniofacial resection in the case of skull base involvement. Now in the era of minimally invasive surgery, more and more such tumors are diagnosed early and operated on via a transnasal endoscopic approach. This article will serve as a guide for surgeons planning to operate upon such tumors endoscopically.

  1. Kawaguchi M, Kato H, Tomita H, et al. Imaging characteristics of malignant sinonasal tumours. J Clin Med 2017;6(12):116. DOI: 10.3390/jcm6120116.
  2. Haerle SK, Gullane PJ, Witterick IJ, et al. Sinonasal carcinomas: epidemiology, pathology, and management. Neurosurg Clin N Am 2013;24(1):39–49. DOI: 10.1016/
  3. Forbes WS, Fawcitt RA, Isherwood I, et al. Computed tomography in the diagnosis of diseases of the paranasal sinuses. Clin Radiol 1978;29:501–511. DOI: 10.1016/s0009-9260(78)80037-3.
  4. Resto VA, Chan AW, Deschler DG, et al. Extent of surgery in the management of locally advanced Sinonasal malignancies. Head Neck 2008;30:222–229. DOI: 10.1002/hed.20681.
  5. Robin TP, Jones BL, Gordon OM, et al. A Comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017; 123(16): 3040–3049. DOI: 10.1002/cncr.30686.
  6. Stelow EB, Bishop JA. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2017;11(1):3–15. DOI: 10.1007/s12105-017-0791-4.
  7. Gallet P, Nguyen DT, Russel A, et al. Intestinal and non-intestinal nasal cavity adenocarcinoma: impact of wood dust exposure. European Ann Otorhinolaryngol, Head Neck Dis 2018;135(6):383–387. DOI: 10.1016/j.anorl.2018.08.012.
  8. Mahalingappa YB, Khalil HS. Sinonasal malignancy: presentation and outcomes. J Laryngol Otol 2014;128;7;654–657. DOI: 10.1017/S0022215114001066.
  9. Lund VJ, Clarke PM, Swift AC, et al. Nose and paranasal sinus tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(S2):S111–S118. DOI: 10.1017/S0022215116000530.
  10. El-Gerby KM, El-Anwar MW. Differentiating benign from malignant sinonasal lesions: feasibility of diffusion weighted MRI. Int Arch Otorhinolaryngol 2017;21(4):358–365. DOI: 10.1055/s-0036-1597323.
  11. Sasaki M, Eida S, Sumi M, et al. Apparent diffusion coefficient mapping for sinonasal diseases: differentiation of benign and malignant lesions. Am J Neuroradiol 2011;32(6):1100–1106. DOI: 10.3174/ajnr.A2434.
  12. Roxbury CR, Ishii M, Richmon JD, et al. Endonasal endoscopic surgery in the management of sinonasal and anterior skull base malignancies. Head Neck Pathol 2016;10(1):13–22. DOI: 10.1007/s12105-016-0687-8.
  13. Segal N, Gluck O, Bavnik Y, et al. The usefulness of preoperative biopsy in unilateral nasal masses. Allergy Rhinol 2014;5(2):e53–e55. DOI: 10.2500/ar.2014.5.0082.
  14. Helsel JC, Bardales RH, Mukunyadzi P. Fine-needle aspiration biopsy cytology of malignant neoplasms of the sinonasal tract: a review of 22 primary and metastatic tumors. Cancer Cytopathol 2003;99;2: 105–112. DOI: 10.1002/cncr.10956.
  15. Stammberger H, Anderhuber W, Walch C, et al. Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies. Acta Otorhinolaryngol Belg 1999;53(3):199–205. PMID: 10635393.
  16. Carrau RL, Kassam AB, Snyderman CH, et al. Endoscopic transnasal anterior skull base resection for the treatment of Sinonasal malignancies. Oper Tech Otolaryngol 2006;17:102–110. 10.1016/j.otot.2006.03.010.
  17. Snyderman CH, Gardner PA. How much is enough?” Endonasal surgery for olfactory neuroblastoma. Skull Base 2010;20(5):309–310. DOI: 10.1055/s-0030-1253583.
  18. Castelnuovo PG, Delù G, Sberze F, et al. Esthesioneuroblastoma: endonasal endoscopic treatment. Skull Base 2006;16(1):25–30. DOI: 10.1055/s-2005-922097.
  19. Fortes FSG, Sennes L U, Carrau RL, et al. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model. Laryngoscope 2008;118(1):44–49. DOI: 10.1097/MLG.0b013e318155a492.
  20. Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116(10):1882–1886. DOI: 10.1097/01.mlg.0000234933.37779.e4.
  21. Chakravarthi S, Gonen L, Monroy-Sosa A, et al. Endoscopic endonasal reconstructive methods to the anterior skull base. Semin Plast Surg 2017; 31(4):203–213. DOI: 10.1055/s-0037-1607274.
  22. Suh JD, Ramakrishnan VR, Chi JJ, et al. Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base. Ann Otol Rhinol Laryngol 2013;122(1):54–59. DOI: 10.1177/000348941312200110.
  23. Pai PS, Moiyadi A, Nair D. Endoscopic v/s conventional approach to sino-nasal tumours - What's the debate? Indian J Surg Oncol 2010;1(2):194–199. DOI: 10.1007/s13193-010-0032-8.
  24. Cavel O, Abergel A, Margalit N, et al. Quality of life following endoscopic resection of skull base tumours. J Neurol Surg B Skull Base 2012;73(2):112–116. DOI: 10.1055/s-0032-1301392.
  25. Solares CA, Ong YK, Snyderman CH. Transnasal endoscopic skull base surgery: what are the limits? Curr Opin Otolaryngol Head Neck Surg 2010;18(1):1–7. DOI: 10.1097/MOO.0b013e3283350035.
  26. Gallia GL, Asemota AO, Blitz AM, et al. Endonasal endoscopic resection of olfactory neuroblastoma: an 11-year experience. J Neurosurg 2018;131(1):238–244. DOI: 10.3171/2018.2.JNS171424.
  27. Nicolai P, Battaglia P, Bignami M, et al. Endoscopic surgery for malignant tumours of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 2008;22(3):308–316. DOI: 10.2500/ajr.2008.22.3170.
  28. Hanna E, DeMonte F, Ibrahim S, et al. Endoscopic resection of Sinonasal cancers with and without craniotomy: oncologic results. Arch Otolaryngol Head Neck Surg 2009;135(12):1219–1224. DOI: 10.1001/archoto.2009.173.
  29. Eloy JA, Vivero RJ, Hoang K, et al. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumours of the anterior skull base. Laryngoscope. 2009;119:834–840. DOI: 10.1002/lary.20186.
  30. Jansen EP, Keus RB, Hilgers FJ, et al. Does the combination of radiotherapy and debulking surgery favour survival in paranasal sinus carcinoma? Int J Radiat Oncol Biol Phys. 2000;48(1):27–35. DOI: 10.1016/s0360-3016(00)00594-0.
  31. Katz TS, Mendenhall WM, Morris CG, et al. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck 2002;24(9):821–829. DOI: 10.1002/hed.10143.
  32. Claus F, De Gersem W, De Wagter C, et al. An implementation strategy for IMRT of ethmoid sinus cancer with bilateral sparing of the optic pathways. Int J Radiat Oncol Biol Phys 2001;51(2):318–331. DOI: 10.1016/s0360-3016(01)01627-3.
  33. Amsbaugh MJ, Yusuf M, Silverman C. Organ preservation with neoadjuvant chemoradiation in patients with orbit invasive sinonasal cancer otherwise requiring exenteration. Radiation Oncology Journal 2016;34(3):209–215. DOI: 10.3857/roj.2016.01739.
  34. Ojiri H, Ujita M, Tada S, et al. Potentially distinctive features of sinonasal inverted papilloma on MR imaging. AJR Am J Roentgenol 2000;175(2):465–468. DOI: 10.2214/ajr.175.2.1750465.
  35. Som PM, Lidov M, Brandwein M, et al. Sinonasal esthesioneuroblastoma with intracranial extension: marginal tumor cysts as a diagnostic MR finding. AJNR Am J Neuroradiol. 1994;15(7):1259–1262. PMID: 7976934.
  36. American Joint Committee on Cancer. Nasal cavity and paranasal sinuses. In: AJCC Cancer Staging Manual. 7th edition. New York, NY: Springer; 2010, pp. 69–73.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.