Long Term Radiographic Prevalence and Management of Chronic Sinusitis after Endoscopic Skull Base Surgery for Malignancy

Purpose: Our purpose was to investigate the prevalence and need for FESS of chronic rhinosinusitis in patients who have undergone endoscopic skull base surgical resection for malignant tumors.

Materials and Methods: A retrospective cohort study of patients after endoscopic resection of skull base malignancies. Radiographic imaging obtained at least 3 months after surgery, symptoms, and endoscopic findings were used to evaluate the presence of chronic rhinosinusitis in this cohort. Pathology, time to presentation, and impact of radiation therapy were evaluated.

Results: 46 patients with skull-based malignancies were treated with endoscopic resection at our institution from 8/2008–9/2012, 30 patients had late (>3 months) post operative imaging as part of their clinical care. Of the 30 patients who met our inclusion criteria, 18 (60%) demonstrated sinusitis on repeat imaging with an average Lund-Mackay score of 6.3 (range 2–12). The average interval between skull base surgery and manifestation of clinical sinusitis was 21.8 months (range 4–59). 26 of 30 patients had radiation therapy and prevalence of sinusitis in this group was 61.5% (16 of 26.) Time from radiation therapy to sinusitis averaged 21 months (range 1–72). Eight patients reported recurrent symptoms of sinusitis and 3 had endoscopic sinus surgery for treatment of their disease.

Conclusions: This study demonstrates that endoscopic skull base surgery for malignancy presents a significant risk factor for chronic rhinosinusitis. Development of signs and symptoms occur over a large time frame. Despite increased prevalence as compared with general population, most patients were managed with medical therapy and irritations. Only 3 of 26 patients required surgical intervention for their disease.