Objective: Patients undergoing endoscopic resection of sinonasal neoplasms with skull base involvement
can develop chronic rhinosinusitis after treatment, and may occasionally benefit from
additional endoscopic sinus surgery (ESS). We investigate the incidence of revision
surgery, risk factors, and outcomes associated with revision ESS after endoscopic
skull base surgery (SBS) for sinonasal neoplasms.
Study Design: Retrospective chart review.
Setting: Tertiary care university hospital.
Participants: Patients with sinonasal neoplasms with skull base involvement who underwent endoscopic
resection at a single institution from 2004 through 2017.
Main Outcome Measures: Incidence and timing of revision surgery, Lund-Mackay (LM) scores, and Sino-Nasal
Outcome Test (SNOT-22) scores.
Results: Eighty-five patients with complete data were included, with a mean age of 55 years.
Sixty-seven percent of neoplasms were malignant. Fifty-five percent of patients required
intradural dissection as part of their resection. Fifty-three percent of patients
received radiation as part of their oncologic therapy, and 28% received chemotherapy.
Revision ESS was indicated in 18 (21%) cases, 12 (14%) of which were due to chronic
rhinosinusitis (CRS). Time between initial resection and revision ESS was an average
of 45 months (range, 7–144 months). Pre- and post-SBS LM scores were not significantly
different (5.7 vs. 4.6, p = 0.438), although pre- and post-SBS SNOT-22 scores showed significant improvement
(29.5 vs. 24.2, p = 0.047). There was a trend to improvement, although not statistically significant,
between SNOT-22 scores after initial SBS and after revision ESS (24.2 vs. 19.9, p = 0.129). Malignant pathology correlated with need for revision ESS (OR 5.07, 95%
confidence interval: 1.08–23.90, p = 0.04).
Conclusion: A significant proportion of patients may develop clinically significant sinusitis
and benefit from revision ESS after endoscopic skull base surgery for sinonasal neoplasms,
with intervention occurring, on average, just under 4 years after initial tumor resection.
Malignant pathology correlated with need for revision ESS.
