Minimally invasive resection of frontal recess/sinus inverted papilloma

Objective: Inverted papilloma (IP) in the frontal recess/sinus poses a unique surgical challenge given the inherent difficulty in endoscopic visualization and limitations in access posed by the anatomic confines of the frontal recess/sinus. The objective of this study is to evaluate the efficacy of the minimally invasive endoscopic approach for resection of frontal recess/sinus IP. Study design: Retrospective chart review. Methods: Five patients with frontal recess/sinus IP comprised the focus of this study. Patient charts were reviewed for demographic data, tumor location and extent, histopathology, surgical treatment strategy, operative parameters (operative time, blood loss), recurrence rate, and follow-up. Results: The average age was 55 years, and all patients were men. All patients underwent computer-aided endoscopic resection of histologically proven IP as the primary surgical modality. Adjunct approaches including endoscopic frontal trephination and modified endoscopic Lothrop were performed in 1 case each. No intra- or postoperative complications occurred in the patient group. No recurrences were noted by endoscopic and/or radiographic surveillance at mean follow-up of 16.8 months. Conclusions: The minimally invasive endoscopic approach is effective for successful resection of frontal recess/sinus IP. Adjunctive open approaches or extended frontal drill-out approaches may be required to achieve complete tumor extirpation. Careful preoperative planning coupled with meticulous surgical technique are absolute requisites for successful management of these difficult tumors.