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Updated: Jul 6, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
[Endoscopic management of the inverted papilloma involving frontal sinus and its drainage pathway]
Luo Zhang1, De-Min Han, Cheng-Shuo Wang
1Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Beijing Tongren Hospital, Capital Medical University. Beijing Institute of Otolaryngology, Beijing 100730, China. luozhang@trhos.com
Objective:
The endoscopic management of inverted papilloma has gained increasing popularity over the last 15 years. However, the appropriate management of lesions involving the frontal sinus and its drainage pathway still has to be determined.
Methods:
We performed a retrospective review of the results of the patients with inverted papilloma in the Otolaryngology Head and Neck Surgery department, Beijing Tongren Hospital from 2004 to 2007 to identify the patients with lesions involving frontal sinus and its drainage pathway. By its appearance on nasal endoscopic examination and CT scanning, the tumors were defined using Krouse staging system. Sinus endoscopy was used to screen for disease after endoscopic resection. And their clinical outcomes were analyzed.
Results:
A total of nine patients (8 males and one female) with inverted papilloma who had frontal sinus and its drainage pathway involvement were identified. All tumors were defined as T3 lesions. Preoperative and postoperative pathologic examinations revealed inverted papilloma as the diagnosis. Four cases with lateral wall of frontal recess attachment underwent endoscopic Draf II A frontal sinusotomy. Three cases with either lateral and posterior walls of frontal recess and frontal infundibulum attachment or medial and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf II B procedure. Two cases with either posterior wall of frontal recess and frontal infundibulum attachment or medial, lateral and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf III procedure. All patients remain disease free with an average follow-up of 13 months.
Conclusions:
Extensive inverted papilloma (Krouse T3 lesions) can be treated successfully with an endoscopic approach.
Insights
Endoscopic surgery effectively treats extensive inverted papillomas involving the frontal sinus and its drainage pathway. This minimally invasive approach offers successful outcomes for these challenging sinonasal tumors.
Area of Science:
- Otolaryngology
- Neurosurgery
- Oncology
Background:
- Endoscopic management of inverted papilloma is increasingly popular.
- Optimal treatment for frontal sinus inverted papilloma remains debated.
Purpose of the Study:
- To evaluate the efficacy of endoscopic resection for inverted papilloma involving the frontal sinus and its drainage pathway.
- To analyze the clinical outcomes of patients treated endoscopically.
Main Methods:
- Retrospective review of nine patients with frontal sinus inverted papilloma (2004-2007).
- Tumor staging using Krouse system based on endoscopic and CT findings.
- Surgical procedures included Draf II A, II B, and III frontal sinusotomies.
- Postoperative surveillance via sinus endoscopy.
Main Results:
- All nine patients had Krouse T3 inverted papillomas involving the frontal sinus.
- Patients underwent various endoscopic sinusotomy techniques based on tumor extent.
- All patients achieved disease-free status with an average follow-up of 13 months.
Conclusions:
- Endoscopic resection is a successful treatment modality for extensive inverted papilloma (Krouse T3) of the frontal sinus.
- Minimally invasive endoscopic techniques provide favorable outcomes for complex sinonasal tumors.
