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Frontal Sinus Inverted Papilloma: Surgical Challenges and Outcomes of a Multi-Institutional Cohort
Tristan Tham1, Alexis H Kim1, Jadyn Wilensky2
1Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
The Laryngoscope
|September 3, 2025
Summary
Frontal sinus inverted papilloma (IP) often involves the skull base, leading to cerebrospinal fluid leaks and requiring staged surgeries. Careful surgical planning and follow-up are crucial for managing this sinonasal tumor.
Area of Science:
- Otolaryngology
- Neurosurgery
- Oncology
Background:
- Inverted papilloma (IP) is a sinonasal tumor known for recurrence.
- Frontal sinus IP presents surgical complexities due to its proximity to the orbit and skull base.
Purpose of the Study:
- To detail the surgical challenges in managing frontal sinus inverted papilloma.
- To report treatment outcomes for frontal sinus inverted papilloma in a multicenter cohort.
Main Methods:
- Retrospective review of frontal sinus inverted papilloma resections from 1993 to 2023.
- Analysis of demographic, clinicopathologic, complication, surgical approach, and outcome data.
- Level 4 evidence.
Main Results:
- Ninety-eight patients with frontal sinus IP were identified; 13.3% had associated carcinoma and 28.6% had bilateral involvement.
- Recurrence occurred in 17.3% of patients, with a median time to recurrence of 29.2 months.
- Skull base dehiscence (23.5%) significantly increased the risk of intraoperative cerebrospinal fluid leak (OR 9.1).
Conclusions:
- Frontal sinus IP frequently attaches to the skull base, correlating with dehiscence and CSF leaks.
- Complete tumor removal is challenging, often necessitating combined open and endoscopic approaches and staged procedures.
- Meticulous surgical planning and vigilant postoperative follow-up are essential for effective disease management.
