Endoscopic surgical treatment of sinonasal Schneiderian papillomas: our experience

Sinonasal Schneiderian papillomas are uncommon epithelial tumors. Although benign, they may behave aggressively, recur after incomplete resection, and, particularly in the inverted subtype, be associated with carcinoma. Endoscopic surgery is now widely used when the site of attachment can be adequately exposed and treated.

To review recurrence, morbidity, attachment-site documentation, and metachronous carcinoma in a single-surgeon endoscopic series of sinonasal Schneiderian papillomas treated with an attachment-site-oriented technique.

We retrospectively reviewed 71 patients with histologically confirmed Schneiderian papilloma treated exclusively by endoscopic surgery between January 2017 and December 2023. Preoperative work-up included nasal endoscopy, CT, and MRI. Disease extent was classified according to the Krouse system. Surgery was planned according to tumor extension and the suspected attachment site. Follow-up was based on serial endoscopic examinations; annual MRI was advised for long-term surveillance. Median follow-up was 46 months.

Krouse staging identified 3 T1, 24 T2, 40 T3, and 4 T4 lesions. Histology included 58 inverted, 8 exophytic, and 5 oncocytic papillomas. Recurrence occurred in 3 patients (4.2%), all with inverted papilloma and advanced-stage disease (T3-T4). Complications were observed in 4 patients (5.6%), including three arterial bleeding episodes and one cerebrospinal fluid leak. One patient developed metachronous squamous cell carcinoma during follow-up.

In this single-surgeon series, attachment-site-oriented endoscopic surgery was followed by few recurrences and acceptable morbidity during the available follow-up. Recurrences were observed only in advanced-stage inverted papillomas. These findings support careful treatment of the attachment site and long-term surveillance, while remaining limited by the retrospective design and heterogeneous follow-up.