2026 Proffered Presentations
S222: ENDOSCOPIC SURGERY OF FIBRO-OSSEOUS LESIONS OF PARANASAL SINUS AND SKULL BASE
Amit Keshri, Prof; Sanjay Gandhi Post Graduate Institute of Medical Sciences, LUCKNOW
Introduction: Fibro-osseous lesion of Paranasal sinus and anterior skull base are rare lesions. They mainly involve the Ethmoid sinus, orbit and surrounding anterior skull base. They present mainly either with nasal obstruction or orbital symptoms with proptosis being the most common orbital symptoms. These lesions are common in young individuals with majority patients belonging to 2nd or 3rd decade of life with very few in children below 10 years and adults above 30 years. Surgery is challenging due to different consistency of tumor and the tendency to bleed during surgery due to blood supply from Anterior and posterior ethmoidal artery during excision and any residual lesion leads to recurrence of symptoms. The present study aimed to report the surgical outcome and clinic-radiological features of these lesions and factors leading to recurrence.
Material and Methods: All fibro-osseous lesions which involved the Ethmoid, sphenoid, orbit and skull base from 2014 to 2024 operated at tertiary care institute in North India with endoscopic approach were included in the study.
Tumors which primarily involved the maxilla and underwent open excision of lesion were excluded from study. Retrospective chart review of above was done and total 24 patients were included in the study.
Results: Majority of patients were male-16 (66%) and 8 patients were female. 17 patients were below 20 years of age and rest 7 were above 20 years of age. 6 patients have recurrent /residual lesions.
Complete excision of lesion leads to recurrence in in only 1 case while 5 patients have recurrence in whom complete excision was not possible either due to extensive skull base involvement or excessive bleeding during surgery leading to incomplete excision.
Ossifying fibroma was most common pathology followed by Aneurysmal bone cyst, fibrous dysplasia, and giant cell granuloma. Giant cell granuloma was most common tumor to recur in the above series. Skull base involvement was seen in 20 cases with orbital involvement in 22 cases.4 patients have CSF leak during surgery, and it was repaired during surgery.
Conclusion: Fibro-osseus lesions of ethmoid, sphenoid and skull base are rare lesions and pose unique challenges as they are vascular and lie in close vicinity of skull base and orbit. Endoscopic excision is possible and CT scan with navigation help in planning the surgery and incomplete excision leads to recurrence of lesions in majority of cases and need revision surgery in most cases.