Overcoming Challenges in the Endoscopic Management of Sinonasal Tumors

Introduction: The complex anatomical relationships of the sinonasal compartment with the surrounding vital structures make it vulnerable, yet simultaneously surgically accessible. Sinonasal tumors, especially those extending beyond, toward the anterior skull base and orbit have always posed a challenge, as far as their en bloc, and when applicable, oncologically safe removal is concerned. Traditionally, numerous external approaches have been employed for their successful removal. With advancements in endoscopic sinus surgical techniques and instrumentation, a majority of these tumors can be removed via purely transnasal endoscopic, and sometimes endoscopicassisted procedures. Materials and methods: A series of 61 sinonasal tumors have been managed by endoscopic or endoscopic-assisted procedures over the last 6 years. The principles of their management and the challenges posed have been highlighted. Methods to tackle the same, backed by evidence from numerous international studies have been applied to these, and the outcome discussed. Conclusion: Endoscopic and endoscopic-assisted procedures are proving to be an effective alternative to the traditional external approaches for the management of sinonasal malignancies with comparable results. However, a long-term meta-analysis is imperative to corroborate these results.