Endoscopic resection of fibro-osseous lesions of the paranasal sinuses

Fibro-osseous tumors, including osteomas, ossifying fibromas, and fibrous d ysplasia, are not uncommon benign lesions al ising in the paranasal sinuses . Conventional wisdom advocates resection when these lesions are symptomati c, or,when they exhibit rapid growth. Traditionally: resection has been per formed via a variety of open approaches. With the advent of sinonasal endos copy in the mid 1980s, and subsequent advances in technology and surgical t echniques, endoscopic management of some of these lesions is now feasible. To date, a search of the literature reveals only three case reports of oste omas resected with endoscopic guidance. We present a series of 10 symptomat ic fibro-osseous lesions (nine osteomas and one fibrous dysplasia) occurrin g in nine patients in which endoscopic techniques were used Seven ethmoid a nd frontal recess osteomas were resected transnasally and one sphenoid sinu s fibrous dysplasia was resected using a transseptal transsphenoidal approa ch with the assistance of direct endoscopic visualization. There were two a nticipated CSF leaks that,were recognized and repaired at the time of surge ry. There Mere no other complications and no turner recurrence. All patient s noted improvement in preoperative symptoms. We discuss patient selection, operative techniques and strategies, and the advantages and disadvantages of the endoscopic approach in the management of paranasal sinus fibro-osseo us lesions.