Endoscopic resection of fibro-osseous lesions of the paranasal sinuses

Fibro-osseous tumors, including osteomas, ossifying fibromas, and fibrous d ysplasia, ar-e not uncommon benign lesions arising ill rite paranasal sinus es. Conventional wisdom advocates resection,when these lesions ai-e symptom atic, or when they exhibit rapid growth. Traditionally, resection has been performed via a variety of open approaches. with the advent of sinonasal en doscopy in the mid 1980s, and subsequence advances ill technology nod surgi cal techniques, endoscopic management of some of these lesions is now feasi ble. To date, a search of the literature reveals only three case reports of osteomas resected,with endoscopic guidance. We present a series of 10 symp tomatic fibro-osseous lesions (nine osteomas and one fibrous dysplasia) occ urring in nine patient in which endoscopic techniques,were used Nine ethmoi d nod frontal recess osteomas were resected transnasally. and one sphenoid sinus fibrous dysplasia was resected using a transseptal transsphenoidal sp henoidal approach with endoscopic visualization. There were two anticipated CSF leaks, which were recognized and repaired nt the time of surgery. Ther e were Ilo other complications mid and no tumor recurrence. All patients no ted improvement in preoperative symptoms. We discuss patient selection, ope rative techniques and strategies, and the advantages and disadvantages of t he endoscopic approach ill the management of paranasal sinus fibro-osscous lesions.