Actualităţi în managementul chirurgical al tumorilor maligne rinosinuzale

Malignant rhinosinonasal tumors are relatively rare and very aggressive, leading to diagnosis in advanced stages.The gold standard seems to be a combination of external or endoscopic approach surgery and radiotherapy. Sur­gi­cal intervention for the treatment of rhinosinusal tu­mors must meet certain standards: sufficiently expose the region for the complete resection of the tumor, ensure good post­ope­ra­tive surveillance, and not cause postoperative func­tio­nal dis­abi­lity. Adequate exposure of the anterior skull base for the excision of neoplasms requires a combined in­tra­cra­nial and extracranial approach. Most commonly, an in­ter­dis­ci­pli­nary approach between neurosurgery and ENT is required. Extensive endoscopic endonasal approaches may be considered for sinonasal malignant tumors of the na­sal cavity and paranasal sinuses, including those with in­volve­ment and extension through the anterior skull base. After performing the preoperative steps, the endonasal ap­proach starts with correcting access issues, for exam­ple: septal deviation and debulking the tumor using a microdebrider. One of the most common complications of extended endonasal approaches in the management of ma­lig­nant skull base and anterior nasosinonasal tumors is cerebrospinal fluid (CSF) leakage, with an incidence below 5% in centers with sig­ni­fi­cant endoscopic experience and expertise. Although the challenges of endoscopic surgery are quite numerous, in appropriately selected patients, these tumors are in­creas­ingly being successfully managed by endoscopic surgical ap­proa­ches, with low morbidity and mortality.