Management strategies of fibrous dysplasia involving the paranasal sinus
and the adjacent skull base
Abstract
Objective: The current management of fibrous dysplasia (FD) involving
the paranasal sinuses and the adjacent skull base is controversial. This
study is to present our experience in the management strategy of FD
involving the paranasal sinuses and the adjacent skull base.
Design/setting: 23 patients from 2006 to 2019 with monostotic fibrous
dysplasia (MFD), polyostotic fibrous dysplasia (PFD), or McCune-Albright
Syndrome (MAS) involving the paranasal sinuses and the adjacent skull
base were retrospectively reviewed. This study series was divided into 3
groups based on the management strategies: the observation group, the
surgery group, and the optic nerve decompression group. Main
outcome/results: The observation group included 9 asymptomatic MFD
patients with a stable condition during the follow-up period of 15 to
164 months. The surgery group included 10 symptomatic MFD patients
having personalized endoscopic endonasal surgery. The patients’ symptoms
were relieved after surgery. The optic nerve decompression group
included 4 patients with visual loss, who underwent endonasal endoscopic
optic nerve decompression with the aid of image-guided navigation. Their
vision improved after surgery. Conclusion: The clinical observation and
periodic computed tomography (CT) scan is adopted for asymptomatic
patients. Surgery is indicated in symptomatic patients. Optic nerve
decompression is recommended as soon as possible if the patient has
visual loss, whereas prophylactic decompression is not recommended if
the optic nerve is encroached upon by FD without visual loss. Navigation
plays an important role in endoscopic surgery involving the paranasal
sinuses and the adjacent skull base, especially in FD resection and
optic nerve decompression.