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.
Keywords: fibrous dysplasia (FD), paranasal sinus, skull base, functional endoscopic sinus surgery (FESS), navigation-assisted surgery
Key Points :The clinical observation is adopted for asymptomatic patients. Surgery is indicated in symptomatic patients. Navigation plays an important role in endoscopic surgery in FD resection and optic nerve decompression.
Introduction
Fibrous dysplasia (FD) of bone, also referred to as fibrous hyperplasia of bone, is a group of non-neoplastic diseases with fibro-osseous bone lesions. FD is a developmental disorder induced by abnormal proliferation of fibroblasts resulting in replacement of normal cancellous bone by structurally immature osseous tissue1-3. FD may involve any bone of the body and affect one or more bones. It is divided into three types: monostotic FD (MFD), polyostotic FD (PFD), and McCune-Albright syndrome (MAS). When the lesion involves the craniofacial skeleton, the skull base is the most common site of involvement1-3.
Because of the low incidence rate, diverse natural history and complicated surgical procedure, at present, the management of FD involving the paranasal sinuses and the adjacent skull base is controversial. Therefore, many scholars have called for development of a global consensus on improving patient management4-7. In this study, we showed our experience and treatment strategies for the management of 23 FD cases which involved the paranasal sinuses and the adjacent skull base.
Material and Methods