Radiologically undifferentiated lesions of the cavernous sinus can pose a diagnostic challenge. While radiotherapy is the mainstay for treatment of cavernous sinus lesions, histological diagnosis allows access to a wide variety of alternative treatment modalities. The region is considered a high-risk area for open trans-cranial surgical access, and the endoscopic endonasal approach presents an alternative technique for biopsy.
A retrospective case series was performed of all patients undergoing endoscopic endonasal biopsy of isolated cavernous sinus lesions at two tertiary institutions. The primary outcomes were the percentage of patients in which a histological diagnosis was achieved and the proportion of patients in which therapy differed from radiotherapy alone. Secondary outcomes included pre- and post-operative 22-item Sino-Nasal Outcome Test symptom scores, as well as peri-operative adverse outcomes.
Eleven patients underwent endoscopic endonasal biopsy, with a diagnosis achieved in ten patients. The most common diagnosis was perineural spread of squamous cell carcinoma, followed by perineuroma and single cases of metastatic melanoma, metastatic adenoid cystic carcinoma, mycobacterium lepri infection, neurofibroma and lymphoma. Six patients had treatments other than radiotherapy including immunotherapy, antibiotics, corticosteroids, chemotherapy and observation alone. There was no significant difference in pre- and post-biopsy 22-item Sino-Nasal Outcome Test scores. There was one case of epistaxis requiring return to theatre for cautery of the sphenopalatine artery and there were no mortalities.
In a limited case series, endoscopic endonasal biopsy was safe and effective in obtaining diagnosis for cavernous sinus lesions and had a significant impact on therapeutic decision-making.
Copyright © 2023. Published by Elsevier Inc.
