Thirty years of endoscopic sinus surgery: What have we learned?

Abstract

Prior to adaptation of endoscopic approaches for sinonasal pathology, patients regularly endured significant morbidity from open approaches to the sinonasal cavity that were often fraught with failure. With improvements in transnasal endoscopy, functional endoscopic sinus surgery subsequently emerged from the work of Messerklinger and other pioneers in the field. The popularity of endoscopic sinus surgery quickly escalated and expanded to pathology other than inflammation. Here, we discuss the evolution of endoscopic sinus surgery as it relates to improvements in understanding disease pathogenesis, improvements in instrumentation and expansion of indications.

Keywords: Chronic sinusitis; Endoscopic sinus surgery; Skull base surgery.

Fig. 1

Through cutting frontal instrumentation.

Fig. 2

The Bachert forceps allows for atraumatic removal of bone in the frontal recess.

Fig. 3

Preoperative MRI shows a sinonasal undifferentiated malignancy. Intraoperatively, the orbit and brain were not grossly invaded and a gross total resection was achieved purely via endoscopic approach.

Fig. 4

Intraoperative view using high definition, real-time infrared fluorescence imaging. A novel radiolabeled compound was injected preoperatively in a patient with a planum meningioma. Intraoperative view after skull base osteotomy shows uptake from the tumor with surrounding brain and sinonasal tissue excluded.