title: Surgical management of rhinosinusitis in endoscopic-endonasal skull-base surgery.
abstract: BACKGROUND
  Endoscopic-endonasal skull base surgery (ESBS) provides an important approach to select pathologies. There remains a paucity of data, however, regarding morbidity in patients undergoing ESBS with comorbid acute rhinosinusitis (ARS), a fungal ball (FB), or chronic rhinosinusitis (CRS).
  
  
  METHODS
  A retrospective database review between January 2008 and January 2013 identified 35 patients with concurrent skull-base pathology and refractory ARS, FB, CRS, and CRS with nasal polyposis (CRSP) who underwent endoscopic sinus surgery (ESS) and ESBS.
  
  
  RESULTS
  Two of 35 (5.7%) had an FB, 3 of 35 (8.6%) had ARS, 19 of 35 (54.2%) had CRSP, and 11 of 35 (31.4%) had CRS. Five of 35 (14.3%) were staged procedures whereas 30 of 35 (85.7%) underwent concurrent ESS and ESBS. Four patients (80%) who were staged carried diagnoses of an FB and ARS. Two patients in the concurrent group required revision ESS for recurrent polyposis. There were no cases of intraorbital or intracranial infectious complications.
  
  
  CONCLUSIONS
  Management of the paranasal sinuses is paramount to maintain healthy sinonasal function in patients undergoing ESBS. In our experience, most cases of CRS and CRSP can be surgically managed at the time of ESBS without increased risk of intracranial infection. Patients with ARS at the time of surgery or an FB should be staged to avoid postoperative ESBS morbidity.
authors: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA.
authors: Gurston G
authors: GG
authors: Nyquist
authors: Mark E
authors: ME
authors: Friedel
authors: Saurabh
authors: S
authors: Singhal
authors: D David
authors: DD
authors: Beahm
authors: Christopher J
authors: CJ
authors: Farrell
authors: James J
authors: JJ
authors: Evans
authors: Marc R
authors: MR
authors: Rosen
mesh_terms: D015897:Comorbidity; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D009181:Mycoses / Q000453:epidemiology; D059747:Nasal Surgical Procedures / Q000379:methods*; D010256:Paranasal Sinuses / Q000503:physiopathology; D012189:Retrospective Studies; D012220:Rhinitis / Q000453:epidemiology / Q000601:surgery*; D012852:Sinusitis / Q000453:epidemiology / Q000601:surgery*; D019291:Skull Base / Q000473:pathology / Q000601:surgery*
keywords: chronic sinusitis; endoscopic sinus surgery; endoscopic skull-base surgery; pituitary; pituitary adenoma; sinusitis; skull base; transsphenoidal