Surgery for Sinonasal Cancer

Surgery is often followed by radiation therapy, which uses energy beams to destroy any remaining cancer cells.

Sinonasal lymphoma is best treated with chemotherapy with or without radiation therapy.

After your doctor performs a physical exam, nasal endoscopy, and imaging tests such as CT and MRI scans, he or she can determine the extent of the tumor and recommend the appropriate surgery for you. Approaches include endoscopic surgery and open surgery.

Some sinonasal tumors can be removed using an endoscope, a thin, lighted tube with a lens at the tip that transmits images to a monitor. The doctor inserts the endoscope through the nose and into the nasal cavity or paranasal sinuses to view the cancer and surrounding structures.

The cancer is removed using small surgical tools inserted through the nostrils. Using this approach, the doctor can often remove the entire tumor through the nose and avoid making incisions on the face. Endoscopic surgery is performed using general anesthesia.

At NYU Langone, our skull base surgeons—a team comprised of otolaryngologists, head and neck surgeons and neurosurgeons—endoscopically remove a sinonasal tumor when it is located at the base of the skull and close to the brain, or near important nerves. A team of clinical neurophysiologists—doctors who specialize in the nervous system—sometimes monitors the brain and important nerves during the procedure. This approach provides real-time feedback on brain and nerve function during surgery, helping minimize injury.

For tumors located near the skull base, surgery is often guided by computer software that displays images of the tumor on a screen. Image guidance helps surgeons avoid critical structures such as the carotid arteries, which carry blood to the brain and face, and optic nerves, which run from the eyes to the brain. It also allows for more complete and safe tumor removal.

Doctors may perform open surgery—which requires making an incision in the face near the nose, under the lip, or through the scalp—to remove large sinonasal cancers that have grown into the skin; the eye; the orbit, commonly known as the eye socket; or the skull.

If the tumor is pressing on or has grown into the brain, a neurosurgeon performs a craniotomy, in which he or she creates an opening in the skull. During a craniotomy, neurophysiologists monitor the brain and important nerves to help preserve their function. Surgeons may also use information obtained from CT or MRI scans of the tumor to guide the procedure.

Doctors may perform reconstructive surgery to repair openings in the skull base that are created if a tumor needs to be removed from this location. They may use a nearby layer of tissue under the scalp that is attached to the blood supply.

All forms of open surgery for sinonasal cancer require general anesthesia.

Doctors may sometimes surgically remove lymph nodes in the neck that contain cancer, a procedure called neck dissection. Sinonasal tumors can spread to the lymph nodes, which make and store lymphocytes—white blood cells that help fight infections and also aid in destroying cancer cells.

A neck dissection, which requires general anesthesia, may be performed if results from a fine needle aspiration show the lymph nodes contain cancer. A doctor may also remove lymph nodes if they appear swollen or he or she suspects the cancer has spread there.

Knowing whether the cancer has spread to the lymph nodes and surrounding tissue can help doctors determine whether radiation therapy or chemotherapy should follow surgery.

The recovery time for sinonasal cancer surgery varies depending on the type of procedure performed. If your surgeon uses an endoscopic approach for a small cancer, you may be able to go home the same day.

Larger tumors that are removed endoscopically may require a hospital stay of one to three days so your doctor can monitor your health and manage any pain and discomfort with medication.

If open surgery is needed, the hospital stay may be a few days longer.