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Ep. 269 Management of Sinonasal Tumors with Skull Base Involvement: Part 1 with Dr. Zara Patel, Dr. JP Almeida, & Dr. Garret Choby
Description
Pathology, anatomy, and staging: how do these three pillars come together to guide sinonasal tumor management? In this episode of the BackTable ENT Podcast, host Dr. Satyan Sreenath is joined by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby to discuss a multidisciplinary approach to sinonasal tumors, emphasizing the triad of pathology, anatomy, and staging to guide treatment.
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Timestamps
00:00 - Introduction
02:04 - First Principles of Workup
05:23 - Case 1: Maxillary Sinus Mass
06:23 - Imaging and Biopsy Strategy
08:11 - Inverted Papilloma Pathology and Surgical Planning
20:28 - Case 2: Unilateral Disease Red Flags
24:34 - MRI Clues for Malignancy
31:47 - Video Walkthrough of Endonasal Resection
38:51 - Surveillance
41:41 - Key Papers
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More about this episode
The panel reviews key workup considerations, including in-office biopsy and the use of CT and MRI to distinguish tumor from retained secretions and guide operative planning. They walk through two illustrative cases of inverted papilloma. The first involves a left maxillary sinus mass treated with an endoscopic medial maxillectomy using a Denker-type approach, with emphasis on complete attachment-site eradication. The second case highlights an elderly patient with frontal and anterior ethmoid disease abutting the orbit and skull base, requiring meticulous endoscopic technique, careful management of the anterior ethmoid artery, and thoughtful handling of bone and periorbita.
The discussion also covers imaging features suggestive of malignant transformation, as well as emerging AI-based CT and MRI tools that show high accuracy in distinguishing benign inverted papillomas from those associated with squamous cell carcinoma. The episode concludes with postoperative surveillance strategies and key consensus and review publications.
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Resources
Joao Paulo Almeida, MD, PhD
https://medicine.iu.edu/faculty/68351/almeida-joao-paulo
Satyan B. Sreenath, MD
https://medicine.iu.edu/faculty/60724/sreenath-satyan
Zara M. Patel, MD
https://med.stanford.edu/profiles/zara-patel
Garret W. Choby, MD
https://providers.upmc.com/provider/garret-w-choby/2592344
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