Endoscopic Endonasal Resection of Sphenoid Sinus Inverted Papilloma with Carotid Artery Preservation: 2-Dimensional Operative Video

Inverted papilloma is the most common benign sinonasal neoplasm. These tumors are locally invasive causing hyperostosis at the site of attachment. The standard treatment is complete resection due to the high rate of recurrence with incomplete resection.(1) The goal of the resection is complete removal of the tumor along with a rim of normal bone and mucosa. They most commonly occur in the lateral nasal wall or maxillary sinus and carry a 5% to 15% chance of malignant transformation.(2) Only 10% to 14% occurring in the sphenoid sinus.(3) We present a 2-dimensional video of endoscopic endonasal resection of a sphenoid sinus inverted papilloma with bony erosion overlying the paraclival internal carotid artery (ICA) bilaterally. A 66-year-old male patient presented with progressive headaches. A computed tomography head revealed a mass filling and expanding the sphenoid sinus with erosion of a portion of the sphenoid body leading to exposure of the bilateral paraclival ICAs. The MRI with contrast revealed a weakly enhancing mass with linear T1 hypointensities suggestive of an inverted papilloma. The patient elected to proceed with surgical resection of the mass. The patient consented to the procedure. The right sphenoid was cleared first to identify and protect the right ICA and obtain a Doppler signal form the left ICA. A gross total resection was obtained, and the surrounding mucosa and bone were removed from the site of attachment. Bilateral ICAs were preserved. Final pathology revealed an inverted papilloma without dysplasia. No further treatment is warranted at this time.