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Object: Brain invasion is unusual in patients with paranasal sinuses cancer. Staging systems do not specify brain invasion extension who has an impact in therapeutic strategy and prognosis. Surgical series of this patient treated by endonasal endoscopic approach are scarce. In this paper, a novel classification and surgical strategy is proposed. Methods: A retrospective review of patients with ethmoidal malignant tumors with brain invasion treated at the National Institute of Oncology and Radiobiology from January 2015 to October 2017 by means endonasal endoscopic surgery was performed. All medical records were reviewed for demographics, diagnoses, presentation, endoscopic approach, reconstructive techniques and clinical outcomes. Pattern of brain invasion was classified in five grades. Chi-squared test, ANOVA test and Kaplan-Meier curves were used. Results: Forty-seven patients (26 males and 21 females) were registered. Mean age was 52.3 years ± 27.0. Only 3 patients presented with neurologic symptoms. Histologic subtypes were squamous cell carcinoma (25 patients), adenocarcinoma (16 patients), and esthesioneuroblastoma (6 patients). Five patients corresponded to Grade I, 39 Grade II and 3 Grade III. The mean surgical time was 351.9 min (±45). The mean blood loss was 704.5 ml (±206). The mean ICU stay was 1.1 (ranging from 1 to 2 ) days and the hospital stay was 5.3 (ranging from 5 to 7) days. Conclusions: Brain invasion represents a particular therapeutic challenge in patients with malignant nasosinusal tumors. Surgical treatment is possible in some cases, including endonasal endoscopic approach. A stage classification of brain invasion helps to establish an optimal surgical strategy and a prognosis.

A Novel Classification of Brain Invasion in Malignant Ethmoidal Tumors and Management Proposal