However, the lack of brain retraction with an endoscopic approach reduces the possibility of brain contusion and edema, which can occur with CFR [4]. Nevertheless, studies which have directly compared the procedures found no difference in complication rates, with the one possible difference being increased blood then loss with CFR [2]. Aside from pure endoscopic resection, endoscopic-assisted CFR has gained acceptance as a standard procedure for management of sinonasal malignancies. This approach allows for a combined transfacial and transnasal technique, resulting in a single external incision. This also avoids the limited working angle which is possible with an endoscopic transnasal approach alone. A combined technique may broaden the cases for which endoscopy is suitable [5, 7].

Table 1 displays an overview of the key advantages and disadvantages of a Transnasal Endoscopic Approach. Table 1 Key advantages and disadvantages of transnasal endoscopic resection. 3.3. The Role of 5-Fluorouracil 5-Fluorouracil is an antimetabolite and can be used to treat a variety of cancers, including head and neck cancers. It can be used both intravenously and topically. Toxicity is unusual, with myelosuppression and cerebellar syndromes being rare complications. Its use in sinonasal malignancy is usually topical following surgery, and this along with other forms of topical chemotherapy are recognised forms of treatment [9, 10]. A large trial in Rotterdam aimed to assess whether a traditional CFR approach was superior to surgical debulking followed by the application of topical chemotherapy.

Survival rates were measured over a 23 year period using the Kaplan-Meier method and a significant increase in survival was found in patients treated with debulking and topical chemotherapy. It suggests that this method becomes the mainstay of treatment for sinonasal malignancy [9]. A further study in the UK directly compared survival rates between 5-Fluorouracil chemotherapy and traditional methods of radiotherapy and CFR. It found that the survival rates of 50% with these traditional methods improved to 86% with initial surgical intervention followed by topical chemotherapy. This is a significant difference and supports the view that topical 5-Fluorouracil treatments following surgery become standard for the management of sinonasal malignancy [11]. 4.

GSK-3 Conclusions Transnasal endoscopic resection could represent an acceptable treatment for patients with sinonasal malignancy that decline the gold standard treatment of craniofacial resection. It is gaining a reputation as a safe and effective treatment. Topical chemotherapy has been shown to increase survival when combined with debulking surgery and is also an effective treatment option. It must also be remembered that TER is not acceptable for patients with locally invading tumours, and patients must be selected carefully.