Ep. 270 Management of Sinonasal Tumors with Skull Base Involvement: Part 2 with Dr. Zara Patel, Dr. JP Almeida and Dr. Garret Choby

Could that routine epistaxis actually be the first sign of a challenging skull base tumor? This week’s episode of the BackTable ENT Podcast is part two of the sinonasal tumor and skull base involvement discussion. Host Dr. Satyan Sreenath is joined again by Dr. Joao Paulo Almeida, Dr. Zara Patel, and Dr. Garret Choby for a case-based deep dive into the multidisciplinary management of complex sinonasal tumors. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:20 - Case 1: Juvenile Nasopharyngeal Angiofibroma05:03 - Considerations for Pre-Operative Embolization 08:10 - Disaster Scenario: High Volume Loss09:21 - Operative Approach18:10 - Post-Op Imaging Considerations21:00 - Case 2: Invasive Keratinizing Squamous Cell Carcinoma24:40 - Operative Approach vs. Neoadjuvant Treatment Strategies28:30 - Importance of Diagnostic Nasal Endoscopy30:15 - Operative Approach32:37 - Lumbar Drain Considerations 40:35 - Closing Thoughts --- More about this episode The panel works through advanced cases presenting with epistaxis, using them to highlight key principles in evaluation, imaging, staging, and operative planning. They first discuss a 16-year-old male with a large juvenile nasopharyngeal angiofibroma extending to the skull base and middle cranial fossa, focusing on vascular supply, preoperative embolization, surgical strategy near the carotid, and planning for intraoperative hemorrhage and postoperative surveillance. They also emphasize the importance of thorough endoscopic evaluation and early referral to experienced centers. They then review a 72-year-old female with invasive, HPV-negative keratinizing squamous cell carcinoma involving the anterior cranial fossa and dura. The conversation addresses tumor board decision-making, neoadjuvant considerations, endoscopic craniofacial resection, reconstruction strategies, and management of delayed positive margins. It highlights how accurate histopathology and coordinated multidisciplinary care guide outcomes in these complex cases. --- Resources Joao Paulo Almeida, MD, PhDhttps://medicine.iu.edu/faculty/68351/almeida-joao-paulo Satyan B. Sreenath, MDhttps://medicine.iu.edu/faculty/60724/sreenath-satyan Zara M. Patel, MD https://med.stanford.edu/profiles/zara-patel Garret W. Choby, MDhttps://providers.upmc.com/provider/garret-w-choby/2592344 --- BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app