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초록

Background: Perineural invasion along the maxillary nerve (V2) in head and neck tumors causes significant morbidity partially due to difficult surgical access, particularly in an interdural segment. Despite ongoing use of the endoscopic endonasal interdural middle fossa approach (EEIMA), its long-term oncological outcomes remain unreported. This study aims to evaluate the long-term oncological outcomes of EEIMA in patients with V2 perineural invasion. Materials and Methods: This single-center, retrospective cohort study was conducted from January 2017 to December 2023. We analyzed oncological outcomes in patients who underwent EEIMA for sinonasal malignancies with V2 perineural invasion and were followed up for more than 50 months. Clinical data, including symptoms, pathological findings, resection margin status, additional treatments, recurrence, and survival status, were reviewed. Results: The mean age of participants was 52.5 years, with equal sex distribution. Adenoid cystic carcinoma was most common, and cheek pain or numbness were present in most patients. No postoperative complications, including cerebrospinal fluid leakage, occurred (0%). Negative resection margins were achieved in two patients (33.3%), while four had microscopic positive margins (66.7%). At a mean follow-up of 60.2 months, patients with negative margins remained disease-free, while those with positive margins showed various outcomes, including lung metastasis, stable disease, and local recurrence. Conclusions: EEIMA provides reliable symptom control in managing malignant tumors with V2 perineural invasion, while also demonstrating favorable long-term oncologic outcomes. This technique alleviates symptoms and maintains tumor control even when negative margins cannot be achieved. With appropriate patient selection, EEIMA represents a practical treatment strategy.

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