Live Surgery Session: Advanced Endoscopic Sinus Surgery for Refractory Eosinophilic CRSwNP With AERD

On December 18, 2025, the EurAsia Group hosted a live surgical session focused on the management of a complex, revision case of eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) in the setting of aspirin-exacerbated respiratory disease (AERD, Samter’s triad). The patient had undergone two prior sinonasal surgeries and presented with extensive recurrent polyposis, reflecting the relapsing and treatment-resistant nature of severe type 2 inflammatory disease.

This session was designed not only to demonstrate operative decision-making in a high-difficulty scenario, but also to facilitate real-time international discussion on perioperative strategy, risk mitigation, and long-term disease control.

Case Complexity and Surgical Objectives

Revision inflammatory sinus surgery presents distinct challenges, particularly in AERD-associated CRSwNP. Distorted anatomy, scarring, and high inflammatory burden can complicate identification of key landmarks and increase the technical demands of safe dissection. In this case, the operative objectives were to:

• Restore durable sinus ventilation and drainage pathways

• Achieve thorough disease clearance while maintaining mucosal preservation where feasible

• Address the frontal sinus outflow tract in a manner appropriate for severe, recurrent disease

• Align surgical management with a comprehensive perioperative plan to reduce recurrence risk

International Multidisciplinary Discussion

A key strength of this event was the presence of international surgeons and physicians who joined the live session and contributed to a structured discussion on perioperative management. Topics included:

• Optimizing preoperative control of inflammation in severe eosinophilic disease

• Revision surgery principles and strategies to prevent avoidable trauma

• Postoperative care pathways, including topical therapy optimization and longer-term treatment planning in AERD

The discussion emphasized that advanced surgery in AERD is most effective when integrated into a broader disease-control plan rather than treated as a one-time intervention.

Featured Surgical Focus: Draf III Frontal Sinusotomy

The central technical highlight of the session was the Draf III procedure, selected due to the severity of frontal sinus involvement and the patient’s revision history. The procedure was discussed in a step-by-step manner, with attention to both technique and decision points.

Key educational takeaways included:

• Indications for escalating to Draf III in severe, recurrent inflammatory disease

• Landmark-based orientation in revision anatomy

• Stepwise creation of a common frontal sinus drainage pathway

• Practical considerations to promote long-term patency and reduce restenosis risk

Throughout the case, the operating team and participants addressed how to balance adequate frontal sinus access with preservation of critical structures, and how to tailor the extent of surgery to disease phenotype and surgical history.

Why This Session Matters

Severe eosinophilic CRSwNP with AERD remains one of the most challenging inflammatory conditions in rhinology. Live, interactive surgical sessions offer a rare opportunity to share advanced technique, refine perioperative approaches, and unify practice patterns through open discussion among experts. EurAsia’s mission is to create exactly these high-yield educational environments, where complex cases become structured learning experiences and where international collaboration directly enhances patient care.

Watch for Upcoming Events

We will continue to host live surgical and case-based educational meetings, with a focus on practical, evidence-informed approaches to complex ENT disease. If you would like to join future sessions or collaborate with the EurAsia Group, please follow our website for announcements and updates.