18
Treatment
Table 6. Grade A/B Evidence-based Recommendations for
Surgical Management of CRS
Intervention Grade Benefit Harm
Hypotensive
Anesthesia
B Controlled hypotension
with MAPs between 60
and 70 mmHg improves
the surgical field
MAP <60 mmHg may
result in cerebral ischemia
Patient Selection
to Achieve a
Postoperative
MCID
B Use of baseline
disease-specific QoL
metrics (e.g., SNOT-22
≥20) as criteria can help
standardize selection
for patients with high
likelihood of achieving a
post-op MCID
Exclusion of patients based
on SNOT-22 scores alone
who may otherwise benefit
from surgery
Extent of Surgery B Reduced tissue
manipulation of mucosa
with limited approaches
(e.g., balloons) has the
potential to reduce
surgical time
Limited techniques can
result in insufficient
removal of diseased tissue,
persistent inflammation,
reduced topical delivery,
less access for postoperative
care, and faster relapse of
symptoms
Image Guidance B Reduced complications,
improved outcomes,
more extensive surgery
performed, reduced
surgeon stress
Increased operating time,
IGS failure leading to
inaccurate localization of
instruments
