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Endoscopic endonasal surgery

Suneeta Gollapudy, David M Poetker, Jasmeet Sidhu, Matthias L Riess
PURPOSE: Visualization of the surgical field is essential for patient safety during endoscopic transsphenoidal tumor surgery. In this retrospective chart review and data analysis of patients undergoing endoscopic transsphenoidal resection of pituitary tumors under general anesthesia we sought to determine if total intravenous anesthesia with propofol and remifentanil leads to decreased bleeding, surgical duration, time to extubation and/or length of stay in the recovery room compared to inhaled anesthesia with sevoflurane or desflurane...
July 5, 2018: American Journal of Otolaryngology
Shefqet Hajdari, Geralf Kellner, Almuth Meyer, Steffen Rosahl, Ruediger Gerlach
BACKGROUND: Endoscopic endonasal transsphenoidal surgery (EETS) is a common treatment for patients with pituitary adenomas (PA). A disadvantage of endoscopic surgery has been the lack of stereoscopic vision and depth perception. Recent developments offer high definition 3D visualization (3D-HD) with a higher resolution and better image quality compared to 3D standard endoscopy (3D-SD). OBJECTIVE: To compared treatment results of surgically treated patients with PA using 3 different visualization systems (2D-HD, 3D-SD and 3D-HD)...
July 12, 2018: World Neurosurgery
Frederick Yoo, Carmen Chan, Edward C Kuan, Marvin Bergsneider, Marilene B Wang
Objectives  Prolactinomas are the most common functional pituitary adenoma. Symptoms of a prolactinoma stem from hormonal causes (menstrual irregularities, galactorrhea, and reduced libido) or from tumor mass effect (visual changes and headache). Gender differences have been noted in prolactinomas, with males presenting with larger tumors and sequelae of mass effect, while females present commonly with hormonal symptoms. The purpose of this study is to evaluate differences in patient and disease characteristics, and outcomes between male and female prolactinoma patients undergoing surgery...
August 2018: Journal of Neurological Surgery. Part B, Skull Base
Raewyn G Campbell, C Arturo Solares, Eric C Mason, Daniel M Prevedello, Ricardo L Carrau
Background  The palatine neurovascular bundle is at risk during endoscopic surgery. Injury may result in significant blood loss and anesthesia of the ipsilateral hard palate. Nonetheless, its endoscopic anatomy has not been described previously. This article strives to establish landmarks to identify the greater palatine canal; thus, avoiding injury to its contents. Methodology  This study comprised 50 deidentified computed tomographic angiograms using landmarks that are immediately visible during endoscopic medial maxillectomy to calculate: the angle of the greater palatine canal to the vertical, the distance from the anteroinferior aspect of the greater palatine canal to the orifice of the nasolacrimal duct, the distance from the anteroinferior aspect of the greater palatine canal to the posterolateral free edge of the hard palate, and the distance from the anterior aspect of the greater palatine canal as it enters the hard palate to the posterior wall of the maxillary sinus...
August 2018: Journal of Neurological Surgery. Part B, Skull Base
Huy Q Truong, Edinson Najera, Robert Zanabria-Ortiz, Emrah Celtikci, Xicai Sun, Hamid Borghei-Razavi, Paul A Gardner, Juan C Fernandez-Miranda
OBJECTIVE The endoscopic endonasal approach has become a routine corridor to the suprasellar region. The superior hypophyseal arteries (SHAs) are intimately related to lesions in the suprasellar space, such as craniopharyngiomas and meningiomas. Here the authors investigate the surgical anatomy and variations of the SHA from the endoscopic endonasal perspective. METHODS Thirty anatomical specimens with vascular injection were used for endoscopic endonasal dissection. The number of SHAs and their origin, course, branching, anastomoses, and areas of supply were collected and analyzed...
July 13, 2018: Journal of Neurosurgery
Daniel G Eichberg, Sheikh C Ali, Simon S Buttrick, Ricardo J Komotar
BACKGROUND: Primary watertight dural closure is the preferred method of postcraniotomy dural repair. However, even when ideal technique is implemented, postoperative infection, cerebrospinal fluid (CSF) leaks, pseudomeningoceles, and dural scarring are possible complications. For this reason, materials that augment the dura's ability to create a watertight seal, prevent disease transmission, and inhibit inflammatory response are sought. Dehydrated amniotic membrane (DAM) allograft appears to fulfil these requirements as it has several beneficial properties that aid wound healing, including promotion of epithelialization, scar tissue prevention, and inhibition of bacterial growth...
July 10, 2018: British Journal of Neurosurgery
Toshihiro Ogiwara, Alhusain Nagm, Takatoshi Hasegawa, Yoshiki Hanaoka, Shunsuke Ichinose, Tetsuya Goto, Kazuhiro Hongo
Various skull base reconstruction techniques have been developed in endoscopic endonasal approach (EEA) for skull base lesions to prevent postoperative cerebrospinal fluid (CSF) leakage. This study was performed to evaluate the efficacy and pitfalls of our method of skull base reconstruction after EEA. A total of 123 patients who underwent EEA (127 surgeries) between October 2014 and May 2017 were reviewed. Our algorithm for skull base reconstruction in EEA was categorized based on intraoperative CSF leakage graded as follows: grade 0 was excluded from this study; grade 1, dural suturing with abdominal fat graft or packing of gelatin sponge into the cavity; grade 2, method for grade 1 with addition of mucosal flap or nasoseptal flap (NSF); and grade 3, duraplasty in fascia patchwork closure with NSF...
July 7, 2018: Neurosurgical Review
Hiroyuki Morishita, Masayoshi Kobayashi, Kazuhiko Takeuchi
Juvenile nasopharyngeal angiofibroma (JNA) is a hypervascular tumor and uncontrolled hemorrhage makes its removal very difficult. Although preoperative intravascular embolization of a feeding artery is recommended, serious complications such as iatrogenic thrombosis in the brain and insufficient decrease in blood flow to the tumor are concerns. Recently, coblation plasma technology has been reported to be useful for tumor removal with minimum hemorrhage under a clear surgical field. Here we report successful removal of advanced JNA without preoperative embolization, using intraoperative ligation of the maxillary artery and coblation plasma technology...
July 3, 2018: Auris, Nasus, Larynx
Rüdiger Gerlach, Steffen Rosahl, Geralf Kellner
OBJECTIVE:  Over the past few years bipolar electrocoagulation techniques in neurosurgery have been continually improving. However, limited access during endoscopic endonasal transsphenoidal surgery (EETS) for central skull base pathologies and the requirement of very precise coagulation in that dedicated anatomical area requires further refinement of bipolar coagulation instruments. We describe our experience (effectiveness of coagulation, intraoperative handling, and the use as a dissecting tool) with a new type of coagulation forceps, the Calvian endo-pen (Sutter Medizintechnik, Freiburg, Germany) during EETS...
July 6, 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Ravi R Shah, William W Thomas, Edward C Kuan, David W Kennedy
BACKGROUND: Aside from endoscopic and image guidance confirmation, the standard method of identifying the lamina involves the surgeon or an assistant applying gentle pressure on the globe externally. This globe push test requires the surgeon to remove one instrument from the endoscopic field or an assistant to press on the globe, and the test is most useful when either the periorbita or periorbital fat is exposed. We propose an alternative, equally accurate, and more efficient technique dubbed the lamina push test...
July 6, 2018: International Forum of Allergy & Rhinology
J K Yashveer, Aneena Chacko
To study the outcome and complications of endoscopic endonasal dacryocystrhinostomy without stenting. Randomised prospective observational design. Tertiary academic centre. Seventy patients, clinically diagnosed as chronic dacryocystitis with nasolacrimal duct obstruction on the basis of syringing, were enrolled. Endoscopy was done for nasal pathology especially mucosal disease, hypertrophied turbinate, DNS. Seventy-eight eyes were operated with endoscopic-dacryocystorhinostomy along with additional surgeries and periodically followed up on OPD-basis at the end of 1st week, 2nd week, 1st month and 3rd month and evaluated clinically and by syringing (Ophthalmologist) and endoscopy done, wherever required...
June 2018: Indian Journal of Otolaryngology and Head and Neck Surgery
Bin Tang, Shen Hao Xie, Li Min Xiao, Guan Lin Huang, Zhi Gang Wang, Le Yang, Xuan Yong Yang, Shan Xu, Ye Yuan Chen, Yu Qiang Ji, Er Ming Zeng, Tao Hong
Endoscopic endonasal approach for craniopharyngioma (CP) resection provides a wide view and direct observation of hypothalamus and origin of tumor. Under endoscopy, 92 CPs were classified into 2 types: Peripheral and Central, according to its relation to pituitary stalk. Peripheral type was further divided into 3 subtypes: Hypothalamic stalk, Suprasellar stalk and Intrasellar stalk CP, according to the different origin site along hypothalamus-pituitary axis. Peripheral type arisen from the stalk but expanded and grown laterally in an exophytic pattern, accounting for 71...
July 5, 2018: Scientific Reports
Chrystelle Cailleaux, Jean-François Papon, Jérôme Nevoux
The obstruction of the Hasner valve is the main cause of congenital obstruction of the lacrimal pathway. Before one year of age, the probability of spontaneous permeabilization is high. For patients between one and five years of age, treatments proposed are often complex, and results are inconsistent. The dacryocystorhinostomy, which is the treatment of choice in adults, is not practical in young children. We propose an efficient surgical technique that can be performed in children older than one year in the refractory cases of congenital obstruction of the lacrimal pathway: an endonasal endoscopic surgery for permeabilization of the distal region of the lacrimal pathway...
July 2, 2018: Clinical Otolaryngology
Jieliang Shi, Yunhai Tu, Wencan Wu
PURPOSE: The aim of this study is to describe a minimally invasive technique of en bloc resection of malignant tumors from lacrimal drainage system (LDS). METHODS: This was a noncomparative, retrospective chart review of the clinical and pathologic findings of patients presenting with a LDS malignant tumor who underwent endoscopic prelacrimal recess approach with a small external incision for en bloc excision of the LDS. RESULTS: A total of 12 patients from April 2010 to July 2017 were reviewed in this study...
June 25, 2018: Journal of Craniofacial Surgery
Dong Hoon Lee, Woo Youl Jang, Tae Mi Yoon, Joon Kyoo Lee, Shin Jung, Sang Chul Lim
OBJECTIVE: The purpose of this study was to review the clinical characteristics, treatment methods, and surgical outcomes of sphenoid sinus mucocele after transsphenoidal pituitary surgery. PATIENTS AND METHODS: A total of 404 patients who underwent transsphenoidal pituitary surgery between January 2010 and December 2016 were identified. Among them, 5 patients with sphenoid sinus mucocele were included in this study. In our hospital, a single-nostril endonasal endoscopic wide sphenoidotomy is routinely used for pituitary tumor surgery...
June 25, 2018: Journal of Craniofacial Surgery
Chiara Caggiano, David L Penn, Edward R Laws
No abstract text is available yet for this article.
June 20, 2018: World Neurosurgery
A N Shkarubo, K V Koval', B A Kadashev, D N Andreev, I V Chernov
Until recently, tumors of the clival region and ventral posterior cranial fossa were considered hard-to-reach and often inoperable via standard transcranial approaches. The introduction of minimally invasive methods combined with the endoscopic technique into neurosurgical practice has enabled removal of hard-to-reach tumors, including midline tumors of the ventral posterior cranial fossa. OBJECTIVE: To improve and introduce the extended endoscopic endonasal posterior (transclival) approach into clinical practice and to analyze the results of its application in surgical treatment of midline skull base tumors extending into the ventral posterior cranial fossa...
2018: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Thomas J Willson, Nicholas R Rowan, Eric W Wang
BACKGROUND: Inadvertent lateralization of the middle turbinate (MT) after endoscopic sinus surgery (ESS) is cited as a common complication that results in both outflow tract obstruction and recurrent symptoms. In endoscopic endonasal skull-base surgery, the MT is frequently lateralized during the parasagittal approach. Little is known about whether this strategy has unintended consequences on the adjacent paranasal sinuses. Intentional lateralization vs surgical resection of the MT were compared for radiographic evidence of sinus obstruction in this patient population...
June 19, 2018: International Forum of Allergy & Rhinology
Liverana Lauretti, Quintino Giorgio D'Alessandris, Mario Rigante, Luca Ricciardi, Pier Paolo Mattogno, Alessandro Olivi
BACKGROUND: In transsphenoidal endoscopic cranial base surgery, a precise navigational support may be crucial. This is particularly evident in case of tumors extending to the parasellar region or in recurrent tumors whereas the normal anatomy has been altered by previous surgery/radiotherapy. METHODS: Previous unsatisfactory experiences with a variety of navigation techniques in this type of surgery, encouraged us to perform an endoscopic endonasal approach with an OArm® (Medtronic, Inc...
June 11, 2018: World Neurosurgery
Mohammad Taghvaei, Seyed Mousa Sadrehosseini, Javad Behjati Ardakani, Manouchehr Nakhjavani, Mehdi Zeinalizadeh
PURPOSE: Endoscopic endonasal approach has recently become an acceptable option for resection of all pituitary adenomas. We assessed biochemical outcome of endoscopic endonasal surgery in growth hormone (GH) secreting adenomas including remission rate, predictors of remission and associated complications. METHODS: Sixty eight consecutive patients with acromegaly who underwent endoscopic endonasal surgery have been analyzed prospectively. Tumors were classified according to the size, Knosp score and Hardy-Wilson classifications...
June 11, 2018: World Neurosurgery
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