Comparison of Submucosal Resection and Radiofrequency Turbinate Volume Reduction for Inferior Turbinate Hypertrophy: Evaluation by Magnetic Resonance Imaging

Object. The goal of this study was to test hypotheses regarding changes in volume in subcortical structures following anterior cingulotomy.Methods. Morphometric magnetic resonance (MR) imaging methods were used to assess volume reductions in subcortical regions following anterior cingulate lesioning in nine patients. Magnetic resonance imaging data obtained before and 9 ± 6 months following anterior cingulotomy were subjected to segmentation and subcortical parcellation.Significant volume reductions were predicted and found bilaterally within the caudate nucleus, but not in the amygdala, thalamus, lenticular nuclei, or hippocampus. Subcortical parcellation revealed that the volume reduction in the caudate nucleus was principally referrable to the body, rather than the head. Furthermore, the magnitude of volume reduction in the caudate body was significantly correlated with total lesion volume.Conclusions. Taken together, these findings implicate significant connectivity between a region of anterior cingulate cortex (ACC) lesioned during cingulotomy and the caudate body. This unique data set complements published findings in nonhuman primates, and advances our knowledge regarding patterns of cortical—subcortical connectivity involving the ACC in humans. Moreover, these findings indicate changes distant from the site of anterior cingulotomy lesions that may play a role in the clinical response to this neurosurgical procedure.

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Long-term clinical results of radiofrequency tissue volume reduction for inferior turbinate hypertrophy

The Journal of Laryngology & Otology ◽

10.1017/s0022215111001976 ◽

2011 ◽

Vol 125 (11) ◽

pp. 1148-1151 ◽

Cited By ~ 9

Author(s):

I Cukurova ◽

E Demirhan ◽

E A Cetinkaya ◽

O G Yigitbasi

Keyword(s):

Inferior Turbinate ◽

Clinical Results ◽

Acoustic Rhinometry ◽

Volume Reduction ◽

Radiofrequency Energy ◽

Tissue Volume ◽

Turbinate Hypertrophy ◽

Inferior Turbinate Hypertrophy

AbstractObjective:To investigate the long-term clinical results of radiofrequency tissue volume reduction for symptomatic inferior turbinate hypertrophy.Study design:Patients who were unresponsive to medical treatment (n = 197) received turbinate reduction using radiofrequency energy. Subjective symptoms were assessed using a 10 cm visual analogue scale, and all patients underwent acoustic rhinometry before the procedure and six, 24, 48 and 60 months afterwards.Results:Of the 197 treated patients, 148 completed the protocol. No significant peri-operative complications were observed. Thirty-two patients required follow-up treatment. Significant improvements were seen in nasal obstruction and discharge scores and in acoustic rhinometry values, at six, 24, 48 and 60 months post-operatively, compared with pre-operative values (p < 0.001 and p < 0.05, respectively).Conclusion:Radiofrequency tissue volume reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit of this procedure persisted 60 months after the procedure.

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Gamma Knife Surgery for Cavernous Hemangiomas in the Cavernous Sinus

Neurosurgery ◽

10.1227/01.neu.0000378026.23116.e6 ◽

2010 ◽

Vol 67 (3) ◽

pp. 611-616 ◽

Cited By ~ 26

Author(s):

Chiang-Wei Chou ◽

Hsiu-Mei Wu ◽

Chun-I Huang ◽

Wen-Yuh Chung ◽

Wan-Yuo Guo ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Gamma Knife ◽

Cavernous Sinus ◽

Tumor Volume ◽

Gamma Knife Surgery ◽

Volume Reduction ◽

Resonance Imaging ◽

Tumor Volume Reduction

Abstract BACKGROUND Cavernous hemangioma in the cavernous sinus (CS) is a rare vascular tumor. Direct microsurgical approach usually results in massive hemorrhage. Radiosurgery has emerged as a treatment alternative to microsurgery. OBJECTIVE To further investigate the role of Gamma Knife surgery (GKS) in treating CS hemangiomas. METHODS This was a retrospective analysis of 7 patients with CS hemangiomas treated by GKS between 1993 and 2008. Data from 84 CS meningiomas treated during the same period were also analyzed for comparison. The patients underwent follow-up magnetic resonance imaging at 6-month intervals. Data on clinical and imaging changes after radiosurgery were analyzed. RESULTS Six months after GKS, magnetic resonance imaging revealed an average of 72% tumor volume reduction (range, 56%–83%). After 1 year, tumor volume decreased 80% (range, 69%–90%) compared with the pre-GKS volume. Three patients had > 5 years of follow-up, which showed the tumor volume further decreased by 90% of the original size. The average tumor volume reduction was 82%. In contrast, tumor volume reduction of the 84 cavernous sinus meningiomas after GKS was only 29% (P < .001 by Mann-Whitney U test). Before treatment, 6 patients had various degrees of ophthalmoplegia. After GKS, 5 improved markedly within 6 months. Two patients who suffered from poor vision improved after radiosurgery. CONCLUSION GKS is an effective and safe treatment modality for CS hemangiomas with long-term treatment effect. Considering the high risks involved in microsurgery, GKS may serve as the primary treatment choice for CS hemangiomas.

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Comparison of the Effectiveness and Safety of Radiofrequency Turbinoplasty and Traditional Surgical Technique in Treatment of Inferior Turbinate Hypertrophy

Otolaryngology ◽

10.1016/j.otohns.2005.08.006 ◽

2005 ◽

Vol 133 (6) ◽

pp. 972-978 ◽

Cited By ~ 65

Author(s):

Matteo Cavaliere ◽

Giampiero Mottola ◽

Maurizio Iemma

Keyword(s):

Surgical Technique ◽

Nasal Obstruction ◽

Inferior Turbinate ◽

Turbinate Hypertrophy ◽

Group A ◽

The Difference ◽

Group B ◽

Inferior Turbinate Hypertrophy ◽

Submucosal Resection ◽

And Function

OBJECTIVES: Inferior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Many different techniques are currently available. We prospectively evaluate the safety and effectiveness of radiofrequency volumetric tissue reduction (RFVTR) compared with the traditional surgical technique. METHODS: The study was conducted on 3 groups of 75 patients with symptoms and signs of nasal obstruction associated with inferior turbinate hypertrophy refractory to medical therapy. In group A, the turbinoplasty (TP) was performed using the classical surgical submucosal resection; in group B, the RFVTR was applied to inferior turbinate; and group C patients were not treated and served as control subjects. Nasal endoscopy, visual analogue scale (VAS), anterior active positional rhinomanometry, and saccharin tests were used to assess treatment outcomes at the end of week 1 and months 1 and 3 after surgery. RESULTS: Turbinate edema and secretions decreased significantly ( P < 0.05) in groups A and B from 1 month after surgery. The secretions in group A increased temporarily on the seventh day after surgery. Concerning the nasal obstruction and related symptoms, significant improvement was observed at 1 month after treatment in all patients ( P < 0.05) and continued up to 3 months after surgery ( P < 0.0001). Rhinomanometric measurements demonstrated a significant nasal flow increase at 3 months ( P < 0.0001). The nasal mucociliary transport time increased in group A at week 1. The difference among the 3 groups at month 1 was observed not significant. CONCLUSION: In this study, we demonstrated that both RFVTR and TP are effective in improving nasal obstruction and related nasal symptoms. In support of the RFVTR, different factors are important: it can be performed in local anaesthesia; it does not require a nasal package; it does not cause either a change of mucociliary function or an increase of secretions and crusts; and the patient can be discharged immediately after treatment. Therefore, we suggest that the RFVTR offers an efficient, gentle, and function-maintaining alternative to TP. However, because of the short follow-up, future investigations are needed for a more exhaustive evaluation of equivalency of the 2 turbinate procedures. EBM RATING: B-2

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