Pituitary apoplexy following endoscopic sinus surgery

2009 ◽  
Vol 124 (6) ◽  
pp. 677-679 ◽  
Author(s):  
G Fyrmpas ◽  
J Constantinidis ◽  
N Foroglou ◽  
P Selviaridis
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Pituitary Apoplexy ◽  
Symptomatic Improvement ◽  
Sinus Surgery ◽  
Effective Technique ◽  
Pituitary Fossa ◽  
Middle Meatal Antrostomy ◽  
Risk Patients ◽  
Life Threatening ◽  
Life Threatening Event

AbstractObjective:To highlight the possibility of pituitary apoplexy after functional endoscopic sinus surgery for elimination of sinonasal infection, an important preparatory step for safe trans-sphenoidal access to the pituitary fossa.Case report:A 67-year-old man with a known pituitary macroadenoma developed headache, diplopia and reduced vision after endoscopic middle meatal antrostomy and ethmoidectomy for rhinosinusitis with polyps. Magnetic resonance imaging showed pituitary haemorrhage. The patient underwent emergency endoscopic trans-sphenoidal resection of the tumour, with significant symptomatic improvement. Despite mild right eyelid ptosis and persistent diabetes insipidus, the patient resumed normal activities in a few weeks. To our knowledge, this is the first report of pituitary apoplexy after a nasal operation.Conclusion:Pituitary apoplexy is a rare and potentially life-threatening event in high risk patients with pituitary adenomas; it may occur spontaneously or after surgical procedures. Early, combined surgical intervention by rhinologists and neurosurgeons is recommended. The endoscopic trans-sphenoidal approach is a safe and effective technique for the acute management of pituitary apoplexy.

scholarly journals Correlations and Comparison between Repeat Computed Tomography Scores, Endoscopy Scores and Symptomatic Improvement before and after Endoscopic Sinus Surgery: A Pilot Study

2013 ◽  
Vol 6 (1) ◽  
pp. 32-40 ◽  
Author(s):  
NV Deepthi ◽  
Indudharan R Menon
Keyword(s):  
Computed Tomography ◽  
Pilot Study ◽  
Endoscopic Sinus Surgery ◽  
Medical Center ◽  
Tertiary Care ◽  
Objective Evaluation ◽  
Symptomatic Improvement ◽  
Sinus Surgery ◽  
Tertiary Care Medical Center ◽  
Before And After

ABSTRACT Background Chronic rhinosinusitis (CRS) is diagnosed on the basis of symptoms, nasal endoscopic findings and computed tomography of the paranasal sinuses (CT PNS). Where indicated, functional endoscopic sinus surgery (FESS) is the surgical treatment. Objective To determine correlations between subjective symptom severity and objective endoscopic and radiologic findings in CRS and to compare these before and after FESS. Materials and methods Analysis of prospectively collected data of 20 patients undergoing FESS at a tertiary care medical center followed up for a minimum period of 6 months after surgery. RSI questionnaire-based symptom score, Lund-Mackay system-based endoscopic and CT finding scores were recorded preoperatively and at 8 weeks and 6 months postoperatively. Results Significant positive correlation was noted between the three parameters before surgery, especially endoscopic and radiological scores (r = 0.94 in the latter, p < 0.01 in all three). Postoperative improvement was statistically significant for all three parameters, even at the 6 months stage (p < 0.001). Postoperative correlations reduced significantly, especially between endoscopic and radiological scores. Conclusion This study showed the relevance of objective evaluation of routine parameters of CRS, preoperatively. It also confirmed the usefulness of FESS in indicated cases, in terms of statistical improvement of these parameters. However, repeat CT scans and the methods of scoring used by us may not be equally applicable in the long-term postoperative scenario. How to cite this article Deepthi NV, Menon UK, Menon IR. Correlations and Comparison between Repeat Computed Tomography Scores, Endoscopy Scores and Symptomatic Improvement before and after Endoscopic Sinus Surgery: A Pilot Study. Clin Rhinol An Int J 2013;6(1):32-40.

APPROACH TO UNCINECTOMY BY SWING DOOR TECHNIQUE VS STANDARD TECHNIQUE – A COMPARATIVE STUDY

2021 ◽  
pp. 37-39
Author(s):  
Praveen Singh ◽  
Tarun Ojha ◽  
Shreya Prasad
Keyword(s):  
Complication Rate ◽  
Endoscopic Sinus Surgery ◽  
Maxillary Sinusitis ◽  
Tertiary Care ◽  
Standard Technique ◽  
Symptomatic Improvement ◽  
Sinus Surgery ◽  
Minor Complication ◽  
Tertiary Care Centre ◽  
Group B

Introduction: Uncinectomy is the most important step in endoscopic sinus surgery which can be performed by various methods. The present study aimed to compare the results and complications of performing uncinectomy and middle meatus antrostomy using the standard and swing door techniques during FESS. Methods: In this study, 50 patients of both gender (aged 18–50 years) suffering from chronic maxillary sinusitis underwent functional endoscopic sinus surgery (FESS) from January 2019 to December 2019 at a tertiary care centre. The patients were divided on random basis into two groups of 25. Group Apatients underwent uncinectomy using standard technique while Group B underwent uncinectomy using swing door technique. Results:The mean VAS scores for Group Aand Group B were 78.50 ± 16.63 and 80.58 ± 14.34, respectively, suggesting that Group B patients have better symptomatic improvement. No major complications were observed in both groups. At the end of Week 2, minor complications were observed in 8 (26.7%) of the patients from Group Aand 2 (6.7%) from Group B. By the sixth week, the minor complication rate was 1 (3.3%) and 0 in Group A and Group B, respectively. When compared statistically during the second week using chi-square test, the difference in minor complication rate was found to be statistically signicant (p < 0.05, 2 = 4.81), with lower incidence of complications in Group B. Conclusion: Uncinectomy performed by swing door technique produces better postoperative results, with lesser complications, when compared to the standard technique.

scholarly journals Computed tomography findings after endoscopic sinus surgery with preserving or enlarging maxillary sinus ostium surgery

2011 ◽  
Vol 49 (4) ◽  
pp. 438-444
Author(s):  
J. Myller ◽  
P. Dastidar ◽  
T. Torkkeli ◽  
M. Rautiainen ◽  
S. Toppila-Salmi
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Symptom Relief ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Ct Findings ◽  
Middle Meatal Antrostomy ◽  
Sinus Ostium ◽  
Subjective Outcomes

Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.

scholarly journals Concomitant orbital and intracranial abscess

2020 ◽  
pp. 189-194
Author(s):  
Andreea Nae ◽  
Stephen Farrell ◽  
Kieron Sweeney ◽  
Siobhan Hoare ◽  
Michael Colreavy
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Pediatric Population ◽  
Sinus Surgery ◽  
Intracranial Abscess ◽  
Case Presentation ◽  
Intravenous Antibiotics ◽  
Intracranial Complications ◽  
Life Threatening ◽  
Team Setting ◽  
Periorbital Swelling

Background:  Intracranial and orbital abscesses in combination together are rare complications of sinusitis. They can be life-threatening and can result in multiple sequelae. Case presentation: A 9-year-old female presented with left periorbital swelling, gaze restriction and headache. Following scans, she underwent emergency endoscopic sinus surgery, evacuation of the intraorbital empyema and stereotactic mini-craniectomy with the evacuation of the extradural empyema as a joint case. The patient recovered well and was discharged to complete intravenous antibiotics for 6 weeks. Conclusion: In the pediatric population intracranial complications of acute sinusitis can have more devastating consequences. Therefore prompt recognition and management are essential within a multidisciplinary team setting. We also highlight the rarity of concomitant multi-site abscess formation and the need to be vigilant for same.

A Prospective Study on the Safety and Effectiveness of a Composite Sinus Stent for Use After Endoscopic Sinus Surgery

2018 ◽  
Vol 33 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Dan Yaniv ◽  
Lena Shlossberg ◽  
Eitan Yaniv
Keyword(s):  
Stent Implantation ◽  
Endoscopic Sinus Surgery ◽  
Medical Center ◽  
Middle Turbinate ◽  
Symptomatic Improvement ◽  
Self Report ◽  
Sinus Surgery ◽  
Postoperative Treatment ◽  
Control Group ◽  
Study Group

Background The composite sinus stent was developed to support the nasal walls, stabilize the middle turbinate, and prevent adhesions following endoscopic sinus surgery (ESS). Objective This study sought to assess its safety and effectiveness. Methods A prospective clinical trial was conducted in a single medical center in 2016–2018. The study included 30 patients (64% males) with a mean age of 41.9 years, who were scheduled for bilateral ESS, were randomized to undergo composite sinus stent implantation for 14 to 28 days or middle meatus placement of a Telfa tampon for 2 to 3 days. Telfa is a nonadherent absorbent dressing that has been compared favorably with other packs for use following ESS. Both groups received the same postoperative treatment. Outcomes were evaluated endoscopically by the principal investigator and also by an independent investigator blinded to the intervention the patient had and by self-report questionnaires at 3 and 12 weeks postoperatively. Results The stent was successfully implanted and removed in all 29 treated sinuses, without complications. None of the stents showed granulation tissue or crusting. Compared to the tampon group, the stent group had significantly less inflammation (mean visual analog scale scores 0.2 vs 4.2 at 12 weeks, P = .01). The probability of having adhesion was 9.3 times greater in the control group compared to the study group ( P = .026), and middle turbinate lateralization rate at 12 weeks was 3.8% versus 44% in the study group and the control group, respectively, at 12 weeks ( P = .006). Patients who underwent stent implantation experienced higher symptomatic improvement (Sino-Nasal Outcome Test 22 of −37.13 vs −28.07, P = .01, in study and control groups, respectively). During stent implantation (2–4 weeks), patients did not suffer from any discomfort. Conclusions The composite sinus stent is safer and more effective than the Telfa tampon in maintaining sinus cavity patency and promoting healing following ESS.

scholarly journals Endoscopic Sinus Surgery with Antrostomy Has Better Early Endoscopic Recovery in Comparison to the Ostium-Preserving Technique

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Annika Luukkainen ◽  
Jyri Myller ◽  
Tommi Torkkeli ◽  
Markus Rautiainen ◽  
Sanna Toppila-Salmi
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Radiologic Findings ◽  
Ostiomeatal Complex ◽  
Middle Meatal Antrostomy ◽  
Computed Tomography Scans ◽  
Endoscopic Score ◽  
Sinus Ostium

Background. Endoscopic sinus surgery (ESS) is considered for chronic rhinosinusitis (CRS) after failure of conservative therapy. Objective. The aim of this study was to evaluate endoscopically ostium patency and mucosal recovery after ESS, with either maxillary sinus ostium-preserving or -enlarging techniques. Materials and Methods. Thirty patients with non-polypous CRS were enrolled. Uncinectomy-only and additional middle meatal antrostomy were randomly and single-blindly performed for each side. Pre- and postoperative endoscopic scores were semi-quantitatively determined according to findings in the ostiomeatal complex area. Adhesions, maxillary sinus mucosal swelling, secretions, and ostium obstruction were also endoscopically evaluated. In addition, symptoms were asked and computed tomography scans were taken preoperatively and 9 months postoperatively. Results. At 16 days postoperatively, a better endoscopic score and a less obstructed ostium were found with antrosomy. At 9 months postoperatively the endoscopic score improved significantly and identically with both procedures, however, obstructed ostia and sinus mucosal swelling/secretions were insignificantly more frequently found on the uncinectomy-only side. Endoscopic and radiologic findings of the maxillary sinus mucosa and ostium correlated significantly 9 months postoperatively. Conclusion. There was a good long-term mucosal recovery with both surgical procedures. In terms of early mucosal recovery and ostium patency, antrostomy might be slighly superior.

Management of Recurrent Acute Rhinosinusitis: A Systematic Review

2021 ◽  
pp. 194589242199499
Author(s):  
Mohamad Z. Saltagi ◽  
Brett T. Comer ◽  
Samuel Hughes ◽  
Jonathan Y. Ting ◽  
Thomas S. Higgins
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Symptom Control ◽  
Clinical Problem ◽  
Symptomatic Improvement ◽  
Sinus Surgery ◽  
Inclusion Criteria ◽  
Management Options ◽  
Radiographic Findings ◽  
Allergy Treatment

Background Objective Study Design RARS is a challenging clinical problem that impacts many patients. This article seeks to systematically review the literature on RARS management. Methods Cochrane, PubMed, EMBASE, and other databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA guidelines. Inclusion criteria included articles specifically addressing RARS management; studies with 3 or more patients; and articles in English. Results A total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 10 met inclusion criteria (five with level 4 evidence, four with level 3 evidence, one with level 2 evidence). The studies included a total of 890 patients (Age range 5.8 to 53.5 years), with follow up ranging from 1 to 19 months. Endpoints were primarily based on symptomatic improvement, although some articles also reported post-treatment endoscopic and radiographic findings. Management options included medical therapy (intranasal steroids, antibiotics, nasal saline irrigations, N-acetylcysteine, allergy treatment, and decongestants), balloon sinus dilation (BSD), and endoscopic sinus surgery (ESS). Surgical patients (BSD and ESS) had a trend towards greater symptom control than medically-treated patients, but meta-analysis was not possible. Conclusion Despite increasing interest in the treatment of RARS, there remains a lack of consensus regarding optimal management. The literature thus far, largely based on expert opinion, suggests that surgical management, either through balloon sinus dilation or endoscopic sinus surgery, may be helpful in improving symptoms and quality of life in those who do not respond to initial trials of medical management.

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