A stepwise approach to open surgery for the frontal sinus

2021 ◽  
Vol 135 (2) ◽  
pp. 173-175
Author(s):  
A Kelly ◽  
N Alhelali ◽  
G W McGarry
Keyword(s):  
Frontal Sinus ◽  
Open Surgery ◽  
Embryological Development ◽  
Stepwise Approach ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Rule Of Thumb

AbstractBackgroundDespite advances in endoscopic techniques, there are still instances when the frontal sinus must be approached externally. Given its variable anatomy, the frontal sinus continues to present a challenge to the surgeon. Our rule of thumb capitalises on the consistent embryological development of the frontal sinus, aiding safe external access.Methods and resultsThe presented stepwise approach includes trephination, fenestration, an osteoplastic flap and obliteration. The obliteration procedure has produced good results in managing those patients with disabling symptoms despite multiple endoscopic procedures.

Anesthesia for Gastrointestinal Endoscopic Procedures

2018 ◽  
Author(s):  
Lori Kral Barton ◽  
Regina Y. Fragneto
Keyword(s):  
General Anesthesia ◽  
Patient Characteristics ◽  
The United States ◽  
Anesthetic Techniques ◽  
Anesthesia Care ◽  
Care Providers ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Sole Agent ◽  
Geographic Regions

As the population ages, patients presenting for endoscopic procedures are more likely to have significant comorbidities. In addition, endoscopic procedures of increasing complexity are being performed. While there are significant differences among geographic regions in the United States, anesthesia care providers are providing sedation or general anesthesia for a greater proportion of procedures performed in the endoscopy suite. A variety of drugs and anesthetic techniques have been used successfully. Propofol remains the most commonly used drug when sedation is provided by an anesthesia professional, sometimes as a sole agent and sometimes in combination with other medications. Dexmedetomine and ketamine have also been used successfully. Patient characteristics and the specific needs of the endoscopist based on the procedure being performed will determine the most appropriate anesthetic regimen for each patient. For more complex endoscopic techniques, general anesthesia may be preferred, with some data indicating improved success of the procedure.

Surgical Revision of the Failed Obliterated Frontal Sinus

2005 ◽  
Vol 19 (5) ◽  
pp. 425-429 ◽  
Author(s):  
Peter H. Hwang ◽  
Joseph K. Han ◽  
Evan J. Bilstrom ◽  
Todd T. Kingdom ◽  
Karen J. Fong
Keyword(s):  
Frontal Sinus ◽  
Retrospective Chart Review ◽  
Surgical Revision ◽  
Fat Graft ◽  
Endoscopic Management ◽  
Persistent Disease ◽  
Endoscopic Techniques ◽  
Management Algorithm ◽  
Sinus Obliteration

Background Surgical revision of failed frontal sinus obliteration, traditionally, has been limited to repeat obliteration. However, endoscopic techniques may be successful in selected cases. We review our experience in surgical revision of failed frontal obliteration and propose a management algorithm. Methods Retrospective chart review was performed over a 5-year period for patients who presented for surgical revision of a previously obliterated frontal sinus. Indications for surgery, radiological findings, and surgical approach were reviewed. Results Nineteen patients were identified, presenting an average of 9.7 years from the initial obliteration. Eighty-four percent (n = 16) were approached endoscopically and 16% (n = 3) were approached by revision obliteration. The mean follow-up was 25 months. In the endoscopic group, patients had either mucoceles in the inferomedial aspect of the frontal sinus or incomplete obliteration with persistent disease in the pneumatized frontal remnant. Eighty-one percent (13/16) were managed successfully with a single endoscopic procedure. Nineteen percent (3/16) had persistent disease requiring either a subsequent obliteration or Riedel ablation because of infected fat graft or frontal osteomyelitis. All patients who were managed successfully endoscopically remained free of disease with patent frontal sinusotomies throughout the follow-up period. The endoscopic failures required one to two additional external procedures to achieve disease resolution. In the revision obliteration group, all patients had mucoceles in either the lateral or the superior frontal sinus. All three patients had resolution of disease after a single procedure and remained free of disease throughout the follow-up period. Conclusion Selected patients undergoing revision of frontal obliteration may benefit from endoscopic approaches. If disease is localized in the frontal recess or inferomedial frontal sinus, endoscopic management may be successful in the majority of patients. Superior or lateral frontal disease appears to be best approached externally. Patients undergoing endoscopic salvage should be counseled about the possible need for revision obliteration if disease persists.

scholarly journals The Bifurcated Frontal Sinus

OTO Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 2473974X1876487
Author(s):  
Edward D. McCoul ◽  
Kiranya E. Tipirneni
Keyword(s):  
Frontal Sinus ◽  
Residual Disease ◽  
Case Series ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
Consecutive Series ◽  
Endoscopic Techniques ◽  
Common Wall ◽  
Computed Tomography Scans ◽  
Extent Of Surgery

Objectives Frontal sinus anatomy is complex, and multiple variations of ethmoid pneumatization have been described that affect the frontal outflow tract. In addition, the lumen proper of the frontal sinus may exist as 2 separate parallel cavities that share an ipsilateral outflow tract. This variant has not been previously described and may have implications for surgical management. Study Design Case series. Setting Tertiary rhinology practice. Subjects and Methods Cases with radiographic and intraoperative findings of separate parallel tracts within a unilateral frontal sinus were identified from a consecutive series of 186 patients who underwent endoscopic sinus surgery between May 2015 and July 2016. Data were recorded including sinusitis phenotype, coexisting frontal cells, and extent of surgery. Results Ten patients (5.4%) were identified with computed tomography scans demonstrating bifurcation of the frontal sinus into distinct medial and lateral lumens. All cases were treated with Draf 2a or 2b frontal sinusotomy with partial removal of the common wall to create a unified ipsilateral frontal ostium. Eleven sides had a coexisting ipsilateral agger nasi cell, 7 had a supra-agger cell, 8 had a suprabullar cell, and 1 had a frontal septal cell. There were no significant complications. Conclusion The bifurcated frontal sinus is an anatomic variant that the surgeon should recognize to optimize surgical outcomes. Failure to do so may result in incomplete clearance of the sinus and residual disease. The bifurcated sinus may occur with other types of frontal sinus cells and may be safely treated with endoscopic techniques.

Endoscopic Approach for Pituitary Surgery Improves Rhinologic Outcomes

2009 ◽  
Vol 118 (9) ◽  
pp. 630-635 ◽  
Author(s):  
Scott M. Graham ◽  
Tim A. Iseli ◽  
Lucy H. Karnell ◽  
John D. Clinger ◽  
Patrick W. Hitchon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Endoscopic Surgery ◽  
Open Surgery ◽  
Pituitary Surgery ◽  
Endoscopic Approach ◽  
Open Group ◽  
Open Approach ◽  
Endoscopic Procedures ◽  
The Mean

Objectives: We hypothesized that the endoscopic approach to pituitary surgery improves rhinology-specific quality of life and has satisfactory tumor outcomes compared with the open approach. Methods: Cases of pituitary surgery from the Department of Neurosurgery database included an inception cohort of all patients who had endoscopic procedures and consecutive patients who had open procedures between January 1998 and February 2008. The Sino-Nasal Outcome Test-22 was mailed. Results: Since January 1998, 71 endoscopic and 122 open pituitary surgeries had been performed. The mean follow-up was longer for open procedures (49.3 months) than for endoscopic procedures (18.8 months). Recurrence was more common after open surgery (28.4%) than after endoscopic surgery (18.2%; p = 0.219). The most common diagnosis was macroadenoma (77.1% of endoscopic procedures and 93.4% of open procedures). The mean hospital stay was shorter for endoscopic procedures (4.1 days) than for open procedures (6.0 days; p < 0.001). Of patients who presented with visual deterioration, 53.8% with endoscopic surgery and 46.7% with open surgery had improvement. Among patients with normal preoperative hormonal function, 27.5% of patients in the endoscopy group and 29.4% of patients in the open group required medication for more than 2 months after surgery. Complications occurred in 33.3% of endoscopic procedures and 43.4% of open procedures. Cerebrospinal fluid leaks were more common in the endoscopy group (p = 0.035), and diabetes insipidus lasting more than 30 days was more common in the open group (p = 0.017). The mean Sino-Nasal Outcome Test-22 score was lower for patients in the endoscopy group (20.4) than for those in the open group (23.2; p = 0.41). Patients in the endoscopy group had a significantly lower rhinology-specific mean score (6.5) than did patients in the open group (9.2; p = 0.03). Conclusions: The endoscopic approach to pituitary surgery offers tumor outcomes comparable to those of open surgery, with no greater incidence of complications and an improved rhinology-specific quality of life.

Osteoplastic Flap Without Obliteration: How I Do It

2018 ◽  
Vol 32 (5) ◽  
pp. 346-349 ◽  
Author(s):  
Catherine G. Banks ◽  
Jaime A. P. Garcia ◽  
Jessica Grayson ◽  
Do Yeon Cho ◽  
Bradford A. Woodworth
Keyword(s):  
Frontal Sinus ◽  
Descriptive Analysis ◽  
Direct Access ◽  
Endoscopic Procedures ◽  
Draf Iii

Background The osteoplastic flap provides access to pathology of the frontal sinus and is often performed with obliteration, which can result in significant long-term complications. Objective To describe the authors’ approach to osteoplastic flap without obliteration. Methods Descriptive analysis. Results Osteoplastic flap without obliteration preserves frontal sinus function while permitting direct access to the frontal sinus. In this study, we demonstrate a combined nonobliterated approach, accessing the frontal sinus with a Draf III approach to remove a large frontal sinus osteoma. Conclusion The approach provides excellent exposure for large tumors not otherwise accessible via purely endoscopic procedures, permits improved surveillance, and minimizes long-term complications of obliterated sinuses.

Endoscopic Treatment of Arachnoid Cysts

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 824-836 ◽  
Author(s):  
Joachim M.K. Oertel ◽  
Wolfgang Wagner ◽  
Yvonne Mondorf ◽  
Joerg Baldauf ◽  
Henry W.S. Schroeder ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Endoscopic Technique ◽  
Arachnoid Cysts ◽  
Success Rates ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Presenting Symptoms ◽  
Long Term Follow Up

Abstract BACKGROUND Surgical treatment of arachnoid cysts remains under debate. Although many authors favor endoscopic techniques, others attribute a higher recurrence rate to the endoscope. OBJECTIVE The authors report their experience with endoscopic procedures for arachnoid cyst. METHODS All pure endoscopic procedures for arachnoid cysts performed by the authors were analyzed. Particular reference was given to surgical complications and patient outcome in relation to cyst location and endoscopic technique. RESULTS Sixty-six endoscopic procedures were performed in 61 patients (mean age, 28 years; range, 23 days to 74 years; 35 males, 26 females). The main presenting symptoms were cephalgia (61%), hemisymptoms (18%), and macrocephalus (18%). Cyst location was temporobasal (34%), suprasellar (21%), at the cisterna quadrigemina (18%), paraxial supratentorial (16%), and various (10%). Thirty cystocisternostomies, 14 ventriculocystostomies, 12 cystoventriculostomies, and 10 ventriculocystocisternostomies were performed. The overall clinical success rate was 90%. The endoscopic technique was abandoned in 4 cases (7%). Postoperative complications were found in 16%; there was only one permanent deficit (2%). Five recurrences (8%) occurred up to 7 years after the first procedure. Of the various locations, the temporobasal cysts were the most difficult to treat with lowest clinical success (81%), highest recurrence (19%), and highest complication rate (24%). Of the various endoscopic techniques, ventriculocystostomy and ventriculocystocisternostomy reached the highest success rates with 100%. CONCLUSIONS Endoscopic techniques provide very good results in arachnoid cyst treatment. The most frequent cyst location is the most difficult to treat. A long-term follow-up is recommended since recurrences can occur many years after the procedure.

scholarly journals Validation of a Hybrid Ex Vivo Integral Colon Simulator in Basic and Advanced Endoscopic Procedures

2019 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Ex Vivo ◽  
Low Cost ◽  
Morphological Characteristics ◽  
Ileocecal Valve ◽  
Hepatic Flexure ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Hybrid Integral ◽  
Therapeutic Procedures ◽  
Level Of Experience

Introduction: Traditionally, training in gastrointestinal endoscopy has been performed directly on the patient under expert supervision, but this practice is not free of errors and risks to the patient. With the growing development of ever more complex therapeutic endoscopic techniques, an ex vivo hybrid integral colon simulator for the teaching of basic and advanced endoscopic procedures was a necessity. It would allow for the necessary repetitions required to overcome the learning curve, with the advantages of accessibility, low cost, reproducibility and with which the use of real accessories was feasible on human-like tissues and therefore, obtain effective training and the development of endoscopic techniques with no risk to the patient. Aim: To validate the ex vivo hybrid integral colon simulator in basic and advanced procedures by experts in colonoscopy. Material and Methods: We developed a questionnaire as a measuring instrument to determine the simulator´s realism. Twentynine (29) expert endoscopists were selected and each was exposed to the simulator and performs a colonoscopy and different therapeutic procedures. The questionnaire was then applied. Statistics: The sum of skill mastery and the overall mastery was calculated, defining “close to reality” as at least, a 90% of responses in its favor. To identify the specialty effect and the level of experience (total colonoscopies) in terms of realism and the simulator´s usefulness, we used the Chi2 test and logistic regression models, considering a p<0.05 statistically significant. Results: Twenty-nine (29) experts evaluated the simulator: 15 were gastroenterologists, 14 were surgeons, with an average of 2683 total colonoscopies. From a maximum overall score of 79 (100%), 9 experts (31%) gave it 79 points (100%), and 13 experts (44%) attributed it a score of 78 points (98%). In terms of the identification of anatomical structures and the simulator´s morphological characteristics, 96.6% considered them to be close to reality. As to the mastery of basic maneuvers and the evaluation of advanced procedures, 100% of the experts considered the simulator useful in terms of reproduction and close to reality. The categorization of realism, usefulness of the simulator by specialty and the number of total colonoscopies were analyzed and no difference was detected. Discussion: Although in the overall score 100% of the experts considered the simulator experience to be close to reality and useful (cutoff point of at least 90%), the following items had greater variability: identification of the ileocecal valve and the hepatic flexure, and the mucosal appearance. We concluded that the simulator is not dependent on the physician´s level of experience nor on the specialty. Conclusion: The simulator is realistic and useful when reproducing basic and advanced procedures, using real equipment and accessories. It is therefore a valuable tool when training in different therapeutic procedures that are a technical challenge and are associated with a broad range of complications if not successfully performed. It offers the possibility of repeating the required procedure to further develop or improve the student´s psychomotor abilities with no risk to the patient.

Il trattamento tradizionale dell'IPB nell'anziano: The traditional treatment of BPH in the elderly

1998 ◽  
Vol 65 (2) ◽  
pp. 222-225
Author(s):  
G. Fiaccavento ◽  
P. Scialpi ◽  
R. Zucconelli ◽  
P. Belmonte
Keyword(s):  
Life Expectancy ◽  
Elderly Patients ◽  
Retrospective Analysis ◽  
Open Surgery ◽  
Benign Prostatic Hypertrophy ◽  
The Elderly ◽  
Prostatic Hypertrophy ◽  
Traditional Treatment ◽  
Endoscopic Procedures ◽  
Made In

Longer life expectancy and the progress made in anaesthesiology have led to an increase over the last few years in the request for treatment of symptomatic benign prostatic hypertrophy (BPH) in elderly patients. A retrospective analysis on 270 patients aged 75 years who underwent surgery on the cervico-prostatic district between 1989 and 1997 showed a rate of complications (10% overall) comparable with that in patients of any age undergoing the same operation. This reinforces the conviction that both open surgery and endoscopic procedures for treating symptomatic BPH are safe and reliable even in the elderly.

scholarly journals Diagnostic Yield of Endoscopic Procedures in Children: Experience of a Portuguese Center

2020 ◽  
Vol 27 (6) ◽  
pp. 404-409
Author(s):  
Sónia Silva ◽  
Cláudia Silva ◽  
Maria do Céu Espinheira ◽  
Isabel Pinto Pais ◽  
Eunice Trindade ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Celiac Disease ◽  
Bowel Disease ◽  
Foreign Bodies ◽  
Epigastric Pain ◽  
Diagnostic Yield ◽  
Quality Criteria ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Inflammatory Bowel

<b><i>Background:</i></b> Over the last decades, the use of gastrointestinal (GI) endoscopic procedures has been increased in children worldwide, allowing the early diagnosis and therapeutic intervention in multiple GI diseases. <b><i>Aims and Methods:</i></b> In order to evaluate the appropriateness and the diagnostic yield of initial GI endoscopic techniques in children in a Portuguese tertiary hospital, we performed a retrospective cohort study during a 12-month period.<b><i> Results:</i></b>A total of 308 procedures were performed in 276 patients; the median age was 11 years and 50.4% were males. Esophago-gastro-duodenoscopy (EGD) corresponded to 81.8% of the procedures and ileo-colonoscopy (IC) to the remaining; 11.6% of the patients underwent both EGD and IC. Overall, 51.3% of the exams showed abnormal macroscopic findings, and 69.6% showed histopathological signs of disease, with IC showing significantly more positive results than EGD (<i>p</i> &#x3c; 0.05). Considering the different indications independently, abnormal serology for celiac disease, suspected ingestion of foreign bodies, suspected inflammatory bowel disease, and food impaction were frequent in our population; and in the majority of the cases, the suspected diagnosis was confirmed: celiac disease, ingestion of foreign bodies, inflammatory bowel disease, and eosinophilic esophagitis, respectively. On the other hand, despite the high frequency of epigastric pain in this population, only nearly one-third of the patients showed abnormal histological findings. The final diagnosis was established in 63% of the patients, and 39.1% initiated the new treatment.<b><i> Discussion:</i></b>Our results emphasize the importance of endoscopic procedures, especially IC, in the diagnosis of GI diseases in pediatric patients, as well as the careful choice of the endoscopic techniques in those with less specific symptoms, as chronic abdominal pain. In this particular situation, given the proportion of cases that may be due to functional disease, good characterization of the clinical context is needed, and endoscopy should be reserved for a second-line approach. <b><i>Conclusion:</i></b> It is important to monitor and examine the endoscopic techniques as an index of quality criteria for clinical practice.

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