Patient History and Ct Findings in Predicting Surgical Outcomes for Patients with Rhinogenic Headache

2009 ◽  
Vol 88 (5) ◽  
pp. 926-929 ◽  
Author(s):  
Louis J. Mariotti ◽  
Reuben C. Setliff ◽  
Mahmoud Ghaderi ◽  
Spencer Voth
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Endoscopic Surgery ◽  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
Primary Treatment ◽  
Sinus Surgery ◽  
Patient History ◽  
Primary Treatment Modality

The concept of rhinogenic headaches remains a subject of much debate. While many authors have reported good results in treating these headaches with endoscopic sinus surgery, few have attempted to establish objective criteria for identifying the best surgical candidates. We conducted a study of 33 adults with rhinogenic headaches to determine if three elements of the history and/or five aspects of computed tomography (CT) would predict which patients might benefit from the minimally invasive sinus technique (MIST) as the primary treatment modality for their headaches. Postoperative follow-up interviews revealed that endoscopic surgery was widely successful, as 28 patients (84.8%) reported improvement. However, we were unable to find any statistically significant history or CT parameters that predicted surgical outcomes.

scholarly journals A 16-Year Study on Incidence and Progression of Diseased Sphenoethmoidal (Onodi) Cell

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ethan I. Huang ◽  
Chia-Ling Kuo ◽  
Li-Wen Lee
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Optic Nerve ◽  
Endoscopic Sinus Surgery ◽  
Visual Loss ◽  
Sinus Surgery ◽  
Acute Visual Loss ◽  
Computed Tomography Images ◽  
Onodi Cell

Traumatic operative injury of the optic nerve in an endoscopic sinus surgery may cause immediate or delayed blindness. It should be cautioned when operating in a sphenoethmoidal cell, or known as Onodi cell, with contact or bulge of the optic canal. It remains unclear how frequent progression to visual loss occurs and how long it progresses to visual loss because of a diseased sphenoethmoidal cell. Research to discuss these questions is expected to help decision making to treat diseased sphenoethmoidal cells. From July 2001 to June 2017, 216 patients received conservative endoscopic sinus surgery without opening a diseased sphenoethmoidal cell. We used their computed tomography images of paranasal sinuses to identify diseased sphenoethmoidal cells that could be associated with progression to visual loss. Among the 216 patients, 52.3% had at least one sphenoethmoidal cell, and 14.8% developed at least one diseased sphenoethmoidal cell. One patient developed acute visual loss 4412 days after the first computed tomography. Our results show that over half of the patients have a sphenoethmoidal cell but suggest a rare incidence of a diseased sphenoethmoidal cell progressing to visual loss during the follow-up period.

Endoscopic Surgery for Frontal and Ethmoid Sinus Mucoceles

1994 ◽  
Vol 8 (3) ◽  
pp. 107-112 ◽  
Author(s):  
Thomas L. Kennedy
Keyword(s):  
Endoscopic Surgery ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Ethmoid Sinus ◽  
Endoscopic Approach ◽  
Sinus Surgery ◽  
Difficult Cases

Seven patients with frontal and ethmoid mucoceles treated by endoscopic sinus surgery were reviewed. Five cases were successfully managed, with two requiring a trephine procedure in combination with the intranasal endoscopic approach. Follow-up ranged from 3 to 33 months with a mean of 17.8 months. The use of endoscopic instruments through a trephine incision is recommended in difficult cases to assure patency of the frontal sinus recess. When a large frontal sinus mucocele extends into the anterior ethmoid, the endoscopic approach becomes ideal. Sinus mucoceles can be handled safely and successfully by endoscopic surgery and may eliminate the need for more traditional external procedures.

Meticulous endoscopic sinus surgery to prevent recurrence of massive nasal polyposis

2012 ◽  
Vol 126 (8) ◽  
pp. 789-794 ◽  
Author(s):  
S M S Hoseini ◽  
B Saedi ◽  
K Aghazadeh
Keyword(s):  
Endoscopic Surgery ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Demographic Data ◽  
Effective Means ◽  
Sinus Surgery ◽  
Previous Surgery ◽  
Endoscopic Findings ◽  
History Of

AbstractObjective:To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis.Study design and method:One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund–Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence.Results:Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014).Conclusion:Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.

scholarly journals Minimally Invasive Endoscopic Sinus Surgery for Frontal Sinus Pathologies Using Interventional Flexible Bronchoscopy: Case Reports

2021 ◽  
Vol 12 ◽  
pp. 215265672110308
Author(s):  
Yann Litzistorf ◽  
François Gorostidi ◽  
Antoine Reinhard
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Case Reports ◽  
Flexible Bronchoscopy ◽  
Sinus Surgery ◽  
Fungus Ball ◽  
Flexible Bronchoscope ◽  
Frontal Sinuses

Background: Lateral pathologies of the frontal sinus are difficult to visualize and treat with classical endoscopic sinus surgery (ESS) using rigid endoscopes and instruments. Hence, they often require extended endoscopic or external approaches. Methods and Results: We describe the advantages of using interventional flexible bronchoscopy in frontal ESS without extended approaches in 2 illustrated cases: (1) A fungus ball in the frontal sinus with a frontoethmoidal cell. The flexible bronchoscope allowed treatment of all recesses of the frontal sinuses and the opening of a frontoethmoidal cell through a Draf IIa. (2) A revision surgery with a frontoethmoidal cell obstructing drainage pathway was successfully treated with this same technique. Patients did not experience complications or recurrent symptomatology after, respectively, 4 and 15 months of follow-up. Conclusion: Flexible bronchoscopy allows a good visualization and treatment of lateral frontal sinus pathologies through limited endoscopic approaches. Through-the-scope instruments permit the resection of frontoethmoidal cells.

Indolent mucormycosis of the paranasal sinus in immunocompetent patients: are antifungal drugs needed?

2013 ◽  
Vol 127 (9) ◽  
pp. 872-875 ◽  
Author(s):  
H Jung ◽  
S K Park
Keyword(s):  
Computed Tomography ◽  
Paranasal Sinus ◽  
Endoscopic Sinus Surgery ◽  
Clinical Symptoms ◽  
Antifungal Drugs ◽  
Sinus Surgery ◽  
Bony Destruction ◽  
Immunocompetent Patients ◽  
Paranasal Sinus Computed Tomography

AbstractObjective:To report the clinical characteristics and treatment outcomes of indolent paranasal mucormycosis in immunocompetent individuals.Materials and methods:A retrospective review of four immunocompetent patients with indolent mucormycosis of the paranasal sinus managed by endoscopic sinus surgery only was performed. One year of regular follow up comprised angled endoscopy and repeated paranasal sinus computed tomography three months after surgery.Results:Clinical symptoms were non-specific. Pre-operative paranasal sinus computed tomography showed opacification of the unilateral maxillary sinus with focal calcification but without bony destruction or extension to the orbit or cranium. All patients underwent endoscopic sinus surgery without administration of antifungal agents. There was no recurrence on regular clinical and radiological follow up.Conclusion:For indolent paranasal mucormycosis in immunocompetent patients, endoscopic sinus surgery can be the treatment of choice, and the administration of antifungal drugs may not be necessary.

Paranasal Sinus Mucoceles: Modern Management

1995 ◽  
Vol 9 (5) ◽  
pp. 251-258 ◽  
Author(s):  
Nigel J.P. Beasley ◽  
Nicholas S. Jones
Keyword(s):  
Paranasal Sinus ◽  
Endoscopic Surgery ◽  
Endoscopic Sinus Surgery ◽  
Surgical Techniques ◽  
The Other ◽  
Diagnostic Radiology ◽  
Sinus Surgery ◽  
External Approach ◽  
Radiological Findings

As a result of the introduction of endoscopic sinus surgery, together with improvements in diagnostic radiology, it is now possible to marsupialize the majority of paranasal sinus mucoceles. We present a review of our management of 34 consecutive mucoceles, of which 22 were approached endoscopically. We discuss the presenting features and radiological findings in these patients, and the surgical techniques employed. At review, two patients have had a recurrence; both had previously had drainage of their mucocele by an external approach. One was then managed by further external surgery and the other endoscopically. There were no significant complications following endoscopic surgery with a follow-up of 6 months to 3 years. We suggest what should be the contraindications to an endoscopic approach.

scholarly journals Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salma S. Al Sharhan ◽  
Mohammed H. Al Bar ◽  
Shahad Y. Assiri ◽  
Assayl R. AlOtiabi ◽  
Deemah M. Bin-Nooh ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
T Test ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
P Value ◽  
Psychological Dysfunction ◽  
Significant Difference ◽  
The Mean ◽  
Snot 22

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value =  < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value =  < 0.001); ear/facial symptoms (t-test = 6.34, p-value =  < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value =  < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

STEREOTACTIC RADIOSURGERY FOR CAVERNOUS SINUS OR ORBITAL HEMANGIOMAS

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 914-918 ◽  
Author(s):  
Aftab A. Khan ◽  
Ajay Niranjan ◽  
Hideyuki Kano ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Tumor Regression ◽  
Target Volume ◽  
Symptomatic Improvement ◽  
Primary Treatment ◽  
Vascular Tumors ◽  
Presenting Symptoms ◽  
Primary Treatment Modality

Abstract OBJECTIVE Hemangiomas are rare but highly vascular tumors that may develop in the cavernous sinus or orbit. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We analyzed our increasing experience using stereotactic radiosurgery (SRS). METHODS Eight symptomatic patients with hemangiomas underwent SRS between 1988 and 2007. The presenting symptoms included headache, orbital pain, diplopia, ptosis, proptosis and impaired visual acuity. The hemangiomas were located in either the cavernous sinus (7 patients) or the orbit (1 patient). Four patients underwent SRS as primary treatment modality based on clinical and imaging criteria. Four patients had previous microsurgical partial excision or biopsy. The median target volume was 6.8 mL (range, 2.5–18 mL). The median prescription dose delivered to the margin was 14.5 Gy (range, 12.5–19 Gy). The dose to the optic nerve in all patients was less than 9 Gy (range, 4.5–9 Gy). RESULTS The median follow-up period after SRS was 80 months (range, 40–127 months). Six patients had symptomatic improvement; 2 patients reported persistent diplopia. Follow-up imaging revealed tumor regression in 7 patients and no change in tumor volume in 1 patient. All the patients improved after SRS. CONCLUSION Our extended experience confirms that SRS is an effective management strategy for symptomatic intracavernous and intraorbital hemangiomas. Our study is the first long-term report on the safety and efficacy of SRS.

Endoscopic sinus surgery for the anterior maxillary sinus, using a 135° reflective CO2 laser

2007 ◽  
Vol 122 (9) ◽  
pp. 918-920 ◽  
Author(s):  
K Sato
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Surgery ◽  
Endoscopic Sinus Surgery ◽  
Maxillary Antrum ◽  
Anterior Wall ◽  
Surgical Instruments ◽  
Sinus Surgery ◽  
Reliable Procedure ◽  
Wall Lesion ◽  
Wall Lesions

AbstractObjectives:Endoscopic sinus surgery has been widely performed to treat nose and paranasal diseases. However, it is difficult to manipulate anterior wall lesions of the maxillary sinus using conventional surgical instruments. This paper presents a method of performing endoscopic surgery for anterior wall lesions of the maxillary sinus, using a 135° reflective CO2 laser.Method:A CO2 laser with a 135° reflective tip on the pipe-guide handpiece and a CO2 laser angulated to the same degree were used. The pipe-guide handpiece with reflective tip was inserted into the nasal cavity and the base of the maxillary sinus anterior wall lesion was vaporised and removed via an enlarged natural ostium. During the procedure, the maxillary antrum was visualised with a 70° endoscope. Ten cases of maxillary sinus anterior wall lesion underwent this surgical procedure.Results:In all cases, the base of the maxillary sinus anterior wall lesion was removed completely and recurrence avoided.Conclusion:This method is a reliable procedure enabling endoscopic sinus surgery for anterior wall lesions of the maxillary sinus.

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