scholarly journals Powered endoscopic endonasal dacrocystorhinostomy using inferiorly based mucosal flap: our experience

2019 ◽  
Vol 5 (4) ◽  
pp. 936
Author(s):  
Ramya B. ◽  
Suprabha M. H. ◽  
Prakash M. D.
Keyword(s):  
Simple Procedure ◽  
Nasolacrimal Duct ◽  
Medial Wall ◽  
Critical Element ◽  
Lacrimal Sac ◽  
Term Outcome ◽  
Endoscopic Endonasal ◽  
Long Term Outcome ◽  
Mucosal Flap

<p class="abstract"><strong>Background:</strong> The most critical element for successful management of lacrimal system pathology distal to common canaliculus that requires endoscopic endonasal dacrocystorhinostomy (EEDCR) is the creation of widest possible marsupialisation of the medial wall of the lacrimal sac. With minor modifications and simplication of the original technique of EEDCR, common surgical failures like obstruction of neo-ostium by granulation tissue or infolding of flap can be avoided. To determine the success of EEDCR using inferiorly based mucosal flap, removal of overlying bone using Kerrison’s punch followed by vertical incision of the medial wall of lacrimal sac with microdebrider assisted trimming of the lacrimal sac flaps.</p><p class="abstract"><strong>Methods:</strong> A total of 31 patients with epiphora secondary to nasolacrimal duct obstruction (NLDO) were operated using the above technique with 3 bilateral cases amounting to a total of 34 procedures. The surgical outcome and long term patency of neo-ostium were evaluated.  </p><p class="abstract"><strong>Results:</strong> Of the 34 procedures, 32 procedures (94.1%) had complete resolution of epiphora at the end of one year follow up. The 2 failures were due to canaliculitis.</p><p class="abstract"><strong>Conclusions:</strong> Powered EEDCR with trimming of medial wall of lacrimal sac and inferiorly based mucosal flap preservation to cover the exposed part of bone is a simple procedure with favourable long term outcome.</p>

scholarly journals Long-Term Outcome of Direct Relief of Subaortic Stenosis in Single Ventricle Patients

2018 ◽  
Vol 9 (6) ◽  
pp. 638-644 ◽  
Author(s):  
Friso M. Rijnberg ◽  
Vladimir Sojak ◽  
Nico A. Blom ◽  
Mark G. Hazekamp
Keyword(s):  
Heart Block ◽  
Single Ventricle ◽  
Ventricular Dysfunction ◽  
Simple Procedure ◽  
Direct Approach ◽  
Subaortic Stenosis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pseudo Aneurysm

Background: Single ventricle patients with unrestrictive pulmonary blood flow and (potential) subaortic stenosis are challenging to manage and optimal surgical strategy is unknown. Direct relief of subaortic stenosis by enlargement of the ventricular septal defect and/or subaortic chamber has generally been replaced by a Damus-Kaye-Stansel or Norwood procedure due to concerns of iatrogenic heart block, reobstruction, or ventricular dysfunction. Studies reporting long-term outcome after the direct approach are limited. The aim of our study was to describe and analyze our experience with direct relief of subaortic stenosis in single ventricle patients. Methods: Demographic data, characteristics, and pre-operative, operative and outcome details were collected for children undergoing direct relief of subaortic stenosis between 1989 and 2016. Results: Twenty-three patients (median age: 7.4 months, range: 10 days to 5.5 years) underwent direct relief of subaortic stenosis. Complete follow-up was available for all patients (median: 15.6 years, range: 34 days to 26.3 years). Seven (30%) patients had recurrence of subaortic stenosis. One (4%) patient developed complete heart block and one patient developed moderate ventricular dysfunction. Five (50%) patients developed a (pseudo)aneurysm at site of the patch and ventriculotomy. There were two perioperative deaths. Eighty-six percent of patients underwent a successful Fontan procedure. Conclusions: Direct relief of subaortic stenosis is associated with a substantial risk of reobstruction and patch (pseudo)aneurysm formation. However, risk of heart block is low and long-term outcome is good with the majority of patients reaching Fontan completion. In our opinion, the direct approach appears to be a good and relatively simple procedure in selected cases for the treatment of subaortic stenosis.

scholarly journals Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach—Long-Term Outcome and Literature Review

2019 ◽  
Vol 8 (11) ◽  
pp. 1873 ◽  
Author(s):  
Tanja Hildenbrand ◽  
Rainer Weber ◽  
Janina Mertens ◽  
Boris A. Stuck ◽  
Stephan Hoch ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Inverted Papilloma ◽  
Term Outcome ◽  
Endoscopic Endonasal ◽  
Long Term Outcome ◽  
Sinus Disease ◽  
Common Benign Tumor ◽  
Patient Morbidity

There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity.

scholarly journals Endoscopic endonasal approach for suprasellar meningiomas: introduction of a new scoring system to predict extent of resection and assist in case selection with long-term outcome data

2020 ◽  
pp. 1-13 ◽  
Author(s):  
Brett E. Youngerman ◽  
Matei A. Banu ◽  
Mina M. Gerges ◽  
Eseosa Odigie ◽  
Abtin Tabaee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extent Of Resection ◽  
Outcome Data ◽  
Incomplete Resection ◽  
Term Outcome ◽  
Endoscopic Endonasal ◽  
Long Term Outcome ◽  
Prior Surgery ◽  
The Relationship

OBJECTIVEThe endoscopic endonasal approach (EEA) has gained increasing popularity for the resection of suprasellar meningiomas (SSMs). Appropriate case selection is critical in optimizing patient outcome. Long-term outcome data are lacking. The authors systematically identified preoperative factors associated with extent of resection (EOR) and determined the relationship between EOR and long-term recurrence after EEA for SSMs.METHODSIn this retrospective cohort study, the authors identified preoperative clinical and imaging characteristics associated with EOR and built on the recently published University of California, San Francisco resectability score to propose a score more specific to the EEA. They then examined the relationship between gross-total resection (GTR; 100%), near-total resection (NTR; 95%–99%), and subtotal resection (STR; < 95%) and recurrence or progression with Kaplan-Meier survival analysis.RESULTSA total of 51 patients were identified. Radiographic GTR was achieved in 40 of 47 (85%) patients in whom it was the surgical goal. Significant independent risk factors for incomplete resection were prior surgery (OR 25.94, 95% CI < 2.00 to 336.49, p = 0.013); tumor lateral to the optic nerve (OR 13.41, 95% CI 1.82–98.99, p = 0.011); and complete internal carotid artery (ICA) encasement (OR 15.12, 95% CI 1.17–194.08, p = 0.037). Tumor size and optic canal invasion were not significant risk factors after adjustment for other variables. A resectability score based on the multivariable model successfully predicted the likelihood of GTR; a score of 0 had a positive predictive value of 97% for GTR, whereas a score of 2 had a negative predictive value of 87.5% for incomplete resection. After a mean follow-up of 40.6 ± 32.4 months (mean ± SD), recurrence was 2.7% after GTR (1 patient with atypical histology), 44.4% after NTR, and 80% after STR (p < 0.0001). Vision was stable or improved in 93.5% and improved in 67.4% of patients with a preoperative deficit. There were 5 (9.8%) postoperative CSF leaks, of which 4 were managed with lumbar drains and 1 required a reoperation.CONCLUSIONSThe EEA is a safe and effective approach to SSMs, with favorable visual outcomes in well-selected cases. The combination of postoperative MRI-based EOR with direct endoscopic inspection can be used in lieu of Simpson grade to predict recurrence. GTR dramatically reduces recurrence and can be achieved regardless of tumor size, proximity or encasement of the anterior cerebral artery, or medial optic canal invasion. Risk factors for incomplete resection include prior surgery, tumor lateral to the optic nerve, and complete ICA encasement.

scholarly journals Long Term Success of Endo-DCR with Silicone Tube Catheter (STC) versus Endo-DCR without STC: A Comparative Study

2016 ◽  
Vol 24 (2) ◽  
pp. 88-93
Author(s):  
Bidhan Ray ◽  
Debabrata Datta ◽  
Pijush Roy
Keyword(s):  
Middle Turbinate ◽  
Nasolacrimal Duct ◽  
Late Complications ◽  
Silicone Tube ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cause Of Failure ◽  
Surgical Emphysema

Introduction   Epiphora  caused by  mechanical block at puncta, canaliculi, lacrimal sac and nasolacrimal duct need surgical correction. EndoDCR  is gaining  popularity over conventional surgery. This study aims at evaluating the role of Silicone Tube Catheter (STC) to improve the long term outcome of endoDCR .               Materials and Method   This retrospective study was conducted on 58 consecutive endoDCR surgeries between 2012 and 2014. 22 subjects had endoDCR without STC, 36 subjects had endoDCR with STC, of whom in 20 cases STC was removed in  3 weeks and in 16 cases in  12 weeks. Clinical and endoscopic data collected post-operatively after 3 weeks,12 weeks and at 1 year. Analysis was done on intention to get suggestion for better result from endoDCR operations.                                           Results   Complications were identified as early and late. Complications like granulations, synaechia, echymosis, eyelid haematoma and surgical emphysema were searched for in every follow up. Development of obliterating scar was the main cause of failure. Epistaxis was negligible. No retrobulbar haematoma or rectus injury was noted. Minor synaechia between middle turbinate and nasal wall noted in 13.6 to 20%  of cases in all groups. Granulations were more in cases had STC for 12 weeks but managed with conservative measures. Obliterating scar was slightly less in this group in comparison to other groups.                                         Discussion    The present study emphasises the use of indwelling STC in endoDCR for a longer period .

Endoscopic Inferior Meatal Antrostomy for Antrochoanal Polyps: A Long-Term Follow-Up

ORL ◽  
2021 ◽  
pp. 1-6
Author(s):  
Roee Landsberg ◽  
Muhamed Masalha ◽  
Ariel Margulis ◽  
Yossi Rosman ◽  
Shay Schneider
Keyword(s):  
Surgical Treatment ◽  
Maxillary Sinus ◽  
Nasolacrimal Duct ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Ostiomeatal Complex ◽  
Middle Meatal Antrostomy ◽  
Long Term Follow Up

<b><i>Background:</i></b> Endoscopic middle meatal antrostomy (EMMA) is considered the standard approach for surgical management of antrochoanal polyps (ACPs). Recently, an endoscopic inferior meatal antrostomy (EIMA) approach for clearing lesions in the maxillary sinus was described. In this study, we compared the long-term outcome of patients with ACP following surgical treatment using one of these 2 approaches (EIMA or EMMA). <b><i>Methods:</i></b> The medical charts of all patients treated for ACPs in our institution between January 1, 2009, and July 1, 2020, were reviewed retrospectively. Patients were invited to complete a long-term follow-up assessment. <b><i>Results:</i></b> Thirty-eight patients were included in the study: EIMA was the only procedure performed in 25 patients (66%) and EMMA was the only procedure performed in 7 patients (18%). Both procedures were performed in 6 patients (16%): 2 patients (5%) underwent simultaneous EMMA and EIMA for better access and visualization and 4 patients (10.5%) underwent surgical revision consisting of EIMA secondary to failed EMMA at other institutions. Median follow-up was 44 months (range, 6 months–11 years). No evidence of recurrent ACPs, recirculation, synechiae, nasolacrimal duct injury, or bleeding was observed in any of our patients. Small nonobstructing cysts were observed in 2 patients (8%) following EIMA. <b><i>Conclusions:</i></b> EIMA prevents violation of the ostiomeatal complex. It provides access to the anteroinferior aspect of the maxillary sinus and should be considered as an alternative to EMMA in patients with ACPs.

scholarly journals Endoscopic endonasal surgery for craniopharyngioma: short- and long-term outcome of neurocognitive function

2021 ◽  
Vol 97 (S.HPT) ◽  
pp. 29-31
Author(s):  
博義 阿久津 ◽  
弘善 木野 ◽  
拓真 原 ◽  
裕介 森永 ◽  
秀峰 田中 ◽  
...  
Keyword(s):  
Neurocognitive Function ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Term Outcome ◽  
Endoscopic Endonasal ◽  
Long Term Outcome ◽  
Short And Long Term
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