Efficacy of Trans-nasal Endoscopic Sphenopalatine Artery Ligation in the Management of Recurrent Posterior Epistaxis

Background: Recurrent posterior epistaxis is a challenging problem for most otolaryngologists. Of the several proposed treatment modalities, endoscopic ligation of SPA (Sphenopalatine artery) provides a simple and effective solution with relatively minor complications. Objectives: Aim of this study was to find out the success rate and complications of endoscopic ligation of SPA in the management of recurrent posterior epistaxis. Materials and Methods: This was an observational study conducted from Jan 2019 to Jan 2021. Total 60 patients were included in this study. Inclusion criteria were - recurrent epistaxis (at least 4 episodes in last 2 months) with bleeding point not seen in anterior rhinoscopy, Failure of previous conservative management with medications and nasal packing, age between 18–60 years of both sexes. All the patients underwent trans-nasal endoscopic Sphenopalatine artery ligation, and patients were followed up for 12 weeks to identify repeated bleeding and to evaluate complications. Results: In this study male to female ratio was 1.5:1. Mean age of study group was 44.66 (±8.62) years. No recurrent bleeding occurred in 51 (85%) and in 9 (15%) nasal bleeding occurred in the 2 months postoperative period. Anesthesia of incisor teeth occurred in 18 patients (30%), 22 patients (37%) complained about increased nasal crusting. Conclusion: Endoscopic ligation of Sphenopalatine artery shows good outcome in prevention of further episodes of epistaxis in most patients. Although some minor complications can occur, these are manageable. KYAMC Journal. 2021;12(3): 133-137

665 Management of Epistaxis Patients After Nasal Pack Removal - Quality Improvement Project

Introduction Epistaxis is a common emergency and treatments include cautery and nasal packing. NICE guidelines recommend Naseptin® (chlorhexidine and neomycin) and routine practice is to perform cautery if bleeding point identified following pack removal. Method Retrospective analysis of electronic records over a 9-month period identified 114 patients admitted with epistaxis. Results Demographics: 65 male, 49 females (roughly 13:10 ratio), an average age of 72.5 and median age: 76. 8 patients had 2 presentations with epistaxis (3 had SPA ligation on repeat admission). 97 patients were packed, 17 no packing performed. Reasons for admission without packing was observation after cautery (7), observation without cautery (5) and admission under medics for non-epistaxis issue (5). Of patients with discharge summaries, 90% had naseptin prescribed. Of patient admitted under medics, only 60% discharged with naseptin. 70 patients (61.4%) were cauterized, 16 patients (14%) examined, but no cautery required, and 28 patients (24.5%) had no documentation of examination or cautery attempt. Conclusions The majority of patients are receiving naseptin on discharge but room for improvement. Although small sample size of 5, greater portion medical patients discharged without naseptin, better handover required. Almost a quarter of patients (24.5%) did not have any documentation of cautery attempts.

Evaluating the histopathological and mechanical effects of a new forceps design: comparison of hemispheric bipolar forceps tip with usual bipolar tip on fresh cadaver cattle brain model

Without electrocautery, many modern surgical interventions are practically impossible. In neurosurgery, bipolar cautery forceps has been evolved to not only be an auxiliary, but as a principal instrument wielded by the dominant hand of the surgeon to navigate through the most delicate tissue that there is. The purpose of this study is to introduce our original bipolar forceps designed exclusively for microneurosurgical interventions and compare its feasibility with a standard bipolar forceps tip. This study has been conducted on two fresh cadaveric cow brains under the operating microscope. The coagulative and ablative effects of the hemispheric bipolar forceps tip (HBFT) have been histologically compared with those of the standard bipolar forceps tip (SBFT). Likewise, their efficacies as a dissection instruments have been compared via performing dissections from the parietal surface down to the corpus callosum. HBFT proved less traumatic to the uninvolved brain tissue during dissection. Also, histological analyses have revealed that ablative effects of the HBFT are more confined to the bleeding point, more effectively sparing the uninvolved brain tissue. Results of this experimental study suggest that HBFT is a better instrument to be used in microneurosurgical interventions, along with other surgical disciplines where selective diathermy is critical.

Evaluation of the hemostatic effect of a combination of hemostatic agents and fibrin glue in a rabbit venous hemorrhage model

Background In neurosurgery, it is important to use local hemostatic agents. We have explored a more powerful method of hemostasis by the combination of commercially available hemostatic agents with fibrin glue in the hopes of synergistic effects. Method A bleeding model was constructed by puncturing the rabbit posterior vena cava with a needle. After applying the sample to the bleeding point, compression was performed for 10 s. If temporary hemostasis was achieved after pressure release, a 30 s wash was performed to confirm that ultimate hemostasis was achieved. Up to three hemostasis attempts were performed on the same bleeding point until hemostasis was achieved, and the number of attempts required for hemostasis was counted. If hemostasis was not achieved after three attempts, it was counted as four times. Four groups were evaluated: (1) gelatin sponge alone, (2) gelatin sponge + fibrin glue, (3) oxidized cellulose alone, and (4) oxidized cellulose + fibrin glue; each group was tested 16 times. Results The median value (range minimum value–maximum value) of the number of hemostatic attempts in Group 1 to Group 4 was 3 (1–4), 1 (1–1), 4 (4–4), and 4 (2–4). In Group 2, there were two test exclusions owing to deviations of the test procedure. Conclusions The compatibility of gelatin sponge and fibrin glue was very good, with a very strong and rapid hemostatic effect compared to other methods, showed its usefulness. This combination method may be effective for a variety of venous hemorrhages in neurosurgery.

Management of PPH (Placental Site Bleeding) by a Direct Haemostatic Suture in True PPH during Caesarean Section

This study includes 20 cases of PPH seen during Caesarean section by a single surgeon Dr. Sadhna Mathur during the last 11 years where this hemostatic suture was used to control PPH from placental site in uterine cavity, after the medical measures failed to control the bleeding from placental site (uterine cavity). The bleeding point was localized and a haemostatic suture in the overlying uterine musculature was applied. It was found to be completely effective hence it is being shared through this paper

Precision silver nitrate cautery of the posterior nasal cavity

Background This technical note describes a novel method of cauterising the posterior nasal cavity through the use of a plastic straw and silver nitrate. Objective This technique aims to prevent unwanted damage to surrounding nasal mucosa. Methods Once the nasal cavity has been prepared for cauterisation, the silver nitrate stick is navigated to the bleeding point covered by the plastic straw. The silver nitrate stick is then advanced onto the bleeding point allowing precise cauterisation of the nasal mucosa, without effecting surrounding healthy mucosa.

The Infective Endocarditis with Recurrent Epistaxis in a Young Patient: A Case Report

Epistaxis is a common emergency, and its main causes are hypertensive crisis and trauma. Nasal packing is the primary treatment. After active symptomatic treatment, the symptoms of epistaxis effectively can be controlled. In this case report, the patient was treated with epistaxis many times in the outpatient department. After nasal examination, there was a clear bleeding point, and it was treated with gauze packing or silver nitrate cauterization. The symptoms of epistaxis gradually got worse and was accompanied with fever and progressive anemia. After blood culture and color Doppler ultrasound examination, it was confirmed that it was endocarditis caused by defective hypoxic bacterial infection. After active antibacterial and surgical treatment, the symptoms of epistaxis, fever and anemia were relieved.

Endoscopic treatment of brain abscess

Background: Treatment of brain abscess is still a subject of controversy. The main treatment is surgical, although medical therapy alone can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or by freehand technique, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. We are reporting our results of endoscopic approach in 12 patients. Methods: This study included 12 patients of brain abscesses treated between January 2015 and January 2018. All the cases except those with small abscesses (<3.0 cm in diameter) were included in the study. Rigid endoscope was used. Follow-up CT scan was done in all cases within 7 and 30 days after surgery. Follow-up periods ranged between 3 and 6 months. Results: There were 11 patients with a history of chronic otitis media and one patient who suffered from congenital cyanotic heart disease. Glasgow Coma Score (GCS) was 5 in one patient, 13 in two cases, and 14–15 in 9 cases. There were one cerebellar, six temporal, and five frontal abscesses. All the patients recovered completely except one who died (GCS 5). There was no procedure-related complication. Hospital stay ranged from 14 to 45 days with an average of 28 days. The endoscopy aided visualization of multiloculations and septation in eight patients which allowed the opening of the septations and complete evacuation. Conclusion: Endoscopic aspiration is safe, easy, and represents an effective way of treatment of brain abscess through proper visualization. It can be used for ensuring the complete aspiration of contents, control of any bleeding point, and also for multiloculated abscess to identify and open the septations which may not be possible in stereotactic or any other guided aspirations.