Endoscopic Approach Research Articles

Variable anatomical features of acromegaly in the nasal cavity and paranasal sinuses: implications for endoscopic endonasal transsphenoidal surgery.

Growth hormone (GH)-secreting pituitary neuroendocrine tumors (PitNETs) are the most common cause of acromegaly. The endoscopic endonasal transsphenoidal approach (EEA) is commonly employed to remove them. Although morphological differences in the nasal cavity exist between acromegaly patients and those with other types of PitNET, few quantitative studies have been performed. This study aimed to evaluate the anatomical features of the nasal cavity and paranasal sinuses in patients with acromegaly. Preoperative computed tomography images of the nasal cavity and paranasal sinuses were compared between 20 patients with a GH-secreting PitNET (acromegaly group) and 22 with a non-functioning PitNET (control group). In the acromegaly group, the relationships between preoperative GH and/or insulin-like growth factor 1 (IGF-1) levels and anatomical characteristics were assessed. In the acromegaly group, the distance between the nostril and dorsum sellae was significantly longer and the distance between the parasellar internal carotid arteries was significantly shorter (p = 0.0022 and 0.0092, respectively). Pneumatization volume in the nasal cavity did not differ between the groups. Nasal mucosa and bony hypertrophy were observed in the acromegaly group. Preoperative GH level was correlated with the width of the piriform aperture (p = 0.0171). The nasal and paranasal changes associated with acromegaly can make EEA challenging to perform. Widening the surgical corridor anterior to the sphenoid sinus is important in these patients.

Circumferential exposure of the cavernous sinus and parasellar region through a combined open and endoscopic endonasal transcavernous approach, a morphometric study.

Although recent trends currently favor the endoscopic endonasal transcavernous approach (EETA) over the pretemporal transcavernous approach (PTA) for certain cavernous sinus pathologies, dedicated assessment of the surgical exposure and maneuverability is wanting. Toward this aim, this morphometric study quantifies these variables within four cavernous sinus compartments by comparing the PTA, EETA, and a combined approach to achieve a circumferential dissection (EETA-PTA). In five latex-injected specimens, exposure volumes of the EETA, PTA, and circumferential EETA-PTA approaches were quantified; the latter combined the most conservative options of both the endoscopic and open approaches. Two clinical cases illustrate the combined approach. EETA-PTA provided the largest volume of exposure (65.6% vs 35% PTA vs 44.6% EETA, P = 0.01) and eliminated the need to mobilize the ICA or cross cranial nerves. Although EETA and PTA approaches afforded comparable exposure volumes along the entire cavernous sinus (34.9 vs 44.6%), the EETA better exposed medial and inferior compartments (whereas the PTA exposed larger volumes in the lateral and superior compartments. The combined EETA-PTA yielded 66% of total cavernous sinus exposure volumes and eliminated the need to mobilize the ICA or cross cranial nerves. Our methodology aligns with strategies that use a modular concept to divide the skull base into compartments for maximal safe resection. Excluding soft tumors, the EETA is preferred for medial and inferior lesions and the PTA for superior and lateral lesions. A staged combined EETA-PTA may safely yield a 360-degree access for extensive multi-compartment lesions that span neurovascular structures within the cavernous sinus.

Totally 3D endoscopic aortic valve replacement: initial results and experience from a single center.

This study aimed to evaluate the feasibility and initial outcomes of totally endoscopic aortic valve replacement (TEAVR) performed via a single working port at the fourth intercostal space (ICS) utilizing a 3D endoscopic system. A retrospective observational study was conducted on 35 consecutive patients who underwent TEAVR over a six-month period from December 2023 to June 2024. Patient selection was based on the presence of isolated aortic valve disease without the need for ascending aorta replacement or aortic root enlargement. A 4 cm single working port was created at the 4th ICS, extending from the right mid-axillary to the anterior axillary line. A 10-mm trocar for a 3D endoscope was placed at the right anterior-axillary line. Peripheral cardiopulmonary bypass (CPB) was established. The primary outcomes investigated included the success rate of the procedure, in-hospital mortality, and perioperative complications. The mean age of the patients was 58.7 ± 12.8 years, with 22.9% being female. The majority of patients (77.1%) presented with aortic stenosis, often accompanied by severe calcification. The medianCPB time was 210 ± 43 min, and the median aortic cross-clamp time was 132 ± 41 min. The procedure was successfully completed in all patients using the endoscopic approach, with no conversions to full sternotomy. Two mortalities were recorded, attributed to postoperative complications including bleeding and cerebral infarctions. The early (30-day) mortality rate was 5.7%. Prolonged mechanical ventilation (>48 h) was required in 17.1% of patients, and reoperation for bleeding was necessary in 2.9% of patients. TEAVR is a feasible procedure with the potential to replace the traditional sternotomy approach for aortic valve replacement.

8301 A Rare Case of IgG4-Related Hypophysitis

Abstract Disclosure: P. Kesavan Chary: None. J.M. Silverstein: None. Background: IgG4-related disease (IgG4-RD) is an immune-mediated condition that presents as systemic inflammation and fibrosis of tissues, often affecting multiple organs. Isolated IgG4-related Hypophysitis is rare and characterized by lymphoplasmacytic infiltration of the pituitary gland by IgG4-positive plasma cells. A combination of clinical, serologic, radiologic, and histopathologic findings is used for diagnosis of IgG4-RD and approximately two-thirds of all patients have elevated serum IgG4 levels. We report a case of isolated IgG4-related Hypophysitis in a middle-aged woman serologically negative for IgG4-related disease. Case Report: A 52 year old female with history of steroid dependent severe persistent asthma, allergic rhinitis, and chronic sinusitis presented with one month of headache, polyuria, and polydipsia. MRI Brain demonstrated an enlarged, rounded pituitary gland 16 x 11 x 9 mm, with homogeneous enhancement, extension into the suprasellar cistern, and mild thickening of the infundibulum suspected to represent a pituitary adenoma. Lab evaluation revealed mild hyperprolactinemia (prolactin 83.2, normal 4.8-23.3 ng/mL) and secondary adrenal insufficiency based on an abnormal high-dose cosyntropin stimulation test in the setting of a low adrenocorticotrophic hormone (ACTH) level (<2.0 pg/mL). Remaining pituitary hormone levels were normal. Inpatient work-up for polyuria and polydipsia showed a low urine specific gravity of 1.003. An overnight water deprivation test was performed. Baseline urine osmolality (UOsm) was 95 mOsm/kg and serum sodium was 144 mmol/L; after 3 hours of water deprivation, serum Osm increased to 301 mOsm/kg (275-300 mOsm/kg) and UOsm only to 215 mOsm/kg, while her sodium increased to 145 mmol/L. Results were felt to be consistent with AVP deficiency (Central Diabetes Insipidus) and the patient was started on desmopressin. Because of the presence of AVP deficiency, further work-up was done to evaluate for an infiltrative process or malignancy. ANA, RPR, ESR, CRP, CBC, ACE level, T-SPOT, and IgG subclasses were unremarkable. Further imaging studies yielded a negative nuclear bone scan and PET/CT scan. For diagnostic purposes, the patient underwent biopsy via an endoscopic endonasal transsphenoidal approach. Pathology showed the presence of >10 IgG4+ plasma cells in a single high-power field, consistent with a diagnosis of IgG4-related Hypophysitis. Conclusion: Isolated IgG4-related Hypophysitis is the least common clinical presentation of IgG4-RD, which is itself a rare and relatively newly recognized condition. IgG4-related Hypophysitis should be suspected in patients presenting with AVP deficiency and pituitary stalk enlargement with an otherwise negative work up. Presentation: 6/2/2024

Endoscopic definitive treatment of liver hydatid cysts ruptured into bile duct.

Intrabiliary rupture (IBR) is one of the most common complications of hepatic hydatid cysts (HHC),and the surgical treatment of major intrabiliary rupture (MIBR) leads to serious morbidity and mortality. This study aimed to evaluate the efficacy of endoscopic definitive treatment of these patients. This study included 38 patients who underwent ERCP for MIBR between 2004 and 2022. Endoscopic sphincterotomy (ES) was performed, followed by evacuation of hydatid contents from the main bile ducts and cyst cavity. A nasobiliary drainage (NBD) catheter was placed inside the cyst cavity in 15 patients, while biliary stenting (BS) was performed in 23 patients. Demographic data, cyst characteristics, hospital stay, complications, treatment success, and recurrence were analyzed. The mean age of patients was 46.5 years, with 12 female and 26 male. All patients had WHO-type-3B hydatid cysts with an average diameter of 7.9 cm. NBD was continued for definitive purposes in 13 of the 15 patients who underwent NBD, and full cure was achieved in 13 patients. Among the 23 patients who underwent biliary stenting (BS), 16 (69.5%) required a second ERCP due to jaundice or cholangitis, and 6 (26%) underwent percutaneous drainage due to hydatid cavity infection. The average length of hospital stay was 16.13 days in the BS group, while it was 8.3 days in the NBD group.The average follow-up period was 23 months. All patients achieved complete recovery. The endoscopic approach is an effective and safe method for the treatment of MIBR, and can be considered as a definitive treatment option in centers with adequate resources and experienced endoscopists.

Endoscopic En Bloc Resection of Giant Cell Tumor of Tendon Sheath of Anterior Ankle

Giant cell tumor of the tendon sheath (GCTTS) originates from the synovial cells of the tendon sheath. It is one of the most common benign soft-tissue tumors of the foot and ankle affecting the joints, bursae, and tendon sheaths and can behave in a locally aggressive manner. Complete surgical resection with long-term follow-up is the preferred treatment. Because GCTTS is a benign condition, the equilibrium between the quality of the surgical margins and functional preservation should be considered. If more aggressive resection is applied, the outcome may negatively affect quality of life, whereas incomplete resection may lead to recurrence. The purpose of this technical note is to describe the details of endoscopic en bloc resection of GCTTS of the anterior ankle. This endoscopic approach can provide a magnified view of the operative site, allowing accurate surgical assessment to ensure complete resection of the lesion without damage to the adjacent normal structures.

Letter to the Editor Regarding “Exposure of the Cavernous Sinus via the Endoscopic Transorbital and Endoscopic Endonasal Approaches: A Comparative Study”

Letter to the Editor Regarding “Exposure of the Cavernous Sinus via the Endoscopic Transorbital and Endoscopic Endonasal Approaches: A Comparative Study”

Extrahepatic Portal Vein Obstruction in Children.

Extrahepatic portal vein obstruction is the most common cause of portal hypertension in children. This study aimed to evaluate the causes, clinical, laboratory and endoscopic findings, treatment approaches, long-term results, and prognosis of extrahepatic portal vein obstruction in children. We retrospectively evaluated 82 patients who were followed up with the diagnosis of extrahepatic portal vein obstruction at Gazi University Pediatric Gastroenterology clinic between January 1, 2011, and October 31, 2021. Among our patients, 58.5% were male, median age at presentation was 36 months (range, 1 month to 6 years), and the follow-up period was 2 years (range, 1-14 years). The most common reasons for admission were gastrointestinal bleeding and splenomegaly. All patients diagnosed with incidentally detected obstruction were children under 5 years of age. The most frequently detected risk factors were history of umbilical vein catheterization (50%) and presence of procoagulant status (31%). Esophageal varices (94.8%), variceal bleeding (73.2%), hypersplenism (64.6%), and growth failure (13.4%) were the most common complications. Weight and/or height z-scores were lower in children with esophageal varices, variceal bleeding, and hypersplenism. Endoscopic treatments were more frequently applied to those with splenomegaly, thrombocytopenia, red color sign, and esophageal variceal bleeding. Rates of splenomegaly, hypersplenism, esophageal variceal bleeding, advanced varicose veins, and portal biliopathy were higher in patients who underwent portosystemic shunt surgery than in patients who did not undergo it. Morbidity and mortality rates of variceal bleeding in extrahepatic portal vein obstruction were lower than bleeding seen in cirrhotic prehepatic portal hypertension. In our study, no patients died from extrahepatic portal vein obstruction-related complications. One patient died from tuberculous meningitis.

Current approaches to facial nerve schwannoma surgery.

Facial nerve schwannomas (FNSs) are exceedingly rare benign tumors. This study aims to report on a series of excised FNSs, providing clinical information and details on their surgical management, including novel approaches. We retrospectively reviewed patients who underwent surgical excision of FNSs in a private otology clinic and public tertiary referral center. The main outcome measures were facial nerve function, complete tumor removal, postoperative complications, tumor recurrence, and hearing. Seventeen patients (10 men and 7 women) with a mean age of 44.23 years (SD, 12.21) underwent surgery during the study period. The most common symptom was facial nerve dysfunction (58.8%). Facial and otoneurologic symptoms (hearing loss, tinnitus, and vertigo) were observed in 88.8% and 77.7% of patients, respectively. The middle cranial fossa (MCF) was the most common approach (six patients, 35.2%), followed by translabyrinthine (TL), transmastoid (TM), and combined TM-MCF (three patients, 17.6% each). Exclusive endoscopic transcanal suprageniculate (ETS) and mastoid combined with cervical approaches were applied once in two patients, 5.8% each. Total tumor removal was achieved in all cases. No significant postoperative complications were observed. The mean follow-up period was 193.2 months (SD, 119.5) and no tumor recurrence was observed. This study provides further evidence for the safety and efficacy of various surgical approaches for FNS, and incorporates the endoscopic transcanal approach. 4.

Anatomical study and clinical outcomes of endoscopic transoral surgery for benign salivary gland tumors in the parapharyngeal space

The existing literature provides little insight into the efficacy of transoral endoscopy in exposing benign tumors originating from salivary glands in the parapharyngeal space at the parotid gland base and resecting part of the deep lobe with a safe margin. This study aims to investigate the efficacy of the endoscopic transoral approach for the visualization and resection of such tumors.Through transoral endoscopic cadaveric dissections and surgical procedures, we examined the anatomical structures of the parapharyngeal space and the deep lobe of the parotid gland, identifying key anatomical landmarks. We conducted a retrospective analysis of 19 patients with benign salivary gland-derived tumors in the parapharyngeal space who underwent transoral endoscopic resection.Intraoperative visualization of the tumor pedicle and the deep lobe of the parotid gland was successfully achieved in all cases, allowing for resection with safe margins. During a median follow-up period of 54.0 months, imaging revealed no signs of recurrence.Endoscopic transoral approach provides effective visualization of the deep lobe of the parotid gland and the medial portion of the parotid bed from the parapharyngeal space. Benign tumors of salivary gland-derived in this area can be well exposed and safely resected with adequate margins.

In Reply to the Letter to the Editor Regarding “Exposure of the Cavernous Sinus via the Endoscopic Transorbital and Endoscopic Endonasal Approaches: A Comparative Study”

In Reply to the Letter to the Editor Regarding “Exposure of the Cavernous Sinus via the Endoscopic Transorbital and Endoscopic Endonasal Approaches: A Comparative Study”

Endoscopic transorbital approach for resection of mediobasal temporal lesions using an optic radiation-sparing strategy.

The endoscopic transorbital approach (ETOA) has emerged as a promising minimally invasive technique for resection of lesions in the mediobasal temporal region (MTR) due to its potential to preserve the integrity of the optic radiation (OR). This study evaluated the safety and efficacy of ETOA using an OR-sparing surgical strategy for mediobasal temporal lesions. A retrospective review was conducted of the medical records of 15 patients (7 females and 8 males) who underwent ETOA for lesions in the MTR between November 2017 and November 2022. Preoperative diffusion tensor imaging (DTI) tractography of the OR was utilized in all cases for surgical planning to visualize the spatial relations between the OR and the target mediobasal temporal lesion. The median age of the treated patients was 43 years (range 22-76 years), with a median follow-up duration of 12 months (range 6-35 months). Eleven lesions (73.3%) involved only the anterior segment of the MTR, while 4 lesions (26.7%) affected both the anterior and middle segments. Gross-total resection was achieved in 13 patients (86.7%) and subtotal resection in 2 (13.3%). The final pathologies included low-grade glioma (n = 5), cavernous malformation (n = 3), glioblastoma multiforme (n = 2), multinodular and vacuolating neuronal tumor (n = 1), pleomorphic xanthoastrocytoma (n = 1), anaplastic oligodendroglioma (n = 1), adenoid cystic carcinoma (n = 1), and metastatic renal cell carcinoma (n = 1). Postoperative neuro-ophthalmological examinations revealed that all patients maintained their previous visual function. Follow-up DTI tractography further confirmed the preservation of the preoperative ORs in the treated patients. No postoperative CSF leaks, infections, or cosmetic problems occurred in this series. The combined use of ETOA and OR tractography appears to be a feasible approach for resecting lesions involving the MTR, especially in the anterior segment. In the authors' experience, this surgical strategy enables maximal safe resection while minimizing the risk of postoperative visual dysfunction. Further studies with larger sample sizes are warranted to validate these findings and assess long-term outcomes.

Papillary Craniopharyngioma: an integrative and comprehensive review.

Papillary craniopharyngioma (PCP) is a rare type of tumor, comprising ∼20% of all craniopharyngioma (CP) cases. It is now recognized as a separate pathological entity from the adamantinomatous type. PCPs are benign tumors, classified as WHO grade 1, characterized by non-keratinizing squamous epithelium. They typically grow as solid and round papillomatous masses or as unilocular cysts with a cauliflower-like excrescence. PCPs primarily occur in adults (95%), with increased frequency in males (60%) and predominantly affect the hypothalamus. Over 80% of these tumors are located in the third ventricle, expanding either above an anatomically intact infundibulum (strictly third ventricle tumors) or within the infundibulo-tuberal region of the third ventricle floor. Clinical manifestations commonly include visual deficits and a wide range of psychiatric disturbances (45% of patients), such as memory deficits and odd behavior. MRI can identify up to 50% of PCPs by the presence of a basal duct-like recess. Surgical management is challenging, requiring complex approaches to the third ventricle and posing significant risk of hypothalamic injury. The endoscopic endonasal approach allows radical tumor resection and yields more favorable patient outcomes. Of intriguing pathogenesis, over 90% of PCPs harbor the somatic BRAFV600E mutation, which activates the mitogen-activated protein kinase (MAPK/ERK) signaling pathway. A phase 2 clinical trial has demonstrated that PCPs respond well to BRAF/MEK inhibitors. This comprehensive review synthesizes information from a cohort of 560 well-described PCPs and 99 large CP series including PCP cases published from 1856-2023 and represents the most extensive collection of knowledge on PCPs to date.

Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery.

Mastery of the posterior clinoidectomy technique is of utmost importance for neurosurgeons who specialize in endoscopic endonasal approaches, because the posterior clinoid process (PCP) is commonly involved in chondroid tumor resection. Three main techniques for posterior clinoidectomy have been developed: intradural, extradural, and transcavernous interdural. The authors introduce here a novel technical variant in which the transcavernous approach is extended to the dorsal clinoidal space after transection of the caroticoclinoid ligament, and they elaborate on its clinical application on the basis of anatomical dissections and radiological studies. The authors reviewed CT angiography images and 3D reconstruction of the PCP in 50 adults to analyze the height and presence of ossified ligament attachments. In addition, endoscopic endonasal posterior clinoidectomy was performed in 20 lightly embalmed postmortem human heads. Three techniques, including extradural, transcavernous, and extended transcavernous posterior clinoidectomy, were performed sequentially, and anatomical landmarks and areas exposed with each technique were investigated and compared. Using radiological studies, the authors categorized the PCPs as 1 of 2 types: 1) normal, defined as less than or equal to 8 mm high with no ossified ligament attachments; or 2) complex, defined as greater than 8 mm high with or without an ossified ligament attachment. Compared with extradural (exposed PCP height 4.7 ± 0.5 mm) and transcavernous (exposed PCP height 7.3 ± 0.8 mm) posterior clinoidectomies, the extended transcavernous posterior clinoidectomy provided the maximally exposed PCP height (9.6 ± 0.4 mm; p < 0.0001). This report details the extended transcavernous posterior clinoidectomy as a novel technical variant for achieving maximal exposure of the PCP in endoscopic endonasal surgery. In addition, the positive results establish the importance of preoperative skull base imaging for surgical planning.

Assessing the Feasibility of Selective Piezoelectric Osteotomy in Transorbital Approach to the Middle Cranial Fossa: Anatomical and Quantitative Study and Surgical Implications

ObjectivesTo verify the feasibility and to discuss advantages and disadvantages of a piezoelectric orbitotomy (PO) during Superior Eyelid Endoscopic Transorbital Approach (SETOA). MethodsFive adult specimens underwent exoscopic/endoscopic SETOA to middle cranial fossa. The surgical corridor was created via piezoelectric orbitotomy by performing three selective and safe micrometric bone cuts providing a one-piece trapezoid bone flap which was repositioned and secured at the end of procedure. A 3D scan of the bone flap allowed us to reconstruct a 3D model and calculate its volume. An illustrative case demonstrating the application of this novel technique was also presented. ResultsAnatomical-morphometric quantitative analysis showed a mean bony-volume gain of 1,574.26 mm3 by using PO.PO yielded concrete surgical advantages and theoretical benefits in terms of functional and esthetic outcomes. All osteotomies were micrometric clear-cut and precise, resulting in a very thin bony gap; a complete sparing of soft tissues and neurovascular structures in- and around the orbit was observed. Lateral orbital wall reconstruction by replacing the bone flap aims to mitigate the risk of enophthalmos, proptosis, CSF leakage, pseudomeningocele and pulsatile headache, which represent significant challenges in the relevant literature. ConclusionPO may offer a viable, selective, effective, safe alternative to high-speed drilling during SETOA, especially for patients affected by intra-axial pathologies in which a watertight closure is mandatory. This procedure could prevent/decrease the risk of some of the main postoperative complications associated to the standard SETOA, resulting potentially in better functional and esthetic outcome.

A recent algorithm for management of orbital floor fractures with the application of a novel minimally invasive endoscopic surgery

Orbital floor (OF) fractures present a dilemma, with controversies surrounding surgical indication, approach, and ideal material for reconstruction. Our study was conducted on cases of OF fracture admitted to a tertiary referral centre. Cases of OF associated with zygomaticomaxillary complex (ZMC) fracture were managed as follows: those with ophthalmological problems were subjected to endoscopically assisted transorbital reconstruction of the floor; cases without ophthalmological problems were subjected to reduction and fixation of the ZMC fracture only. The recently developed endoscopic endonasal transmaxillary approach was used to manage cases with pure OF fracture, while the same approach with added endoscopic transethmoidal reconstruction of the medial orbital wall (MOW) was applied to cases with associated MOW fracture. Outcome measurements were the correction of diplopia and enophthalmos, along with the restoration of normal globe function. The study included 80 patients, who were divided into four groups according to the proposed algorithm. OF reconstruction was performed in 32 cases with either septal cartilage (n = 4), titanium plate (n = 11), or porous polyethylene mesh (n = 17). Our study presents the novel role of minimally invasive endoscopic surgery in the management of OF fracture, together with a recently developed management plan that could maximize positive outcomes and decrease morbidity.

Short-Term Bed Rest is not a Risk Factor for Venous Thromboembolism After Endoscopic Skull Base Surgery

IntroductionDeep venous thromboembolisms (DVT) increase morbidity in postoperative patients, and no current guidelines identify which patients undergoing endoscopic endonasal approach (EEA) to the skull base may be at increased risk. Postoperative care for these patients often includes a period of inactivity to prevent transient ICP shifts which may impact skull base reconstruction. We seek to characterize if postoperative bedrest puts EEA patients at increased risk of developing thromboembolic complications. MethodsRetrospective chart review of patients undergoing intradural surgery with primary skull base reconstruction for intraoperative CSF leak via EEA for any skull base pathology between July 2018 and May 2024 was performed yielding 221 patients who met inclusion criteria. Univariate and multivariable regression were performed with patient demographics, extent of approach, intraoperative leak flow rate, bedrest duration, presence and length of postoperative lumbar drainage (LD), and use of postoperative mechanical VT prophylaxis. ResultsThe mean age of included patients was 52.6 ± 16.8 years, 48% were male, and 3.6% of patients had DVTs. Age (OR 1.01, 95% CI 0.96-1.06, p=0.83), sex (OR 0.40, 95% CI 0.05-2.19, p=0.31), BMI (OR 0.98, 95% CI 0.87-1.07, p=0.74), extended approach (OR 0.80, 95% CI 0.13-4.36, p=0.80), CSF leak flow rate (OR 5.71, 95% CI 0.77-118.90, p=0.14), bedrest duration (OR 1.06, 95% CI 0.77-1.27, p=0.60), and presence of LD (OR 1.10, 95% CI 0.55-2.02, p=0.76) were not significant predictors of postoperative VTE incidence on multivariable analysis. ConclusionShort-term bedrest after EEA is not a risk factor for development of VTE in the immediate postoperative period.

S3987 Novel Endoscopic Approach of Transluminal Drainage for Deep Pelvic Collections in Acute Necrotizing Pancreatitis

S3987 Novel Endoscopic Approach of Transluminal Drainage for Deep Pelvic Collections in Acute Necrotizing Pancreatitis

Transcanal Endoscopic Management of Squamosal Type of Chronic Otitis Media.

Endoscopic middle ear surgery can be utilized to visualize and excise retraction pockets without the need for extensive bone work and removal of lateral bone. To evaluate the role of endoscope in the management of squamosal type of chronic otitis media. A total of 25 adults subjects (male = 12, female = 13) in the age group of 18-55years suffering with chronic otitis media were operated by transcanal endoscopic approach. High resolution computed tomography of temporal bone was done to help identify the anatomy and underlying extent of disease. All patients were operated by transcanal endoscopic technique. The study concluded that the endoscope gives a better visualization of the middle ear and its hidden areas. The extensive bone work and associated cavity related problems can be avoided and normal anatomy can be preserved with the help of endoscopic ear surgery.

S2677 Managing Disrupted Pancreatic Duct Syndrome With a Multimodal Endoscopic Approach

S2677 Managing Disrupted Pancreatic Duct Syndrome With a Multimodal Endoscopic Approach