Endoscopic Surgical Management Research Articles

Endoscopic surgical management of juvenile nasopharyngeal angiofibroma: Correlating tumour characteristics, risk of hemorrhage, and recurrence

ObjectivesJuvenile nasopharyngeal angiofibroma is an uncommon tumour primarily seen in young males. It is characterized by its vascular nature and aggressive growth pattern, presenting a significant surgical challenge. Endoscopic sinonasal surgery has become the treatment of choice, reducing both morbidity and blood loss, as well as recurrence rates. This study aims to present the clinical characteristics and surgical outcomes of patients with juvenile nasopharyngeal angiofibroma treated exclusively with endoscopic surgery at our centre. MethodsA retrospective cohort study was conducted on cases of juvenile nasopharyngeal angiofibroma treated with endoscopic surgery at a single centre between 2013 and 2023. ResultsA total of 21 patients were included in the study, with a mean age of 17.7 years. 57.14 % of the patients presented with an advanced stage (Stage ≥ IIc Radkowsky). The median volume was 79.2 cm3. Pre-surgical embolization was performed in all cases. 7 patients (33.3 %) required blood transfusion. The need for blood transfusion was associated with greater tumour volume (p = 0.0028), intracranial extension (p = 0.025), extension to the infratemporal fossa (p = 0.024), and orbital extension (p = 0.026). There were 2 cases (9.5 %) of tumour recurrence/persistence, both classified as stage IIIb. Tumour persistence/recurrence was more common in patients with intracranial extension (p = 0.045). ConclusionExclusive endoscopic resection of these tumours, regardless of volume and extension, does not increase the risk of blood loss or recurrence. Advanced-stage tumours, especially those with intracranial extension, present a higher risk of bleeding and tumour persistence. In these cases, the low morbidity of the endoscopic approach becomes more evident.

Efficacy of endoscopic surgical management for recurrent nasopharyngeal carcinoma

Compared with re-radiotherapy or open surgery, endoscopic surgery for recurrent nasopharyngeal carcinoma has a better effect, which not only improves the overall survival rate, but also reduces serious complications, improves the quality of life and saves medical costs. With the advancement of modern surgical equipment and instruments, the deepening of anatomical research in the field of skull base, the improvement of surgical techniques and the development of multidisciplinary teamwork, the safety of endoscopic surgery and the rate of complete tumor resection will also increase. The indications for surgery are further expanded, and more patients with recurrent nasopharyngeal carcinoma benefit from endoscopic minimally invasive surgery. This article reviews the efficacy of endoscopic surgery for recurrent nasopharyngeal carcinoma, and then provides insights for the selection of clinical treatment strategies for recurrent nasopharyngeal carcinoma.

Surgical Nonresponders in Zenker Diverticulum and Lower Esophageal Pathology (POUCH Collaborative).

To identify characteristics of patients who have poor improvement in symptoms following surgical management of Zenker Diverticulum (ZD). Prospective, multicenter cohort study of all individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative who underwent surgical repair of ZD between August 2017 and January 2024. Patient demographics, esophagrams, and the 10-item Eating Assessment Tool (EAT-10) pre- and post-procedure were obtained from a REDCap database. t-tests, Wilcoxon rank sum tests, Chi-square or Fisher's exact tests were used to compare the characteristics. Patients with <50% improvement in their EAT-10 scores were deemed surgical nonresponders (SNRs). Those with ≥50% improvement in their EAT-10 scores were deemed surgical responders (SRs). A total of 184 patients were prospectively followed after undergoing either open or endoscopic surgical management. Twenty-two patients (12%) were deemed SNRs. Preoperative presence of a hiatal hernia was statistically significant characteristic between the SNRs (63.6%) and SRs (32.1%) (p = 0.004). Size of the ZD and history of previous ZD surgery was not a significant characteristic. The length of stay and complication rate were not statistically different between the groups. Coexistent esophageal pathology may lead to poor symptomatic improvement following ZD surgery. Preoperative workup of other esophageal disorders is recommended to detect likely SNRs. For SNRs, further esophageal workup may be necessary to evaluate for other esophageal causes related to poor symptomatic improvement following ZD surgery. Level 3 Laryngoscope, 2024.

A Meta Analysis of Endoscopic Surgical Management of Choanal Atresia with and without Stent

Abstract Background Congenital choanal atresia is a rare abnormality, affecting approximately 1 in 7000–8000 newborns, with a female predominance. In congenital choanal atresia, the widened vomer fuses with the atretic plate, resulting in an hourglass configuration of the nasopharynx and the choanal region. Materials and Methods This meta analysis included 17 studies all were published between 2016 and 2021. Two different techniques, endoscopic management with and without stents, this study demonstrated success with no stent approach and lower rate of re stenosis when compared to stent used approach, however there are some indications and benefits of using stents. Results For our knowledge this is the second systematic review and metaanalysis to report the pooled success of endoscopic repair of choanal atresia with and without the use of nasal stents. Analysis of 5 studies that included 142 patients who were not stented demonstrated that the weighted pooled proportion of successful surgery was higher and significantly different when compared with three studies that evaluated 57 patients who were stented 86% (79%, 92%) vs 61% (40%, 81%). From an analysis of nine comparative studies including 405 patients Overall odds ratio (95% CI) = 3.56 (2.10, 6.05) with unimportant heterogeneity across studies (I-squared = 37%, Cochrane Q p = 0.12) favoring no stenting over stenting. Conclusion Success rates for management without stents is higher than using stents. The use of nasal stents may be associated with more frequent and more severe complications. Perioperative adjuncts such as nasal stenting should be considered in the context of the individual patient and surgeon preference. If the surgeon decides to stent, a duration of 1 week or shorter may be associated with better surgical outcomes; however, the evidence is limited.

Endoscopic surgical management of the fronto-ethmoido-orbital mucopyocele: a case report and literature review

Abstract Frontal sinus mucocele are benign, pseudocystic lesions that derive from the destruction of the sinus ostium, resulting in a continuous accumulation of mucus. The process of mucocele growth leads to a progressive enlargement of the sinus cavity, thickening and erosion of its bone walls until the invasion of surrounding tissues. Mucoceles are more common in the frontal sinuses, while involvement in the sphenoid, ethmoid and maxillary sinus is rare. The frontal sinus floor is divided by the upper orbital wall; thus, an early displacement of the orbit occurs in the growth of the frontal mucocele. This paper presents one of our experiences in endoscopic surgical management of frontal sinus mucopyocele with secondary orbital complications.

Impact of facility volume on survival in primary endoscopic surgery for sinonasal squamous cell carcinoma

ObjectivesTo evaluate the impact of facility volume on outcomes following primary endoscopic surgical management of sinonasal squamous cell carcinoma (SNSCC). MethodsThe 2010–2016 National Cancer DataBase (NCDB) was queried for patients diagnosed with T1-T4a SNSCC surgically treated endoscopically as the primary treatment modality. Factors associated with overall survival (OS) were evaluated, including facility volume. ResultsA total of 330 patients who underwent endoscopic surgical management of SNSCC were treated at 356 unique facilities designated as either low-volume (LVC; treating 1–2 cases; 0-75th percentile), intermediate-volume centers (IVC; 3–4 cases total; 75th–90th percentile), or 144 high-volume (HVC; treating 5+ cases total; >90th percentile) centers. HVC treated patients with higher T staging (42.1 % vs. 29.8 %) and tumors in the maxillary sinus (26.9 % vs. 13.2 %) and ethmoid sinus (10.3 % vs. ≤8.3 %), while LVCs treated lower T stage tumors (70.2 % vs. 57.9 %) and tumors that were located in the nasal cavity (70.2–78.5 % vs. 62.8 %). On multivariable analysis, factors associated with decreased OS included higher T stage (T3/T4a vs. T1/T2; OR 1.92, 95 % CI 1.06–3.47) and older age (>65 vs. <65; OR 2.69, 95 % CI 1.62–4.49). Cases treated at high-volume centers were not associated with a higher likelihood of OS when compared to low-volume centers (OR 0.70, 95 % CI 0.36–1.35). ConclusionsHVC are treating more primary tumors of the maxillary and ethmoid sinuses and tumors with higher T stages with endoscopic approaches, although this does not appear to be associated with increased OS. Short summarySinonasal squamous cell carcinoma (SNSCC) presents late in disease process with poor prognosis. We investigated the impact of facility volume on outcomes following endoscopic treatment of SNSCC. High-volume centers treat more advanced and complex disease with comparable OS.

Endoscopic management of subglottic stenosis

Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords that can lead to respiratory distress and in severe cases, airway obstruction. Endoscopic surgical management of SGS has been established as a safe and effective treatment option. The aim of this manuscript is to provide an overview of the current state of the art in endoscopic surgical management of SGS. Endoscopic management of SGS typically utilizes laser (CO2 or Nd:YAG) or cold knife incision or wedge excision in combination with rigid or balloon dilation. Topical antifibrotic therapies and steroid injections are frequently employed intraoperatively. The choice of technique depends on the location and severity of the stenosis, and a multimodal approach is common. For patients with extensive stenosis or who have failed previous endoscopic treatments, open surgery may be necessary. Preoperative assessment of the airway is critical for identifying the extent of the stenosis and ensuring appropriate treatment planning. Postoperative care includes close monitoring for complications such as bleeding, infection, and airway edema and adjuvant medical therapies such as proton pump inhibitors, inhaled corticosteroids, and antibiotics are used frequently. In conclusion, endoscopic surgical management of SGS has become an important treatment option for patients with subglottic stenosis, and new techniques such as endoscopic resection with adjuvant medical therapy (ERMT) have been employed effectively in some patients. With proper patient selection, technique selection, and postoperative care, this approach can provide effective relief of symptoms and improve patient outcomes. Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords that can lead to respiratory distress and in severe cases, airway obstruction. Endoscopic surgical management of SGS has been established as a safe and effective treatment option. The aim of this manuscript is to provide an overview of the current state of the art in endoscopic surgical management of SGS. Endoscopic management of SGS typically utilizes laser (CO2 or Nd:YAG) or cold knife incision or wedge excision in combination with rigid or balloon dilation. Topical antifibrotic therapies and steroid injections are frequently employed intraoperatively. The choice of technique depends on the location and severity of the stenosis, and a multimodal approach is common. For patients with extensive stenosis or who have failed previous endoscopic treatments, open surgery may be necessary. Preoperative assessment of the airway is critical for identifying the extent of the stenosis and ensuring appropriate treatment planning. Postoperative care includes close monitoring for complications such as bleeding, infection, and airway edema and adjuvant medical therapies such as proton pump inhibitors, inhaled corticosteroids, and antibiotics are used frequently. In conclusion, endoscopic surgical management of SGS has become an important treatment option for patients with subglottic stenosis, and new techniques such as endoscopic resection with adjuvant medical therapy (ERMT) have been employed effectively in some patients. With proper patient selection, technique selection, and postoperative care, this approach can provide effective relief of symptoms and improve patient outcomes.

Disentangling Brain Network Connectivity During Monetary and Drug-Related Reward Processing in Stimulant Use Disorder

Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords that can lead to respiratory distress and in severe cases, airway obstruction. Endoscopic surgical management of SGS has been established as a safe and effective treatment option. The aim of this manuscript is to provide an overview of the current state of the art in endoscopic surgical management of SGS. Endoscopic management of SGS typically utilizes laser (CO2 or Nd:YAG) or cold knife incision or wedge excision in combination with rigid or balloon dilation. Topical antifibrotic therapies and steroid injections are frequently employed intraoperatively. The choice of technique depends on the location and severity of the stenosis, and a multimodal approach is common. For patients with extensive stenosis or who have failed previous endoscopic treatments, open surgery may be necessary. Preoperative assessment of the airway is critical for identifying the extent of the stenosis and ensuring appropriate treatment planning. Postoperative care includes close monitoring for complications such as bleeding, infection, and airway edema and adjuvant medical therapies such as proton pump inhibitors, inhaled corticosteroids, and antibiotics are used frequently. In conclusion, endoscopic surgical management of SGS has become an important treatment option for patients with subglottic stenosis, and new techniques such as endoscopic resection with adjuvant medical therapy (ERMT) have been employed effectively in some patients. With proper patient selection, technique selection, and postoperative care, this approach can provide effective relief of symptoms and improve patient outcomes.

A COMPARATIVE STUDY ON INFERIOR BASED FLAP AND POSTERIOR BASED FLAP AND ITS OUTCOME IN ENDOSCOPIC DACROCYSTORHINOSTOMY IN PATIENTS WITH DACROCYSTITIS ATTENDING TO ENT DEPARTMENT AT TERITIARY CARE HOSPITAL

Occlusion of the nasolacrimal duct (NLD) is a frequent condition that is characterized by tearing1 known as Epiphora. The surgical procedure of diversion of lacrimal ow within a nasal cavity through an articial stula made at the level of a lacrimal sac is called Dacryocystorhinostomy (DCR). This includes complete blockages anywhere from the lacrimal punctum to the nasal cavity. The majority of nasolacrimal system obstruction is unknown. Endoscopic DCR can be done by the creation of a different types of mucosal aps like posteriorly based mucosal ap or inferiorly based mucosal ap. In this study, we compare in detail the Chronic Dacryocystitis disease pattern and difference in surgical outcomes of endoscopic surgical outcomes of endoscopic surgical management with its 3 months follow up

Outcomes Following Endoscopic versus Open Carpal Tunnel Release—A Matched Study

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the world. Surgical treatment can be performed in an open or endoscopic fashion. To date, similar rates of complications for both approaches have been described. We sought to compare the results of endoscopic carpal tunnel release (ECTR) with open carpal tunnel release (OCTR) in patients with CTS. Patients with a diagnosis of CTS undergoing open or endoscopic surgical management were identified between January 2010 and October 2020. The primary outcome of the study was nerve injury within 30 days of the procedure. Secondary outcomes included readmission, wound-related complications, hematoma, seroma formation, and cost. A total of 735,631 patients were identified as undergoing CTR. Following a 1:1 match procedure, 292,626 patient records were analyzed. Patients undergoing OCTR versus ECTR had an increased odds of readmission at 30 days (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.73-2.06), developing an infection (OR 1.59, 95% CI 1.41-1.80), and experiencing wound complications (OR 1.97, 95% CI 1.74-2.23). No significant difference in odds of developing a seroma (OR 1.17, 95% CI 0.83-1.65), hematoma (OR 1.15, 95% CI 0.95-1.39), or nerve injury (OR 1.18, 95% CI 0.98-1.43) was noted. The reimbursement cost of ECTR was significantly greater than OCTR ($310.60 ± $1639.57 vs. $237.69 ± $1488.93, P < 0.001). In the largest study to date on the surgical management of CTR, OCTR was seen to be associated with an increased odds of readmission, infection, and wound complications, but reduced costs for the procedure alone.

Percutaneous fully endoscopic surgical management of the ruptured epidural catheter: Rescue of the novice anesthesiologist from his dilemma.

BackgroundEpidural nerve block and analgesia are basic anesthetic techniques for anesthesia. Epidural catheter rupture and partial retention are adverse events and rare complications of epidural catheterization technique. The probability of occurrence when applied by novice doctors is high. Removal of the residual catheter by conventional surgery causes more trauma and bleeding, slows recovery, and may causes medical disputes. We hypothesized that percutaneous spinal endoscopy a safe and effective remediation technique. This study was to analyze the efficacy and safety of removing the residual dural catheter by a percutaneous full-endoscopic technique(PFET) and discuss the clinical technique and precautions.MethodsThis was a retrospective analysis of 7 patients with ruptured epidural catheters treated in our department from October 2015 to October 2019 using the PFET to remove the remaining epidural catheter. The operation time, intraoperative bleeding volume, surgical complications, and neurological symptoms before and after surgery were recorded. The Self-Rating Anxiety Scale (SAS) was used to assess the anxiety level of the anesthesiologist and the patient before and after the catheter removal operation, and the postoperative low back pain VAS score was recorded.ResultsThe remaining epidural catheter was successfully removed from all 7 patients. The operation time was 54.14 ± 14.45 (32–78) minutes, and the intraoperative blood loss was 9.134 ± 3.078 (5–15) ml. There were no cases of dural damage, cerebrospinal fluid leakage, sensorimotor dysfunction of the lower limbs, or bowel dysfunction. The anxiety symptoms of the patient and the anesthesiologist disappeared after removal of the residual epidural catheter. The patients' postoperative back pain VAS score was 0 to 2 points.ConclusionPFET is a safe and effective minimally invasive technique for removing residual epidural catheters. It causes less trauma and less bleeding, allows a faster recovery. It does not affect the recovery of patients from other surgical operations and reduces both medical risks and medical costs. At the same time, it avoids or reduces the occurrence of medical disputes and eliminates the pressure on novice anesthesiologists regarding similar adverse events.

Does the 5-item Frailty Index predict surgical complications of endoscopic surgical management for benign prostatic obstruction? An analysis of the ACS-NSQIP.

To assess whether the 5-item Frailty Index (5i-FI) predicts surgical complications of endoscopic surgery for benign prostatic obstruction (BPO) and examine the rates of these complications across BPO surgical modalities adjusting for patient frailty. The ACS-NSQIP registry was queried for patients who underwent transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), and laser enucleation of the prostate (LEP) between 2009 and 2019. Patients' frailties were estimated using the 5i-FI. We assessed the association between 5i-FI and the following endpoints: all complications, major complications (Clavien-Dindo ≥ 3), length of stay (LOS) ≥ 2days, and 30-day postoperative readmission. Inverse probability of treatment weighting (IPTW) was used to account for selection bias in treatment allocation. IPTW-adjusted rates for 30-day complications were compared between surgical modalities. The cohort included 38,399 (62.6%) TURP, 19,121 (31.2%) PVP, and 3797 (6.2%) LEP. Men with 5i-FI score ≥ 2 were more likely to receive TURP (22.7%) and PVP (22.5%) than LEP (18.8%). 5i-FI ≥ 2 was associated with higher odds of all complications (OR 1.50), major complications (OR 1.63), LOS ≥ 2 (OR 1.31), and readmission (OR 1.65). After IPTW, LEP had the lowest rates for all complications (6.29%; 95%CI 5.48-7.20), major complications (2.30%; 95%CI 1.83-2.89), and readmission (3.80%; 95%CI 3.18-4.53). The 5i-FI score is an independent predictor of 30-day postoperative surgical complications after endoscopic BPO surgery. After IPTW, LEP and PVP were associated with lower rates of complications than TURP. However, frail patients were less likely to undergo PVP and LEP. Preoperative frailty assessment could improve risk stratification before BPO surgery.

Quality of life in sinonasal tumors: an up-to-date review.

To assess the impact of benign and malignant sinonasal tumors and their management on patients' Quality of Life (QOL) as measured by Patient Reported Outcome Measures (PROMS). Although there is a growing consensus that endoscopic surgical management in carefully selected patients with sinonasal tumors is at least as (and probably more) effective than open resection, it is not clear to what extent this translates to better QOL outcomes. Earlier studies reported better outcomes in the emotional and physical function domains after endoscopic resection, and it seems that postsurgical morbidity is less in endoscopic compared to open approaches. QoL after endoscopic surgery for sinonasal and anterior skull base tumors seems to improve within several months of surgery in both benign and malignant tumor groups. However, patients with benign sinonasal tumors have a higher QOL pre and post operatively compared to those with malignancy mainly due to absence of (neo) - adjuvant radiotherapy and/or chemotherapy. Factors that seem to be associated with worse QoL include > 60 years, less than 6 months from surgery, prior and adjuvant chemo and radiotherapy, smoking history, advanced staging and malignancy. There is not a universally accepted PROM for use in patients with sinonasal benign and malignant tumors: A variety of different PROMs have been used with different degrees of effectiveness. Most likely a combination of disease-specific (such as SNOT 22 and anterior skull base questionnaire) and generic (such as Short Form health survey questionnaire (SF-36) and Karnofsky Performance Status) health outcome measures provide the most insight into QOL of patients with sinonasal tumors. QOL of these patients appears to undergo a bimodal impact with patients experiencing an initial dip in QOL after surgical treatment followed by a slow improvement over time. However, while patients with benign tumors' return to their status quo ante QOL, this is not the case for patients with malignant tumors who stabilize at a lower than initially QOL. To a large extent this seems to be the effect of (neo) adjuvant chemo radiotherapy.

Quality of Life After Endoscopic Surgical Management of Pituitary Adenomas.

Patient-reported quality of life (QOL) is a vital metric for surgical success. To assess the effect of surgery on QOL in the largest prospectively collected, longitudinal cohort of surgically managed pituitary adenomas. A consecutive surgical adenoma cohort (n = 304) between late 2016 and mid-2020 underwent a scheduled overall (Anterior Skull Base Questionnaire-35) and sinonasal-specific (Sinonasal Outcome Test-22) QOL assessment. Scores were stratified by adenoma subtype and analyzed for clinical predictors of QOL changes. The average age was 53.8 ± 16 yr, and 53% of participants were female. 60.9% of adenomas were nonfunctioning while adrenocorticotropic hormone adenomas (16.4%), growth hormone adenomas (14.1%), and prolactinomas (5.9%) were the most prevalent secreting adenomas. Baseline overall QOL differed between tumor types (P = .006), with adrenocorticotropic hormone adenomas worse than growth hormone adenomas (P = .03) and nonfunctioning pituitary adenomas (NFPA) (P < .001). Sinonasal QOL worsened in the 3 wk after surgery but returned to baseline by 6 wk and beyond. Overall QOL worsened at 3 wk after surgery (P < .001) but significantly improved from baseline by 3 mo (P = .009) and beyond (P < .001). Emotional functioning improved soon after surgery, followed by performance and pain, and then, by 6 mo, physical function and vitality. Predictors of improved QOL were sellar/suprasellar lesions (P = .01), prolactinomas (P = .003), and NFPA (P = .04). Conversely, new postoperative hypopituitarism (P = .04) and larger adenoma volume (P = .04) predicted QOL worsening. QOL is worsened after surgery at early time points. Prolactinomas and NFPA enjoy significant QOL improvements from surgery as early as 3 mo postoperatively. Other functional tumors may experience early benefits in younger patients without hypopituitarism and when isolated to the sellar/suprasellar region. These findings provide valuable information for counseling patients and setting expectations for surgery.

Percutaneous Endoscopic Posterior Decompression for Therapy of Spinal Cord Compression Due to Ossification of the Ligamentum Flavum: A Long-Term Follow-up

Thoracic ossification of the ligamentum flavum (OLF) is a pathologic condition that affects ligamentation of the OLF and causes slowly progressive myeloradiculopathy. There is a trend toward performing minimally invasive surgery. In this study, we assess the long-term efficacy of percutaneous endoscopic surgical management of thoracic OLF. Twenty patients with thoracic myelopathy due to thoracic OLF underwent percutaneous endoscopic surgical management. We investigated clinical outcomes and neurologic improvements. Magnetic resonance imaging was performed on all patients preoperatively and postoperatively, and intramedullary signal changes were evaluated. The operation time averaged at 170.4 minutes (range 110-320 minutes). The mean intraoperative blood loss was 29.6 mL (range 5-100 mL). Cerebrospinal fluid leakage occurred in 1 patient and healed well. The follow-up period ranged from 60 to 72 months. The mean score on the Japanese Orthopedic Association scale improved from (6.0 ± 1.41) preoperatively to (7.83 ± 1.40) at 1 month postoperatively to (9.67 ± 1.30) at the final follow-up (P<0.05). At the final follow-up stage, 11 patients had excellent outcomes, 6 good, 2 fair, and 1 unchanged, according to the Hirabayashi recovery rate. No patient had postoperative deterioration in neurologic status. Percutaneous endoscopic surgical management of thoracic OLF has proven to be both safe andeffective for the resection of the OLF in the thoracic spine.

Primary hyperparathyroidism misdiagnosed as metastatic disease, with trans-oral endoscopic surgical management.

Primary hyperparathyroidism is not so uncommon a disease. In high-income countries, with the introduction of routine biochemical testing in 1980s, it is diagnosed early, and the majority are seen as asymptomatic disease. However, in India, a severe symptomatic form is still seen, and many times patients are undiagnosed, thus continuing to suffer debilitating disease. Here, we report such a patient who was being treated as having bony metastases from an unknown primary source, when in fact he had osteitis fibrosa cystica due to primary hyperparathyroidism and was cured after surgery.

Management of Jugular Bulb Injury During Transcanal Endoscopic Tympanoplasty.

Variable internal jugular vein anatomy is not rare. A high jugular bulb (JB) is reported in 6 to 34% of cases and, it can be jeopardized during middle ear surgery, especially if dehiscent. Its injury represents a threatening complication of ear surgery. In recent years there has been an increasing trend in the use of endoscopic ear surgery for a wide range of otologic procedures, but being a one-hand technique, the management of bleeding still represents a challenge. The aim of this video, http://links.lww.com/MAO/B280 is to report the endoscopic surgical management of internal jugular vein hemorrhage during endoscopic type I tympanoplasty.

Endoscopic surgical treatment of epistaxis in hereditary haemorrhagic telangiectasia: our experience.

SUMMARYObjectivesHereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease characterised by epistaxis. Surgical procedures for epistaxis vary from diathermocoagulation to nasal closure. The aim of this paper is to report our experience in endoscopic surgical management of epistaxis in HHT patients.MethodsThis is a descriptive, longitudinal study carried out at the Otorhinolaryngology Department of IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent surgery for epistaxis from 1996 to 2015, including only those treated with endoscopic surgery.ResultsAmong the 591 patients hospitalised and screened for HHT, 323 (54.7%) underwent endoscopic surgery for epistaxis, for a total of 679 procedures. General anaesthesia was used in 77.2% of procedures; argon plasma coagulation was the instrument of choice in the majority of patients, followed by lasers and quantum molecular resonance technology.ConclusionsWe report one of the largest cohorts undergoing endoscopic treatment of epistaxis in HHT patients. This mini-invasive surgical treatment allowed us to control epistaxis without major complications and nasal packaging and can be repeated over time. For these reasons, we recommend it as first choice in case of epistaxis in HHT patients.

Chronic Sphenoiditis With Deep Neck Space Extension: Case Report With Review of the Literature and Postulated Mechanisms for Extracranial Extension.

Isolated primary sphenoid sinusitis is a rare occurrence, estimated to make up less than 3% of sinus infections. The posterior anatomic location of the sphenoid makes treatment challenging when it becomes infected. Complications involving intracranial extension to surrounding structures often result in cranial nerve deficits due to their proximity. A single case of chronic sphenoiditis with direct extracranial extension into the prevertebral space is reported with a discussion on clinical presentation, diagnosis, and management. A 46-year-old female patient with diffuse headaches radiating into the neck and throat was evaluated in the office. Computed tomography demonstrated sphenoiditis with direct extension into the prevertebral space. Imaging revealed a purported route of direct extension through the clinoid and directly into the clivus to form an abscess in the longus colli muscle. The patient underwent endoscopic surgical management including drainage of the prevertebral abscess and has since made a full recovery. This is the first reported case of direct extension of sphenoiditis into the prevertebral space. The findings highlight the importance of aggressive treatment of chronic sphenoid infections to prevent detrimental complications. Computed tomography imaging proved an advantageous imaging modality to demonstrate bony erosion and sinus tracts from the skull base to the deep neck space.

Development and validation of a postoperative nomogram for predicting overall survival after endoscopic surgical management of olfactory neuroblastoma.

BackgroundOlfactory neuroblastoma (ONB) is a rare malignancy arising in the nasal vault. Endoscopic resection has been reported to improve overall survival (OS). At present, clinicopathological predictors of the prognosis of ONB remain undefined.MethodsData including demographics, clinical characteristics and follow-up information of ONB patients treated with endoscopic surgery were collected. Risk factors on OS rates were investigated by LASSO and Cox analyses. A nomogram was developed and evaluated with internal validation. Risk groups were established according to patients’ points in the nomogram.Findings154 ONB patients treated with surgery were included in this single center study. A nomogram based on multivariate Cox regression model including multiple tumor history, orbital invasion, carotid canal invasion, modified Kadish stage, delivery sequence of RT and surgery, sequence of chemotherapy and surgery was developed. The bias-corrected C-index (0.886 [95% CI: 0.843-0.943]) was significantly higher than of conventional staging classifications. The AUC of nomogram regarding 1-, 2- and 5-year OS probabilities reached 0.912, 0.929 and 0.957, respectively. The risk levels based on nomogram points were more discriminative than conventional classifications.InterpretationValidation analysis showed good predictive accuracy and discriminative ability of the nomogram. Therefore, the nomogram could be utilized to individually predict survival probability for ONB patients after endoscopic resection.FundingThis study was funded by the Chinese Academy of Medical Sciences (No. 2019-I2M-5-003), the Shanghai Science and Technology Commission (No. 19411950600), the Shanghai Hospital Development Center (No. SHDC12018118) and the Eye, Ear, Nose and Throat Hospital of Fudan University (No. SYB202006).