Nasal Endoscopic Approach Research Articles

A Case of Post-Traumatic Cerebrospinal Fluid Rhinorrhea with Encephalocele

Posttraumatic cerebrospinal fluid (CSF) leakage may frequently develop after a skull base frac-ture. A patient with a 1-month history of intermittent watery rhinorrhea was referred to our de-partment from the Department of Neurosurgery. He had been treated for 8 months due to a skull base fracture after a motor vehicle accident. He had undergone cranial trephination due to brain abscess prior to this presentation. On radiologic examination, a large skull base defect with enc-ephalocele was observed. Using the nasal endoscopic approach, we identified a large protruding mass of soft brain tissue with pulsating CSF in the ethmoid roof. CSF lumbar drainage was per-formed in order to reduce the protruding mass by decreasing intracranial pressure. After CSF lum-bar drainage, the protruding brain tissue was returned to the cranial cavity, and the leak site was successfully repaired with septal cartilage and graft material.

Endoscopic removal of alloplastic sinus graft material via a wide middle antrotomy

The purpose of this paper is to discuss the treatment required for a patient affected by chronic maxillary sinusitis following a sinus grafting procedure with an alloplastic material. Sinusitis was not the consequence of migration of alloplastic material into the maxillary sinus, but rather the consequence of overfilling the subantral space followed by obstruction of the ostium. The treatment involved removal of the alloplastic material and correction of the ostium obstruction via a nasal endoscopic approach.

CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings

Skull base defects can result in CSF leaks, with meningitis as a potential complication. Surgeons are now routinely repairing these leaks via a nasal endoscopic approach. Accurate preoperative imaging is essential for surgical planning. A variety of imaging regimens have been employed, including axial and direct coronal CT, CT cisternography with iodinated contrast, radionuclide cisternography, and MR imaging. Now that multidetector helical CT is available, the purpose of this study was to determine how well coronal and sagittal multiplanar reformatted (MPR) images generated from a high-resolution axial dataset correlate with intraoperative findings in a group of patients with clinically proved CSF leaks. We retrospectively reviewed imaging findings and surgical records of 19 patients who presented to our tertiary care institution during a 2.5-year period with clinically proved CSF leak. Patients underwent preoperative imaging with high-resolution helical CT (section collimation, 10 patients with 0.625-mm and 9 patients with 1.25-mm images), with MPR images processed by a neuroradiologist at a workstation. Two neuroradiologists, blinded to the intraoperative findings, determined the location and size of the skull base defects. All patients underwent endoscopic evaluation by an experienced sinonasal otolaryngologist, who confirmed the site of the CSF leak by direct inspection and measured the corresponding osseous defect. CT was considered accurate if it correctly localized the CSF leak and was within 2 mm of the endoscopic measurement. At endoscopy, 22 leaks of CSF were identified in 18 of 19 patients. CT correctly predicted the site of the leak in 20 (91%) of 22 cases and was accurate (within 2 mm of the endoscopic measurement) in 15 (75%) of 20 cases preoperatively localized. The CT measurement of the skull base defect differed from the endoscopic size in 5 (25%) of 20 cases, ranging from 7.4 mm below to 13 mm above the intraoperative measurement. When analysis was limited to the subgroup of 10 patients who had 0.625-mm axial images, the accuracy was improved, and of the 11 CSF leaks described at CT, all were verified at endoscopy. In addition, the submillimeter CT accurately measured the size of the osseous defect in 9 (82%) of 11 cases. In the remaining 2 (18%) of 11 cases, CT minimally overestimated the size of the osseous defect by only 3 mm. Axial images, and coronal, sagittal, and oblique MPR images generated from high-resolution axial CT performed well preoperatively, localizing the skull base defect responsible for the CSF leak. However, active manipulation of the axial dataset at a workstation is crucial in identifying and correctly describing these lesions. When submillimeter collimation is available, measurement of the osseous defects are accurate most of the time.

Polipectomia endoscópica com meatotomia média como tratamento de pólipo antrocoanal

Pólipo antrocoanal (PAC) ou pólipo de Killian é uma lesão benigna, não atópica, do seio maxilar. O sintoma predominante é a obstrução nasal. Diversas opções cirúrgicas para o tratamento dos PACs têm sido sugeridas para minimizar a recorrência pós-operatória. A endoscopia vem sendo utilizada como opção terapêutica na ressecção intra-sinusal maxilar da implantação do pólipo através do próprio óstio maxilar ou de uma antrostomia meatal média, com uma menor morbidade que as outras condutas cirúrgicas. OBJETIVO: Avaliar o índice de recidiva da polipectomia endoscópica com meatotomia média no tratamento do PAC. MATERIAL E MÉTODO: Foram avaliados, em estudo retrospectivo, 29 pacientes com o diagnóstico de PAC baseado na história, exame físico, tomografia computadorizada e exame anatomopatológico, tratados entre 1997 e 2004. O procedimento cirúrgico adotado foi polipectomia endoscópica com meatotomia média. RESULTADOS: 29 pacientes com pólipo antrocoanal, 17 (58,6%) do sexo feminino e 12 (41,4%) do masculino, com idades entre 7 e 75 (média 27,55 anos), foram incluídos nesse estudo. Os principais sintomas apresentados foram obstrução nasal, 24 (82%), respiração oral, 11 (37,9%), roncos, 9 (31%), rinorréia, 5 (17%), epistaxe, 2 (6,9%), cefaléia, 2 (6,9%) e gotejamento, 1(3,4%). A associação com atopia foi de 9 (31%). A média de seguimento foi de 17 meses (3-63 meses). Apenas 2 pacientes (6,9%) apresentaram recidiva. CONCLUSÃO: O índice de recidiva obtido por nosso trabalho não difere dos dados da literatura, mesmo quando comparado com procedimentos longamente estabelecidos.

Endoscopic Polipectomy with Middle Meatal Antrostomy for Antrochoanal Polyp Treatment

SummaryAntrochoanal polyp (ACP) or Killian polyp is a benign nonatopic lesion of the maxillary sinus. Patients usually present nasal obstruction. Many surgical options for the treatment of ACPs have been suggested to minimize postoperative recurrence. The endoscopic nasal approach is a surgical option for maxillary intrasinusal resection of the polyp implantation through the maxillary ostium or middle meatal antrostomy, with lower morbidity when compared to other surgical approaches. Aim: To evaluate the rate of endoscopic antrochoanal polypectomy with middle meatotomy in the treatment of ACP. Materials and Methods: Were evaluated by means of a retrospective study, 29 patients, who were diagnosed based on history, physical examination, computed tomography, and histological findings, treated between 1997 and 2004. The surgical approach was endoscopic polypectomy with middle meatotomy. Results: Twenty-nine patients with ACP, 17(58.6%) were females and 12(41.4%) males, age range, 7-75 years (average of 27.55years) were included in this study. The main symptom were nasal obstruction 24(82%), oral breathing 11(37.9%), snoring nine (31%), rhinorrhea 5(17%), epistaxis 2(6.9%), headache 2(6.9%), and drip one (3.4%). The association with atopy was found in nine (31%). The mean follow-up period was 17 months (3-63 months). Only two patients (6.9%) presented recurrence. Conclusion: The rate of recurrence obtained in our study is no different from literature data, even when compared with former and gold standard procedures.

비내시경과 천공술로 치료한 거대 전두 점액낭종 1예

Paranasal sinus mucocele is slowly expanding lesion of benign entity caused by retention of mucous secretions in the sinus. Frontal sinus is the most common site and if frontal mucocele extends to orbital and intracranial structures, orbital symptoms such as pain, swelling, exopthalmos, diplopia, and loss of vision are mainly presented. The surgical treatments of paranasal sinus mucocele are divided into external and transnasal approach, and transnasal approach by nasal endoscopy is recently the major choice for surgical treatment of paranasal sinus mucocele. But, nasal endoscopic marsupialization by transnasal approach in frontal sinus mucocele has limitations in some cases because of difficulty of approach and risk of recurrence. Especially, in giant mucocele of frontal sinus, which has orbital symptoms, wide excision by external approach had been recommended acc-ording to past reports. We had the excellent surgical result by bimanual methods using nasal endoscopic marsupialization and endoscopic approach through external trephination in giant mucocele of frontal sinus. (J Clinical Otolaryngol 2007;18:117–121)

Pulmonary carcinoid tumor presenting with simultaneous orbital and intracranial metastases: value of transnasal endoscopic orbital biopsy and decompression

A 62-year-old woman presented with a 10-week history of blurred vision in the left eye. Examination revealed mild limitation of upgaze of the left eye and evidence of a left optic neuropathy. Magnetic resonance imaging revealed an enhancing mass in the posteromedial left orbit as well as an enhancing lesion in the inferior occipital lobe. The patient underwent a left orbital biopsy and partial decompression via a left nasal endoscopic approach, following which the optic neuropathy improved significantly. Histopathologic examination yielded a diagnosis of carcinoid tumor. Biopsy of the occipital lesion was also consistent with this diagnosis. The primary tumor was found in the lungs.

비내시경술로 절제된 비인강 혈관섬유종 1례

비내시경술로 절제된 비인강 혈관섬유종 1례