Endoscopic Transnasal Research Articles

Analysis of Added Postoperative Diplopia After Transnasal Endoscopic Inferomedial Wall Decompression for Thyroid-Associated Ophthalmopathy.

The authors retrospectively analyzed the reported rate of added diplopia and associated factors in patients with thyroid-associated ophthalmopathy (TAO) after transnasal endoscopic inferomedial wall decompression, to illuminate the issue and look for ways to improve prognosis. Retrospective analysis was done on the medical records of patients with moderate-to-severe TAO between 2023-01 and 2024-01. Under general anesthesia, transnasal endoscopic inferomedial wall decompression was carried out on each subject. Clinical outcomes included postoperative added diplopia (including new-onset and aggravated), strabismus, and alterations in the extraocular muscles. Sixty-five eyes in 65 patients received treatment. Nineteen patients (29.3%) had new-onset horizontal diplopia at 1 month and 10 patients (15.4%) at 6 months postoperatively; 9 patients (13.8%) experienced aggravated horizontal diplopia at 1 month and 6 patients (9.2%) at 6 months (C2=4.947, P<0.05). The average volume of the medial rectus muscle was the only one to increase in the extraocular muscles (F=34.131, P<0.001), and the preoperative medial rectus muscle volume was higher in the added diplopia patients than in the no-added diplopia patients (F=267.405, P<0.001). Postoperative diplopia (both new-onset and aggravated) increased in TAO with transnasal endoscopic inferomedial wall decompression. Most added diplopia was horizontal and most added strabismus was esotropia. They were closely associated with changes in the medial rectus's thickness, displacement, and structural alterations. The preoperative medial rectus volume is one of the possible markers of further postoperative diplopia.

The benefits of transnasal endoscopy compared to conventional endoscopy in adolescents

Background and aimTransnasal endoscopy (TNE) has been proven to reduce the need for intravenous anesthesia and the cost of the exams compared to conventional esophagogastroduodenoscopy (EGD) in adults. The objective of this study is to evaluate the benefits and the adverse effects of TNE in adolescents compared to conventional EGD. MethodsWe reviewed the pediatric patients from 2012 to 2022, who had undergone TNE at National Taiwan University Hospital due to epigastralgia. Age and gender-matched controls, who had undergone conventional EGD for epigastralgia at the same time, were also recruited. ResultsTotally 15 patients, aged between 12 and 20 years old, who had undergone TNE for epigastralgia at National Taiwan University Hospital were recruited as the study group. Another 60 age and gender-matched adolescents were also recruited in the control group. The needs of conscious sedation (9.3% vs 58.3%), hospitalization rate (13.3% vs 43.3%), the mean exam time (7.34 vs 9.96 min), and the cost of endoscopy (57.6 vs 93.2 USD) were significantly lower in the group of TNE as compared with the conventional EGD group. There was no difference in the percentage of complications, including dizziness, epistaxis, nausea, and vomiting, after procedures (P > 0.05.) ConclusionsTNE is a cost-effective exam and it also reduces the exposure to conscious sedation, the need for hospitalization and the exam time, making it a good choice for adolescents who are scheduled to undergo EGD for epigastralgia.

Endoscopic transnasal and transoral resection of the odontoid process and C1 combined with occipitocervical fusion for osteoradionecrosis of the upper cervical spine: a case report and literature review

BackgroundOsteoradionecrosis (ORN) of the upper cervical spine is a rare but severe complication of head and neck cancer radiotherapy. To raise awareness of this condition, we describe a patient with a history of nasopharyngeal carcinoma who developed ORN of the upper cervical spine and review the published literature reporting surgical management.Case presentationA 59-year-old female patient with persistent neck pain for one month and limited range of neck motion who had undergone radiotherapy for nasopharyngeal carcinoma with a total dose of 69.96 Gy 15 years ago presented to our hospital. The patient underwent endoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch, combined with occipitocervical fusion. To better understand surgical management of ORN of the upper cervical spine, the literature published in the PubMed, Ovid MEDLINE, and Embase databases was reviewed. Our patient experienced alleviation of cervical pain and did not exhibit any postoperative complications. Since 2005, 11 cases of surgical management of ORN of the upper cervical spine (including the present case) have been published. Basilar invagination and/or atlantoaxial subluxation were observed in 4 /11 cases. Endoscopic procedures were performed in 4/11 cases, and occipitocervical fusion was performed in 8 /11 cases.ConclusionEndoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch is a safe and effective treatment option for ORN of the upper cervical spine. Occipitocervical fusion is useful in patients with basilar invagination and atlantoaxial subluxation.

Transorbital Endoscopic Approach for Managing Challenging Frontal Sinus Lesions: Results and Operative Technique Description

Abstract Objective The aim of this study was to describe our experience using the transorbital endoscopic approach (TEA) in the frontal sinus and the step-by-step technique used. Materials and Methods We reviewed the charts from adult patients who underwent management of frontal sinus lesions with TEA performed from 2017 to 2022. Results Seven patients underwent eight surgeries for frontal sinus lesions using TEA in combination with the endoscopic transnasal approach (ETA), with the majority on the left side (5/8, 62.5%). The average age was 53.9 years, with six male patients and one female patient. Gross total resection (GTR) was achieved in all cases. The most common symptoms leading to surgery were headaches or a sensation of pressure in the forehead (5/8, 62.5%), followed by a decreased sense of smell (3/8, 37.5%), diplopia (3/8, 37.5%), proptosis (2/8, 20%), periorbital cellulitis (2/8, 20%), and decreased visual acuity (1/8, 12.5%). The most common etiology in this case series was mucocele (5/8, 62.5%), followed by osteoid osteoma (2/8, 20%), and inverted papilloma (1/8, 12.5%). The length of stay in all cases was 1 day. The most common complication was mild and transitory V1 numbness, which fully recovered after 6 months (5/8, 62.5%). The average follow-up period was 24.6 months (range of 3–48 months). Conclusion Transoral Endoscopic Approach (TEA) demonstrated being a valuable complement to ETA approaches for treating frontal sinus lesions, especially in challenging regions. The transorbital approach is feasible and can safely achieve GTR for a variety of pathologies while effectively controlling symptoms and resulting in a 1-day hospital stay.

Transcranial extraventricular endoscopic surgeries: Expanding the role of endoscope in neurosurgery.

Background and Aim: Transcranial endoscopic surgeries are mainly limited to intraventricular lesions. This study aims to elaborate on the various benefits of transcranial endoscopic surgeries in extraventricular regions of the brain. Methods and Materials/Patients: It is a retrospective study of transcranial extraventricular endoscopic surgeries (TEESs) operated between June 2022 to May 2023. The authors described the surgeries done for brain lesions other than intraventricular lesions as extraventricular surgeries. Access to the intracranial region was obtained through the transcranial approach. The transnasal rigid endoscope was used for the surgeries. The surgery was performed as either pure endoscopic surgery or endoscopic-assisted microscopic surgery. Results: The authors have performed 6 microvascular decompressions using an endoscope. Three pineal tumors, 3 craniopharyngiomas, 1 cerebellopontine angle epidermoid cyst, and 1 petrous neurenteric cyst were excised using an endoscope by transcranial approach. One internal carotid artery bifurcation aneurysm was clipped using an endoscope. All patients improved in the postoperative period. Surgeries were done using the 0-degree and 30-degree endoscopes. The endoscopic eye was able to reach the deep-seated area of surgical interest and authors were able to visualize the structures in a wide panoramic view with good illumination and magnification. There was no misinterpretation of structures. Conclusion: Endoscope can reach the deep-seated extraventricular areas of the brain with a narrow corridor, giving good illumination and magnification at the site of surgery. An endoscope can reach beyond the obstructing anatomical structure and visualize the area behind it. It is used as a complimentary to microscope to access the microscopic invisible areas. It has increased the ease of doing surgery, decreased tissue dissection, decreased complications, and improved surgical results. TEES improves the hand-eye coordination of surgeons in transcranial surgeries and it will help in adapting to exoscope easily

Sphenoclival fibrous dysplasia with cyst formation causing abducens nerve palsy in an older patient: illustrative case.

Fibrous dysplasia (FD) is typically asymptomatic but is known to occasionally cause neurological symptoms such as visual disturbances. However, FD-associated abducens nerve palsy is extremely rare. A 76-year-old woman had a left abducens nerve palsy due to mass effect on the abducens nerve at Dorello's canal caused by FD and its associated cyst, which was resolved by resection of the cyst through an endoscopic transnasal route. Although FD is generally an asymptomatic lesion occurring in younger patients, it can occasionally cause abducens nerve palsy even in older patients. In particular, cystic degeneration within FD tends to trigger a mass effect and thus can require surgical decompression. https://thejns.org/doi/10.3171/CASE24424.

8342 A Rare Case of a Corticotropic and Gonadotropic Pituitary Double Adenoma

Abstract Disclosure: S. Gruber: None. D. Kirschenbaum: None. T. Hortobagyi: None. C. Serra: None. A. Bink: None. F. Beuschlein: None. Z. Erlic: None. Background: Pituitary adenomas account for about 15% of all intracranial neoplasms and typically arise from monoclonal proliferation of anterior pituitary cells. While lactotropic and clinically hormone-inactive adenomas make up by far the largest proportion, somatotropic and corticotropic adenomas have a significantly lower prevalence. This case describes the very rare finding of a corticotropic and gonadotropic double adenoma. Clinical Case: A 63-year-old Caucasian man (BMI 36.7 kg/m2) presented in the obesity clinic. Hypercortisolism was suspected by repeated lack of cortisol suppression in low-dose dexamethasone suppression tests [minimal 87 nmol/l] and disrupted circadian rhythm of cortisol secretion according to salivary cortisol profile. Cortisol levels in a 24-hour sample of urine were normal. ACTH levels were elevated [73 ng/l; n&amp;lt;61 ng/l] leading to suspicion of Morbus Cushing. Concomitant diseases include sleep apnea, arterial hypertension and newly diagnosed type 2 diabetes mellitus. Medical history was notable for deep vein thrombosis and pulmonary embolism. Other stigmata of hypercortisolism were not evident. The rest of endocrine work up confirmed partial secondary hypothyroidism and hypogondotropic hypogonadism. An MRI of the pituitary gland revealed a pituitary macroadenoma with a maximum dimension of 20 mm. The patient underwent an endoscopic transnasal adenomectomy with post-operative corticotropic insufficiency. Contrary to our expectations, the histological examination of the surgical resection revealed a gonadotrophic pituitary adenoma with SF1 and focal FSH expression. The discrepancy between clinical, biochemical and histological findings led to subsequent examinations of the specimen with detection of an small fragment accounting for less than 5% of the total sample with expression of T-Pit and ACTH but neither SF1 nor Pit-1, corresponding to an additional corticotropic adenoma with densely granulated pattern. The tumor cells did not show overlapping expression patterns of transcription factors or hormones, which indicates the coincidence of two distinct adenomas. Three months postoperatively, the patient is biochemically cured. Partial anterior pituitary insufficiency remained. Conclusion: Pituitary double adenomas are found in 0.5-1.5% of all surgical specimens. They are characterized by their origin from different cell lines, which distinguishes them from plurihormonal adenomas, which originate from one single cell line. Here we demonstrate a SF1-T-Pit lineage combination resulting in a neighboring ACTH and FSH-adenoma. In this particular case, the clinically relevant corticotropic adenoma was comparatively tiny, making it easy to miss. This illustrates well the importance of careful correlation of clinical, laboratory and histologic findings as correct diagnosis is crucial for postoperative patient management. Presentation: 6/2/2024

Successful removal of a stuck plastic stent in an echoendoscope by additional insertion of a transnasal endoscope.

Successful removal of a stuck plastic stent in an echoendoscope by additional insertion of a transnasal endoscope.

Unsedated transnasal endoscopy experience at a tertiary referral center in India

Unsedated transnasal endoscopy experience at a tertiary referral center in India

Collision of pituitary neuroendocrine tumor and anterior clinoid meningioma treated with a two-stage minimally invasive surgical strategy: illustrative case.

The locations of pituitary neuroendocrine tumor (PitNET) and anterior clinoid meningioma (ACM) appear to be very close but essentially different, as the former is inside the sella turcica while the latter is in the intradural space. A collision tumor thus requires a specific treatment strategy but has been rarely reported. A 77-year-old woman presented with progressive visual impairment due to significant compression of the optic apparatus by a collision of PitNET and ACM. With a minimally invasive two-stage therapeutic strategy, the ACM was first resected using an endoscopic mini-pterional approach, then the PitNET was removed with an endoscopic transnasal approach 8 weeks later, leading to significant improvement in visual function. The authors' literature search identified only 2 documented cases of a similar collision. This case underscores the complexity of the decision-making process in the management of collision tumors and suggests the potential benefit of staged minimally invasive surgical interventions in preserving visual function. Further accumulation of cases is warranted for refining the treatment strategy. https://thejns.org/doi/10.3171/CASE24240.

A Rare Case Report of Nasal Schwannoma.

Schwannoma is a rare mass that is benign. It develops from the Schwann cells found in the peripheral nerves. Schwannomas consists of spindle cells exhibiting two unique histological patterns, which may be combined: Antoni type A and type B. When evaluating individuals who have a polyp-like growth in their nose and complain of one-sided nasal blockage, it is crucial to take into account the possibility of a schwannoma as part of the potential diagnoses. A 70-year-old female patient arrived with a gradual and persistent obstruction of the nasal passages over a period of six months. A polypoidal reddish mass was observed in the middle meatus during nasal endoscopy. Endoscopic transnasal excision was carried out. Additionally, a middle meatal antrostomy was done. The potential differential diagnoses encompass carcinoma, inverted papilloma, sarcoma, lymphoma, and neurofibroma. The most recommended method for treating nasal schwannoma is transnasal endoscopic surgery.

Endoscopic Transclival Approach for Evacuation of Retroclival Hematoma: 2-Dimensional Operative Video.

Retroclival hematomas are a rare entity, presenting anteriorly to the brainstem in the epidural, subdural, or subarachnoid space. Although those that develop in the epidural space often arise from trauma, subdural retroclival hematomas frequently occur spontaneously in the setting of coagulopathy, aneurysm rupture, or pituitary apoplexy, with many cases having an unknown etiology.1-4 Although most are treated with conservative management, surgical intervention is preferred for those presenting with evidence of brainstem compression, hydrocephalus, worsening neurological deficits, and clinical deterioration.5 In this report, we present the case of a 75-year-old woman with a medical history of mitral regurgitation, nonischemic cardiomyopathy, and atrial fibrillation on warfarin presenting with 4 days of temporoparietal headaches and double vision. On examination, the patient demonstrated right abducens and hypoglossal nerve palsies. Computed tomography revealed a subdural hemorrhage within the retroclival cistern, extending into the dorsal inferior aspect of the C2 vertebral body, resulting in posterior displacement of the pons, medulla, and proximal cervical spinal cord. Spinal and cerebral angiograms did not show evidence of any vascular malformation. An endoscopic transclival approach was selected for hematoma evacuation. Key surgical steps included harvesting of nasoseptal flap, endoscopic transnasal approach to the sellar/subsellar space, transclival drilling, retroclival hematoma evacuation, and clival reconstruction. The patient tolerated the procedure well and was discharged 15 days postoperatively with resolution of prior cranial nerve deficits. Postoperative computed tomography imaging revealed complete retroclival hematoma evacuation. At her 3-month follow-up, the patient remained neurologically intact with imaging confirming no residual subdural hematoma. Institutional Review Board approval was obtained for this submission (2018-9379). Patient consent was not obtained as personal identifying information was kept confidential, following guidelines set forth by Institutional Review Board requirements.

Meningiomas in the Central Skull Base:From the Perspective of Endoscopic Transnasal Surgery

Recent advancements in endoscopic transnasal surgery(ETS)have expanded the application of this technique to meningiomas in the central skull base area, offering a less invasive alternative with a potentially lower physical burden on patients than conventional microscopic skull base surgery. Notably, while ETS allows surgeons to reach tumors without traversing the brain and nerves, thus theoretically reducing the risk of cranial nerve damage, it requires a high level of proficiency to avoid inadequate resection and tumor recurrence. In this article, we discuss the various surgical considerations, including preoperative imaging, surgical setting, nasal cavity expansion, skull base opening, tumor removal, and skull base reconstruction, as general procedures for specific meningiomas. We further describe the concept and details of our multi-layer fascial closure technique for dural repair in ETS, underlining the importance of skilled dural reconstruction in preventing postoperative complications. In conclusion, while ETS for skull base meningiomas presents a promising and less invasive treatment option, its success relies heavily on the surgeon's experience and understanding of the skull base anatomy, stressing the need for careful approach selection.

The usefulness of narrow-band Imaging (NBI) in nasopharyngeal lesions-Validation of the Ni NBI classification dedicated for vascular pattern in the nasopharynx.

This study aims to explore the applicability of narrow-band imaging (NBI) involving the Ni classification for the diagnosis of nasopharyngeal mucosal lesions in order to distinguish malignant tumours (NPT) from non-malignant lesions. Each patient (n = 53) with a suspected nasopharyngeal lesion underwent a trans-nasal flexible video endoscopy with an optical filter for NBI. We assessed the suspected area using white light imaging (WLI) in terms of location and morphology as well as the vascular pattern (using Ni classification of nasopharyngeal microvessels) and surrounding tissue by using NBI. Based on the results of the NBI and WLI, patients were classified into "positive" or "negative" groups. All lesions of the nasopharynx were biopsied and submitted for final histological evaluation. NBI showed higher sensitivity, specificity, and accuracy than WLI. There was a significant correlation between the final histological result and the NBI pattern of the NPT: Chi2(1) = 31.34; p = 0.000001 and the WLI assessment of the NPT: Chi2(1) = 14.78; p = 0.00012. The assessment of the NPT in NBI using Ni NBI classification proved valuable in suspected mucosa assessment. NBI not only confirms the suspicious areas in WLI, but it also shows microlesions beyond the scope of WLI and allows for proper sampling.

Graves-Basedow ophthalmopathy surgical approaches: Open vs Endoscopic

Graves-Basedow's disease (GBD) is an autoimmune pathology that affects the thyroid and is characterized by the presence of goiter, hyperthyroidism, ophthalmopathy, and dermopathy. Graves-Basedow ophthalmopathy (GBO) is a set of inflammatory and infiltrative alterations of the orbital tissue that affects 40–90% of subjects suffering from GBD. Our study aims to investigate the differences in the clinical outcomes of patients treated with two different techniques: the classic open and the more modern endoscopic. A retrospective clinical study was carried out from the year 2011 until the year 2020 to evaluate the clinical outcomes of two different surgical techniques for the treatment of GBO. Eighteen patients were given surgical indications, 12 males and 6 females aged between 37 and 69 years (average age 48.5 years), for a total of 36 orbits. From the year 2011 to the year 2014, all patients were treated with the open orbital decompression technique; from 2015 onwards, patients were subjected to orbital decompression with the endoscopic transnasal approach. Pre- and postoperative ophthalmometry, reduction of proptosis, and reduction of oculo-orbital index were compared for the two techniques. As evidenced by the statistical analysis carried out on the sample before and after surgical treatment, there is a statistically significant difference between ophthalmometry and the Oculo-Orbital Index (IOO) values; this indicates that surgical orbital decompression with two walls (floor and medial wall) is effective in reducing exophthalmos. The positive result is also confirmed by the reduction of proptosis, measured in millimeters, averaging 1.7 mm. In the analysis of data relating to the two different patient groups, treated respectively with endoscopic orbital decompression (Technique 1) and classical open orbital decompression (Technique 2), the results obtained show that there is no statistically significant difference between the results of the two techniques. Therefore, the choice of surgical approach is at the discretion of the surgeon. It is our opinion that orbital decompression with the endoscopic transnasal technique should be an absolute indication in all patients who have clinical and radiographic signs of involvement of the optic nerve at the orbital apex (crowded apex syndrome) thanks to the ability of this technique to add and decompress the optical channel at the apex. For all other patients with GBO, the endoscopic technique of orbital decompression can be indicated as a first-line surgical approach considering the absence of skin scars and the best aesthetic results.

Primary abscess of the sella turcica of odontogenic nature (observation from practice)

Abscess of the sella turcica is an extremely rare disease of the chiasm and sellar region which often clinically and radiologically imitates other lesions in this area complicating the diagnosis.The article presents a clinical case of a 42‑year‑old female patient with primary abscess of the sella turcica which at first was considered to be pituitary adenoma. The patient underwent surgery through endoscopic transnasal access with good postoperative outcome. Additional postoperative examination revealed a possible source of hematogenic advancement of infectious process into the sella turcica cavity – pericoronitis of tooth 4.8. The article also presents review of publications on the topic.

Effect of perioperative medical therapy on prognosis in recurrent nasopharyngeal carcinoma: A comparative effectiveness research.

e18051 Background: Transnasal endoscopic (TEN) surgery has evolved to be an important treatment for rNPC.The role of perioperative chemotherapy or immunotherapy has not been determined yet. Methods: Three single arm, prospective researches were pooled to analyze the comparative effectivenessof neoadjuvant, adjuvant therapy and surgery only in rNPC patients undergoing TEN surgery through 2019 to 2023. Data was collected including sex, age, TNM staging, treatment modality and internal carotid artery (ICA) management in three investigator initial trials (NCT05011227, ChiCTR1900026341, NCT05350891). The primary and secondary outcomes were overall survival (OS) and local recurrence free survival (LRFS). Statistical analysis was performed using SPSS 29.0 (IBM).Variables with two-sided P-values &lt;0.05 in log-rank tests were identified as significant. Multivariable Cox regression analysis was conducted to reveal the prognostic value of treatment modality. Results: Overall, 233 eligible participants were divided into three treatment groups (neoadjuvant, adjuvant, and surgery only group). The clinicopathological characteristics were balanced (Table). In a mean follow-up period of 605 days, the 1-year, 2-year OS rate were 91.9%, 83.3% respectively. According to Kaplan Merier survival analysis, immunotherapy± chemotherapy after surgery significantly improved OS compared with surgery only (P&lt;0.001). Although no significance (P=0.176) was noted in neoadjuvant compared with surgery only group, partially because of the small sample size, the 1-,3-year OS rate was much higher. When blended together, neoadjuvant+adjuvant group also won over surgery only group regarding OS (P&lt;0.001) and LRFS (P=0.002). Subgroup analysis also indicated that age≥52 (P=0.002), higher T staging (P&lt;0.001), and embolization of ICA (P&lt;0.001) were associated with worse prognosis. Sex showed no significant effect on survival (P=0.533). The above four factors were adopted for multivariate COX analysis, elucidating that age (P=0.005), T staging (P=0.024) and treatment modality (P=0.007) were independent predictor for OS, however, embolization of ICA (P=0.097) was not. Conclusions: Adjuvant therapy, as an independent predictor of OS, improved the overall survival in rNPC patients underwent TEN surgery. The efficacy of neoadjuvant therapy demanded solid evidence from larger sample size cohort. Clinical trial information: NCT05011227 , NCT05350891 , ChiCTR1900026341. [Table: see text]

Advances in Skull Base Reconstruction After Transnasal Endoscopy

Endoscopic transnasal approach have experienced rapid development and gradual maturation in just a few decades (Kassam AB, Prevedello DM, Carrau RL, et al, 2011; Eloy J A, Vivero R J, Hoang K, et al, 2009). It has expanded from the removal of conventional pituitary tumours to the application of an endoscopic extended transsphenoidal approach for the resection of tumours in the intrasellar, suprasellar and even ventricular systems (Cappabianca P, Cavallo L M, Esposito F, et al, 2008). Larger bone and dural defects at the skull base, causing more severe postoperative complications and resulting in a multiplication of the healthcare burden (Eloy J A, Shukla P A, Choudhry O J, et al, 2013). Skull base Reconstruction after tumour removal has become a great challenge. Currently, skull base reconstruction is mainly divided into soft and rigid reconstruction, and soft reconstruction is represented by the technique of pedicled nasal septum mucosal flap (PNSF) (Thorp B D, Sreenath S B, Ebert C S, et al, 2014)0. As for rigid reconstruction, it is still controversial (Shin J, Forbes J, Lehner K, et al, 2019; Eloy J A, Shukla P A, Choudhry O J, et al, 2012). From the current studies, rigid reconstruction has a role that cannot be ignored. In this article, we will describe the development of skull base surgery and several high-profile skull base reconstruction techniques.

Transnasal Endoscopy Acquires Esophageal Biopsies Adequate for Comprehensive Pathology Evaluation in Patients With Eosinophilic Esophagitis.

Transnasal endoscopy (TNE) does not require general anesthesia, an attractive characteristic for monitoring eosinophilic esophagitis (EoE). We evaluated the adequacy of TNE-obtained esophageal biopsies using the EoE Histology Scoring System (EoEHSS). The Cincinnati Center for Eosinophilic Disorders database was searched for esophageal biopsies obtained by the same endoscopist, using either TNE or conventional endoscopy (CE). Whole-slide biopsy images were evaluated. The Mann-Whitney test was used for median (interquartile range) values and Fisher exact test for categorical variables. P ≤ .05 was considered significant. Median age (P = .82) or height (P = .83) did not differ between TNE (n = 17) and CE (n = 17) groups. Although median largest piece size (mm2) differed between the groups (TNE: 0.59 (0.45, 0.86), CE: 2.24 (1.09, 2.82), P < .001), all 8 EoEHSS features were evaluated in each group; only 1 feature (lamina propria fibrosis) was missing in both groups (TNE: 19/34, CE: 11/34, P = .09). The median peak eosinophil count/high-power field differed (TNE: 3 (0, 29), CE: 16 (1, 66), P = .03), but overall grade (TNE: 0.17 (0.10, 0.29), CE: 0.22 (0.14, 0.46), P = .12), stage (TNE: 0.14 (0.10, 0.24), CE: 0.20 (0.10, 0.43), P = .15), and non-eosinophil-related individual EoEHSS scores did not differ. TNE- and CE-obtained esophageal biopsies are similarly sufficient for evaluation of key pathological features in EoE.

Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques.

Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital, endoscopic transoral, and endoscopic sublabial transmaxillary approaches to address extensive lesions not amenable to a single approach. The study provides anatomical metrics including area of exposure and degree of surgical freedom. Five human cadaveric specimens (10 sides) were dissected to expose and methodically analyze the anatomical intricacies of the ITF using the following minimal access approaches: endoscopic transnasal transpterygoid (EETA), endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques. Area of exposure at the pterygopalatine fossa and surgical freedom at the ITF were obtained for each approach. The endoscopic sublabial transmaxillary sinus and the combined approach afford a significantly greater exposure than an isolated EETA. The difference in exposure (mean) between the endoscopic sublabial transmaxillary and EETA was 1.62 ± 0.85 cm2 (p < 0.001), and the difference between the combined approach and EETA was 4.25 ± 0.85 cm2 (p < 0.001). Combining minimal access endoscopic approaches to the ITF can provide significantly greater exposure than an isolated EETA; thus, providing enhanced access to address lesions with extensive involvement of the ITF, especially those with superolateral and inferolateral extensions. In addition, some approaches may have an adjunctive role to the resection, such as the endoscopic transoral approach offering the potential for early control of the internal maxillary artery and its branches, some of which may be supplying the tumor in the ITF; or the endoscopic transorbital approach yielding a direct line of sight to the superior ITF and middle cranial fossa. NA.