Rhinopathic migraine: evaluation and surgical treatment

The concept of rhinopathic migraine has evolved during the last few years, although its pathophysiology and treatment are still controversial. This prospective study was conducted to assess the efficacy of endoscopic sino-nasal surgery in its treatment. Fifty patients with diagnosed migraine who failed to improve after full neurological work up and treatment underwent complete sino-nasal evaluation. Thirty-five patients met the diagnostic criteria of rhinopathic migraine [chief complaint of migraine, positive response to nasal anesthetic and the absence of significant sino-nasal symptoms]. Endoscopy and sinus computed tomography revealed either anatomic variations [e.g. septal deviation, 71.4% and concha bullosa, 25.7%] and/or mucosal disease [e.g. thickening, 40% and retention cyst, 11.4%] in all 35 patients. Endoscopic surgery, tailored to the pathology of each patient, succeeded in eliminating or significantly reducing migraine attacks in 32 patients [91.5%], while 3 patients [8.5%] failed, to improve [mean follow-up period of 24 months]. We conclude that endoscopic sino-nasal surgery is highly effective in eliminating rhinopathic migraine in carefully selected cases

Endoscopic versus open approaches in trating huge locally advanced angiofibromas

Juvenile nasopharyngeal angiofibroma [JNA] is a combined vascular and fibrous neoplasm arising in the nasopharynx of prepubertal and adolescent males. Studies indicate that surgery is a good form of treatment, especially when there is no intracranial involvement. The surgical approach depends on the pre-operative findings. Recurrence is a common problem in JNA treatment. A recent study by Radkowski et al. found that pre-operative tumor stage was the most important factor in determining the chances of recurrence after surgery. A retrospective chart analysis study was done for 42 cases of histologically proved angiofibromas staged II or III -according to Andrew's [Modified Fisch] classification- managed in the department of otolaryngology faculty of medicine Cairo University in the period between February 1996 and March 2003 with Minimal follow up of 3 years. Group 1, 29 patients were subjected to open surgical approach [Mainly before 2001] in the form of 1-ateral rhinotomy in 14 cases, and 2-facial degloving approach in 15 cases. Group 2, 13 patients mainly after 2001 were treated with endoscopic removal of tumor. Comparative analysis was done between both groups as regard local control parameters and morbidity parameters. Endoscopic approaches were superior to open approaches as regard total eradication of neoplasm as the incidence of residual tumor was nearly the double with open approaches compared to endoscopic approaches. As regard recurrent tumor both techniques were nearly equal as regard the incidence of recurrent tumors As regard the Morbidity Parameters, endoscopic approaches were associated with much less morbidity than open approaches. From previous results it is quite clear that endoscopic approach offers patients with huge advanced angiofibromas less morbidity with equal or even better local control