Clinical analysis of brain abscess after endoscopic repairment of cerebrospinal fluid rhinorrhea / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical characteristics of the complication of brain abscesses after cerebrospinal fluid rhinorrhea repairment.@*Methods@#A retrospective analysis was conducted on 149 patients undergone endoscopic repairment of cerebrospinal fluid rhinorrhea from October 2007 to October 2017 in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin HuanHu Hospital. The clinical characteristics and treating methods of 3 brain abscess cases were analyzed.@*Results@#Of the 149 patients accepted the endoscopic repairment of cerebrospinal fluid rhinorrhea, 3 cases were complicated with postoperative brain abscesses, which showed as frontal lobe abscess by strengthened head MRI. The incidence of abscess was 2.0%. Abscess formation time was within 10 d after surgery. One case was treated with antibiotic and reducing intracranial pressure, while other 2 cases were treated with puncture drainage. After following-up of 1 to 24 months, these 3 cases had no recurrence of cerebrospinal fluid rhinorrhea or abscess.@*Conclusions@#The complication of brain abscess formation after endoscopic repairment of cerebrospinal fluid rhinorrhea is more common in frontal lobe, which may take place within 7-10 d postoperatively. Conservative treatment is the first choice. Under the condition of obvious symptoms and pus cavity fusion, puncture drainage can be performed.

Clinical analysis on the endoscopic or endoscopy-assisted treatment for the malignant transformation of sinonasal inverted papilloma / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo investigate malignant transformation of sinonasal inverted papilloma(SNIP) treated by endoscopic or endoscope assisted surgery, in order to analyze its probable prognostic factors and the optimized method.METHODSThe clinical data of 27 cases with malignant transformation of SNIP treated by endoscopic or endoscope assisted surgery from September 2001 to September 2010 were reviewed. According to preoperative imaging examination and UICC staging criteria, 3 cases were T1, 8 cases were T2, 12 cases were T3 and 4 cases were T4. 16 of them received radiotherapy after endoscopic surgery while the other 11 received surgery alone. RESULTSAll cases were confirmed as squamous cell carcinoma pathologically after surgery. The 5-year overall survival rate was 77.8% for all the patients. The 5-year survival rate was 75.0% for surgery alone group, of which 5 cases recurred locally after operation. The 5-year survival rate was 81.8% for surgery combined with radiotherapy group, of which 5 cases recurred locally and 2 cases died from intracranial metastasis.CONCLUSIONEndoscopic or endoscope assisted surgery can be used in the management of malignant transformation of SNIP to improve the quality of life, with the preponderances of desired effect and less complication. Application of radiotherapy after surgery could improve long-term survival rate of the patients.

Treatment of cystic lesions in sella through transsphenoidal endoscopic endonasal approach: retrospective analysis of 46 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical and imaging characteristics of patients with cystic lesions in sella region and to describe the experience of endoscopic transsphenoidal surgery.</p><p><b>METHODS</b>Fourty-six cases of cystic lesions in sella region confirmed by surgery and pathology between June 2003 and September 2013 were retrospectively analysed. The clinical features, imaging, surgical technique and postoperative recurrence in 46 cases were presented.</p><p><b>RESULTS</b>All lesions were resected through transsphenoidal endoscopic endonasal approach. Followed up lasted from 6 months to 6 years. Postoperatively, headache was recovered in 26 cases and wasn't recovered in 8 cases, visual was improved in 12 cases and wasn't improved in 2 cases, hypopituitarism was relieved in 18 cases and wasn't relieved in 15 cases, polyuria was disappeared in 8 cases and wasn't disappeared in 4 cases. Seven cases recurred, including 4 cases of craniopharyngioma, 2 cases of pituitary abscess, 1 case of cystic adenoma. There were no death and serious complication. The small age of onset, visual acuity and visual field symptoms, tumor in suprasellar, third ventricle compression was easy to occur in craniopharyngioma; cystic tumor, cavernous sinus invasion, the solid part homogeneous enhancement could be seen in cystic adenoma; Rathke cyst showed simple cystic, lighter clinical symptoms and a short course. Prone to diabetes insipidus, low multiple hormone level and the lesions of annular enhancement was more common in pituitary abscess.</p><p><b>CONCLUSIONS</b>The clinical features and imaging of cystic lesions in sella region feature overlap each other, but there are certain specificity. Transsphenoidal endoscopic endonasal approach for the surgery of cystic lesions in sella is effective and safe.</p>

Clinical analysis of sphenoid sinusitis after transsphenoidal sellar surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the possible influence factors of sphenoid sinusitis after endoscopic transsphenoidal sellar surgery.</p><p><b>METHODS</b>A retrospective analysis of 177 patients who underwent transsphenoidal sellar surgery, from January 2009 to January 2014 in Tianjin Huanhu Hospital was performed. All patients were followed up with nasal endoscope. The risk factors of sphenoid sinusitis after surgery were analyzed statistically, such as sex, age, categories of disease, surgical produres, tumor size, using artificial or self material repair, with or without EC glue intraoperatively, etc. SPSS 17.0 software was used to analyze the data.</p><p><b>RESULTS</b>After surgery, there were 34 (19.2%) patients developed postoperative sinusitis. EC glue was the sole risk factor for postoperative sinusitis (34.57% vs 6.25%, χ(2)=22.701, P<0.01), but the sex, age, categories of disease, surgical produres, tumor size and patching material had no significant difference (all P>0.05).</p><p><b>CONCLUSIONS</b>In patients with endoscopic transsphenoidal sellar surgery, regular postoperative nasal endoscopic follow-up found that the use of EC glue was the risk factor for the development of postoperative sphenoid sinusitis.</p>

Analysis on the prognosis of malignant transformation of sinonasal inverted papilloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize the clinical characteristics and treatments of patients with malignant transformation of sinonasal inverted papilloma (SNIP), and to explore the factors influencing the prognosis of malignant SNIP.@*METHOD@#To retrospectively analyze the clinical data of 35 patients with malignant SNIP. The prognosis affected by age, gender, pathogenetic locations, pathology, clinical stages and treatments were analysed using Kaplan Meier, Log rank and Cox method.@*RESULT@#In our research, 5 years survival rate was 68.6% in malignant SNIP. There were 3 factors effecting the 5 years survival rate of malignant SNIP: clinical staging, histopathological features and treatments while gender, age, disease location, and percentage of the malignant cell in the entire tumor tissue had no effect on overall survival rate. Clinical staging and treatment were the independent factors that influenced the prognosis of malignant SNIP (P value was 0.019 and 0.006).@*CONCLUSION@#Risk factors that independently influence the survival of patients with malignant SNIP were the clinical staging and treatment. The degree of histo pathological features can be the secondary indicator to judge the prognosis of malignant SNIP. Endoscopic surgery or comprehensive therapy performed on patients properly is therapeutically effective.

Olfactory function in patients with Alzheimer' disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the relationship between olfactory bulb (OB) volume, depth of olfactory sulcus (OS) and olfactory function in patients with Alzheimer' disease (AD).@*METHOD@#Fifty patients with AD patients and 50 healthy subjects were examined by olfactory function T&T testing, OB volume and depth of OS assessed with Magnetic resonance imaging (MRI).@*RESULT@#T&T olfactory testing revealed that AD patients had higher scores than control group (1.50 ± 0.17, 2.80 ± 0.31, P 0.05). Olfactory discriminate threshold was negatively correlated with average olfactory bulb volumes (r = -0. 711, P 0.05) in AD patients.@*CONCLUSION@#The OB volume were lower in AD patients as compare to controls, the depth of OS has no significant changes in AD patients; The OB volume is correlated with olfactory function, the depth of OS is no correlated with olfactory function. Cognitive impairment degree in AD patients is accordance with the lower degree olfactory function. The olfactory loss may be the earlier period and objective diagnosis indicator for AD patients.

Endoscopic removal of foreign body in nasal apex: a case report / 临床耳鼻咽喉头颈外科杂志

We present a rare case report of foreign body of the nasal apex in a 22-year man who were hospitalized because of a bit of metal rebounded. There was slight bleeding at wound site with a feeling of pain and swelling. On physical examination, the apex lied in the median position with a bleeding cut about 3 millimeter in length. There was no visible stump on the cut or rupture in the nasal vestibular. Computed tomographic scan showed the abnormal high-density shadow in the nasal apex while the foreign body was located in the subcutaneous tissue of the antero-upper part of septal cartilage. The admitting diagnosis was foreign body in nasal apex. Endoscopic surgery was adopted to remove the foreign body.

Related factors analysis of spontaneous cerebrospinal fluid leak recurrence after endoscope operation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To Summarize and analyze the clinical characteristics and treatment of patients with spontaneous cerebrospinal fluid rhinorrhea, and to explore the related factors of recurrence.@*METHOD@#Retrospective- ly analyze the clinical data of 58 patients of spontaneous cerebrospinal fluid rhinorrhea from July 2002 to July 2012, combined with its clinical characteristics, and statistically analyze the related recurrence factors.@*RESULT@#Fifty-eight cases were accepted the nasal endoscopic repairment of cerebrospinal fluid rhinorrheak, follow-up 3 years, 20 cases (34.5%) recurred, 1 case recurred in half a year after operation. In the first year, there were 10 cases recurred. In the second year there were 9 cases recurred, and 1 case recurred in the third year. Through multiariable analysis it was found that higher BMI, empty sella and skull base bone defect were the independent risk factors influencing the recurrence of spontaneous cerebrospinal fluid rhinorrhea (P < 0.05).@*CONCLUSION@#The recurrence rate of spontaneous cerebrospinal fluid rhinorrhea is high, needing long-term follow-up. Higher BMI, empty sella, skull base bone defect are independent risk factors of recurrence of the disease, and the treatment should be individualized.

The treatment principles of frontal sinus tract after the frontal approach craniotomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the causes, clinical manifestation and treatment principles of frontal sinus tract after the frontal approach craniotomy.@*METHOD@#The clinic data of 13 patients with frontal skin sinus tract after the frontal approach craniotomy were retrospectively analyzed. All of them were described in the clinical record to have undergone frontal sinus mucosa pushing down or shaving and bone wax filling in the frontal sinus during the surgery, of whom 3 cases had history of frontal abscess incision drainage. All patients were performed endoscopic frontal sinus surgery and forehead skin sinus tract excision and suture.@*RESULT@#All of the patients successfully recovered after one-stage operation, and the frontal skin sinus tract was healed.@*CONCLUSION@#The frontal approach craniotomy with postoperative frontal sinus tract was related with the improper use of bone wax tamponade and sealing of frontal sinus. The treatment principles were to remove bone wax, remove inflammatory granulation tissue around the sinus tract, and to open frontal sinus and promote frontal sinus drainage.

Multiple-factors analysis on the prognosis of nasal mucosa malignant melanoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics and treatment of patients with malignant nasal mucosa melanoma, and explore the factors influencing the prognosis of malignant nasal mucosa melanoma.</p><p><b>METHODS</b>To retrospectively analyze the clinical data of 29 patients with malignant nasal mucosa melanoma in Tianjin Huanhu hospital, department of otorhinolaryngology head and neck surgery between October, 1999 and June, 2013. Eighteen of them were male, other eleven were female, the median age was 61.5 years. The patients were staged according to the American Joint Committee on Cancer (AJCC) staging system, eight cases were in T1, ten cases were in T2, six cases were in T3, five cases were in T4. Among the 29 cases, twenty-two patients received surgical treatment, twenty-eight patients accepted radiotherapy, seventeen patients had the chemotherapy. The Kaplan-Meier method was used to analyze the prognosis impacts of gender, age, disease location, clinical staging, treatment, and histopathological features and so on.</p><p><b>RESULTS</b>In this series, the overall 3 year survival rate was 48.3% and 5 year survival rate was 27.6%. There were 4 factors effecting the 5 year survival rate : the location of tumor, T stage, surgical treatment and black pigmentation (P value was 0.008, 0.012, 0.021 and 0.027). But, gender, age, chemotherapy and other factors had no effect on overall survival rate.</p><p><b>CONCLUSIONS</b>AJCC staging system can effectively predict the prognosis of patients. The prognosis of patients with pathogenic site in nasal septum is better than the others. The surgical treatment is the preferred method of treatment. Histological features such as tumor melanin pigmentation affect the prognosis of the patients.</p>

Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess.</p><p><b>METHODS</b>Eighteen pathologically diagnosed pituitary abscess were resected through transsphenoidal endoscopic endonasal approach at Tianjing Huanhu hospital between January 2000 and December 2011.Retrospective analysis was done upon clinical presentations and imaging features. There were 6 males and 12 females. The average age was 48.5 years old and the average disease course was 5.8 years. The typical clinical manifestations included headache (13 cases), pituitary dysfunction (10 cases), Diabetes Insipidus (4 cases) visual interference (8 cases) and fever (4 cases). All cases were resected by transsphenoidal endoscopic endonasal approach with general anesthesia. The postoperative symptoms and follow-up results were recorded.</p><p><b>RESULTS</b>All patients were followed up from 6 months to 6 years. Postoperatively, headache was recovered in 13 cases, visual was improved in 6 cases, hypopituitarism was relieved in 8 cases and polyuria was disappeared in 3 cases. One case was recurrent and cured by transsphenoidal endoscopic endonasal approach.</p><p><b>CONCLUSIONS</b>Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess is effective.</p>

Analysis of factors of intracranial infection after transnasal endoscopic crannialbase approach / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the factors of intracranial infection after transnasal endoscopic crannialbase approach.@*METHOD@#Retrospective analysis of 346 patients of ransnasal endoscopic crannialbase approach, logistic regression analysis of the factors was carried out.@*RESULT@#The total number of cases of postoperative infections were 19 cases in 346 patients, the infection rate was 5.49%. The cerebrospinal fluid rhinorrhea , the restitution of skull base, the history of crannialbase approach, the history of radiotherapy and diabetes were infection fators after transnasal endoscopic diabetes (P 0.05).@*CONCLUSION@#Intracranial infection after transnasal endoscopic the use of artificial material was affected by many factors. Much attention should be paid for the intracranial infection prevention.

Analysis of intracranial infection factors after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the factors of intracranial infection after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea.</p><p><b>METHODS</b>One hundred and seventy-three patients who accepted transnasal endoscopic repair of cerebrospinal fluid rhinorrhea were retrospectively analyzed. The intracranial infection factors was analyzed by Logistic regression analysis with SPSS 17.0 software.</p><p><b>RESULTS</b>Postoperative infection was found in 17 cases among 173 patients, the infection rate was 9.83%. The unsuccessful transnasal endoscopic repair of cerebrospinal fluid rhinorrhea (χ(2) = 6.89, P = 0.001) , the defective diameter of skull base (χ(2) = 9.98, P = 0.001) and medical history of intracranial infection (χ(2) = 11.08, P = 0.001) were infection factors after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea (all P < 0.05), while sex, age, the site of defection, the aetiological agent, longer application of antibiotics before or after operation and the use of artificial material had no obvious effect (all P > 0.05).</p><p><b>CONCLUSION</b>Intracranial infection after transnasal endoscopic repair of cerebrospinal fluid rhinorrhea is affected by many factors, such as the unsuccessful transnasal endoscopic repair of cerebrospinal fluid rhinorrhea, the defective diameter of skull base and medical history of intracranial infection.</p>

Clinical analysis of nasogenic brain abscess / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of nasogenic brain abscess.</p><p><b>METHOD</b>Four patients with nasogenic brain abscess diagnosed in Tianjin huanhu hospital between June 2007 and January 2013 were reported and the relevant literatures reviewed.</p><p><b>RESULTS</b>All four patients were frontal abscess, however, the pathogeny of frontal abscess were different. These four patients were treated by different methods and followed up from 12-28 months, no recurrence was found. All four patients were cured.</p><p><b>CONCLUSIONS</b>The clinical manifestation of nasogenic brain abscess was hiding and was easy to misdiagnosis. Enhanced MRI is the key of the diagnosis. According to the pathogeny of brain abscess, it was important to cure nasogenic brain abscess with different ways.</p>