The impact of resection of skull base tumor via an endoscopic endonasal approach on the visual function of vision impaired patients and the analysis of factors affecting their visual recovery / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the visual outcomes of patients with visual impairment after resecting skull base tumor via an endoscopic endonasal approach, and to analyze the factors affecting visual recovery.@*Methods@#One hundred and fifty-three patients with skull base tumor who suffered from preoperative visual impairment from Skull Base Surgery Center of Xuanwu Hospital were operated through an endoscopic endonasal approach. Both preoperative and postoperative visual function outcomes as well as factors that might have affected their visual recovery were analyzed retrospectively by Chi square test and Logistic regression analysis.@*Results@#Complete resection was achieved in 85.6% of the patients using this technique. The rate of postoperative visual recovery in the female group (86.1%) was higher than that in the male group (73.9%), the benign group (90.2%) higher than the malignant group (20.0%), the group without optic atrophy (97.1%) higher than the one with (51.2%), and the acute group (96.6%) higher than the chronic group (80.0%). Significant differences were found between the abovementioned groups (χ2 value was 5.849, 87.860, 79.757, 4.745, respectively, all P<0.05). The degree of optic atrophy and the property of tumors were significantly associated with visual improvement after treatment (Wold χ2 value was 18.597 and 35.623, all P<0.001).@*Conclusions@#Our results indicate that endoscopic endonasal surgery shows its ability both to resect skull base tumors and to improve visual function in the majority of patients. The timing of treatment for patients suffered from preoperative visual impairment should be selected in early stage before optic atrophy occurs.

Early experience of radiofrequency ablation-assisted resection of skull base tumor through an endoscopic endonasal approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To describe the early experience of resecting skull base tumor via a radiofrequency ablation-assisted endoscopic endonasal approach, investigate the safety and feasibility of the technique, and to assess its preliminary treatment outcomes.</p><p><b>METHODS</b>Ten patients with skull base tumor who were admitted between September and November 2013 were operated on through a radiofrequency ablation-assisted endoscopic endonasal approach in Xuanwu hospital of capital medical university. In this study, the operative technique was described, and the degree of resection, complications and the early clinical outcomes was presented.</p><p><b>RESULTS</b>Complete resection was achieved in all patients using this technique. No patient in the series experienced a new neurological deficit, cerebrospinal fluid leak or meningitis after surgery. No recurrence and death related to skull base tumor were found in the follow-up period (16-18 months). The volume of intraoperative blood loss was 60 to 1 000 ml (medium 285 ml). The duration of operations was from 42 to 150 min (medium 95 min). The hospital stay was from 14 to 19 d (average 15.7 d).</p><p><b>CONCLUSION</b>Our limited experience indicates that this technique is feasible and safe for the complete resection of some skull base tumors in selected cases.</p>

Endoscopic skull base surgery under the guidance of image navigation technology / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of image navigation technology in endoscopic skull base surgery.</p><p><b>METHODS</b>This study consisted of 75 patients who underwent the endoscopic operations with the help of the image navigation system by the same surgeon between March 2010 and March 2013. The time to prepair image navigation system, identifying anatomical structure, complications, tumor resection, and follow-up results were analysed.</p><p><b>RESULTS</b>The application of image navigation technology in the endoscopic skull base operations was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors, such as internal carotid artery, optic canal, comb, saddle bottom, foramen rotundum, foramen ovale, foramen lacerum, jugular foramen, cerebral dura mater. The tumor was removed completely, subtotally, or partially. All patients were successfully registered with accuracy, and the preoperative time was 8-15 minutes for preparation, 11 minutes in average. The target error was less than or equal to 1.5 mm. With guidance of the image navigation system, all patients were successfully operated on without serious complication. There were 13 cases with anterior skull base tumor, all were removed completely. There were 28 cases with sella region tumor, 21 totally resected, 7 subtotally resected. There were 20 cases with petroclival region tumor, 12 totally resected, 5 subtotally resected, 3 partially resected. There were 14 cases with pterygopalatine fossa and/or infratemporal fossa region tumor, 11 totally resected, 3 subtotally resected. All patients were available for follow-up (mean = 26 months) except 6 cases.</p><p><b>CONCLUSION</b>Image navigation technology can be applied in endoscopic skull base operations with advantages of accurately locating, clearly marking, significantly decreasing incidence of complications, and maximally removing the lesions.</p>

Diagnosis and endoscopic therapy for lateral sphenoid sinus recess lesions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To highlight concepts critical to achieving successful diagnosis and endoscopic therapy for lateral recess of the sphenoid sinus (LRSS) lesions, operative techniques, and avoiding complications in the treatment were discussed.@*METHOD@#Pathology within a lateral recess of a widely pneumatized sphenoid sinus is difficult to access with the use of traditional open and current endoscopic surgical approaches. A new surgical procedure, the endoscopic tranapterygoid approach, directly accesses this region. A clinical experience over several years with this approach is reported as well as a refined and updated description of the technique. Twenty-six patients with LRSS lesions were retrospectively studied, from 2008 to 2013, 11 males and 15 females. Ages ranged from 21 to 68 years (mean 43 years). Radiological investigations consisted of computed tomography (CT) scan and magnetic resonance images (MRI) in all cases. An endoscopic tranapterygoid approach was performed in all patients under general aneasthesia, 4 to resect a middle fossa meningoencephalocele and repair the CSF leak and associated skull base defect.@*RESULT@#All the operations were successful. Patients tolerated the approach well and no significant complications occurred. Post operative pathology made definite diagnosis. Meningoencephalocele 4 cases, sphenoid sinus cyst 10 cases (4 cases only were subtotal resected for it's tight adhesions with optic nerve or internal carotid artery) , fungal sinusitis 5 cases (non-invasive fungal sinusitis, pathogenic funga was aspergillus) chronic sphenoid sinusitis 5 cases. Nine patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia, not given treatment, gradually relieved after 6 months. No recurrence was found during follow-up for 6 to 53 months (mean 23.8 months).@*CONCLUSION@#It had very important implications for high resolution CT combined with MRI in diagnosis of LRSS lesions. In selected cases, the endoscopic tranapterygoid approach enables the otolaryngologist to meet modern demands to treat conditions in the lateral sphenoid using minimally invasive techniques that are well-tolerated by patients. The endoscopic transpterygoid approach is an excellent approach for dealing with LRSS lesions.