ABSTRACT
Introduction: Carotid artery injury (CAI) is the most feared and potentially catastrophic intraoperative complication an endoscopic skull base surgeon may face. With the advancement of transnasal endoscopic surgery and the willingness to tackle more diverse pathology, evidence-based management of this life-threatening complication is paramount for patient safety and surgeon confidence. Objectives: We review the current English literature surrounding the management of CAI during endoscopic transnasal surgery. Data Synthesis The searched databases included PubMed, MEDLINE, Cochrane database, LILACS, and BIREME. Keywords included sinus surgery, carotid injury, endoscopic skull base surgery, hemostasis, transsphenoidal and pseudoaneurysm. Conclusions: Review of the literature found the incidence of CAI in endonasal skull base surgery to be as high as 9% in some surgeries. Furthermore, current treatment recommendations can result in damage to critical neurovascular structures. Management decisions must be made in the preoperative, operative, and postoperative setting to ensure adequate treatment of CAI and the prevention of its complications such as pseudoaneurysm. Emphasis should be placed on surgical competency, teamwork, and technical expertise through education and training...
Subject(s)
Humans , Carotid Artery Injuries , Endoscopy , Hemorrhage , Review Literature as TopicABSTRACT
A abordagem cirúrgica do saco lacrimal por via intranasal assistida por videoendoscopia é, hoje, realizada com altos índices de sucesso. Apesar da técnica tradicional por via externa apresentar resultados bastante satisfatórios, tem a grande desvantagem de necessitar de uma incisão de pele e sua consequente cicatriz local. Com o desenvolvimento e aprimoramento do instrumental e das técnicas endonasais, a abordagem endoscópica é cada vez mais utilizada. OBJETIVO: Este artigo revisa a anatomia do sistema lacrimal, a avaliação pré-operatória e os detalhes técnicos da cirurgia assistida por endoscopia que podem proporcionar os desfechos cirúrgicos mais favoráveis ao paciente. As complicações e as causas de insucesso cirúrgico são também brevemente revisadas. METODOLOGIA: Trata-se de uma revisão da experiência dos autores nos últimos 10 anos de aplicação da técnica endoscópica para cirurgia do saco lacrimal. CONCLUSÃO: Os resultados da dacriocistorrinostomia endoscópica são, no mínimo, iguais aos da técnica tradicional externa. Apesar disto, o trabalho conjunto do oftalmologista e do otorrinolaringologista é muito vantajoso para o melhor manejo possível do paciente com epífora.
The endonasal surgical approach of the lacrymal sac assisted by video-endoscopy is carried out today with high success rates. Despite the satisfactory results reached with the traditional external approach, it has the disadvantage of requiring a skin incision and a consequent local scar. With the development and enhancement of the endonasal techniques, the endoscopic approach is increasingly preferred by surgeons. OBJECTIVE: This paper reviews the lacrymal system anatomy, the preoperative assessment and the technical details of the endoscopic assisted approach which may provide better surgical outcomes for patients. We will also briefly discuss complications and causes for surgical failure. METHODOLOGY: This is a review of the experience of the authors in the past 10 years of employing the endoscopic technique for the lacrymal sac surgery. CONCLUSION: Outcomes regarding the endoscopic dacryocystorhinostomy are, at leas, equal to those from the traditional external approach. Notwithstanding, the joint work between the otorhinolaryngologist and the ophthalmologist is of great benefit to patients with epiphora.
Subject(s)
Humans , Dacryocystorhinostomy/methods , Lacrimal Duct Obstruction/surgery , Dacryocystorhinostomy/adverse effects , Natural Orifice Endoscopic Surgery/methodsABSTRACT
La epífora producida por obstrucción del conductor nasolagrimal ha sido tratada tradicionalmente con una dacriocistorrinostomía externa (DCR). La DCR endonasal puede ofrecer asimismo una tasa elevada de permeabilidad prolongada del conducto sin requerir una incisión nasal externa y sin interrupción del ligamento de canto medial y el efecto posterior que esto puede tener sobre el mecanismo de bomba lagrimal. Esta revisión describe la técnica de la DCR endonasal de alta potencia y resume los resultados logrados con esta técnica.
Epiphora caused by obstruction of the nasolacrimal ducthas traditionally been treated with an external dacrocystorhinostomy (DCR). Endonasal DCR can offersimilarly high rate of long term duct patency without requiring an external nasal incision and without the disruption of the medial canthal ligament and subsequent effect that this may have on the lacrimal pump mechanism. This review describes the technique of powered endonasal DCR and summarises the results achieved with this technique.