Transnasal endoscopic repair of anterior skull base fistulas

CSF rhinorrhea is the leakage of CSF from the subarachnoid space through the nose. CSF rhinorrhea or liquorrhea commonly occurs following head trauma [frontobasal skull fractures], as a result of intracranial surgery, or destructive lesions, however, CSF rhinorrhea may be spontaneous. The incidence of CSF fistula after ESS is less than 1% yet it represents since recently a common cause of iatrogenic CSF fistula. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection which could produce fulminant meningitis, hence the importance of the prompt diagnosis and treatment of such condition. Since the introduction of transnasal endoscopic techniques the morbidity of surgical repair has been significantly reduced when compared with previous intracranial techniques. Is to evaluate the endoscopic endonasal approach in terms of morbidity and efficacy to control CSF fistulas. 43 cases of CSF rhinorrhea operated in the period between 1999 to 2006 are included in this retrospective study. Patients' data preoperatively as regarding history, examination and investigations, as well as operative details and postoperative care and outcome are carefully reviewed, analyzed and compared to the literature. Endoscopic transnasal repair of CSF fistulas in our study had an excellent outcome with a success rate of 95% in the first attempt and reaching up to 100% in the second attempt without any significant postoperative complication. Our leak sites were mainly found in the ethmoidal region [in 67.4%]. The endoscopic repair of CSF Rhinorrhea provides a safe and efficient technique for closure of the anterior and middle skull base sinonasal defects with minimal morbidity and hospital stay

Endoscopic trans-sphenoid approach to pituitary tumors Kasr El-Eini Cairo University hospitals experience

Over the last decades pituitary surgery has been one of the models of the minimally invasive surgeries. Horsley performed the first reported pituitary operation in 1889 through a trans-cranial approach. Schloffer was the first to introduce the trans-sphenoid approach in 1907. Gushing popularized the sublabial trans-septal approach in 1910 and with the introduction of the operating microscope and intra-operative fluoroscopy in the 1950s and 1960s, the trans-septal approach became the gold standard for pituitary surgery. In the 1980s and 1990s, the nasal endoscope became the standard of care in surgery of the nose and PNS. Trans-sphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal specula and nasal packing for some operators. To present the endoscopic trans-sphenoidal approach for surgical treatment of pituitary adenomas and to evaluate its results and complications. From 1996 to 2006 in the Departments of Otorhinohryngology and Neurosurgery in Cairo University Hospital, 310 patients with pituitary adenomas were operated using the trans-sphenoidal endoscopic approach, among which 197 patients had giant adenomas with supra or para sellar extensions. Complete tumor removal was accomplished in 284 patients [91.6%]. Mortality rate was 3 patients [0.97%]. Morbidity rate was 68 patients [21.9%] in the form of transient diabetes insipidus in 64 patients [20.6%], intraoperative CSF leak in 2 patients [0.6%], bilateral visual loss in 1 patient [0.3%] and tension pneumocephalus in 1 patient [0.3%]. The endoscopic trans-sphenoid approach is the management of choice for pituitary adenomas including invasive type. The surgery can be done with minimal morbidity and more radically than classic transsphenoidal surgery. Invasion of the cavernous sinus is no longer a taboo and could he attempted in 68.2% of the cases with a parasellar extension