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1.
Rev. Hosp. Ital. B. Aires (2004) ; 41(4): 187-192, dic. 2021. ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1366967

ABSTRACT

La sinusitis micótica alérgica es una enfermedad inflamatoria de la mucosa rinosinusal producida por hongos que pueden aislarse de la cavidad de nasal de individuos sanos. Se produce indirectamente por los hongos que actúan como antígeno y desencadenan una reacción inmunológica mediada por IgE que origina pólipos y una secreción mucosa espesa con detritus e hifas denominada mucina. Su presentación clínica más frecuente es una sinusitis crónica unilateral o bilateral con pólipos. Con menos frecuencia, las sustancias originadas por la desgranulación de los eosinófilos producen remodelación o destrucción ósea y la sinusitis puede simular una neoplasia. Se describe el caso clínico de un paciente que padeció una sinusitis micótica alérgica con destrucción ósea masiva de la base del cráneo y que tuvo extensión intracraneal extradural e intraorbitaria de la enfermedad. Fue tratado con éxito mediante cirugía y corticoides. (AU)


Allergic fungal sinusitis is an inflammatory disease of the rhinosinusal mucosa caused by fungi that can be isolated from the nasal cavity of healthy individuals. The pathology is produced indirectly by the fungus that acts as an antigen and triggers an IgE-mediated allergic reaction that causes polyps and a thick mucous discharge with detritus and hyphae called mucin. Its most common clinical presentation is unilateral or bilateral chronic sinusitis with polyps. Less commonly, substances originated by the degranulation of eosinophils cause bone remodeling or destruction, and sinusitis can simulate a neoplasia. We describe the clinical case of a patient who suffered from allergic fungal sinusitis with massive bone destruction of the skull base and who had intracranial, extradural and intraorbital extension of the disease. He was successfully treated with surgery and corticosteroids.Key words: allergic fungal sinusitis, intracranial extension, endoscopic surgery, transorbital transpalpebral approach. (AU)


Subject(s)
Humans , Male , Middle Aged , Sinusitis/diagnostic imaging , Skull Base/physiopathology , Rhinitis, Allergic/diagnostic imaging , Invasive Fungal Infections/diagnostic imaging , Curvularia/pathogenicity , Sinusitis/surgery , Sinusitis/drug therapy , Prednisone/administration & dosage , Skull Base/surgery , Budesonide/administration & dosage , Rhinitis, Allergic/surgery , Rhinitis, Allergic/drug therapy , Invasive Fungal Infections/surgery , Invasive Fungal Infections/drug therapy
2.
Braz. j. otorhinolaryngol. (Impr.) ; 87(6): 689-694, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1350338

ABSTRACT

Abstract Introduction: Endoscopic access to the sellar region by videoendoscopy shows a low rate of surgical complications, with findings that indicate risk factors for reducing morbidities during and after the postoperative period. Objective: To evaluate, over a nine-year period, the acquisition of skills by the anterior skull base surgical team, according to the time of elimination of nasal crusts and/or the presence of morbidities in the postoperative follow-up of individuals treated in a tertiary public hospital. Methods: After confirming the diagnosis of skull base pathologies, the individuals in this study underwent endoscopic surgery according to the rostrocaudal or coronal axis. For the skull base reconstruction, the nasoseptal flap (associated or not with fascia lata with thigh fat) or free graft was used; clinical follow-up of individuals occurred for a minimum period of 12 months. To assess the impact of the surgical approach on patient clinical evolution, qualitative data related to smoking, post-nasal discharge, nasal flow, smell, taste, clinical symptoms of headache, cranial paresthesia, comorbidities and postoperative morbidities were obtained. Results: The most frequent diagnosis was pituitary macroadenoma (84.14%). The mean absence of crusts in this cohort was 124.45 days (confidence interval 95% = 119.50-129.39). There was a low cerebrospinal fluid fistula rate (3%). Reconstruction with the nasoseptal flap with a fat graft was an independent variable that recorded the highest mean time for the elimination of nasal crusts (=145 days, confidence interval 95% = 127.32-162.68). Allergic rhinitis and smoking were shown to be the most important and independent variables that increased the mean time to eliminate nasal crusts. Conclusion: The mean time to eliminate nasal crusts did not change over the years during which the procedures were performed, demonstrating the adequate training of the surgical team. Debridement and nasal irrigation with saline solutions should be performed more frequently and effectively in patients with allergic rhinitis, smokers and those who received the nasoseptal flap and fascia lata graft with autologous fat.


Resumo Introdução: O acesso endoscópico à região selar por videoendoscopia demonstra baixo índice de complicações cirúrgicas, com achados que apontam fatores risco para reduzir as morbidades durante e após o período pósoperatório. Objetivo: Avaliar fatores morbidades no seguimento pós-operatório de indivíduos atendidos em um hospital público terciário. Método: Depois de confirmado o diagnóstico de doenças da base do crânio, os indivíduos deste estudo foram submetidos a cirurgia endoscópica conforme o eixo rostrocaudal ou coronal. Para a reconstrução da base do crânio usava-se o retalho nasoseptal (associado ou não à fáscia lata com gordura de coxa) ou enxerto livre; o seguimento clínico dos indivíduos ocorreu por um período mínimo de 12 meses. Para avaliar o impacto da abordagem cirúrgica na evolução clínica dos pacientes foram obtidos os dados qualitativos relativos ao tabagismo, descarga pós-nasal, fluxo nasal, olfato, paladar, sintomas clínicos de dor de cabeça, parestesia craniana, comorbidades e morbidades pós-operatórias. Resultados: O diagnóstico mais frequente foi o macroadenoma hipofisário (84,14%). A média da ausência de crostas nesta coorte foi de 124,45 dias (intervalo de confiança [95% CI] 119,50-129,39). Baixo índice de fístula liquórica (3%). A reconstrução com o retalho nasoseptal com enxerto de gordura apresentou-se com variável independente que necessitou de maior tempo médio para a eliminação de crostas nasais (=145 dias, 95% CI 127,32-162,68). A rinite alérgica e o tabagismo se demonstraram como as variáveis mais importantes e independentes para aumentar o tempo médio de eliminação de crostas nasais. Conclusão: O tempo médio de eliminação de crostas nasais não se alterou ao longo dos anos em que os procedimentos foram feitos. Deve-se fazer com maior frequência e eficácia o debridamento e as irrigações nasais com soluções salinas nos pacientes com rinite alérgica, tabagistas e os que usaram o retalho nasoseptal e enxerto de fáscia lata com gordura autóloga.


Subject(s)
Humans , Reconstructive Surgical Procedures , Postoperative Period , Retrospective Studies , Follow-Up Studies , Morbidity , Treatment Outcome , Skull Base/surgery , Endoscopy , Nasal Septum/surgery
3.
Article in Chinese | WPRIM | ID: wpr-942596

ABSTRACT

Objective: To investigate the treatment method and effect of surgical resection and free flap repair of recurrent malignant tumors of maxillofacial paranasal sinus and skull base. Methods: The clinical data of 9 patients with recurrent maxillofacial paranasal sinus and skull base malignant tumors who underwent surgical resection and free flap repair in the Department of Otorhinolaryngology Head and Neck Surgery of Shandong Provincial Hospital from August 2009 to May 2019 were analyzed retrospectively, including 5 males and 4 females, aged 32-69 years. There were 4 cases of squamous cell carcinoma, 3 cases of adenoid cystic carcinoma, 1 case of myoepithelial carcinoma and 1 case of malignant fibrous histiocytoma. All patients were repaired with anterolateral femoral flap. The treatment process and postoperative effect were analyzed by descriptive statistics. Results: All patients were followed up from 16 months to 6 years. There were 6 cases of recurrence after operation, including 1 case of local recurrence and 5 cases of skull base and craniocerebral recurrence. The median tumor free survival time of recurrent patients was 35 months. Conclusion: Surgical resection and free flap repair can effectively prolong the life of patients with recurrent maxillofacial paranasal sinus and skull base malignant tumors.


Subject(s)
Carcinoma, Squamous Cell/surgery , Female , Free Tissue Flaps , Humans , Male , Neoplasm Recurrence, Local/surgery , Reconstructive Surgical Procedures , Retrospective Studies , Skull Base/surgery
4.
Article in Chinese | WPRIM | ID: wpr-942554

ABSTRACT

Objective: To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy. Methods: The total excision rate, postoperative complications and postoperative curative effect of 7 patients (4 males and 3 females, aging from 32 to 63 years old) who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed. All patients were followed up for 6 to 36 months. The postoperative MRI, clinical symptoms and recurrence were reviewed. Descriptive statistical methods were used for analysis. Results: Among the 7 patients, there were total resection (complete resection of cyst contents and capsule) in 4 patients, near-total resection (complete resection of cyst contents, incomplete resection of cyst capsule) in 1 patient, and subtotal resection (incomplete resection of cyst contents and capsule) in 2 patients. The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms. One case had postoperative cerebrospinal fluid rhinorrhea, which was cured after lumbar drainage and nasal iodoform gauge packing. Up to now, 7 patients (including patients with partial resection) had no recurrence. Conclusion: Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.


Subject(s)
Adult , Cholesteatoma , Endoscopy , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Retrospective Studies , Skull Base/surgery
5.
Article in Chinese | WPRIM | ID: wpr-942453

ABSTRACT

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.


Subject(s)
Adult , Carotid Artery, Internal/surgery , Female , Humans , Infratemporal Fossa , Male , Middle Aged , Neoplasm Recurrence, Local , Petrous Bone/surgery , Skull Base/surgery , Skull Base Neoplasms/surgery
6.
Article in Chinese | WPRIM | ID: wpr-942388

ABSTRACT

Objective: To evaluate the value of Hadad-Bassagasteguy flap (HBF) in endoscopic endonasal approaches (EEA) skull base reconstruction by radioanatomic measurements on CT of the skull base of Chinese adults. The following data in terms of anterior skull base defect and reconstruction, sphenoid platform area and middle skull base defect and reconstruction including sphenoid platform and sella area, clivus area defect and reconstruction, and HBF were collected and assessed. Methods: CT image data of 42 Chinese adults were selected to obtain radioanatomic measurement data related to HBF, anterior skull base defect and reconstruction, middle skull base defect and reconstruction, and defect and reconstruction of clivus area. SPSS 26.0 software was used to analyze the data. Results: The radioanatomic measurement data about HBF and skull base of 42 Chinese adults were obtained. The width of the leading edge of HBF [(37.49±2.86) mm] was 6 mm more than the anterior skull base width at the level of the anterior ethmoidal artery [(30.87±8.61) mm], and the width of the trailing edge of HBF [(42.61±3.95) mm] was also 6 mm more than the anterior skull base width at the level of the sphenoethmoidal junction [(26.79±2.79) mm]. The total length of HBF including the pedicle [(79.68±4.96) mm] was 6 mm more than the length of the anterior skull base reconstruction [(54.06±8.67) mm], and the length of HBF without pedicle [(46.27±3.14)] mm was 6 mm more than the length of anterior skull base defect [(30.87±8.61) mm]. The trailing edge width was 6 mm more than the planum sphenoidal width at the level of the optic strut [(30.87±8.61) mm]. The total length of HBF including the pedicle was 6 mm more than the length of the planum sphenoidal, and the sella reconstruction [(64.44±10.25) mm], also was 6 mm more than the length of the planum sphenoidal reconstruction [(73.61±8.28) mm]. The length of HBF without pedicle was 6 mm more than the length of the planum sphenoidal, and the sella defect [(27.88±3.74) mm], also was 6 mm more than the length of the planum sphenoidal defect [(15.50±3.38) mm]. The width of the leading edge of HBF and the width of the trailing edge were both 6 mm more than the width of clivus reconstruction at the level of the foramen lacerum [(21.68±2.30) mm]. The total length of HBF including pedicles was 6 mm more than the clivus reconstruction length [(67.09±5.44) mm], while the length of HBF without pedicles was also 6 mm more than the clivus defect length [(37.19±3.80) mm]. Conclusions: In this study, the radiosanatomic measurements ensured that HBF could provide sufficient tissue flap for the reconstruction of the anterior skull base and sphenoid plateau and extend the reconstruction area to sella and clivus. Preoperative radiosanatomic measurement can be used to predict the size of HBF required for skull base reconstruction, which provides important guidance for flap harvest.


Subject(s)
Adult , Endoscopy , Humans , Nose/surgery , Reconstructive Surgical Procedures , Skull Base/surgery , Skull Base Neoplasms/surgery , Sphenoid Bone , Surgical Flaps
7.
Article in Chinese | WPRIM | ID: wpr-942383

ABSTRACT

Objective: To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement. Methods: A total of 7 patients (4 males and 3 females, aging from 27 to 65 years old, with a medium age of 48) undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively. The patients included 2 cases of recurrent invasive pituitary adenoma, 3 cases of basal skull meningiomas, 1 case of clivus chondrosarcoma, and 1 case of recurrent nasopharyngeal carcinoma. The lesion extensively infiltrated nasal cavity, extending to the paranasal sinus, bilateral cavernous sinus, sellar region, suprasellar, superior clivus, temporal lobe, pterygopalatine fossa, infratemporal fossa and important intracranial vessels. All the 7 patients were treated under general anesthesia by endoscopic endonasal approach combined with frontotemporal orbitozygomatic approach under the microscope. Total excision rate, intraoperative and postoperative complications and postoperative curative effect were observed. All of them were followed up for 6 to 12 months. The Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Result: Total tumor removal was performed in 5 cases, subtotal removel in 2 cases. There was no complication during the operation. Postoperative severe complications occurred in 2 cases, including 1 case of cerebrospinal fluid rhinorrhea and intracranial infection, which was cured by lumbar cistern drainage and intrathecal injection; 1 case occurred oculomotor nerve paralysis, which recovered during follow-up. Postoperative complications occurred in 1 case of trochlear nerve dysfunction, 2 cases of facial numbness, and 1 case of tinnitus. During follow-up, all patients recovered to varying degrees. There was no bleeding and death after the operation. No tumor recurred during the follow-up period. All patients were recovered well with GOS grade Ⅳ-Ⅴ. Conclusions: Endoscopic transnasal approach combined with microscopic frontotemporal orbitozygomatic approach can remove tumors in one stage, reduce surgical complications and improve surgical effect. It has good application prospects and is suitable for excising complex intracranial and extracranial communicating tumors of widely involving sellar, clivus and petrous apex area.


Subject(s)
Adult , Aged , Endoscopy , Female , Humans , Male , Meningeal Neoplasms , Meningioma , Middle Aged , Pterygopalatine Fossa , Retrospective Studies , Skull Base/surgery , Skull Base Neoplasms/surgery
8.
Article in Chinese | WPRIM | ID: wpr-942380

ABSTRACT

Objective: To evaluate the feasibility of the endoscopic transnasal approach (ETA) and to analyze the outcomes and factors of this surgical technique in the management of the tumor invading the anterior skull base. Methods: A retrospective analysis was performed on 42 patients (31 males and 11 females, with mean age of 49 years) with sinonasal tumor invading the anterior skull base, who underwent ETA from June 2015 to April 2019 in Eye, Ear, Nose and Throat Hospital of Fudan University. Pathologically, there were 15 cases of squamous carcinoma (14 patients with T4bN0M0 and 1 patient with T4bN1M0) and 27 of olfactory neuroblastomas with Kadish stage C. Anterior skull base reconstruction was performed using the vascular pedicled nasoseptal mucoperiosteal flap and fascia lata. Brain non-contrast-enhanced CT was performed on the first postoperative day to exclude massive pneumocephalus, relevant brain edema and subarachnoid hemorrhage. Sinonasal contrast-enhanced MR was performed to assess the extent of the tumor removal. Kaplan-Meier analysis was used to calculate the overall survival (OS) and Cox multivariate regression analysis was used to determine the prognostic factors. Results: The mean duration of the surgery was 452 minutes. Total resection was performed in 36 patients (85.7%), subtotal resection in 2 patients (4.8%) with orbital involvement, partial resection in one patient (2.4%) with injury of the internal carotid artery. One patient (2.4%) underwent the second resection because of the tumor residual, two patients (4.8%) with unsure tumor residual. Mean follow-up was 20 months, with 17 months of median follow-up. One-, two-and three-year overall survival was 86.5%, 76.9% and 64.5%, respectively. For squamous carcinoma, one-, two-and three-year overall survival was 86.2%, 86.2% and 57.4%, respectively. For olfactory neuroblastomas, One-, two-and three-year overall survival was 86.9%, 75.3% and 67.8%, respectively. Multivariate analysis showed that tumor residual (P=0.001) and recurrence (P<0.01) were independent prognostic factors for survival. Conclusions: The ETA is safe and feasible in selected patients with sinonasal tumor invading the anterior skull base. Tumor residual and recurrence are independent prognostic factors for survival.


Subject(s)
Female , Humans , Male , Middle Aged , Nasal Cavity , Neoplasm Recurrence, Local , Nose Neoplasms/surgery , Retrospective Studies , Skull Base/surgery , Skull Base Neoplasms/surgery
9.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(3): 281-286, set. 2018. ilus
Article in Spanish | LILACS | ID: biblio-978813

ABSTRACT

RESUMEN El cavum de Meckel (CM) es un divertículo localizado en la fosa media adyacente al seno cavernoso. Las neoplasias de esta región son extremadamente raras y representan un desafío para el cirujano debido a las estructuras neurovasculares que se encuentran en la región. Para los tumores ubicados en esta área se han descrito diversos abordajes quirúrgicos, los cuales no logran una adecuada exposición a la porción anteromedial del CM. En la última década, se ha postulado el abordaje endoscópico endonasal extendido (AEE) como una alternativa quirúrgica para el manejo de lesiones ubicadas en esta región. Se presenta el caso de un paciente portador de un schwannoma del nervio trigémino situado en el CM derecho tratado mediante AEE.


ABSTRACT The Meckel's cave (CM) is a diverticulum located in the middle fossa adjacent to the cavernous sinus. The neoplasms of this region are extremely rare and represent a challenge for the surgeon due to the neurovascular structures that occupy and surround the parasellar region. For tumors located in this area, several surgical approaches have been described, all of which do not achieve an adequate exposure to the anteromedial portion of CM. In the last decade, the extended endonasal endoscopic approach (EEA) has been postulated as an alternative for the surgical management of tumors located in this region. We present the case of a patient with a trigeminal schwannoma located in the right CM treated by EEA.


Subject(s)
Humans , Male , Adult , Infratentorial Neoplasms/surgery , Neurosurgical Procedures/methods , Endoscopy/methods , Nasal Cavity/surgery , Infratentorial Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Skull Base/surgery , Neurilemmoma/surgery
10.
Rev. Fed. Argent. Soc. Otorrinolaringol ; 25(1): 43-49, 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-1005291

ABSTRACT

INTRODUCCIÓN: El uso del endoscopio junto con el avance de la tecnología ha facilitado la extensión de los límites tradicionales en la cirugía de la base del cráneo, la cavidad nasal y los senos paranasales. OBJETIVO: Describir los hallazgos epidemiológicos, clínicos e histopatológicos en los pacientes intervenidos por cirugía endoscópica avanzada en una unidad de Otorrinolaringología en 40 meses. MATERIAL Y MÉTODOS: Estudio retrospectivo. Los protocolos quirúrgicos e historias clínicas fueron revisados. Se realizó un análisis univariado descriptivo con aplicación de test de Chi-cuadrado para significancia estadística (p<0,05)...


INTRODUCTION: The use of the endoscope and the advance of the technology has facilitated the extension of the traditional limits in the surgery of skull base, nasal cavity and paranasal sinuses. OBJECTIVE: To describe the epidemiologic, clinical and histopathological findings in patients intervened under advanced endoscopic surgery in an Otorhinolaryngology unit in 40 months. MATERIAL AND METHODS: Retrospective study. Surgical protocols and medical records were reviewed. A descriptive univariate analysis was performed with the application of Chi-square test for statistical significance (p <0.05)...


INTRODUÇÃO: O uso do endoscópio junto com o avanço da tecnologia facilitou a extensão dos limites tradicionais na cirurgia da base do crânio, a cavidade nasal e os seios paranasais. OBJETIVO: Descrever os achados epidemiológicos, clínicos e histopatológicos em pacientes submetidos a cirurgia endoscópica avançada em uma unidade de Otorrinolaringologia em 40 meses. MATERIAL E MÉTODOS: Estudo retrospectivo. Os protocolos cirúrgicos e os registros médicos foram revisados. Uma análise descritiva univariada foi realizada com a aplicação do teste Qui-quadrado para significância estatística...


Subject(s)
Humans , Male , Adult , Skull Base/surgery , Skull Base/physiopathology , Natural Orifice Endoscopic Surgery/statistics & numerical data , Postoperative Complications/classification , Postoperative Complications/epidemiology , Retrospective Studies , Craniopharyngioma/epidemiology
11.
Rev. otorrinolaringol. cir. cabeza cuello ; 77(4): 373-379, dic. 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-902790

ABSTRACT

RESUMEN Introducción: La elaboración de colgajos ha representado un cambio en reconstrucción de defectos resultantes de exéresis de tumoraciones de base de cráneo. No siempre indispensables, existen circunstancias, planificados o no, donde debemos emplearlos. Preservando los pedículos de la mucosa, damos cobertura a urgencias intraquirúrgicas, como fístula LCR no sospechada, así como reintervenciones. Objetivo: Presentar nuestra experiencia en pacientes, a quienes hemos realizado colgajo tipo rescue flap. Material y método: Se diseña este colgajo, sin comprometer su pedículo. En caso de fístula, sospecha de ésta o herniación del diafragma selar, se extiende, cubriendo el defecto. Resultados: De 34 pacientes intervenidos de patología hipofisaria endoscópicamente, en 18 diseñamos colgajo tipo rescue flap. 12 casos se elaboraron, no utilizándolos. En 4 pacientes con extenso tumores lo empleamos preventivamente. En 1 caso, de reintervención, previamente con colgajo Hadad izquierdo, realizamos colgajo de mucosa contralateral. En otro, diseñamos un rescue flap derecho, al objetivar salida de LCR, sellamos con este colgajo. No evidenciamos fístulas. Discusión: Esta técnica consiste en levantar parcialmente mucosa del potencial colgajo, preservando su pedículo, pudiendo utilizarse en casos de fístula LCR no programada, o reintervenciones. Sin realizar colgajos innecesariamente. Conclusión: La técnica rescue flap favorece un corredor quirúrgico, menos invasivo, manteniendo mucosa para eventuales reintervenciones.


ABSTRACT Introduction: The development of flaps has represented a change in reconstruction of defects resulting from excision of skull base tumors. It not always indispensable, there are circumstances, planned or not, where we must use them. Preserving the pedicles of the mucosa, we cover intraoperative emergencies, such as unsuspected CSF fistula, as well as reinterventions. Aim: We present our experience where we performed rescue flap. Material and method: This flap is designed without compromising its pedicle. In case of fistula, suspicion of this or herniation of the selar diaphragm, it extends, covering the defect. Results: Of 34 patients who underwent endoscopic surgery for pituitary pathology, in 18 we designed a rescue flap. 12 cases were made, not using them. In 4 patients with extensive tumors we used it preventively. In 1 case, of reintervention previously with left Hadad flap, we performed contralateral mucosa flap. In another, we designed a right rescue flap, when we observed LCR output, we seal with this flap. We did not show fistulas. Discussion: This technique consists in partially lifting the mucosa of the potential flap, preserving its pedicle, and may be used in cases of unscheduled CSF fistula, or reinterventions. Without flapping unnecessarily. Conclusions: The Rescue Flap technique favors a less invasive surgical corridor, maintaining mucosa for posible reinterventions.


Subject(s)
Humans , Male , Female , Middle Aged , Pituitary Neoplasms/surgery , Surgical Flaps , Adenoma/surgery , Reconstructive Surgical Procedures/methods , Skull Base/surgery , Endoscopy/methods , Cerebrospinal Fluid Leak/prevention & control
12.
Rev. chil. neurocir ; 43(1): 53-58, July 2017. ilus
Article in Spanish | LILACS | ID: biblio-869779

ABSTRACT

A pesar del desarrollo de las técnicas quirúrgicas de base de cráneo, los meningiomas petroclivales constituyen un reto para el neurocirujano debido a su localización y relación con estructuras neurológicas y vasculares críticas. Se reportan 2 pacientes con diagnóstico de meningioma petroclival que recibieron tratamiento por etapas incluyendo derivación ventrículo peritoneal asistida por endoscopia para la hidrocefalia, abordaje endonasal endoscópico (AEE) extendido al ápex petroso, keyhole subtemporal y retromastoideo con remoción de la lesión. La evolución fue satisfactoria. Se concluyó que los abordajes endoscópicos y por etapas constituyen una excelente opción en el tratamiento de los meningiomas petroclivales.


In spite of the development of the skull base surgery techniques, petroclival meningiomas are a challenge for neurosurgeon due to their localization and relationship with neurovascular structures. Those are two patient with diagnostic of petroclival meningioma whom received treatment step by step included ventricle peritoneal shunt with endoscopic guide for hydrocephalus, extended endonasal approach to petrous apex, subtemporal and retrosigmoid keyhole. The endoscopic approach is an excellent option in the treatment of petroclival meningioma.


Subject(s)
Humans , Male , Adult , Middle Aged , Nasal Cavity/surgery , Natural Orifice Endoscopic Surgery/methods , Endoscopy/methods , Petrous Bone/pathology , Meningioma/surgery , Meningioma/diagnostic imaging , Ventriculoperitoneal Shunt , Brain Neoplasms , Skull Base/surgery , Hydrocephalus, Normal Pressure , Hypertension , Magnetic Resonance Imaging/methods , Osteotomy/methods , Paresis , Radiosurgery/methods , Tomography, Spiral Computed/methods
13.
Braz. j. otorhinolaryngol. (Impr.) ; 83(3): 349-355, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-889250

ABSTRACT

Abstract Introduction: The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination. Objective: To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. Methods: This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations. Results: The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation. Conclusion: The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.


Resumo Introdução: O grande crescimento no número de cirurgias endoscópicas transnasais para a base do crânio ocorreu a partir de um maior conhecimento anatômico da região; do desenvolvimento de materiais e instrumentais específicos e, principalmente, após o uso do retalho nasosseptal como uma barreira entre o trato sinusal (cavidade contaminada) e o espaço subaracnóideo (área estéril), com redução de grandes riscos de contaminação. Objetivo: Avaliar as complicações otorrinolaringológicas nos pacientes submetidos à cirurgia endoscópica da base do crânio, na qual foi usado o retalho nasoseptal. Método: Estudo retrospectivo, no qual foram avaliados os pacientes submetidos à cirurgia da base do crânio por via endoscópica com retalho nasosseptal, quanto à presença no pós-operatório das seguintes complicações: fístula liquórica, meningite, formação de mucocele, sinéquia nasal, perfuração septal (anterior à septectomia posterior), insuficiência de válvula nasal interna, epistaxe e alteração olfatória. Resultados: Foram avaliados 41 pacientes submetidos à cirurgia. Desses, 35 eram portadores de adenomas hipofisários (macro ou microadenomas; selares e extensão supraselar), três meningiomas (dois de tubérculo selar e um da goteira olfatória), dois craniofaringiomas e um abscesso intracraniano. As complicações observadas foram: fístula liquórica (três pacientes - 7,3%), meningite (três pacientes - 7,3%), sinéquia em fossa nasal (oito pacientes - 19,5%), insuficiência de válvula nasal interna (seis pacientes - 14,6%) e queixa de pioria do olfato (16 pacientes - 39%). O teste olfatório evidenciou anosmia ou hiposmia em 10 pacientes (24,3%). Nenhum paciente apresentou mucocele, epistaxe ou perfuração septal. Conclusão: O uso do retalho nasosseptal proporcionou uma revolução na cirurgia da base do crânio por via endoscópica e tornou os procedimentos mais eficazes e com baixa morbidade, comparado com a via tradicional. Porém, passou a ocasionar morbidades nasais principalmente transitórias, mas em alguns casos permanentes, como hiposmia e anosmia. Assim, torna-se necessário um aperfeiçoamento dessa técnica para proporcionar uma melhoria na qualidade de vida do paciente e diminuir possíveis complicações.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Pituitary Neoplasms/surgery , Brain Abscess/surgery , Craniopharyngioma/surgery , Natural Orifice Endoscopic Surgery/methods , Meningioma/surgery , Nasal Septum/surgery , Postoperative Complications , Surgical Flaps , Retrospective Studies , Treatment Outcome , Skull Base/surgery , Natural Orifice Endoscopic Surgery/adverse effects
14.
Rev. otorrinolaringol. cir. cabeza cuello ; 77(1): 16-26, mar. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-845642

ABSTRACT

Introducción: La cirugía guiada por imágenes corresponde a una herramienta quirúrgica que comienza a desarrollarse a mediados del siglo XX. En 1990 comienza a utilizarse en otorrinolaringología, siendo sus principales indicaciones la cirugía endoscópica de cavidades paranasales y la cirugía de base de cráneo anterior. Objetivo: Analizar y presentar el resultado del uso de cirugía guiada por imágenes en pacientes intervenidos en el Hospital Clínico de la Universidad de Chile (HCUCH). Material y método: Se realizó un estudio retrospectivo incluyendo todos los casos de cirugía endoscópica nasosinusal y base de cráneo asistida por imágenes en HCUCH. La selección para usar la navegación se hizo en base a las recomendaciones de la Academia Americana de Otorrinolaringología. Resultados: De un total de 12 pacientes intervenidos con el uso de navegación, se obtuvo 100% de éxito quirúrgico con disminución de los síntomas y sin complicaciones intraoperatorias. Conclusión: La cirugía asistida por navegación en cavidades paranasales y base de cráneo, es una herramienta de suma utilidad en casos seleccionados que potencia las habilidades quirúrgicas del cirujano sin reemplazar sus conocimientos anatómicos. Otorga seguridad y precisión en cirugías que comprometen estructuras nobles como base de cráneo y órbita entre otros.


Introduction: Image Guided Surgery is a surgical tool that develop in the mid-twentieth century. In 1990 it began to be used in otolaryngology, being its main indications endoscopic surgery of paranasal sinuses and anterior skull base. Aim: To analyze and present the result of image-guided surgery in patients undergoing surgery at the Hospital of the University of Chile. Material and method: A retrospective study included all cases of endoscopic sinus surgery and skull base imaging assisted at the Clinical Hospital of the University of Chile from August 2015 to August 2016. The choice to use the navigation was made in based on the recommendations of the American Academy of Otolaryngology, and analyzed case by case. Results: A total of 12 patients were operated using Navigation, achieving 100 % of surgical success with decreased symptoms and without intraoperative complications. Conclusion: Image Guided Surgery in paranasal sinuses and skull base is a tool very useful in selected cases where enhances the surgeon skills without replacing their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others. their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Endoscopy/methods , Paranasal Sinuses/surgery , Skull Base/surgery , Surgery, Computer-Assisted , Retrospective Studies , Treatment Outcome
15.
Prensa méd. argent ; 103(1): 7-11, 20170000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1379995

ABSTRACT

Los abordajes tradicionales a la base de cráneo incluyen incisiones transcraneales con grandes resecciones óseas, retracción y manipulación del cerebro generando altos índices de morbimortalidad. Los abordajes endoscópicos cambian el enfoque de la base de cráneo permitiendo crear corredores más directos, disminuyendo las complicaciones. Esto comprende un verdadero trabajo en equipo entre Neurocirujanos y Otorrinolaringólogos experimentados. El objetivo de este artículo fue analizar y describir algunos de los abordajes endoscópicos ampliados de base de cráneo.


Traditional approaches to the skull base include transcranial incisions with large bone resections, brain retraction and manipulation, generating high rates of morbidity and mortality. Endoscopic approaches shift the focus of the skull base allowing to create more direct corridors, reducing complications.True teamwork is necessary between experienced Neurosurgeons and Otolaryngologists. The aim of this paper was to analyze and describe some of the extended endoscopic skull base approaches.


Subject(s)
Humans , Patient Care Team , Minimally Invasive Surgical Procedures/methods , Skull Base/surgery , Skull Base/injuries , Endoscopy
16.
Rev. chil. neuro-psiquiatr ; 54(3): 198-206, set. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-830123

ABSTRACT

Introduction: Malignant cranial base neoplasm constitutes a heterogeneous group of lesions with common seat in this localization. In the last years endonasal endoscopic approach has been more used. Methods: It was carried out a descriptive retrospective study of the database of the Service of Neurosurgery of "Hermanos Ameijeiras" Hospital between September 2009 and September 2015 with the objective of determining the results of endoscopic treatment to these lesions. Results: They were treated a total of 12 patients with wicked lesions of the cranial base inside. Six of them corresponded to anterior cranial base: 5 carcinomas (2 indiferenciate carcinoma, 2 carcinomas of scamous cells and 1 adenocarcinoma) and a metastases of renal carcinoma. Other six corresponded to cordoma (3 patients) and hematopoyetic neoplasm (2 plasmocitomas and 1 linfoma). The age average was of 51,1 years with a masculine-feminine relationship of 1,1:1. Conclusions: Surgical resection according to oncological principles can be used with endoscopic technics that in fact are associate with less morbility, better vision, betercompartiments access, nasolacrimal system and medial canthal tendon, absence of facial scar, craniectomy and brain retraction.


Introducción: Las neoplasias malignas de la base craneal constituyen un grupo heterogéneo de lesiones con asiento común en esta localización. En los últimos años el abordaje endonasal endoscópico ha cobrado mayor auge. Métodos: Se realizó un estudio retrospectivo descriptivo de la base de datos del Servicio de Neurocirugía del Hospital "Hermanos Ameijeiras" durante el período comprendido entre septiembre de 2009 y septiembre de 2015 con el objetivo de determinar los resultados del tratamiento endonasal endoscópico a estas lesiones. Resultados: Fueron tratados un total de 12 pacientes con lesiones malignas de la base craneal, 6 de la base craneal anterior dentro de los cuales 5 correspondieron a carcinomas (2 carcinomas indiferenciados, 2 carcinomas de células escamosas y 1 adenocarcinoma) y una metástasis de carcinoma renal. De los 6 de fosa posterior 3 presentaron cordomas y 3 lesiones hematopoyéticas (2 plasmocitomas y 1 linfoma). El promedio de edad fue de 51,1 años con una relación masculino-femenino de 1,1:1. Conclusiones: La resección quirúrgica acorde a los principios oncológicos se puede realizar utilizando las técnicas endoscópicas que incluso se asocian a menor morbilidad, mayor visión, mejor acceso a determinados compartimentos, preservación del sistema nasolacrimal, del tendón cantal medial, ausencia de cicatriz facial, de craneotomía y de retracción cerebral.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Endoscopy/methods , Neurosurgical Procedures/methods , Skull Base Neoplasms/surgery , Skull Base/surgery , Paranasal Sinus Neoplasms/surgery , Retrospective Studies , Treatment Outcome
17.
Arq. bras. neurocir ; 35(2): 128-134, jun.2016.
Article in English | LILACS | ID: biblio-846738

ABSTRACT

The Expanded Endoscopic Endonasal Transtuberculum / Transplanum (EEETT) approach emerged as an amenable option to remove midline lesions, such as giant pituitary tumors, craniopharyngiomas, and tuberculum sellae meningiomas. Herein, the author's aim is to show a stepwise approach to the suprasellar area by EEETT and a case illustration.


A abordagem endoscópica endonasal expandida (AEEE) trans- tubérculo/ trans-plano têm se mostrado uma opção favorável para lesões da linha média para lateral, como tumores da hipófise, craniofaringiomas gigantes e meningiomas selares. O objetivo do autor é demonstrar os passos desta abordagem para a região suprasellar, por AEEE e um caso de ilustração.


Subject(s)
Humans , Female , Aged , Skull Base/surgery , Endoscopy/methods , Skull Base Neoplasms
18.
Arq. neuropsiquiatr ; 73(7): 611-615, 07/2015. graf
Article in English | LILACS | ID: lil-752376

ABSTRACT

Objective The purpose of this study was to describe the endoscopic combined “transseptal/transnasal” approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula.Method Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined “transseptal/transnasal” approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.Results Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%).Conclusion The endoscopic combined “transseptal/transnasal” approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.


Objetivo O objetivo deste estudo foi descrever o acesso endoscópico transeptal/transnasal combinado com a criação do flap naso-septal pediculado para reconstrução da base do crânio em cirurgias de resseção de adenoma de hipófise, especialmente nos casos que ocorrem fístula líquido cefalorraquidiano (FLC).Método Noventa e um pacientes consecutivos portadores de adenoma de hipófise foram retrospectivamente revisados. Complicações pós-operatórias relacionadas ao flap foram analisadas.Resultados Fístulas líquido cefalorraquidiano intra e pós-operatórias foram observadas em 36 (40%) e 4 (4,4%) dos pacientes, respectivamente. Entre os 4 pacientes, drenagem lombar e repouso absoluto foram suficientes para o fechamento da fístula e intervenção cirúrgica foi necessária em apenas um paciente. Outra complicação relacionada ao flap foi o sangramento em 3 (3,3%) dos pacientes.Conclusão O acesso endoscópico transeptal/transnasal combinado é melhor aplicado quando realizado por dois cirurgiões e o flap naso-septal é uma técnica eficaz para prevenção de fístula pós-operatória em cirurgias de hipófise.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Adenoma/surgery , Cerebrospinal Fluid Leak/prevention & control , Fistula/prevention & control , Natural Orifice Endoscopic Surgery/methods , Pituitary Neoplasms/surgery , Skull Base/surgery , Surgical Flaps/surgery , Cerebrospinal Fluid Leak/etiology , Fistula/etiology , Nasal Cavity/surgery , Nasal Septum/surgery , Natural Orifice Endoscopic Surgery/adverse effects , Postoperative Complications/prevention & control , Reproducibility of Results , Retrospective Studies , Risk Factors , Reconstructive Surgical Procedures/methods , Time Factors , Treatment Outcome
20.
Rev. chil. neurocir ; 38(2): 99-104, dic. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-716543

ABSTRACT

Los meningiomas clinoideos son tumores benignos originados en la leptomeninges que rodea el proceso clinoideo anterior, representando el 17 por ciento de los basales. Con el objetivo de caracterizarlos se estudiaron los pacientes operados en el Servicio de Neurocirugía del Hospital Hermanos Ameijeiras (2000 al 2010). La serie estuvo integrada por 10 pacientes, 9 mujeres y un hombre, la edad promedio fue de 49,8 años, clínicamente caracterizados por cefalea (10 pacientes) y déficit de la agudeza visual (9 pacientes). A todos se les practicó un abordaje frontotemporal-orbitozigomático (FTOZ) alcanzándose 7 resecciones totales y 3 subtotales, 3 pacientes sufrieron complicaciones, al alta ocho de los diez operados egresaron en excelente estado, no tuvimos recidiva ni recrecimiento tumoral en los casos con resecciones parciales y al año de seguimiento la calidad de vida según la escala de Karnofsky fue superior o igual a 80 puntos en todos los casos. Concluimos que los meningiomas clinoideos por su asiento en el centro de la base craneal relacionados anatómicamente con estructuras neurovasculares críticas y por las grandes dimensiones que alcanzan en el momento de su diagnóstico, representan un desafío en la práctica neuroquirúrgica, comportándose en nuestra serie más frecuentes entre las mujeres con la cefalea y el déficit visual monocular como síntomas principales. Las técnicas de base de cráneo y en nuestras manos la craneotomía FTOZ complementadas con osteotomías basales de diferentes grados, han demostrado ser una alternativa eficaz para mejorar la suficiencia de la resección tumoral con mínima morbilidad, ausencia de recurrencias y mortalidad.


Clinoidal meningeomas are benign tumors originated in the liptomeningeo surrounding the anterior clinoidal process representing 17 percent of basal tumors. With the objective to characterize it, studied were patients operated in the neurosurgical service of Hermanos Ameijeiras hospital from 2000 to 2010.The series were composed of 10 patients, 9 female and a male, the mean age was 49.8 years and were clinically characterized with headache (10 patients) and visual deficit (9 patients). To all were practiced a frontotemporal orbitozygomatic approach (FTOZ) reaching 7 total and 3 subtotal removal,3 patients suffered complications, 8 out of 10 patients operated were discharged in good condition. There was no recurrence after total removal and after a year of fellow up, the life quality following Karnofsky scale was superior o equal to 80 points in all the cases. In conclusion Clinoidal meningeomas due to its placement in the cranial base with anatomical relations with critical neurovascular structures and also the great dimension to reach in the moment of its diagnosis represents a challenge to neurosurgical practice. It comports in our series with more frequency within females presenting headache and mono ocular visual defect as the principal symptoms. Craneal base techniques and in our case frontotemporal-orbitozygomatic craniotomy complimented with basal osteotomy of different grades, had demonstrated to be an efficient alternative to better the technique of total removal with less mobility, zero recurrence and mortality.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Skull Base/surgery , Craniotomy , Diagnostic Imaging , Meningioma/surgery , Meningioma/complications , Meningioma/diagnosis , Meningioma/mortality , Meningeal Neoplasms/surgery , Osteotomy , Cuba , Epidemiology, Descriptive , Retrospective Studies
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