Craneofaringiomas: cirugía transnasal via endoscópica / Craniopharyngiomas: endoscopic transnasal surgery

Introducción: Debido a su ubicación anatómica, los craneofaringiomas son tumores complejos en su tratamiento. Una resección completa tiene riesgos elevados de morbimortalidad y si se opta por una resección parcial la tasa de recurrencia es alta. Según su extensión supraselar y su relación con el tallo hipofisario, pueden dividirse en preinfundibulares, transinfundibulares y retroinfundibulares. Objetivo: El objetivo de este video es describir la técnica vía endoscópica para la resección de un craneofaringioma preinfundibular. Materiales y Métodos: Se seleccionó un caso de un paciente con un craneofaringioma preinfundibular operado en el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires, por vía endoscópica transnasal. Resultados: Se realizó una exéresis completa de la masa tumoral, sin evidenciar complicaciones tales como, diabetes insípida o fistula de líquido cefalorraquídeo y con recuperación completa del déficit campimétrico. Conclusión: El tratamiento quirúrgico de los craneofaringiomas requiere un conocimiento detallado de la anatomía de base de cráneo así como de las diferentes técnicas quirurgicas. El uso de la endoscopia ha permitido un mejor acceso a éste tipo de lesiones, disminuyendo las comorbilidades en el paciente y la estadía hospitalaria. Un resultado quirúrgico satisfactorio se obtiene con la resección completa y la menor morbilidad posible para el paciente

Introduction: Due to its anatomical location, craniopharyngiomas are difficult tumors to treat. Complete resection has high morbidity and mortality and if a partial resection is chosen, the recurrence is common. According to their suprasellar extension and its relationship with stalk, it can be classified into: preinfundibular, transinfundibular and retroinfundibular. Objetive: The aim of this video is to describe the surgical technique we use for preinfundibular craniopharyngioma. Methods: We review a preinfundibular craniopharyngioma operated on the Neurosurgery Department of the Hospital Italiano de Buenos Aires, through a transnasal endoscopic approach. Results: Total removal was achived, no acute complications were found such as diabetes insipidus or cerebrospinal fluid leak and improved their visual field. Conclusion: Craniopharyngioma surgery requires detailed knowledge of skull base anatomy and approaches. The use of endoscopy has allowed better access to this type of lesions, reducing comorbidities and patient hospital stay. Complete resection with low morbidity are the treatment of this tumors

Endoscopic Transnasal Repair of Bilateral Choanal Atresia in Neonates: Our Experience

Introduction: Congenital choanal atresia is the developmentalfailure of the nasal cavity to communicate with nasopharynx.The newborn baby presents with intermittent attacks ofcyanosis and respiratory distress soon after birth. Inabilityto pass nasal catheters in both the nares reveals the diagnosisof bilateral Choanal Atresia. Study aimed to present ourexperience with a endoscopic approach for transnasal repairof choanal atresia.Material and Methods: Seven patients with mean age 7 dayswith bilateral choanal atresia,underwent endoscopic repairusing a mucoperichondrial flap from the nasal septum. Thebony stenosis was opened with a surgical curette or drill, andthe raw surface was covered by the flap.Results: A total of 7 choanae were operated. With meanfollow-up 27 months. Out of seven patients operated by us,five patient survived with a patent choana.We had two deaths,one patient expired during the procedure due to bleeding andone patient expired three hour after the procedure due to CCF.Conclusion: Endoscopic repair of choanal atresia is a safe andrapid procedure.

Expanded Endoscopic Transnasal Approach to the Chordoid Glioma of the Third Ventricle : The First Case Ever Reported

Chordoid glioma of the third ventricle is a rare and challenging tumor to surgery because of its unique anatomical location and its close juxtaposition to the neurovascular structures and hypothalamus. The authors report a case of chordoid glioma of the third ventricle in a 43-year-old woman, who presented with headache and somnolence. The tumor was approached by endoscopic transnasal technique with a favorable result. Histopathologic examination disclosed a neoplastic tissue composed of eosinophilic epithelioid cells, mucinous, periodic acid Schiff-diastase positive, extracellular matrix, and scattered lymphoplasmacytic infiltrates. The best treatment option remains controversial. Customarily, the surgical route to remove chordoid glioma is transcranial; however, the undersurface of the optic chiasm and optic nerves preclude an adequate surgical visualization. In contrast, an expanded endoscopic transnasal approach provides a direct midline corridor to this region without any brain retraction.

Endoscopic Transnasal versus Transcaruncular Reconstruction in Isolated Medial Orbital Wall Fractures

PURPOSE: To compare 2 surgical techniques, endoscopic transnasal reconstruction and transcaruncular reconstruction in isolated medial orbital wall fractures. METHODS: This study included 79 isolated medial orbital wall fracture patients from January 2011 to December 2012 of Department of Ophthalmology, Inha University Hospital. The authors compared computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-surgery. Thirty-five patients received endoscopic transnasal reconstruction and 44 received transcaruncular reconstruction. RESULTS: The 2 surgical methods showed no significant differences in primary gaze diplopia (p = 0.50), restriction of EOM movements (p = 0.48), remaining enophthalmos of more than 2 mm (p = 0.99), and improvement in enophthalmos (p = 0.07) when compared 6 months after surgery. Statistically significant differences were observed in peripheral diplopia (p = 0.04) 6 months after surgery. CONCLUSIONS: The 2 surgical methods present similar effectiveness in postoperative primary gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic transnasal reconstruction method showed advantages. The surgical method should be selected by comparing advantages and disadvantages.

Studying anatomical landmarks by the CT Multislides and its application in endoscopic transnasal dacryocystorhinostomy surgery

The study was carried out on 50 adults without physical defects and injuries in head, face, nose, eyes and cavity regions. The result: the height of lachrymal sac was 1.095± 0.036 cm, the width of lachrymal sac was 0.455± 0.020cm, the distance from the inferior turbinate to the lachrymal sac was 1.145± 0.030 cm and the distance from the anterior nasal spine to the lachrymal sac was 4.220± 0.010 cm. The anatomical landmarks in initial step have been applied on 30 patients. The surgery position is exactly determined, there is no mistake in any case, hurting neighboring areas is reduced, less bleeding, surgery and hospitalization time were shortened

Combination Therapy with Endoscopic Removal and Ambisome for Rhinocerebral Aspergillosis Invading Frontal Lobe: Report of a Case / 대한이비인후과학회지

The rhinocerebral aspergillosis invading sinuses and CNS is known to be a fatal desease in immunocompromised patients. The management principle of rhinocerebral aspergillosis is often by extensive surgical removal through craniotomy combined with amphotericin B therapy, and endoscopic removal had not been reported until now. We report in this study a case of rhinocerebral aspergillosis invading the left frontal sinus and the left frontal lobe which were treated by the combination therapy of endoscopic removal and antifungal agents.

Dacryocystorhinostomy with Intraoperative Mitomycin C

Nowadays endscopic transnasal dacryocystorhinostomy(DCR) has been done popularly in patients who had epiphora chronically because of lacrimal obstruction. The most frequent cause of DCR failure is obstruction of osteotomy site due to formation of granuloma. We used the mitomycin C to suppress proliferation of fibroblast to increase success rate. Between July 1996 and september 1997, 15 patients(16 eyes) who had visited ophthalmology department in Seoul Advantist Hospital made went endoscopic transnasal DCR and packed merocel socked with 0.2mg/ml between 3 months to 18 months(mean 11.5 months). One case showed recurrent epiphora 2 months after surgery, and success rate was 94%. In conclusion, endoscopic transnasal DCR with Mitomycin C should be considered to suppress proliferation of granuloma and increase success rate.

A Case of Rathke's Cleft Cyst in the Sphenoid Sinus / 대한이비인후과학회지

Isolated sphenoid sinus disease is difficult to diagnose because of the obscure and nonspecific initial findings of the disease. Because of the complex anatomic relations of the sphenoid, the disease often manifests itself through the neuroophthalmologic complications. We have recently experienced a case of intrasphenoidal symptomatic Rathke's cleft cyst, which was managed by endoscopic transnasal sphenoidotomy approach with good results. The endoscopic approach affords excellent visualization and sufficient exposure of the sinus cavity, and allows easy postoperative inspection of the sphenoid sinus.