Surgical Treatment of Concha Bullosa: A Comparison of the Short-term Results of Crushing and Lateral Laminectomy with and without Mucosal Preservation.

Pneumatized middle turbinate (Concha bullosa) is one of the commonest intranasal anatomical variants. Surgery is the effective method to control symptomatic concha bullosa, however, still no clear definition for the best surgical technique. The aim of our study to assess and compare the short-term outcomes of crushing and lateral laminectomy with and without mucosal preservation in the surgical treatment of symptomatic concha bullosa. Thirty patients who underwent concha bullosa surgery (a total of 42 conchae surgeries) were included in this prospective randomized study. Patients were allocated consecutively and equally into 3 groups: Group A (lateral laminectomy without mucosal preservation, n = 10), Group B (lateral laminectomy with mucosal preservation, n = 10) and Group C (Crushing, n = 10). Patients underwent the preoperative and postoperative visual analogue score (VAS) for nasal obstruction and headache, sinonasal outcome test-22 (SNOT-22) and olfactory detection test. All patients were arranged to postoperative reevaluation for 3 months. All groups showed strong significant improvement in VAS results, SNOT-22 and smell test between preoperative and postoperative scores (P < 0.001). There was a significant difference between the three groups only upon comparing lateral laminectomy groups with crushing group. No significant differences were detected between group A and B regarding all the evaluated variables. According to our results, lateral laminectomy was more advantageous than crushing in surgical management of concha bullosa. Moreover, lateral laminectomy without mucosal preservation was as effective as lateral laminectomy with mucosal preservation and there is no detectable difference between both techniques.

Comparing The Effects of Botulinum toxin-A and multiple surgical parasympathectomy on treatment of allergic rhinitis.

OBJECTIVE: Allergic rhinitis (AR) is a common disease with a recent increasing in prevalence. Traditional treatment strategies of AR, sometimes, show limited effectiveness and side effects. Intranasal injection of Botulinum toxin type A (BTX-A) and multiple postganglionic parasympathectomy of pterygopalatine ganglion (PPG) are among the increasingly used alternative treatment options of AR. In this study, we compared the early efficacy of BTX-A and multiple surgical parasympathectomy (MSP) on treatment of uncontrolled AR. METHODS: Sixty patients who were diagnosed with uncontrolled AR, were recruited to the study. Participants randomly underwent either intranasal injection of BTX-A (45 IU in each nostril) (Group A) or bilateral MSP (Group B). All patients were evaluated in terms of nasal hypersecretions, congestion and sneezing with visual analogue scale prior to treatment and at weeks 1, 2, 4, 8, 12 and 6 months during the follow-up period. RESULTS: A significant difference in the degree of nasal hypersecretions and sneezing could be identified in both groups before and after the interventions. Although the significant efficacy on sneezing was documented in group A and B only in the first 4 and 8 weeks, respectively, such efficacy on nasal hypersecretions extended for 12 weeks in group A and throughout the follow-up period in group B. Nasal congestion did not differ significantly in both groups. CONCLUSION: Both BTX-A and MSP, in patients with uncontrolled AR, may be a long-lasting therapeutic option for the treatment of nasal hypersecretions, but not as effective as for sneezing and nasal congestion.

Endoscopic transsellar transdiaphragmatic approach for extensive suprasellar pituitary macroadenomas.

OBJECTIVE: In pituitary macroadenomas with extensive suprasellar extension (SSE), suprasellar region can be approached by extending exposure either anteriorly by adding bone removal of the tuberculum sellae and planum sphenoidal or posteriorly from inside the sellar cavity through diaphragma sella. The later approach has been rapidly regressed in favor of the anteriorly extended approach, mainly due to the inadequate angled illumination. Benefiting from the continuous evolution of visualization, authors, in current series, tried to revive this technique in form of pure endoscopic trans-sellar trans-diaphragmatic approach (ETSDA) for extra-capsular resection of pituitary macroadenomas with extensive SSE. METHODS: A prospective review including 10 patients of pituitary macroadenomas with extensive SSE more than 10 mm underwent extra-capsular resection via the ETSDA. The detailed technical nuances and surgical outcome of this approach were evaluated. RESULTS: Six of 10 patients had SSE > 10 mm and 4 patients had SSE > 20 mm, grade B and C, respectively. Gross total resection was achieved in all cases. Postoperatively, visual field deficit was ameliorated to varying degrees in all patients. There were no serious intraoperative complications, and the clinically overt postoperative CSF rhinorrhea was not observed in any case. CONCLUSION: Extra-capsular resection of pituitary macroadenomas with extensive SSE can be effectively and safely achieved using the ETSDA. Thus, it may be more preferable to the anteriorly extended approach that may potentially increase the risk for postoperative CSF rhinorrhea.

Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation.

OBJECTIVES: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing. METHODS: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A - with no intrasellar packing, Group B - with haemostatic materials packing, and Group C - with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome. RESULTS: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. CONCLUSIONS: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our preferred technique, at least if no intraoperative CSF leakage is evident.