Endoscopic management of frontal sinus CSF leaks / Manejo endoscópic de fístulas liquóricas do seio frontal

Abstract Introduction: Endoscopic management of frontal sinus cerebrospinal fluid leaks has become the gold standard of treatment, with high success rates and low morbidity. The aim of this study is to review our experience in managing this challenging condition. Objective: To review our experience in treating frontal sinus cerebrospinal fluid leaks through an endonasal endoscopic approach. Methods: A retrospective evaluation of patients undergoing endoscopic surgery for frontal sinus cerebrospinal fluid leaks was performed. Demographics, defect location and etiology, surgical and reconstructive technique, complications, and postoperative followup were examined. Results: Twenty-two patients with a mean age of 40.4 years were treated surgically by the senior author between 2015 and 2019. Cerebrospinal fluid leak was either traumatic (17) or spontaneous (5). Successful first-attempt endoscopic repair was accomplished in all cases. A combined endoscopic-trephination approach was necessary in 5 patients (22.8%). No serious complications were reported, and frontal sinus drainage pathway was patent in all our cases. Revision surgery was necessary in only 2 patients for synechia formation. The mean patient followup was 22.7 months (range: 7 - 41 months). Conclusion: Progress in the field of endoscopic surgery has shifted the paradigm, establishing endoscopic repair of frontal sinus leaks as the standard of care. A few remaining limits of this approach could be addressed by combining endoscopy with frontal trephination.

Resumo Introdução: O manejo endoscópico das fístulas liquóricas do seio frontal tornou-se o padrão-ouro, com altas taxas de sucesso e baixa morbidade. Objetivo: Revisar nossa experiência no tratamento de fístulas liquóricas do seio frontal por meio de uma abordagem endoscópica endonasal. Método: Foi feita uma avaliação retrospectiva de pacientes submetidos à cirurgia endoscópica para fístulas liquóricas do seio frontal. Dados demográficos, localização e etiologia do defeito, técnica cirúrgica e reconstrutiva, complicações e seguimento pós-operatório foram analisados. Resultados: Foram tratados cirurgicamente pelo autor principal 22 pacientes com média de 40,4 anos entre 2015 e 2019. A fístula liquórica foi traumática (17) ou espontânea (5). O reparo endoscópico foi feito com sucesso na primeira tentativa em todos os casos. Uma abordagem combinada de trefinação e endoscopia foi necessária em 5 pacientes (22,8%). Nenhuma complicação grave foi relatada e a via de drenagem do seio frontal estava patente em todos os nossos casos. A cirurgia de revisão foi necessária em apenas 2 pacientes devido à formação de sinéquia. O seguimento médio dos pacientes foi de 22,7 meses (variação: 7 a 41). Conclusão: O progresso no campo da cirurgia endoscópica mudou o paradigma, estabeleceu o reparo endoscópico de fístulas liquóricas do seio frontal como o padrão de tratamento. Alguns poucos limites remanescentes dessa abordagem podem ser resolvidos pela combinação da endoscopia com a trefinação frontal.

Endoscopic management of frontal sinus CSF leaks.

INTRODUCTION: Endoscopic management of frontal sinus cerebrospinal fluid leaks has become the gold standard of treatment, with high success rates and low morbidity. The aim of this study is to review our experience in managing this challenging condition. OBJECTIVE: To review our experience in treating frontal sinus cerebrospinal fluid leaks through an endonasal endoscopic approach. METHODS: A retrospective evaluation of patients undergoing endoscopic surgery for frontal sinus cerebrospinal fluid leaks was performed. Demographics, defect location and etiology, surgical and reconstructive technique, complications, and postoperative followup were examined. RESULTS: Twenty-two patients with a mean age of 40.4 years were treated surgically by the senior author between 2015 and 2019. Cerebrospinal fluid leak was either traumatic (17) or spontaneous (5). Successful first-attempt endoscopic repair was accomplished in all cases. A combined endoscopic-trephination approach was necessary in 5 patients (22.8%). No serious complications were reported, and frontal sinus drainage pathway was patent in all our cases. Revision surgery was necessary in only 2 patients for synechia formation. The mean patient followup was 22.7 months (range: 7 - 41 months). CONCLUSION: Progress in the field of endoscopic surgery has shifted the paradigm, establishing endoscopic repair of frontal sinus leaks as the standard of care. A few remaining limits of this approach could be addressed by combining endoscopy with frontal trephination.

Trepanación corneal cónica como nuevo perfil de corte para las queratoplastias penetrante y lamelar anterior / Conic corneal trephination as a new cutting profile for penetrating and anterior lamellar keratoplasties

Objetivos: describir las características y empleo de la trepanación corneal cónica. Métodos: se realizó un estudio experimental en el Instituto Cubano de Oftalmología Ramón Pando Ferrer de enero a diciembre de 2010. Se realizó la trepanación en diez globos oculares no útiles para trasplante, con un trépano corneal de vacío que tiene como característica fundamental la creación de un corte oblicuo. Se analizaron los parámetros: longitud del corte, grosor corneal, diámetro externo del botón, diámetro interno del botón y ángulo del corte. Se utilizó la estadística descriptiva para expresar los resultados. Resultados: la longitud media del corte fue de 1 776,7 ± 273,7 mm y el grosor corneal medio a nivel del corte fue de 850,0 ± 119,2 mm, con una diferencia entre estos de 926 mm. El diámetro externo medio del botón corneal fue de 7,6 ± 0,2 mm y el interno de 8,5 ± 0,4 mm, con una diferencia de 0,9 mm. El ángulo de corte medio fue de 28,4 ± 2,1°. Se estableció una fórmula para calcular la longitud o profundidad del corte en base a la paquimetría media del círculo en el que se realizó la trepanación para un ángulo de corte determinado. Conclusiones: se obtuvo un corte regular, simétrico y de mayor longitud que el grosor corneal y con el aspecto cónico planificado. Dicho patrón de corte provee una mayor área de contacto y una tendencia autosellante

Objectives: to describe the characteristics and use of the conic corneal trephination.Methods: an experimental study was performed in Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to December 2010. Ten eyeballs not useful for transplantation underwent trephination, with a corneal vacuum trephine particularly designed to create an oblique corneal cut. The cutting length, the corneal thickness, the external diameter of the disc, the internal diameter of the disc and the cutting angle were the analyzed parameters. Descriptive statistics were applied to show the results. Results: the mean cutting length was 1776.7 ± 273.7 mm and the mean corneal thickness at the cutting point was 850.0 ± 119.2 mm , being the difference between them equals to 926 mm. The mean external diameter was 7.6 ± 0.2 mm and the internal diameter was 8.5 ± 0.4 mm, with a difference of 0.9 mm. The mean cutting angle amounted to 28.4 ± 2.1°. A formula was developed to calculate the cutting length or depth based on the mean pachymetry of the circle where the trephination is performed for a determined cutting angle. Conclusions: aregular symmetric cut was obtained, longer than the corneal thickness with the planned conic profile. Such cutting pattern provides a larger contact surface and self-sealing tendency

Trepanação óssea e extração de molares com equino em posição quadrupedal: Relato de caso / Standing Trepanation and extraction of cheek teeth in horse: case report

As afecções dentárias são de alta incidência em equinos, muitas vezes evoluindo às alvéolos-periostites e sinusites. Nesses casos a extração dos dentes molares e pré-molares envolvidos fazem-se imprescindível, sendo que três técnicas são citadas: trepanação óssea e repulsão de molares sob anestesia geral, bucotomia lateral e extração intraoral sob neuroleptoanalgesia.O objetivo do artigo é relatar o caso de uma égua de 24 anos , utilidade de carroça, com diagnóstico de alvéolo periostite dos dentes 208 e 210, reabsorção do 209 e sinusite. Por dificuldades financeiras e de execução, foi realizada, como opção extrema, a trepanação óssea e repulsão de molares com animal sob neuroleptoanalgesia e em posição quadrupedal, apresentando resultados satisfatórios, sem intercorrências anestésicas e/ou cirúrgicas.(AU)

The dental diseases are of high incidence in horses, many times evolving to alveolar periostitis and sinusitis. In these cases the cheek teeth extraction is essential, being that three techniques are cited: bone trephination and cheek teeth by repulsion, with animal under to general anesthesia; lateral buccotomy and oral extraction, with animal under to neuroleptoanalgesy. The aim of this article is to report the case of a mare with 24 years old,wagon traction utility,with alveolar periostitis diagnosis of the 208 and 210, resorption of the 209 and sinusitis. By financial and execution difficulties, it was carried though, as extreme option, the standing bone trephination and extraction by repulsion, presenting satisfactory results, without anesthesical or surgical complications.(AU)

Trepanação óssea e extração de molares com equino em posição quadrupedal: Relato de caso / Standing Trepanation and extraction of cheek teeth in horse: case report

As afecções dentárias são de alta incidência em equinos, muitas vezes evoluindo às alvéolos-periostites e sinusites. Nesses casos a extração dos dentes molares e pré-molares envolvidos fazem-se imprescindível, sendo que três técnicas são citadas: trepanação óssea e repulsão de molares sob anestesia geral, bucotomia lateral e extração intraoral sob neuroleptoanalgesia.O objetivo do artigo é relatar o caso de uma égua de 24 anos , utilidade de carroça, com diagnóstico de alvéolo periostite dos dentes 208 e 210, reabsorção do 209 e sinusite. Por dificuldades financeiras e de execução, foi realizada, como opção extrema, a trepanação óssea e repulsão de molares com animal sob neuroleptoanalgesia e em posição quadrupedal, apresentando resultados satisfatórios, sem intercorrências anestésicas e/ou cirúrgicas.

The dental diseases are of high incidence in horses, many times evolving to alveolar periostitis and sinusitis. In these cases the cheek teeth extraction is essential, being that three techniques are cited: bone trephination and cheek teeth by repulsion, with animal under to general anesthesia; lateral buccotomy and oral extraction, with animal under to neuroleptoanalgesy. The aim of this article is to report the case of a mare with 24 years old,wagon traction utility,with alveolar periostitis diagnosis of the 208 and 210, resorption of the 209 and sinusitis. By financial and execution difficulties, it was carried though, as extreme option, the standing bone trephination and extraction by repulsion, presenting satisfactory results, without anesthesical or surgical complications.