RESUMO
Difficult access can make identification of a cerebrospinal fluid leak from the lateral wall of the sphenoid sinus very difficult, especially in a well-pneumatized sinus. Access to the sphenoid sinus has become easier with the advancement of minimally invasive endoscopic technology. In this article we describe our approach to a cerebrospinal fluid leak originating from this location, which has not been described previously in the literature.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Seio Esfenoidal/cirurgia , Idoso , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Fascia Lata/transplante , Feminino , Adesivo Tecidual de Fibrina , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Cartilagens Nasais/transplante , Seio Esfenoidal/patologia , Adesivos Teciduais , Tomografia Computadorizada por Raios X , Conchas Nasais/transplanteRESUMO
OBJECTIVES: The purpose of this study is to identify the difference between patients perspectives regarding the given information during the consenting procedure of mastoidectomy and the type of the provided information by the medical practitioners. This subject is becoming increasingly important because of the increase in the medico-legal litigation due to inadequate consenting process. METHODS: Nineteen patients who had undergone mastoid surgery were asked to identify which risks of mastoid surgery they felt were important to be informed of prior to surgery. This was compared to 20 ENT consultants' answers on which risks they routinely discuss with patients preoperatively. RESULTS: Our results show the 'average' patient would expect to be consented for all of the risks we asked about except for keloid scarring and altered taste, compared with the 'average' consultant who would discuss all risks routinely except for bleeding, intracranial complications and keloid scarring. The most obvious difference between doctor patient opinions is the topic of intracranial problems arising from surgery, 84.2% of patients would want to be warned about this but only 20% of surgeons routinely mention it (P-value < 0.001). CONCLUSION: The main reasons for consultants omitting discussion of intracranial complications were their rarity and patients potentially finding it distressing. However, recent court rulings indicate that these reasons are invalid and not giving comprehensive consent may be indefensible.
