1,720,997 research outputs found
The endoscopic diving technique in pituitary and cranial base surgery: Technical note
No full textObjective: We used the diving technique to go beyond mere visualization of the surgical field and used it as an important step in removing the lesion itself, improving the optical field, and optimizing visualization with a dynamic fluid film lens. Likewise, having extended endoscopic endonasal surgery to the entire base of the skull and in particular to the sinus cavity, "diving surgery" has proven to be effective in visualizing and dissecting more extended tumors. Methods: We performed diving surgery in more than 350 surgical procedures to remove lesions in the sellar, sinus cavity, and clival regions. Intrasellar hydroscopy was performed in all cases to check that the lesion was removed completely and to gently dissect any intracavitary residual tumoral tissue. Diving surgery can be performed in the sellar cavity, in the cavernous sinus, and at the level of the posterior cranial fossa in the cavity obtained after clivectomy. Results: The hydrodissection and continuous flushing of the sellar cavity, together with better control of bleeding, allow the surgeon to perform piecemeal removal of the lesion with direct control of the cleavage plane and tumor residue and avoid blind curettage near the pituitary gland. This technique is particularly useful in identifying small infiltrations of the cavernous sinus and in checking the integrity of the pituitary stalk when instruments are introduced into the sella. Conclusion: Diving surgery is a useful step in dealing with minor complications that can occur during endonasal endoscopic surgical procedures. Copyright © 2010 by the Congress of Neurological Surgeons
Direct fascia lata reconstruction to reduce donor site morbidity in endoscopic endonasal extended surgery: A pilot study
No full textObjective Fascia lata is a validated source of autologous grafts, adopted by many surgical figures throughout different types of reconstructive procedures. Postoperative pain and muscle prolapse are frequent complications after harvesting fascia lata; donor site morbidity causes delayed mobilization and increased lenght of hospital stay. In our department fascia lata is used as autologous graft in reconstruction of skull base after extended endoscopic transsphenoidal surgery (EETS) and the thigh defect is usually repaired with allograft to restore tissue continuity and avoid muscle prolapse. Our aim was to evaluate the post-operative pain and muscle prolapse in a group of patients who underwent EETS with fascia lata reconstruction with allograft. Methods We retrospectively analyzed clinical data of 11 patients who underwent harvesting and reconstruction of fascia lata during EETS, collected in our department of Neurosurgery between January 2012 and September 2015. "Pain on rest" and "pain on walking" data were collected daily according to the Numerical Rating Scale (NRS) system, during hospital stay until sutures removal and 1 month after surgery. Furthermore, the degree of muscle prolapse was analyzed at the time of sutures removal and 1 month following surgery. Results 11 patients were studied between January 2012 and September 2015: 4 men and 7 women (1:1.75). Mean age 53.6 ± 11.1 years. During the post-operative stay, "pain on rest" and "pain on walking" values of all patients did not exceed grade 4 of NRS. While removing sutures, "pain on rest" resulted grade 1 of NRS in 27.3% (3/11) patients, while "pain on walking" was grade 1 of NRS in 18.2% (2/11) and grade 2 in 9.1% (1/11). After a month of surgery "pain on rest" reduced to NRS grade 1 in 9.1% (1/11), while patients NRS results for "pain on walking" were the same as the previous evaluation. Mean duration of hospital stay was 5.7 ± 2.28 days. 10 patients were discharged home, only 1 patient was transferred to a rehabilitation ward. No visible nor palpable muscle prolapse was found in our group of patients during the entire assessment. Conclusion Findings show how fascia lata reconstruction with allograft reduced post-operative discomfort and muscle prolapse in our serie; it also permitted their early mobilization and discharge. These are promising results. However further studies are needed to see this technique approved
Endonasal approaches to the sellar and parasellar regions: Closure techniques using biomaterials
No full textPurpose: We reviewed the clinical outcomes resulting from various closure techniques used following endoscopic endonasal surgery for lesions in the sellar and parasellar regions. We compared our current closure technique, which uses a biological matrix of native equine collagen (TissuDura) fixed with fibrin sealant (Tisseel), with the technique we employed previously, using autologous materials, in order to assess the comparative efficacy and tolerability of both methods over the medium- to long-term. Methods: A review was conducted of all cases of endonasal endoscopic intervention carried out in our institution between 1997 and 2007. Operations performed between January 1st 1997 and December 31st 2003 involved a sellar closure technique using autologous materials, either alone or supported by fibrin sealant. From January 1st 2004, sellar reconstruction techniques involving resorbable heterologous materials were used in the closure phases. Post-operatively, clinico-endoscopic assessments took place at 15 days, 1, 3, and 6 months and yearly thereafter, supplemented by magnetic resonance imaging (MRI) scanning at 3 months and annually. Results: Between January 1st 1997 and December 31st 2003, 79 operations were performed in which the sellar closure technique involved the use of autologous materials. Between January 1st 2004 and January 1st 2008, 125 operations were performed in which biomaterials were used for sellar closure. The incidence of complications (fluid fistula) was 2.5% in the autologous materials closure group and 1.6% in the biomaterials closure group. The most marked difference between the two approaches was seen at 1-month follow-up, when restoration of mucociliary transport in the sphenoidal sinus and physiological functionality of the nasal mucosa and paranasal sinuses were observed to be superior in the biomaterials patient cohort. Conclusions: The development of biomaterials for closure of the sellar floor offers a viable alternative to traditional techniques using autologous materials. © 2009 Springer-Verlag
Metachronous sites of osteonecrosis of jaw (ONJ) in all four quadrants of maxilla bones and mandible: a case report
No full textCochlear Implantation as a Treatment for Sudden Autoimmune Sensorineural Hearing Loss in a Patient Affected by Eosinophilic Granulomatosis with Polyangiitis: A Case Report and A Review of Literature
No full textObjective: To report presentation, diagnostic process, management and outcome of a case of autoimmune inner ear disease (AIED) related with Churg-Strauss syndrome, also known as eosinophilic granulomatosis with polyangiitis (EGPA), treated with cochlear implantation, and review of relevant literature. Case presentation and management: A retrospective case report of AIED associated with EGPA treated with cochlear implantation was described. A multi-step approach for diagnosis and confirmation of AIED and hearing rehabilitation was conducted, eventually leading to left cochlear implantation. Results: The surgery was without complications and postoperative course was uneventful. Two years after surgery, pure-tone and speech soundfield audiometry with left cochlear implant switched on showed a good improvement in pure-tone threshold and a word recognition score of 50% at 60 dB nHL. Literature review does not report any previous case of AIED EGPA-related. Conclusions: Cochlear implantation in AIED EGPA-related have been shown to be a viable treatment option in a stabilized phase of disease
Endoscopic treatment of maxillary inverted papilloma
No full textObjectives: Evaluate the efficacy of endoscopic treatment in maxillary inverted papilloma (IP). Methodology: Between July 2002 - April 2008, 20 patients affected by maxillary localization of IP were treated in our Clinic. All patients underwent endoscopic treatment consisting of an endoscopic medial maxillectomy (simple or extended), or attachment-site endoscopic tumour surgery. Results: The cohort was composed of 20 patients (♂: 15, ♀: 5), mean age 58 years, and included 21 endoscopic resections of maxillary IP. Minimum follow-up: 24 months, mean follow-up: 50 months. We registered only 1 case of tumour persistence/recurrence after 15 months, which underwent a second endoscopic treatment. No association with malignant lesions was noted. The efficacy of the endoscopic treatment was 95% after primary surgery, and 100% after endoscopic revision. Conclusions: Our experience demonstrates the efficacy of endoscopic treatment in maxillary IP. Based on its reduced morbidity in comparison to external approaches and its good control of the disease, we consider it our standard treatment for maxillary-originated inverted papilloma
The role of clarithromycin in the management of chronic rhinosinusitis
No full textThe anti-inflammatory effects of macrolides, particularly clarithromycin, have been described in patients with chronic rhinosinusitis without polyps and also other chronic inflammatory airway diseases. There is no consensus in the literature on the efficacy of clarithromycin in patients with chronic rhinosinusitis with sinonasal polyposis. The purpose of this study is to evaluate the efficacy and safety of prolonged low-dose clarithromycin therapy in patients with chronic polyp rhinosinusitis (CRSwP) after endoscopic breast surgery (ESS)
Main corridors in the transphenoidal skull base surgery
No full textSphenoid sinus is very close to important and vulnerable structures of the skull base and therefore a delayed diagnosis and treatment can be potentially lethal. Endoscopic sinus surgery is a safe and effective technique that allows a direct route to the sphenoid sinus and therefore is considered the gold standard for the surgical approach to this region. Over the years, the indications for transnasal approaches in skull base surgery have extended in order to obtain an adequate resection of the pathology as with other conventional approaches, with a minor morbidity and an equal efficiency. Many classifications, divided in base of intracranial pathology or intracranial anatomical landmarks, have been proposed to define the transnasal corridors in base of the localization through the middle cranial base. In this chapter, we propose a review of classification of transsphenoidal skull base approaches and show the main transnasal corridors to the sphenoid sinus based on the anatomical sphenoidal target and extension of pathology
The role of Leptin in laryngeal squamous cell carcinoma
No full textLeptin is a peptide produced by peptidergic cells or those able to process and secrete peptides. Originally, this function was considered proper and exclusive of certain neurons of the magnocellular and parvicellular hypothalamus. These cells originated from a common precursor, namely neural crest cells, which have the ability to produce hormonal neuropeptides. From this primitive neuroectodermal site, cells migrate to other organs: the gastro-entero-pancreatic system (GEP), the lung, heart, reproductive and urinary systems. Leptin is considered the typical neuropeptide with an anorexic function, and is also called the “satiety hormone” because it plays a key role in the control of energy expenditure and food intake. Leptin was identified for the first time in white and brown adipocytes. Although initially thought to be exclusively expressed and secreted by adipocytes, leptin has been identified in other tissues related with nutritional homeostasis, such as gastric and salivary glands. In addition, leptin or its receptors have been observed in gastric, colorectal and breast cancers. It is believed to have a role in stimulating cell proliferation, and is associated with a risk of developing cancer as well as progression and invasiveness. To date, the role of leptin in the development of the carcinoma of the larynx has been poorly investigated. The principal endpoint of this chapter was to evidence the peptidergic immunohistochemical expression of leptin in laryngeal SCCs, its possible role in cell proliferation and the prognostic factor and predictor of locoregional recurrences
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