1,721,026 research outputs found
Prognostic role of EAONO/JOS, STAMCO, and ChOLE Staging for Exclusive Endoscopic and Endoscopic‐Microscopic Tympanoplasty
No full textObjective
The aim of the study is to evaluate cholesteatoma's surgical outcomes in patients treated with endoscopic ear surgery (EES) or a combined endoscopic-microscopic approach (cEMA) according to STAM, STAMCO, ChOLE, and EAONO/JOS system (EJS) classifications and staging.
Study Design
Retrospective study.
Setting
Monocentric study in a tertiary referral center.
Methods
One-hundred sixty-eight patients who underwent EES or cEMA for cholesteatoma between 2010 and 2018 were classified according to the abovementioned classification and staging. Data on cholesteatoma's recurrence and residual rates were collected. Inferential statistical analysis was performed to evaluate surgical outcomes and the prognostic value of classifications and staging.
Results
The recurrence rate was significantly lower in cholesteatomas classified in EJS stage 1 (2.6%) and STAM stage 1 (0%). A comparison of the different stages of the disease showed a significantly lower recurrence only for stage 1 versus the superior stages of both classifications. Involvement of mastoid bone was associated with a higher risk of recurrence (odds ratio [OR]: 4.12; p = .031). Attical involvement was associated with a higher risk of residual cholesteatoma (OR: 1.165; p = .046).
Conclusion
EES or cEMA represents an effective treatment for middle ear cholesteatoma. The STAM classification and the EJS have shown a prognostic value, with STAM 1 and EAONO-JOS 1 stages associated with a better prognosis. Mastoid involvement represents a risk factor for recurrence. Attic localization is associated with residual disease. Localization at difficult access sites did not implicate a higher risk for recurrence or residual. ChOLE classification, Ossicular chain status, and complication status did not provide prognostic information regarding recurrence or residual cholesteatoma
Comparative Anatomy and Radiology: Human vs. Ovine Model
No full textAn accurate knowledge of comparative anatomy and radiology between ovine and human is mandatory and a preliminary requirement to start the training in endoscopic ear surgery on the ovine model in the proper way. Indeed, the comprehension of the differences and similarities regarding the anatomical structures and radiological findings allows performing all the surgical procedures with a more precise and better surgical point of view. By the means of the endoscope, some of the areas of the middle ear cavity simply inaccessible by microscope have been described, and thanks to the capability of the endoscope to “look around the corner” almost every space of the middle ear cavity has been explored. In addition, angled lenses (i.e., 30°, 45°, 70°) might help to assess even deeper recesses (i.e., type B facial sinus, type B sinus tympani). In this chapter the anatomic details of the ovine model are highlighted and compared to those of the human. A specific knowledge of the ovine model’s anatomy is obvious prerequisite to start this training program. The middle ear anatomy of the ovine is quite similar to the human one and is suitable to perform endoscopic surgical procedures
Endoscopic Assisted Retrosigmoid Approach
No full textThe retrosigmoid route represents one of the traditional surgical approaches to the posterior cranial fossa and, in particular, to the cerebellopontine angle. The indications are neoplasms of the poste- rior cranial fossa and/or the cerebellopontine angle, like VIII cranial nerve schwannomas, meningiomas, epidermoid cysts, and metasta- ses, with or without internal auditory canal involvement with/with- out serviceable hearing, symptomatic neurovascular conflicts, or brainstem implant placement. The retrosigmoid approach requires a retromastoid craniotomy (or craniectomy), a microscopic dissection with dural incision behind the sigmoid sinus, in order to expose the cerebellar cisterna and open the arachnoid to enter the subarach- noid space. This maneuver allows cerebrospinal fluid drainage, which is a key step to decompress the anatomical structures inside the cerebellopontine angle and to create enough space to work in this region. At the end of microscopic lesion removal, an angled optics is useful to help the surgeon dissect the pathology and remove the remnants with intrameatal extension inside the fundus of the internal auditory canal. In this way, an extensive drilling of the posterior portion of the internal auditory canal can be avoided. Other important things to consider are the possibility to check the relationship of the pathology with the anatomical structures in the cerebellopontine angle at the beginning of the procedure and the great value of the angled optics (45-degree and 70-degree lenses) during the final check to control the radicality of the excision. Moreover, in case of neurovascular conflict, the endoscope allows the surgeon to directly reach the area. In these cases, the magnifica- tion of the image also provides a better visualization of any possible anomalies of the nerve position, and the final check after the surgical procedure also allows the surgeon to be sure about the correct reso- lution of the conflict and to make an accurate hemostasis
Ruolo dei sistemi di digital image enhancement (IMAGE 1 S) nell’ individuazione di colesteatoma nella chirurgia endoscopia dell’orecchio medio
No full textRazionale Nella chirurgia endoscopica dell’orecchio (EES) per otite media colesteatomatosa (OMC) la radicalità è fondamentale per minimizzare il rischio di recidiva: particolari sistemi di rielaborazione dell’immagine forniti dal sistema SPIES IMAGE1S (Storz) potrebbero essere d’ausilio nell’identificazione dei residui di colesteatoma. In particolare, riportiamo la nostra esperienza nell’utilizzo dei sistemi di enhancement CLARA, SPECTRA A e SPECTRA B durante la EES per OMC.
Materiali e Metodi
Sono stati analizzati retrospettivamente 45 pazienti sottoposti a timpanoplastica con esclusivo approccio endoscopico per primo riscontro di OMC. In ogni caso i filtri SPECTRA A e B sono stati applicati per la ricognizione finale del campo operatorio, e confrontati con la luce bianca (WL). Le lesioni target sospette sono state rimosse e inviate per esame istologico. Sulla base dei dati si è calcolato sensibilità, specificità, valore predittivo positivo (PPV) e valore predittivo negativo (NPV) per le modalità di visualizzazione SPECTRA A e B. Successivamente si è condotto uno studio trasversale che ha coinvolto 12 pazienti sottoposti a EES per OMC. Per ogni paziente è stata eseguita, a fine chirurgia, una ricognizione del campo operatorio e il tessuto residuo, sospetto o meno, è stato fotografato con i tre filtri CLARA, SPECTRA A e B, escisso ed inviato per esame istologico. Con le immagini ottenute sono stati creati 10 questionari, sottoposti a 51 chirurghi, per giudicare la presenza o meno di colesteatoma. Dal confronto tra le risposte ed il risultato dell’esame istologico, per ogni filtro è stato calcolato specificità, sensibilità, accuratezza, VPP e VPN. Ogni chirurgo ha inoltre espresso una preferenza rispetto ai diversi filtri.
Risultati Nella fase preliminare dello studio, la rilevazione del colesteatoma mediante filtri selezionati IMAGE1 S SPECTRA ha rivelato i seguenti dati: sensibilità 97%, specificità 95%, PPV 95%, NPV 97%. In 3 casi su 45, non c’è stata corrispondenza tra l’endoscopia con sistema SPIES e l’istologia, in 5 casi su 45 (11%) tramite SPECTRA sono stati rilevati residui di colesteatoma, altrimenti inosservati all’ispezione con WL. Nella fase successiva CLARA è risultato il filtro con maggior accuratezza, seguita da SPECTRA A e SPECTRA B. Maggior sensibilità ha mostrato il filtro SPECTRA B, seguito da SPECTRA A e CLARA. Il VPP e VPN più alti sono stati raggiunti rispettivamente con CLARA e SPECTRA B. CLARA è risultato il filtro preferito.
Conclusioni I nostri risultati indicano un ruolo per i filtri del sistema IMAGE1 S durante la EES per OMC, prediligendo il filtro CLARA durante la fase di rimozione del colesteatoma e riservando l’utilizzo di SPECTRA B nella fase di ricognizione della cavità chirurgica per il riconoscimento di eventuali residui di colesteatoma
Vestibular Schannoma removal though expanded transcanal transpromontorial approach: advantages and limitations according to a multicentric experience
No full text
Horizontal glottectomy: is it an out-of-date procedure?
No full textPurpose: The aim of the study is to illustrate our experience with horizontal glottectomy (HG), reviewing the indications and results of this uncommon partial laryngectomy. Materials and Methods: It is a retrospective study. We completed a chart review of patients who underwent partial laryngectomy between May 2003 and June 2010. Patients who underwent HG were included in the study. Data obtained were collected and analyzed. Results: Seven male patients were included in the study (mean age was 78 years; range, 69-88 years). In all cases, the TNM classification was pT1bN0M0 apart from one patient who had pT1N1MO. Three patients had a moderately differentiated neoplasm (G2), whereas 4 patients had a well-differentiated tumor (G1). Tracheotomy tube removal, oral feeding, and voice analysis have been evaluated and reported in the study. Mean follow-up was 16 months. Conclusions: Horizontal glottectomy might be a worthwhile treatment option in selected patients nowadays. In older patients with anterior commissure involvement, this procedure guarantees adequate functional and good oncological results. This study may possibly help surgeons dealing with glottic cancer involving the anterior commissure because we believe that some patients could benefit from HG, even in this radiotherapy and transoral laser surgery "era." (C) 2011 Elsevier Inc. All rights reserved
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