Quality-of-life evaluation for patients submitted to nasal endoscopic surgery for resection of pituitary tumours.

PURPOSE: This study aimed to evaluate the pre- and post-operative quality-of-life of patients submitted to the resection of pituitary adenoma via endoscopic transsphenoidal. METHODS: This was a prospective study on patients submitted to endoscopic transsphenoidal pituitary surgery with the harvest of a nasoseptal flap who responded to the questionnaires FV-36 and SNOT-22 in the pre-operative and in months 1, 3 and 6 following the surgical procedure. RESULTS: A total of 42 patients submitted to pituitary adenoma resection surgery via endoscopic transsphenoidal with a nasoseptal flap were recruited. In all of the physical and mental domains (SF-36) evaluated, there was an improvement in the long-term evaluation (6 months), compared to the pre-operative, as well as in the site-specific evaluation (SNOT-22). CONCLUSION: The global and site-specific questionnaires in the 6th post-operative month follow-up presented an important improvement in all the physical and mental domains evaluated, as well as in nasal function in the perception of the patients submitted to pituitary adenoma resection via endoscopic transsphenoidal, demonstrating the safety and efficiency of the procedure.

Prevalence of HPV infection and genotypes in women with normal cervical cytology in the state of Paraná, Brazil.

OBJECTIVE: We investigated the prevalence of the human Papillomavirus (HPV) and its genotypes in women with normal cervical cytology in the state of Paraná, Brazil, and also epidemiological characteristics. METHODS: The enrolled patients were seen at six primary health-care units in Paiçandú City, Paraná. Through polymerase chain reaction (PCR) and PCR-RFLP (restriction fragment length polymorphism) techniques, 40 HPV genotypes were found, including 15 high risk, 3 undetermined risk and 22 low risk. Socio-demographic characteristics and sexual behavior were also recorded by interviews based on a structured questionnaire completed at the time of enrollment. RESULTS: Among 418 patients examined, HPV was detected in 6.7 %, mainly in women aged <25 years. The overall prevalence of high-risk, low-risk and undetermined-risk HPV types was 42.9, 45.7, and 11.7 %, respectively. HPV-16 was the most common type detected (14.3 %), followed by types 66 (11.4 %) and 31 and 70 (8.6 % each). Detection of HPV DNA was positively associated with the number of sexual partners within the previous 12 months (p < 0.031; OR = 5.4; CI = 0.98-29.8). CONCLUSION: When considering the lack of studies in Paraná on women with normal cytology, the results of this study will improve estimates of HPV DNA populations, and provide baseline values against which the impact of vaccination can be assessed in the future.

Relationship Between the Bilateral Removal of the Middle Nasal Turbinate and the Olfactory Function in Endoscopic Skull Base Surgery.

OBJECTIVE: To determine the impact of endonasal endoscopic access to the skull base on the olfaction sense, involving the harvest of a nasoseptal flap, with the removal of the middle nasal turbinate. METHODS: A study was performed on a prospective cohort of 50 patients who underwent transnasal endoscopic surgery of the anterior skull base, with the harvest of a nasoseptal and reverse flap. The patients were divided into 2 groups: partial unilateral removal of the middle nasal turbinate and bilateral removal. Connecticut Chemosensory Clinical Research Center tests were administered before surgery and in months 1, 3, and 6 after surgery. RESULTS: There was no difference in the olfactory sense, when comparing the partial removal of the middle nasal turbinate and the bilateral removal, as well as when comparing the side without the middle nasal turbinate and the side with this structure preserved. There was a worsening in olfaction (P < 0.001) in months 1 and 3 after surgery, returning to baseline in month 6 (P > 0.05). CONCLUSIONS: Bilateral removal of the middle nasal turbinate, compared with unilateral resection, showed no impact on the olfactory function 6 months after surgery. In both groups, there was a transitory decrease in the first month, but this normalized by the sixth postoperative month.

Closure of Skull Base Defects after Endonasal Endoscopic Resection of Planum Sphenoidale and Tuberculum Sellae Meningiomas.

BACKGROUND: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage. OBJECTIVE: The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas. METHODS: A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects. RESULTS: Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (fungal ball in right frontal sinus and brain abscess). The skull base defect created for resection measured, on average, 3.58 cm2. CONCLUSION: Our experience suggests that closure of skull base defects using combined fascia lata inlay and nasoseptal flap onlay is effective for preventing postoperative CSF leakage in resection of planum sphenoidale and/or tuberculum sellae meningiomas, and offers high reproducibility due to its low cost.

Development of an Experimental Model for Studying the Nasosinusal and Skull Base Arterial and Venous Systems Using Iodinated Contrast and Latex in Cadavers.

BACKGROUND: Cadaver dissection remains one of the most reliable and safest ways to study anatomy, whereas computed tomography angiography (CTA) is an essential technology for enabling students to become familiar with human anatomy and surgical planning. Thus, the convergence of both radiologic and anatomic information is important for surgical success, especially in regions of complex anatomy such as the nasosinusal and skull base regions. Here we propose an experimental model in formalinized cadaver heads consisting of intravascular injection of colored latex and iodinated contrast mixture, followed by CTA scans of the nasosinusal and skull base arterial and venous systems before dissection. METHODS: Six cadaver heads that had been preserved for >5 years in 10% formaldehyde were immersed for 72 hours in a solution containing a dimethyldiethanol mono/dialkyloyl ester quaternary ammonium salt. In 5 of these heads, a mixture composed of latex, tissue ink, and iodinated contrast (Ultravist 300) was injected into the vascular system. CTA scans were performed sequentially after the injection, followed by endonasal and macroscopic dissections. RESULTS: There was good radiologic and macroscopic vessel uptake in 4 specimens, allowing a detailed anatomic study. CONCLUSIONS: An experimental model was made feasible by injecting iodinated contrast and colored latex into formalinized cadavers for CTA evaluation of the nasosinusal and skull base arterial and venous systems before performing dissections.