Endonasal endoscopic duraplasty: our experience.

OBJECTIVE: Endoscopic repair of cerebrospinal fluid (CSF) leaks is a recognized technique. We consider our experience and evaluate the outcomes in patients who underwent endoscopic repair of CSF leaks. METHODS: A retrospective case note review of 135 patients who underwent anterior cranial repairs of CSF leaks between August 1995 and December 2004 at a tertiary referral center. We describe the technical details and outcomes of care by purely endoscopic procedures. RESULTS: Thirteen patients had combined transcranial and endonasal repairs and 122 patients had their repairs using an endoscopic approach only. There were 64 males and 71 females with ages that ranged from 1 to 75 years (mean age 42 years, median age 44 years). The success rate for first attempt only was 93.4%. Eight of the 122 patients (6.6%) needed a second surgical repair. In one patient a bicoronal approach was necessary while in the other cases a revision endoscopic procedure was appropriate. The period of follow-up ranged from 2 months to 9 years (mean 5 years, median 39 months). CONCLUSIONS: Our experience confirmed that endoscopic surgery is an effective and safe method of treatment for most CSF leaks. A variety of different endoscopic techniques allowed CSF leaks to be repaired in almost every site of the anterior skull base with very few exceptions.

Esthesioneuroblastoma: endonasal endoscopic treatment.

OBJECTIVES: To illustrate endoscopic techniques used in the treatment of esthesioneuroblastoma and to advocate this method of management followed by radiation therapy in selected cases. METHODS: A retrospective case series of 10 patients with esthesioneuroblastomas treated between 1999 and 2004 at a tertiary referral center using endonasal techniques. RESULTS: Mean age of patients at presentation was 56.2 years (median 57 years). Seven patients were female and 3 patients were male. Kadish staging at presentation was: A - 3 patients, B - 5 patients, C - 2 patients. Dulguerov stage at presentation was: T1 - 4 patients, T2 - 4 patients, T3 - 2 patients. The period of follow-up ranged from 11 months to 74 months (mean 38.1 months, median 39 months). To date no recurrence has developed in any patient. CONCLUSIONS: Our experience suggests that endoscopic surgery can be an effective method of management. Strict attention to selection criteria, careful surgical techniques, and regular follow-up are key elements for success.

Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience with 47 patients.

OBJECTIVE: To demonstrate the potentials and limitations of three different endoscopic procedures employed for treatment of inverted papilloma (IP) of the sinonasal tract. STUDY DESIGN: Retrospective analysis of a cohort of patients treated at two University hospitals. METHODS: From January 1992 to June 2000, 47 patients with IP underwent endoscopic resection. Preoperative workup included multiple biopsies of the lesion and imaging evaluation by computed tomography or magnetic resonance imaging. Massive skull base erosion, intradural or intraorbital extension, extensive involvement of the frontal sinus, abundant scar tissue caused by previous surgery, or the concomitant presence of squamous cell carcinoma were considered absolute contraindications for a purely endoscopic approach. Three types of resection were used: ethmoidectomy with wide antrostomy and sphenoidotomy (type 1) for IPs confined to the middle meatus, medial maxillectomy with ethmoidectomy and sphenoidotomy (type 2) for IPs partially invading the maxillary sinus, and a Sturmann-Canfield operation (type 3) for IPs involving the mucosa of the alveolar recess or of the anterolateral corner of the maxillary sinus. All patients were followed by periodic endoscopic evaluations. RESULTS: Type 1, 2, and 3 resections were performed in 26, 15, and 6 patients, respectively. No recurrences were observed after a mean follow-up of 55 (range 30-132) months. One patient, who underwent a type 2 resection, developed a stenosis of the lacrimal pathways requiring endoscopic dacryocystorhinostomy. CONCLUSIONS: Our experience confirms that endoscopic surgery is an effective and safe method of treatment for most IPs. The availability of different endoscopic techniques allows the entity of the dissection to be modulated in relation to the extent of disease. Strict application of selection criteria, meticulous use of subperiosteal dissection in the involved areas, and regular follow-up evaluation are key elements for success.

Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience.

BACKGROUND: The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base. METHODS: A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy. RESULTS: One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 +/- 3.9% and 58.8 +/- 8.6% (p = 0.0004) for the EEA and CEA group, respectively. CONCLUSION: To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.

Endonasal endoscopic resection and radiotherapy in olfactory neuroblastoma: our experience.

BACKGROUND: Our aim was to evaluate the efficacy of a bimodal method of treatment consisting in endoscopic resection followed by radiotherapy in patients with olfactory neuroblastoma (ON). METHODS: This is a retrospective review on 10 patients with ON treated at a tertiary referral center. All the patients were treated with endonasal endoscopic resection, and 1 refused postoperative radiotherapy. RESULTS: No mortality was observed. Local tumor control was obtained in all the patients. Follow-up ranged from 15 to 79 months (median, 37 months). One patient developed a regional recurrence and for this was treated with bilateral, modified type III radical neck dissection plus radiotherapy on the neck. All patients regained a good quality of life after the treatment. CONCLUSIONS: This method of treatment causes minimal injury to the patients, reduces side effects, and improves the quality of life of those with olfactory neuroblastoma.

Endoscopic treatment of ethmoidal hemangioendothelioma: case report and review of the literature.

Hemangioendothelioma (HE) is a rare vascular tumor of endothelial cell origin that usually involves long bone or soft tissue. However, there are cases of head and neck involvement. In the literature, only 19 cases of nasal involvement are described. We report a case of an 18-month-old child who had HE of the ethmoid sinus. Endoscopic resection of the tumor was performed. The patient is well without any recurrence after 4 years of follow-up. Because of its rarity, the literature on HE in the nasal cavity and paranasal sinus is reviewed and its management is discussed.

Endoscopic treatment of the isolated sphenoid sinus lesions.

Presenting symptoms of the isolated sphenoid sinus lesion are often vague and non-specific. Diagnostic nasal endoscopy procedures and imaging techniques are of great value for an early and precise diagnosis. Moreover, endoscopic sinus surgery is a safe and effective technique that allows a direct route to the sphenoid sinus. Because of its close vicinity to important and vulnerable structures of the skull base, delay in diagnosis and treatment can be potentially lethal. Endoscopically controlled procedures for the sphenoid sinus provide the surgeon with an obvious alternative to the traditional approaches. From November 1994 to May 2001 the authors operated on 41 patients with isolated sphenoid lesions. The pathology spectrum was rather wide and included 11 cases of isolated fungal sinusitis, 10 mucoceles, 7 bacterial sinusitis, 7 cerebrospinal fluid leaks, 3 inverted papillomas, 1 chondrosarcoma, 1 ossifying fibroma and 1 foreign body. The sphenoid sinus was the only sinus involved, and lesions arising from adjacent tissues were excluded. In this paper, the authors present clinical symptoms, endoscopic findings and imaging data as well as endoscopic surgical techniques for the treatment of sphenoid sinus disease.

Endoscopic resection of nasal haemangiopericytoma.

Haemangiopericytomas are vascular tumours derived from Zimmerman's pericytes; they account for about 1% of all vascular tumours. About 5% of the cases occur in the nasal cavity and usually show well-differentiated tumours with low potential for local recurrence or metastasis. The treatment of choice is surgical resection. We present a case of nasal haemangiopericytoma treated by endoscopic resection, and we emphasise the advantages of this minimally invasive method compared with traditional methods.

Rhinoplasty for the Mediterranean nose.

Homogenization of world culture through communications media, refinements in surgical techniques, and improved rhinoplasty results have resulted in a more extended dissemination of rhinoplasty among non-Caucasians. This request has led to increasingly anatomic, morphologic, and anthropometrical studies of the non-Caucasian nose upon which surgical techniques have been proposed and addressed to create in these patients nasal features typical of a Caucasian-looking nose. There are few reports in medical literature concerning rhinoplasty that specifically address particular Caucasian ethnic groups (Anglo-Saxon, Germanic, Latin, and Slavic). Generally included within the Latin group are subjects presenting both paradigmatic nasal morphologies (typically, the classic "Greek," "Roman," and "French" noses) and important cultural differences that greatly influence the subjective perception of the defect and, therefore, the type of change requested. These challenging conditions require a highly "customized" approach, both in the phase of the preoperative planning and in the choice of surgical options. The authors, by means of a photographic analysis systematically used with all their rhinoplasty patients, have identified some archetypes of nasal pyramid configurations that are typical of the reference population (44% Northern Italy, 15% Central Italy, 41% Southern Italy) and, on the basis of a medium/long-term evaluation of the relationship between adopted surgical techniques and results, propose some surgical options that are specific for every nasal archetype. This categorization helps the surgeon carry out a structured preoperative aesthetical analysis and provides him/her with both an anticipation of what findings to expect and the ability to deal with already diagnosed problems. Every archetype shows strong similarities in terms of preoperative analysis, surgical solutions, and subjective perception of the success of the surgery. The surgical options used proved to be apt to modify some paradigmatic defects in a satisfactorily predictable way. Combining the different tesserae of this puzzle to reach the goal of a satisfied patient (and not necessarily a beautiful nose) makes rhinoplasty a true challenge that requires a special talent from the surgeon: combining analysis capabilities, surgical logic, and manual skills with artistic sensitivity.