Simplifying Access to the Lateral Sphenoid Recess: A Modification of the Transpterygoid Approach.

BACKGROUND: Meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be difficult to access. Historically, the endoscopic transpterygoid approach was advocated, which carries additional morbidity given the dissection of the pterygopalatine fossa (PPF) contents to provide a direct line approach to the defect. Given our increased facility with angled endoscopes and instrumentation, we now approach this region in a less invasive manner. METHODS: We describe the endoscopic modified transpterygoid approach (MTPA), a quicker approach to the lateral sphenoid recess which preserves the PPF contents through a single nostril corridor. RESULTS: In the MTPA, the face of the sphenoid and anterior junction of the pterygoid plates are removed, allowing for mobilization of the PPF contents with the periosteum intact. Angled instrumentation is then used to resect the meningoencephalocele and repair the skull base defect in the lateral recess. If increased exposure is needed, this can be gained by sacrificing the sphenopalatine artery and even the vidian nerve, although this is rarely required. CONCLUSIONS: The MTPA obviates the need for PPF dissection and simplifies access to the lateral sphenoid recess while minimizing postoperative morbidity. This approach should be considered for accessing meningoencephaloceles and other benign lesions in this challenging location.

Índices de trauma como método prognóstico em pacientes vítimas de trauma abdominal atendidos no Hospital de referência de Urgência e Emergência no estado do Pará / Trauma scores as prognostic method in patients with abdominal trauma treated on emergency department in a reference hospital in Pará state

Objetivo: Avaliar os índices de trauma como método prognóstico de mortalidade em pacientes vítimas de traumaabdominal. Método: pesquisa realizada no Hospital Metropolitano de Urgência e Emergência, com o preenchimentode ficha de avaliação para cálculo do Revisited Trauma Score (RTS),InjurySeverityScore (ISS) e TraumaandInjurySeverityScore (TRISS). Os índices foram analisados para avaliar a qualidade do serviço de cirurgia prestadoaos pacientes vítimas de traumatismo abdominal. A pesquisa foi realizada com a análise de 189 prontuários referentesao ano de 2010. Resultados: pacientes do sexo masculino, na terceira década de vida, foram as principais vítimasde trauma abdominal. Feridas por projétil de arma de fogo foram os mais prevalentes, sendo o intestino grosso eintestino delgado as vísceras mais acometidas. O tórax foi a região associada mais frequente. O RTS mostrou-se bomcomo fator preditivo de mortalidade; os pacientes com RTS aumentado apresentaram um risco relativo de evoluirpara óbito quatro vezes maior quando comparados aqueles com RTS dentro da normalidade. A mortalidade para ogrupo de pacientes com ISS > 25 foi maior que para o grupo com ISS < 25. O TRISS mostrou que a maioria dospacientes que evoluíram para o óbito tinha maior probabilidade de sobreviver. Conclusão: A população mais expostaao trauma abdominal foram os jovens do sexo masculino;o principal mecanismo de trauma as feridas por projétil dearma de fogo. Os índices de trauma apresentaram-se úteis para determinar o prognostico de sobrevida dos pacientes,porém com limitações.

Objective:Evaluate the trauma scores as mortality prognostic method in patients with abdominal trauma.Method:Thesearch was performedon Emergency Department at Metropolitan Hospital (HMUE), Belém, Pará.An evaluation formwas used for the calculation of Revisited Trauma Score (RTS), Injury Severity Score (ISS) e Trauma and InjurySeverity Score (TRISS).Trauma scores were then analyzed to assess the quality of trauma surgery service provided topatients victims of abdominal trauma. The research was conducted by analyzing of 189 records of patients attendedduring the years 2010-2011. Results:Male patients in their thirties were the most frequent victims of abdominaltrauma.Injuriesbyprojectilefrom a firearmwere the mostprevalent,the large intestineandthe small intestinethe mostaffectedviscera. The thorax was the region most frequently associated. The RTS was a good predictor of mortalitybecause the patients with high values of this trauma score showed a relative risk of death four times higher whencompared to patients with normal RTS. The mortality rate for the group of patients with ISS >25 was higher thanfor the group with ISS < 25. On the other hand,TRISSshowed that mostof the patientswho died hada higherchanceof survival. Conclusion:The mostexposed people toabdominaltraumawereyoungmale patients, andthe main causeoftrauma was the gunshot wounds. Thetrauma scores showed as useful method for determiningtheprognosisofpatientsurvival, but with limitations.