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1.
J Otolaryngol Head Neck Surg ; 49(1): 71, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023663

RESUMO

Within Neurotology, special draping systems have been devised for mastoid surgery recognizing that drilling of middle ear mucosa is an aerosol generating medical procedure (AGMP) which can place surgical teams at risk of COVID-19 infection. We provide a thorough description of a barrier system utilized in our practice, along with work completed by our group to better quantify its effectiveness. Utilization of a barrier system can provide near complete bone dust and droplet containment within the surgical field and prevent contamination of other healthcare workers. As this is an early system, further adaptations and national collaborations are required to ultimately arrive at a system that seamlessly integrates into the surgical suite. While these barrier systems are new, they are timely as we face a pandemic, and can play a crucial role in safely resuming surgery.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Otopatias/epidemiologia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Pneumonia Viral/epidemiologia , Base do Crânio/cirurgia , Comorbidade , Otopatias/cirurgia , Humanos , Pandemias , Equipamento de Proteção Individual
2.
Otol Neurotol ; 41(9): 1175-1181, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925833

RESUMO

: Since the beginning of 2020, the world has been confronted by the Covid-19 pandemic. The lock-down aims to limit the circulation of the virus and thus avoid overwhelming healthcare systems. Healthcare workers have had to adapt by postponing consultation and surgical activities. Otolaryngologists are particularly exposed to infection from the upper airway where the virus is highly concentrated. Literature has previously reported other human coronaviruses in the middle ear and mastoid, suggesting a risk of infection to staff during ear surgery where aerosolizing procedures are usually used. The aim of this article is to propose a strategy for planning consultations and surgeries for ear and lateral skull base diseases, in the context of the current active evolution of the pandemic and of the future gradual recovery to normal practice.


Assuntos
Infecções por Coronavirus/prevenção & controle , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Procedimentos Cirúrgicos Otológicos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Simulação por Computador , Desinfecção , Orelha Média/cirurgia , Hospitalização , Humanos , Processo Mastoide/cirurgia , Salas Cirúrgicas , Otorrinolaringologistas , Pacientes Ambulatoriais , Período Pré-Operatório , Base do Crânio/cirurgia , Carga Viral
3.
Neurol India ; 68(Supplement): S141-S145, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32611906

RESUMO

Background: The COVID-19 pandemic is currently an evolving situation. Operating rooms (OR) are high-risk areas for the transmission of any respiratory infection with multiple personnel involved, in close proximity. Of concern to neurosurgeons, is the high-risk of aerosol generating procedures (AGPs) like transsphenoidal and endonasal surgery. Endonasal AGPs theoretically present a higher risk of viral exposure due to the longer duration of exposure and aggressive disruption of potentially virus-containing mucosa. Objective: The current review discusses potential strategies to neuro-surgeons to avoid transmission of COVID 19 during endo-nasal and trans-sphenoidal surgeries. Materials and Methods: We searched PubMed using the search terms "COVID-19", "SARS-CoV-2", "coronavirus" in combination with "neurosurgery", and identified 13 relevant articles. A pre-surgical risk assessment score is proposed based on the risk of transmission. A flow chart of patient selection and care has been formulated. Conclusion: In all emergency patients, it is preferable to consider transcranial surgery or a sub-labial approach avoiding exposure to mucosa. Due to laboratory constraints routine swabs is not always available. Therefore, routine preoperative screening computed tomography (CT) chest is performed in all patients. Based on risk of transmission of infection to others, we propose a classification of patients for skull-based surgery into low, high and very high risk groups and suggest suitable personal protective equipment. Additionally, we discuss avoiding use of powered drills in or any AGP. However, cold procedures involving shavers and microdebriders generate lesser amounts of aerosol. Post-operatively, the length of stay could be reduced with a multidisciplinary approach.


Assuntos
Algoritmos , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Neurocirurgiões , Pneumonia Viral/transmissão , Base do Crânio/cirurgia , Betacoronavirus , Humanos , Neuroendoscopia , Pandemias
4.
Artigo em Russo | MEDLINE | ID: mdl-32649815

RESUMO

RATIONALE: When removing the meningiomas of the sellar region, there is always a risk of visual impairment for various reasons, in particular, as a result of traction damage to the optic nerve. Decompression of the optic canal increases nerve mobility during tumor manipulation. In cases of meningioma growing into the canal, its decompression often seems necessary. AIM: Evaluation of the effectiveness and risks of performing decompression of the optic canal. MATERIALS AND METHODS: The study included patients with meningiomas of the parasellar location, who underwent surgical treatment at the Burdenko Neurosurgical Center for the period from 2001 to 2017. They were divided into two groups - main and control. The main group consisted of 129 patients who underwent decompression of the optic nerve canals when the tumor was removed. The tumor matrix in this group was most often located in the region of the tuberum sellae, supradiaphragmally, in the region of the anterior clinoid process and the optic canal. In 31 cases, decompression was bilateral - during one operation and using one access in 27 patients; in 4 cases, the decompression of the second canal was delayed for 1.5-3 months after the first operation. 160 decompressions were performed by the intradural and 7 - by extradural methods. During intradural decompression, the roof of the optic canal was resected, and during extradural decompression, the lateral wall of the canal was trephined. The control group consisted of 308 patients who did not undergo canal decompression when the tumor was removed. It included meningiomas with a predominant location of the matrix in the area of the tuberclum and diaphragm of the sella. Tumors in both groups were removed according to the same principles (matrix coagulation, mainly the gradual removal of the tumor, the use of ultrasonic aspirator, a situational decision on the radicality of the operation, etc.). The main difference between operations in these two groups was only canal related algorithms (with or without its trepanation), as well as the probable prevalence of significant lateral tumor growth in cases with canal trepanation. Visual functions in the «primary¼ group were evaluated before and after operations with trepanation of the canal depending on various factors - the initial state of vision and the radicality of the tumor excision, including removal from the canal. The differences in the postoperative dynamics of vision in the main and control groups were studied. The primary data processing was carried out using the program MSExcel. Secondary statistical processing was carried out using the program Statistica. To assess the statistical significance of differences in the results obtained in the compared patient groups, the Chi-square test was used, and in the case of small groups - the exact Fisher test was applied. RESULTS: In the main group postoperative vision improvement of varying degrees on the side of trepanation was registered in 36.9% (59 out of 160) cases, no vision changes were found in 36.9% (59 out of 160), and in 26,2% (42 out of 160) the eyesight deteriorated. If preserving vision is attributed to a satisfactory result, then in general the results of these operations should be considered good. A comparative study of the results of removal of meningiomas with trepanation of the canals (main group) or without it (control group) was carried out among patients with the most critical vision situation (visual acuity 0.1 and below, up to only light perception). These groups are comparable in the number of observations - 62 and 73 respectively. The predominance of cases with improved vision in the main group compared with the control group (50.0% versus 38.36%) and a lower incidence of vision impairment (22.58% versus 34.25%) were found. However, the revealed differences are statistically unreliable and make it possible for us to talk only about the trend. The complications associated with trepanation of the canal include mechanical damage to the nerve by the drill. In our series of observations, there was only 1 case of abrasion of the nerve surface with the burr, which did not lead to a significant visual impairment. With the intradural method of trepanation in the area of the medial wall of the canal, the sphenoid sinus may open (in our series, in 34 cases out of 160 trepanations). Immediately closure of these defects was performed by various auto- and allomaterials in various combinations (pericranium, fascia, muscle fragment, hemostatic materials, and fibrin-thrombin glue). A true complication - CSF rhinorrhea liquorrhea developed in only one case, which required transnasal plastic surgery of the CSF fistula using a mucoperiostal flap. CONCLUSIONS: 1. Trepanation of the optic canal in cases of meningiomas of parasellar localization is a relatively safe procedure in the hands of a trained neurosurgeon and does not worsen the results of operations compared with the excision of the same tumors without trepanation of the canal. 2. The literature data and the results of our study make it possible to consider the decompression of the optic canal as an optional, but in many cases, useful option that facilitates the transcranial removal of some meningiomas of the sellar region.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Descompressão Cirúrgica , Humanos , Procedimentos Neurocirúrgicos , Nervo Óptico/diagnóstico por imagem , Estudos Retrospectivos , Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Resultado do Tratamento
5.
J Laryngol Otol ; 134(6): 473-480, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32508301

RESUMO

OBJECTIVES: Treatment of inflammatory and neoplastic disease in the maxillary sinus, pterygopalatine and infratemporal fossae requires appropriate surgical exposure. As modern rhinology evolves, so do the techniques available. This paper reviews extended endoscopic approaches to the maxillary sinus and the evidence supporting each technique. METHODS: A literature search of the Ovid Medline and PubMed databases was performed using appropriate key words relating to endoscopic approaches to the maxillary sinus. RESULTS: Mega-antrostomy and medial maxillectomy have a role in the surgical treatment of refractory inflammatory disease and sinonasal neoplasms. The pre-lacrimal fossa approach provides excellent access but can be limited because of anatomical variations. Both the transseptal and endoscopic Denker's approaches were reviewed; these appear to be associated with morbidity, without any significant increase in exposure over the afore-described approaches. CONCLUSION: A range of extended endoscopic approaches to the maxillary sinus exist, each with its own anatomical limitations and potential complications.


Assuntos
Endoscopia/efeitos adversos , Seio Maxilar/cirurgia , Doenças dos Seios Paranasais/cirurgia , Base do Crânio/anatomia & histologia , Endoscopia/métodos , Endoscopia/tendências , Humanos , Doenças dos Seios Paranasais/patologia , Base do Crânio/cirurgia
7.
World Neurosurg ; 140: 374-377, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32479908

RESUMO

BACKGROUND: A novel viral strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a worldwide pandemic known as coronavirus 2019 (COVID-19). Early reports from China have highlighted the risks associated with performing endoscopic endonasal skull base surgery in patients with SARS-CoV-2. We present a rare complication of nasoseptal flap (NSF) necrosis associated with COVID-19, further emphasizing the challenges of performing these procedures in this era. CASE DESCRIPTION: A 78-year-old man underwent an extended endoscopic endonasal transplanum resection of a pituitary macroadenoma for decompression of the optic chiasm. The resulting skull base defect was repaired using a pedicled NSF. The patient developed meningitis and cerebrospinal fluid (CSF) leak on postoperative day 13, requiring revision repair of the defect. Twelve days later, he developed persistent fever and rhinorrhea. The patient was reexplored endoscopically, and the NSF was noted to be necrotic and devitalized with evident CSF leakage. At that time, the patient tested positive for SARS-CoV-2. Postoperatively, he developed acute respiratory distress syndrome complicated by hypoxic respiratory failure and death. CONCLUSIONS: To our knowledge, this is the first reported case of NSF necrosis in a patient with COVID-19. We postulate that the thrombotic complications of COVID-19 may have contributed to vascular pedicle thrombosis and NSF necrosis. Although the pathophysiology of SARS-CoV-2 and its effect on the nasal tissues is still being elucidated, this case highlights some challenges of performing endoscopic skull base surgery in the era of COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus , Procedimentos Neurocirúrgicos/efeitos adversos , Pandemias , Pneumonia Viral , Base do Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia , Idoso , Vazamento de Líquido Cefalorraquidiano/etiologia , Humanos , Masculino , Necrose/etiologia , Complicações Pós-Operatórias/virologia , Retalhos Cirúrgicos/virologia
8.
World Neurosurg ; 140: 166-172, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32497852

RESUMO

BACKGROUND: Cerebrospinal fluid (CSF) leakage after penetrating skull base injury is relatively rare compared with close head injuries involving skull base fractures. CASE DESCRIPTION: We report the case of a 65-year-old man who had presented with epistaxis and serous rhinorrhea. When he had fallen to the ground near his bee boxes, a garden pole had poked into his right nostril. He had instantly removed the pole from his nostril himself. However, immediately after removal of the pole, he had developed nasal bleeding and serous rhinorrhea. He then drove to our emergency room. Computed tomography showed pneumocephalus with a minor cerebral contusion in the left frontal lobe and a penetrating injury in the left anterior skull base. His CSF leakage had not resolve spontaneously within 1 week after the injury with strict bed rest. We repaired the CSF leakage using a fat (adipose tissue)-on-fascia autograft plug and caulked the defect in the anterior skull base with the fat-on-fascia graft (FFG) plug through the left nostril with endoscopic guidance. The CSF rhinorrhea was successfully controlled. Intranasal local application of fluorescein aided in the detection of the direction of flow of the CSF leakage. CONCLUSIONS: Endonasal endoscopic caulking of a skull base defect using an FFG plug can be useful to treat CSF leakage due to the localized skull base defect, especially in the coronavirus disease 2019 pandemic. It is simple, inexpensive, and timesaving. It requires no special skills nor sophisticated instruments that can cause aerosolization, reducing the risk of infection during the surgery.


Assuntos
Betacoronavirus/patogenicidade , Lesões Encefálicas/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Base do Crânio/cirurgia , Fraturas Cranianas/cirurgia , Idoso , Humanos , Masculino , Cavidade Nasal/cirurgia , Cavidade Nasal/virologia , Procedimentos Cirúrgicos Reconstrutivos/métodos
9.
J Craniofac Surg ; 31(4): 1010-1014, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503095

RESUMO

PURPOSE: How different from "normal" are the cranial base and vault of infants with nonsyndromic, single-suture sagittal synostosis (NSSS)? This study quantitatively addresses this question utilizing computed tomography (CT) analytic technology. METHOD: Head CT scans of infants with NSSS and normocephalic controls were analyzed using Mimics to calculate craniometric angles, distances, and segmented volumes. Craniometric measurements and asymmetry indices were compared between NSSS and control groups using linear regressions controlling for age. Ratios of anterior-, middle-, and posterior-to-total cranial vault volume were compared between groups using beta regressions controlling for age. RESULTS: Seventeen patients with NSSS and 19 controls were identified. Cranial index and interoccipital angle were significantly smaller in NSSS compared with controls (P = 0.003 and <0.001, respectively). Right-but not left-external acoustic meatus angle and internal acoustic meatus-to-midline distance were significantly greater in NSSS than in controls (P = 0.021 and 0.016, respectively). NSSS patients and controls did not significantly differ in any asymmetry indices, except for the articular fossa angle asymmetry index (P = 0.016). Anterior vault volume proportion was greater in NSSS relative to controls (proportion ratio = 1.63, P < 0.001). NSSS trended toward a smaller posterior vault volume proportion (P = 0.068) yet did not differ in middle vault volume proportion compared with controls. CONCLUSION: In this small study, patients with nonsyndromic, single-suture sagittal craniosynostosis had relatively similar cranial base measurements, and larger anterior vault volumes, when compared with controls. Further work is needed to confirm the possibility of rightward asymmetry of the anterior cranial base.


Assuntos
Cefalometria , Suturas Cranianas/cirurgia , Craniossinostoses/cirurgia , Base do Crânio/cirurgia , Craniossinostoses/diagnóstico por imagem , Meato Acústico Externo/diagnóstico por imagem , Meato Acústico Externo/cirurgia , Feminino , Humanos , Lactente , Masculino , Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
10.
Rhinology ; 58(3): 289-294, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-342762

RESUMO

On March 11th 2020, the World Health Organization (WHO) declared COVID-19 pandemic, with subsequent profound impact on the entire health care system. During the COVID-19 outbreak, activities in the rhinology outpatient clinic and operation rooms are limited to emergency care only. Health care practitioners are faced with the need to perform rhinological and skull base emergency procedures in patients with a positive or unknown COVID-19 status. This article aims to provide recommendations and relevant information for rhinologists, based on the limited amount of (anecdotal) data, to guarantee high-quality patient care and adequate levels of infection prevention in the rhinology clinic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Endoscopia , Doenças Nasais , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral , Base do Crânio , Infecções por Coronavirus/epidemiologia , Endoscopia/métodos , Humanos , Controle de Infecções , Doenças Nasais/cirurgia , Pneumonia Viral/epidemiologia , Base do Crânio/cirurgia
11.
Rhinology ; 58(3): 289-294, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32441710

RESUMO

On March 11th 2020, the World Health Organization (WHO) declared COVID-19 pandemic, with subsequent profound impact on the entire health care system. During the COVID-19 outbreak, activities in the rhinology outpatient clinic and operation rooms are limited to emergency care only. Health care practitioners are faced with the need to perform rhinological and skull base emergency procedures in patients with a positive or unknown COVID-19 status. This article aims to provide recommendations and relevant information for rhinologists, based on the limited amount of (anecdotal) data, to guarantee high-quality patient care and adequate levels of infection prevention in the rhinology clinic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Endoscopia , Doenças Nasais , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral , Base do Crânio , Infecções por Coronavirus/epidemiologia , Endoscopia/métodos , Humanos , Controle de Infecções , Doenças Nasais/cirurgia , Pneumonia Viral/epidemiologia , Base do Crânio/cirurgia
12.
Otolaryngol Head Neck Surg ; 163(3): 482-490, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32452722

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic disrupted the standard management paradigms for care of patients with sinus and skull base presentations due to concern for patient and health care provider safety, given the high aerosol-generating potential of endonasal procedures. DATA SOURCES: We reviewed the relevant literature complied from available sources, including PubMed, Google Scholar, and otolaryngology journals providing electronic manuscripts ahead of indexing or publication. REVIEW METHODS: Incorporating available evidence and the projected infection control and resource limitations at our institution, we collectively authored a dynamic set of protocols guiding (1) case stratification, (2) preoperative assessment, (3) operative setup, and (4) postoperative care of patients with sinus or skull base presentations. Due to the rapidly evolving nature of COVID-19 publications, lack of rigorous data, and urgent necessity of standardized protocols, strict inclusion and exclusion criteria were not employed. CONCLUSIONS: As scarce hospital resources are diverted to COVID-19 care and staff are redeployed to forward-facing roles, endonasal procedures have largely ceased, leaving patients with ongoing sinonasal and skull base complaints untreated. Skull base teams now weigh the urgency of surgery in this population with the regional availability of resources. IMPLICATIONS FOR PRACTICE: The COVID-19 pandemic will have an enduring and unpredictable impact on hospital operations and surgical skull base practices and will require a dynamic set of management protocols responsive to new evidence and changing resources. In the current resource-limited environment, clinicians may utilize these protocols to assist with stratifying patients by acuity, performing preoperative assessment, and guiding peri- and postoperative care.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia/métodos , Controle de Infecções/métodos , Procedimentos Cirúrgicos Nasais/métodos , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/epidemiologia , Base do Crânio/cirurgia , Betacoronavirus , Humanos , Pandemias
14.
Int Forum Allergy Rhinol ; 10(8): 963-967, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32348025

RESUMO

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious with devastating impacts for healthcare systems worldwide. Medical staff are at high risk of viral contamination and it is imperative to know what personal protective equipment (PPE) is appropriate for each situation. Furthermore, elective clinics and operations have been reduced in order to mobilize manpower to the acute specialties combating the outbreak; appropriate differentiation between patients who require immediate care and those who can receive telephone consultation or whose treatment might viably be postponed is therefore crucial. Italy was 1 of the earliest and hardest-hit European countries and therefore the Italian Skull Base Society board has promulgated specific recommendations based on consensus best practices and the literature, where available. Only urgent surgical operations are recommended and all patients should be tested at least twice (on days 4 and 2 prior to surgery). For positive patients, procedures should be postponed until after swab test negativization. If the procedure is vital to the survival of the patient, filtering facepiece 3 (FFP3) and/or powered air purifying respirator (PAPR) devices, goggles, full-face visor, double gloves, water-resistant gowns, and protective caps are mandatory. For negative patients, use of at least an FFP2 mask is recommended. In all cases the use of drills, which promote the aerosolization of potentially infected mucous particles, should be avoided. Given the potential neurotropism of SARS-CoV-2, dura handling should be minimized. It is only through widely-agreed protocols and teamwork that we will be able to deal with the evolving and complex implications of this new pandemic.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções , Cirurgia Endoscópica por Orifício Natural/métodos , Pandemias , Pneumonia Viral , Base do Crânio/cirurgia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália , Procedimentos Cirúrgicos Nasais/métodos , Procedimentos Neurocirúrgicos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
16.
J Clin Neurosci ; 75: 218-220, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32249175

RESUMO

Pneumocephalus describes the presence of air within the cranial cavity and is often self-limiting. Tension pneumocephalus is a neurosurgical emergency manifested by headaches, seizures, reduced consciousness and even death resulting from raised intracranial pressure. Differentiating both entities clinically is often challenging but crucial. We present a case involving a sixty-year-old male who was transferred to our unit after he collapsed while undergoing rehabilitation. The patient had undergone a combined bifrontal craniotomy and transnasal endoscopic resection of recurrent sinonasal adenocarcinoma with anterior skull base involvement eight days prior. Imaging demonstrated the classic Mt. Fuji sign and a diagnosis of tension pneumocephalus was formed. The patient proceeded for definitive management which included a multi-layered repair of the anterior skull base. The three mechanisms that propose the development of tension pneumocephalus include the ball-valve mechanism, the inverted soda-bottle effect and rarely, infection from gas forming organisms. A review of current literature on PubMed/MEDLINE revealed tension pneumocephalus after skull base surgery to be a rare entity with only eleven cases reported. Most patients achieved complete recovery of symptoms post-treatment. Clinicians should recognise tension pneumocephalus as a potential complication after skull base surgery. Accurate diagnosis requires appreciation of imaging features and a high index of suspicion. Prompt management is imperative to prevent possible devastating outcomes.


Assuntos
Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Craniotomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos
17.
World Neurosurg ; 139: 182-185, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305607

RESUMO

BACKGROUND: Intracranial bronchogenic cysts (BCs) are extremely rare. To our knowledge, this is the first report of a BC in which lesions involve the middle and posterior cranial fossa, as well as the infratemporal fossa. CASE DESCRIPTION: We present the case of a 38-year-old woman who suffered from a cranial nerve dysfunction for 2 years. Magnetic resonance imaging showed that there were skull base communication lesions across the middle and posterior fossa. The patient was operated on through an infratemporal fossa approach. The final diagnosis was BC after histopathologic examination and immunohistochemical verification. The patient's neurologic dysfunction was partially ameliorated at the half-year follow-up. CONCLUSIONS: Intracranial BCs are rare. However, they should be considered in the differential diagnosis for cystic lesions with edge enhancement or extracranial extension.


Assuntos
Cisto Broncogênico/cirurgia , Base do Crânio/cirurgia , Adulto , Cisto Broncogênico/complicações , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/patologia , Fossa Craniana Média , Fossa Craniana Posterior , Craniotomia , Paralisia Facial/etiologia , Feminino , Perda Auditiva/etiologia , Humanos , Hipestesia/etiologia , Imagem por Ressonância Magnética , Procedimentos Neurocirúrgicos , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Tomografia Computadorizada por Raios X
18.
World Neurosurg ; 139: 460-470, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32330621

RESUMO

OBJECTIVE: The influence of graft type (nonautologous vs. autologous) on surgical outcomes in endoscopic anterior skull base (EASB) reconstruction is not well understood. This review systematically evaluated rates of postoperative complications of EASB repairs that utilized autologous or nonautologous grafts. METHODS: Original studies reporting EASB reconstruction outcomes were extracted from PubMed, Ovid, and the Cochrane Library from database inception to 2019. Risk ratios, risk differences, χ2 tests, and multivariate logistic regression were used to evaluate outcome measures: postoperative cerebrospinal fluid (CSF) leaks, meningitis, and other major complications (OMCs). RESULTS: A total of 2275 patients from 29 studies were analyzed. Rates of postoperative CSF leaks, meningitis, and OMCs were 4.0%, 1.6%, and 2.3%, respectively, using autologous grafts, and 5.0%, 0.3%, and 1.0%, respectively, using nonautologous grafts. Multivariate analysis of 118 patients demonstrated no significant differences in age, CSF flow rate, single or multilayer reconstruction, and presence of intraoperative CSF leak or lumbar drain. Meta-analyses of 6 studies yielded a risk ratio of 0.64 (95% confidence interval [CI], 0.19-2.14; P = 0.47) for postoperative CSF leakage, and risk differences of -0.01 (95% CI, -0.06 to 0.05; P = 0.80) and -0.02 (95% CI, -0.09 to 0.05; P = 0.51) for postoperative meningitis and OMCs, respectively. There were no significant differences in postoperative CSF leakage (P = 0.95) and OMCs (P = 0.41) between graft types among cases with intraoperative CSF leaks. However, meningitis rates were lower (P = 0.04) in the nonautologous group. CONCLUSIONS: EASB reconstructions utilizing autologous and nonautologous grafts are associated with similar rates of postoperative CSF leakage and OMCs. In cases with intraoperative CSF leakage, nonautologous grafts were associated with reduced postoperative meningitis.


Assuntos
Neuroendoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Transplantes/transplante , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/epidemiologia , Retalhos Cirúrgicos/transplante
19.
Otolaryngol Head Neck Surg ; 162(6): 922-925, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32180502

RESUMO

Mastery of lateral skull base (LSB) surgery requires thorough knowledge of complex, 3-dimensional (3D) microanatomy and techniques. While supervised operation under binocular microscopy remains the training gold standard, concerns over operative time and patient safety often limit novice surgeons' stereoscopic exposure. Furthermore, most alternative educational resources cannot meet this need. Here we present proof of concept for a tool that combines 3D-operative video with an interactive, stereotactic teaching environment. Stereoscopic video was recorded with a microscope during translabyrinthine approaches for vestibular schwannoma. Digital imaging and communications in medicine (DICOM) temporal bone computed tomography images were segmented using 3D-Slicer. Files were rendered using a game engine software built for desktop virtual reality. The resulting simulation was an interactive immersion combining a 3D operative perspective from the lead surgeon's chair with virtual reality temporal bone models capable of hands-on manipulation, label toggling, and transparency modification. This novel tool may alter LSB training paradigms.


Assuntos
Simulação por Computador , Educação de Pós-Graduação em Medicina/métodos , Imageamento Tridimensional/métodos , Procedimentos Neurocirúrgicos/educação , Otolaringologia/educação , Base do Crânio/cirurgia , Interface Usuário-Computador , Realidade Virtual , Humanos , Reprodutibilidade dos Testes , Base do Crânio/diagnóstico por imagem
20.
Otolaryngol Head Neck Surg ; 162(6): 942-949, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32204657

RESUMO

OBJECTIVE: To investigate audiometric outcomes and incidence of chronic ear disease following lateral skull base repair (LSBR) of cerebrospinal fluid (CSF) leaks. STUDY DESIGN: Retrospective review. SETTING: Tertiary skull base center. SUBJECTS AND METHODS: Consecutive adults undergoing LSBR of CSF leaks between 2012 and 2018 were reviewed. Audiometric data included mean air conduction pure-tone average (PTA), air-bone gap (ABG), speech recognition threshold (SRT), and word recognition score (WRS). The incidence and management of the following were collected: effusion, retraction, otitis media and externa, perforation, and cholesteatoma. RESULTS: Seventy-three patients underwent transmastoid (n = 5), middle cranial fossa (n = 2), or combined approach (n = 67) for repair of spontaneous leaks (sCSFLs, n = 41) and those occurring in the setting of chronic ear disease (ceCSFLs, n = 32). ABG decreased 7.23 dB (P = .01) in sCSFL patients. Perforations (P = .01) were more likely in ceCSFL. No sCSFL patient developed a cholesteatoma, perforation, or infection. Effusions (n = 7) were transient, and retractions (n = 2) were managed conservatively in the sCSFL cohort. Eight ceCSFL patients required tubes, 3 underwent tympanoplasties with (n = 2) and without (n = 1) ossicular chain reconstruction (OCR), and 1 had tympanomastoidectomy with OCR. CONCLUSION: Lateral skull base repair of CSF leaks maintained or improved hearing. Patients with preexisting chronic ear disease were more likely to require additional intervention to sustain adequate middle ear aeration compared to the sCSFL cohort. LSBR of sCSFL does not appear to increase risk for developing chronic ear disease.


Assuntos
Audiometria/métodos , Vazamento de Líquido Cefalorraquidiano/cirurgia , Otopatias/diagnóstico , Audição/fisiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias , Base do Crânio/cirurgia , Adulto , Idoso , Doença Crônica , Otopatias/etiologia , Otopatias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
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