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1.
Isr Med Assoc J ; 22(1): 13-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927799

RESUMO

BACKGROUND: During Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) the surgeon operates exclusively through a single vaginal entry point, leaving no external scarring. OBJECTIVES: To evaluate the learning curve of vNOTES hysterectomy by experienced gynecologists based on surgical times and short-term outcomes. METHODS: A retrospective study was conducted of the first 25 vNOTES hysterectomy surgeries performed from July to December 2018 at Rambam Health Care Campus by a single surgeon. The primary outcome was hysterectomy time. Secondary outcomes included intra-operative bleeding, length of hospitalization, postoperative pain, and need for analgesia. Socio-demographic and clinical data were retrieved from patient electronic medical charts. RESULTS: Median age was 64.5 years (range 40-79). Median hysterectomy time was 38 minutes (range 30-49) from the first cut until completion. Comparisons between median hysterectomy time in the first 10 hysterectomies and in the 15 subsequent procedures demonstrated a significant decrease in median total time: 45 minutes (range 41-49) vs. 32 minutes (range 30-38), respectively (P = 0.024). The median estimated intraoperative blood loss decreased from 100 ml (range 70-200) in the first 10 hysterectomies to 40 ml (range 20-100) in the subsequent procedures (P = 0.011). CONCLUSIONS: vNOTES hysterectomy is feasible by an experienced gynecologist, with an exponential improvement in surgical performance in a short period as expressed by the improvement in hysterectomy time, low complication rates, negligible blood loss, minimal post-surgical pain, fast recovery, and short hospitalization. vNOTES allows easier and safer access to adnexal removal compared to conventional vaginal surgery.


Assuntos
Ginecologia/educação , Histerectomia Vaginal/educação , Curva de Aprendizado , Cirurgia Endoscópica por Orifício Natural/educação , Adulto , Idoso , Feminino , Humanos , Histerectomia Vaginal/métodos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
2.
World Neurosurg ; 133: 260-265, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605847

RESUMO

BACKGROUND: Coexistence of sinonasal and skull base tumors is uncommon but possible, and the endonasal route seems to be the best option to manage both lesions simultaneously. We report the first case in the English literature of concomitant sphenoid sinus inverted papilloma and pituitary macroadenoma treated through an endoscopic endonasal approach. CASE DESCRIPTION: A 68-year-old man presented with a history of progressive visual loss and nasal obstruction. Clinical examination disclosed bitemporal hemianopsia. Computed tomography scan and magnetic resonance imaging obtained on admission showed a large sellar/suprasellar enhancing lesion with a marked mass effect on the optic chiasm. Imaging also showed a second mass extending from the sphenoid sinus to the left nasal cavity with obstruction of the maxillary sinus ostium and development of maxillary sinus mucocele. Both tumors were entirely resected by an endoscopic endonasal approach. Additionally, middle meatal antrostomy and marsupialization with drainage of the maxillary mucocele was performed. Biopsy confirmed the coexistence of a pituitary macroadenoma and sphenoid sinus inverted papilloma. CONCLUSIONS: This case and the literature suggest that patients with concomitant nasal and skull base pathologies can be simultaneously managed. The otolaryngologist plays an essential role in removing the sinonasal lesion to ensure a safe surgical corridor before entering the intracranial cavity and for planning for the skull base reconstruction.


Assuntos
Adenoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Papiloma Invertido/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neuroendoscopia/métodos , Papiloma Invertido/diagnóstico por imagem , Papiloma Invertido/patologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
World Neurosurg ; 133: e503-e512, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550544

RESUMO

BACKGROUND: The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for most skull base defects in endonasal endoscopic approaches. The superior nasal turbinate (ST) has received little attention. We report our preliminary experience with the use of the ST mucosal flap in selected cases. METHODS: We performed a retrospective review of patients who underwent endonasal endoscopic approaches and identified 9 patients who were reconstructed with vascularized ST mucosal flaps as part of a double-layer or triple-layer reconstruction. When there was no intraoperative cerebrospinal fluid (CSF) leak, we used a double-layer technique. If there was an intraoperative CSF leak, regardless of the quality of leakage, we preferred a triple-layer repair technique. In patients with high-flow leaks, triple-layer repair was performed using only autologous tissue grafts and flaps. RESULTS: Intraoperative CSF leaks were noted in 7 of 9 patients. Among them, 4 patients had low-flow CSF leaks (grade 1 and 2) and 3 patients had high-flow CSF leaks (grade 3). All reconstructions had complete defect coverage with the ST flaps and NSFs were preserved. All the flaps were viable at 4 weeks without a CSF leak or complication at the reconstruction site. There was no contraction or partial loss of the flap. After a mean follow-up period of 9 months, none of the patients required a flap revision, developed a mucocele, infection, or other complication. CONCLUSIONS: An ST flap can be used for the vascularized reconstruction of sellar defects if it is bilaterally available. This option should not be overlooked and wasted.


Assuntos
Mucosa Nasal/cirurgia , Neuroendoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Nariz , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
4.
World Neurosurg ; 133: e695-e701, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574333

RESUMO

BACKGROUND: Little is known on the impact of the pattern and extent of pneumatization of the sphenoid sinus (SS) on the dimensions of the surgical windows used in extended endoscopic endonasal transsphenoidal approaches. We therefore investigated whether the distances between the 2 optic canals and between the paired paraclival carotid arteries are influenced by the pattern and extent of pneumatization of the SS. METHODS: One hundred high-resolution computed tomography scans from 47 adult female and 53 adult male patients were analyzed. The pattern of SS pneumatization was classified into conchal, presellar, and sellar types. Sellar-type sinuses were then classified according to a newer detailed classification system. Maximal anteroposterior (AP), transverse (TR), and craniocaudal diameters of the SS, interoptic distance at the limbus sphenoidale (IODL) and at the entrance of the optic canal (IODE) and the intercarotid distance between the paraclival carotids (ICD) were measured. A 2-tailed Mann-Whitney U test and Pearson correlation coefficient (R) were used for statistical analysis. A P value <0.05 was considered statistically significant. RESULTS: Positive correlation was found between IODL and both AP and TR diameters of the SS; between IODE and both AP and TR diameters of the SS; and between ICD and all diameters of the SS. The highest correlation for each of the IODL, IODE, and ICD was noted with the TR diameter of the SS. CONCLUSIONS: During the development of the SS, pneumatization progress likely exerts quantitative and direction-specific forces, which gradually increase the interoptic and intercarotid distances.


Assuntos
Seio Esfenoidal/anatomia & histologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Nariz , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X
5.
Khirurgiia (Mosk) ; (12): 18-27, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825339

RESUMO

OBJECTIVE: To analyze own initial experience of transoral thyroid surgery. MATERIAL AND METHODS: There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm. RESULTS: Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days. CONCLUSION: Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.


Assuntos
Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Carcinoma Papilar/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Boca/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
6.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 440-444, Out.-Dez. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1024425

RESUMO

Introduction: Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Objectives: The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results. Methods: This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months. Results: During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% ( n = 123) of the patients 6 months after the intervention. Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively. Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant ( p < 0.001). Conclusion: The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Cartilagem da Orelha/transplante , Cirurgia Endoscópica por Orifício Natural/métodos , Miringoplastia/métodos , Otite Média , Doença Crônica , Estudos Prospectivos , Resultado do Tratamento , Testes Auditivos
7.
World Neurosurg ; 132: 258-264, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518745

RESUMO

BACKGROUND: Synovial cysts are cystic masses lined with pseudostratified columnar cells and containing clear or xanthochromic fluid. Although they are commonly encountered in the lumbar spine, synovial cysts infrequently occur in the cervical spine and rarely involve the odontoid process. The causes of synovial cysts of the odontoid process are unknown, but growth of synovial rests, proliferation of multipotent mesenchymal cells, atlantoaxial instability, and trauma are thought to play a role. CASE DESCRIPTION: We present 3 cases of atlantoaxial cysts with the associated radiographic features, surgical management, and clinical outcomes. No patient had rheumatoid arthritis. In all cases, preoperative differential diagnosis included neoplastic pathologic changes. Two patients underwent odontoidectomy through either an endonasal or a transoral approach, followed by posterior occipitocervical fusion. The third patient underwent an endoscopic transsphenoidal approach for cyst decompression. CONCLUSIONS: Tissue diagnosis is important in confirming pathologic analysis because synovial cysts have radiographic characteristics similar to those of a wide variety of neoplasms of the craniovertebral junction.


Assuntos
Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Fusão Vertebral/métodos , Cisto Sinovial/cirurgia , Idoso , Idoso de 80 Anos ou mais , Drenagem , Humanos , Masculino , Boca , Cavidade Nasal , Processo Odontoide/cirurgia
8.
Zhonghua Wai Ke Za Zhi ; 57(9): 686-690, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31474061

RESUMO

Objective: To investigate the safety and feasibility of the modified transoral endoscopic thyroidectomy vestibular approach (TOETVA) by dissection of mental nerve in clinical practice. Methods: Totally 140 patients underwent the modified TOETVA from the Department of Head and Neck Surgery, Hunan Cancer Hospital from July 2016 to June 2018 were analyzed retrospectively. There were 130 females and 10 males, aging (35.4±9.8) years (range: 11 to 56 years). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative suction drainage, postoperative pain score, postoperative cosmetic satisfaction and postoperative complications (recurrent laryngeal nerve palsy, hypoparathyroidism, infection, pneumoderm, seroma and mental nerve injury) were summarized. Results: Of the 140 patients, 1 patient was transferred to open surgery. Fifty-nine patients underwent thyroidectomy with an operation time of (100.8±18.9) minutes. Sixty-three patients underwent thyroidectomy and central lymphadenectomy with an operation time of (112.1±16.6) minutes. Eighteen cases underwent total thyroidectomy and central lymphadenectomy with an operation time of (185.3±25.9) minutes. The postoperative hospital stay was (3.76±0.98) days. The postoperative drainage was (96.8±36.2) ml. The 24-hour postoperative pain score was 2.66±1.23, the postoperative cosmetic satisfaction was 9.65±0.24. Among the postoperative complications, there were 3 cases of temporary recurrent laryngeal nerve palsy, 2 cases of permanent recurrent laryngeal nerve palsy, 4 cases of temporary hypoparathyroidism but no permanent hypoparathyroidism, 2 cases of infection, 1 case of seroma, 3 cases of pneumoderm, and no cases of mental nerve injury. Conclusion: The modified TOETVA by dissection of mental nerve is safe and feasible.


Assuntos
Nervo Mandibular/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adolescente , Adulto , Criança , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Boca , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Resultado do Tratamento , Adulto Jovem
9.
World Neurosurg ; 132: e665-e669, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442636

RESUMO

OBJECTIVE: Olfactory dysfunction is a significant postoperative complication related to endoscopic transsphenoidal surgery (TSS). This study aimed to determine the impact of endoscopic TSS on olfactory function. METHODS: We conducted a prospective study of 32 patients with sellar or parasellar tumors who were treated with endoscopic TSS between December 2013 and October 2016. TSS was performed via a right transseptal approach. We performed the Toyota and Takagi olfactometer test and the venous olfaction test for the evaluation of olfactory function preoperatively and at 1 and 3 months postoperatively. RESULTS: The results of the Toyota and Takagi test showed that olfactory function deteriorated in 4 of 32 (12.5%) patients 1 month postoperatively and improved to preoperative baseline levels in all patients 3 months after the procedure. Olfactory function deteriorated in 1 of 31 (3.2%) patients 3 months after the procedure. The venous olfaction test revealed no response in 1 of 31 (3.2%) patients 1 month postoperatively, with no improvement 3 months after the procedure. CONCLUSIONS: Endoscopic single-nostril transseptal TSS for sellar or parasellar tumor resection has minimal impact on olfactory function.


Assuntos
Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Transtornos do Olfato/epidemiologia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Neuroendoscopia/efeitos adversos , Nariz , Transtornos do Olfato/etiologia , Complicações Pós-Operatórias/etiologia
10.
Eur Arch Otorhinolaryngol ; 276(11): 3113-3122, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31451900

RESUMO

PURPOSE: Definitive radiotherapy (RT) is recommended by NCCN guidelines for T4b tumors of sinonasal squamous cell carcinomas (SNSCC). However, no multi-institutional clinical studies have proved its advantage over surgery-based modalities. The aim of this study was to assess the survival of T4bN0M0 SNSCC patients who received surgery plus postoperative radiation (S + PORT) compared with those who received RT. METHODS: This study extracted 220 patients from the SEER database from 2004 to 2015. Propensity score matching (PSM) was used to eliminate the baseline variations. RESULTS: In SEER database, 43.6% of patients received S + PORT, and subsequently followed by RT (36.4%). Five-year overall survival (OS) and cancer-specific survival rates (CSS) in S + PORT were 42.5% and 46.9%, respectively, significantly better than for RT (21.7% and 26.7%). Multivariate analysis showed that therapy of RT had higher cancer-specific mortality risk than S + PORT [hazard ratio (HR) 1.578, p = 0.032]. After PSM, 57 pairs of patients were selected. There was still a significant difference noted with regard to 5-year OS or 5-year CSS between patients receiving S + PORT and RT (43% vs 22.5%, p = 0.012; 45.8% vs 27.7%, p = 0.025). The univariate and multivariate analyses of factors predictive of CSS showed that therapy of RT (HR 1.877, p = 0.018) and primary subsite of maxillary sinus (HR 2.629, p = 0.001) were significantly correlated with adverse outcomes. CONCLUSION: Combination of surgery and postoperative radiotherapy may contribute to prolonged survival in T4bN0M0 SNSCC. Invasion of the sites of T4b tumors is not an absolute contraindication for surgery.


Assuntos
Carcinoma de Células Escamosas , Cirurgia Endoscópica por Orifício Natural , Neoplasias dos Seios Paranasais , Radioterapia , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , China/epidemiologia , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Pesquisa Comparativa da Efetividade , Tratamento Conservador/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/estatística & dados numéricos , Estadiamento de Neoplasias , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/terapia , Radioterapia/efeitos adversos , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos , Taxa de Sobrevida
11.
Eur Arch Otorhinolaryngol ; 276(10): 2835-2841, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31367833

RESUMO

OBJECTIVE: The purpose of this study was to investigate and summarize the characteristics of spontaneous cerebrospinal fluid rhinorrhea cases and the efficacy of transnasal endoscopic repair of spontaneous cerebrospinal fluid rhinorrhea with the assistance of computer-assisted navigation system. METHODS: This is a retrospective study including 21 adult patients with spontaneous cerebrospinal fluid rhinorrhea who underwent transnasal endoscopic repair with the assistance of computer-assisted navigation system between January 2007 and December 2017. Data collected included patient demographics, body mass index, patient symptoms, biochemical findings, radiographic findings, location of defect, type and size of defect, type of repair, follow-up time, reoccurrence, and complications. RESULTS: Spontaneous cerebrospinal fluid rhinorrhea was more commonly seen in females who were middle-aged and overweight in our series. The effluent was determined as cerebrospinal fluid by testing of glucose concentration and ß2-transferrin. The location of the lesion was determined by rigid nasal endoscopy combined with radiologic study. Intraoperatively, the skull base defects were found most frequently on the ethmoid roof in 12 cases (57.1%), followed by the cribriform plate in seven cases (33.3%), and sphenoid sinus in two cases (9.5%). The size of the skull base defect was < 5 mm in 13 cases, 5 mm ~ 10 mm in six cases and two cases involved defects of ≥ 10 mm. The graft materials were chosen based on the size of the defect. In small leaks, the thigh muscle was dumbbell-shaped herniated into the bony defect, reinforced by fascia lata. Larger defects were packed with the anterior part of middle turbinate with an overlay of fascia lata. All 21 patients had no recurrence of cerebrospinal fluid rhinorrhea during the follow-up period, which ranged from 11 to 24 months. CONCLUSION: The transnasal endoscopic approach with assistance of computer-assisted navigation system is a safe and effective procedure for the repair of spontaneous cerebrospinal fluid rhinorrhea.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Cirurgia Endoscópica por Orifício Natural/métodos , Base do Crânio , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Transplante de Tecidos/métodos , Resultado do Tratamento
12.
World Neurosurg ; 131: e415-e424, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376554

RESUMO

BACKGROUND: The Eustachian tube and sphenoid spine have been previously described as landmarks for endonasal surgical identification of the most distal segment of the parapharyngeal internal carotid artery (PhICA). However, the intervening space between the sphenoid spine and PhICA allows for error during exposure of the artery. In the present study, we have characterized endoscopic endonasal transmasticator exposure of the PhICA using the sphenoid spine, vaginal process of the tympanic bone, and the "tympanic crest" as useful anatomical landmarks. METHODS: Endonasal dissection was performed in 13 embalmed latex-injected cadaveric specimens. Two open lateral dissections and osteologic analysis of 10 dry skulls were also performed. RESULTS: A novel and palpable bony landmark, the inferomedial edge of the tympanic bone, referred to as the tympanic crest, was identified, leading from the sphenoid spine to the lateral carotid canal. Additionally, the vaginal process of the tympanic bone, viewed endoscopically, was a guide to the PhICA. The sphenoid spine was bifurcate in 20% of the skulls, with an average length of 5.98 mm (range, 3.9-8.2 mm), width of 5.81 mm (range, 3.0-10.6 mm), and distance to the carotid canal of 4.48 mm (range, 2.5-6.1 mm). CONCLUSION: The sphenoid spine and pericarotid space has variable anatomy. Using an endoscopic transmasticator approach to the infratemporal fossa, we found that the closest landmarks leading to the PhICA were the tympanic crest, sphenoid spine, and vaginal process of the tympanic bone.


Assuntos
Pontos de Referência Anatômicos , Artéria Carótida Interna/anatomia & histologia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Osso Esfenoide/anatomia & histologia , Tecido Adiposo , Cadáver , Tuba Auditiva/anatomia & histologia , Fáscia , Humanos , Nervo Mandibular/anatomia & histologia , Artérias Meníngeas/anatomia & histologia , Cavidade Nasal , Músculos Pterigoides/anatomia & histologia
13.
Eur Arch Otorhinolaryngol ; 276(9): 2491-2498, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31342144

RESUMO

PURPOSE: The endoscopic endonasal approach is increasingly being used for resection and reconstruction of anterior skull base lesions. The vascularized nasoseptal flap (NSF) has become the workhorse for reconstruction of anterior skull base defects, resulting in a significant decrease in the incidence of cerebrospinal fluid (CSF) leak. This study presents a single center's experience with NSFs and reports associated complications. METHODS: Patients who underwent endoscopic skull base defect repair with a NSF between 2008 and 2014 were retrospectively evaluated. Complications reviewed were divided into major and minor. Major complications included new-onset and continuing CSF leak and meningitis. Minor complications included long-standing crust formation, synechia, epistaxis, septal perforation, sinusitis and anosmia. RESULTS: Of the 77 patients included in the study, 47 (61%) underwent trans-sphenoidal surgery for pituitary lesions during which CSF leak was observed. The other 30 patients underwent reconstructive surgeries for post-traumatic CSF leaks or extirpation of lesions involving the anterior skull base. A high-flow intra-operative CSF leak was observed in 25 patients (25/77, 32%). The median follow-up was 16 months (range 3-81 months). 9 patients had major complications and 27 patients had minor complications. Only high-flow intra-operative CSF leak correlated with major complications (p = 0.012). CONCLUSION: NSF is an extremely effective tool for skull base reconstruction. While it is associated with a low rate of major complications, minor complications are frequent and require local treatment, although they tend to resolve in the late postoperative period.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos , Adulto Jovem
14.
Medicine (Baltimore) ; 98(29): e16377, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335687

RESUMO

RATIONALE: Small intestine stromal tumors (SISTs) are a type of gastrointestinal stromal tumor (GIST) that has an insidious onset. Natural orifice specimen extraction (NOSE) surgery has been gradually developed for the treatment of colorectal, stomach, small intestine, hepatobiliary, and gynecological tumors because of its safety and feasibility. This case study explored the possibility of applying the NOSE method for the treatment of SIST. PATIENT CONCERNS: A 59-year-old male patient was admitted to the hospital after having an irregular abdominal mass for >1 month that was detected by a medical examination. Thoracic and abdominopelvic enhanced computer tomography revealed irregular masses on the left side of the abdominal cavity. DIAGNOSIS: Sist. INTERVENTIONS: Nose (laparoscopic resection of intestinal stromal tumors with transrectal extract specimen and no abdominal auxiliary incision) surgery was performed. OUTCOMES: The patient underwent operation successfully and recuperates well with no complications. LESSONS: Nose surgery is minimally invasive, results in patient recuperation with no complications, and is considered to be feasible for SIST treatment.


Assuntos
Colectomia/métodos , Tumores do Estroma Gastrointestinal , Neoplasias Intestinais , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/fisiopatologia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias Intestinais/patologia , Neoplasias Intestinais/fisiopatologia , Neoplasias Intestinais/cirurgia , Intestinos/diagnóstico por imagem , Intestinos/patologia , Intestinos/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(28): e16475, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305482

RESUMO

Afferent loop obstruction is an uncommon complication associated with Billroth-II distal gastrectomy. Inappropriate treatment may result in life-threatening events as perforation and peritonitis. For the benign afferent loop obstruction, Braun or Roux-en-Y reconstruction has been reported as the choice. However, the edematous afferent loop may result in anastomotic fistula. In this study, a less invasive technique was described for treatment of benign afferent loop obstruction. The aim of this study was to investigate the effectiveness and safety of endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction.We conducted a retrospective review of the data of 2548 gastric cancer patients who underwent distal gastrectomy from January 2002 to January 2018. Patients who developed benign afferent loop obstruction were treated by this procedure. Outcomes were recorded. Follow-up was scheduled at 3, 6, and 12 months after the treatment.Twenty-six patients (1.0%) developed afferent loop obstruction. The median age, consisting of 19 men and 7 women, was 60 years (range 36-69 years). Of these 26 patients, 23 underwent the endoscopic treatment. The obstructive symptoms had a rapid relief in all the 23 patients. No one died due to this procedure. However, 2 patients underwent surgical treatment due to intestinal obstruction because of adhesion at >4 and 7 months after the endoscopic drainage, respectively.Endoscopic nasogastric tube insertion is an effective and safe procedure for treatment of benign afferent loop obstruction. In addition, it could be considered as the first step in treatment, especially in high-surgical-risk patients.


Assuntos
Síndrome da Alça Aferente/terapia , Endoscopia Gastrointestinal , Gastrectomia , Intubação Gastrointestinal , Complicações Pós-Operatórias/terapia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/métodos , Endoscopia Gastrointestinal/métodos , Seguimentos , Humanos , Intubação Gastrointestinal/métodos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Estudos Retrospectivos , Resultado do Tratamento
16.
J Laparoendosc Adv Surg Tech A ; 29(9): 1093-1104, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313957

RESUMO

Background: Although laparoscopic Heller myotomy (LHM) with partial fundoplication has long been considered the gold standard for treatment of patients with achalasia, peroral endoscopic myotomy (POEM) has emerged in the last decade as a viable alternative. Methods: A collective review of literature concerning investigations that have reported patient outcomes and treatment success of LHM and POEM for all achalasia subtypes. Results: While POEM has shown excellent short-term safety and efficacy in the relief of symptoms, the long-term symptomatic outcomes after the intervention are yet to be concluded. Further evaluation of patients' interpretations and answers on subjective questionnaires is warranted before determining treatment success for POEM. Use of more reliable and disease-specific health-related quality-of-life questionnaires are better justified when comparing a new endoscopic procedure to an established gold standard. The need for objective parameters to measure reflux, longer follow-up studies, and randomized trials comparing POEM to LHM is particularly important when assessing the outcome of this new technique. High incidence of post-POEM pathologic reflux and indication for daily proton pump inhibitor use is of concern, and the lack of more long-term, objective evidence leaves the clinical value of the procedure in a state of uncertainty. Conclusions: The LHM combined with partial fundoplication is still considered to be the gold standard treatment modality for achalasia, but as the POEM procedure rapidly becomes common practice, this treatment may be performed in the majority of achalasia cases. Given the number of flaws overlooked in seminal investigations, careful consideration should be given to the patients being selected for this therapy.


Assuntos
Acalasia Esofágica/cirurgia , Esofagoscopia/métodos , Miotomia de Heller/métodos , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Seguimentos , Humanos , Duração da Cirurgia , Resultado do Tratamento
17.
World Neurosurg ; 127: 710-735, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31266133

RESUMO

In the study and practice of neurosurgery at the "Federico II" University of Naples, a central role has always been reserved for anatomy. Based on worldwide cooperation, the meaning of anatomical research has evolved from methodological investigation to an educational and communication tool. The contribution of our school to the anatomical data on the sellar region has been chronologically reviewed in the present report. The path that brought us to focus on the endoscopic endonasal anatomy has been presented, together with the evolution of anatomical investigation. The confidence achieved with decades of cadaveric laboratory studies has changed the profile of our anatomical investigations. The quantification and comparison became essential in these studies owing to their effect on surgical application and advanced imaging techniques entered the field of anatomical dissection. Anatomy at our school is an evolving science. Our efforts in anatomical scientific publications and organization of participatory courses have made us a center of reference for endoscopic endonasal surgery and have allowed us to share our knowledge with other specialists in this field.


Assuntos
Neuroendoscopia/métodos , Órbita/anatomia & histologia , Base do Crânio/anatomia & histologia , Cadáver , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Órbita/cirurgia , Sela Túrcica/anatomia & histologia , Base do Crânio/cirurgia
18.
Acta Otolaryngol ; 139(9): 816-822, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31268399

RESUMO

Background: We aimed to reduce the morbidity related to treatment and to preserve organ function in patients with hypopharyngeal squamous cell carcinoma (HPSCC) by applying a new surgical treatment protocol based on transoral robotic surgery (TORS). Aims/objectives: In this study, we analyzed the prognostic factors related to survival to confirm the validity and effectiveness of TORS in patients with advanced-stage HPSCC. Methods: We retrospectively analyzed the data of 44 HPSCC patients who had undergone TORS-based therapy. Results: In univariate analysis, only the surgical marginal status showed a statistically significant correlation with the survival of the patients (p = .009). In multivariate analysis, surgical margin status was the only statistically significant prognostic factor related to survival (p = .008). Forty-one patients (93.2%) recovered speech function sufficiently to perform daily conversation without artificial aids. Forty-one patients (93.2%) were able to ingest food orally. Conclusions: In the treatment of advanced hypopharyngeal cancer, TORS-based therapy helped the surgeon obtain a clear surgical margin in patients with HPSCC, and it showed superior oncologic and functional outcomes compared to the existing treatment methods.


Assuntos
Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Adulto , Idoso , Análise de Variância , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hipofaríngeas/tratamento farmacológico , Neoplasias Hipofaríngeas/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Boca , Terapia Neoadjuvante , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Análise de Sobrevida
20.
Eur Arch Otorhinolaryngol ; 276(10): 2819-2826, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332548

RESUMO

BACKGROUND: The discomfort and complications have always been problems for nasal packing materials. This study provided a new nasal packing material called high expansion degradable cotton (HEDC). METHODS: Nasal endoscopic surgery was used to establish a dog model of nasal bleeding, and wound surfaces were filled with Merocel, Nasopore and HEDC, respectively. Intraoperative and postoperative bleeding of 24 h was calculated. We evaluate the absorbability score, adhesion score, infection sore and nasal mucosal epithelium in postoperative 3, 7, 14 and 28 days. HE staining and electron microscopy were used to evaluate the recovery of nasal mucosa. RESULTS: There was no significant difference in nasal bleeding between HEDC, Merocel and Nasopore. Nasal endoscopic examination revealed HEDC absorbability of score, adhesion score, infection score were significantly lower than Merocel and Nasopore. The epithelialization time of HEDC was significantly shorter than that of Merocel and Nasopore. HE staining showed that HEDC and Nasopore could significantly reduce scar hyperplasia on the wound surface. The results of electron microscopy suggested that HEDC could protect the edge cilia of the wound. CONCLUSION: HEDC could be used as new choice for hemostasis after nasal endoscopic surgery, which could reduce nasal epithelialization time, and protect wound edge cilia.


Assuntos
Epistaxe/terapia , Formaldeído/administração & dosagem , Procedimentos Cirúrgicos Nasais/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Álcool de Polivinil/administração & dosagem , Hemorragia Pós-Operatória/terapia , Animais , Cães , Técnicas Hemostáticas , Hemostáticos/administração & dosagem , Humanos , Modelos Animais , Procedimentos Cirúrgicos Nasais/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Aderências Teciduais , Resultado do Tratamento
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