Endoscopic endonasal repair of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles.

Object: The endoscopic endonasal approach has become the preferred technique for CSF leak and encephalocele repair of the anterior skull base. The purpose of this study is to identify patient characteristics; review adjunctive perioperative treatments, reconstruction techniques, and outcomes; and identify risk factors for failure in patients undergoing endoscopic endonasal repair of anterior skull base CSF leaks and encephaloceles.

Methods: This is a prospective observational study of patients undergoing endoscopic endonasal repair of a CSF leak between October 2004 and May 2009.

Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus.

Object: Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare lesions that are hypothesized to result from persistence of the lateral craniopharyngeal canal. Prior reports of the management of this lesion have been limited by its relative rarity. The objective of this paper is to report the theoretical etiology, surgical technique, and outcomes in patients undergoing endoscopic repair of spontaneous meningoencephalocele of the sphenoid sinus.

Endoscopic endonasal transclival resection of chordomas: operative technique, clinical outcome, and review of the literature.

Object: Transcranial approaches to clival chordomas provide a circuitous route to the site of origin of the tumor often involving extensive bone drilling and brain retraction, which places critical neurovascular structures between the surgeon and pathology. For certain chordomas, the endonasal endoscopic transclival approach is a novel minimal access, but it is an equally aggressive alternative providing the most direct route to the tumor epicenter.

Methods: The authors present a consecutive series of patients undergoing endonasal endoscopic resection of clival chordomas.

Three-dimensional endoscopic pituitary surgery.

Objective: We describe a novel 3-dimensional (3-D) stereoendoscope and discuss our early experience using it to provide improved depth perception during transsphenoidal pituitary surgery.

Methods: Thirteen patients underwent endonasal endoscopic transsphenoidal surgery. A 6.

Prolonged exposure to high dietary lipids is not associated with lipotoxicity in heart failure.

Previous studies have reported that elevated myocardial lipids in a model of mild-to-moderate heart failure increased mitochondrial function, but did not alter left ventricular function. Whether more prolonged exposure to high dietary lipids would promote a lipotoxic phenotype in mitochondrial and myocardial contractile function has not been determined. We tested the hypothesis that prolonged exposure to high dietary lipids, following coronary artery ligation, would preserve myocardial and mitochondrial function in heart failure.

Transnasal endoscopic resection of a cavernous sinus hemangioma: technical note and review of the literature.

Unlabelled: Objective/Importance: Hemangiomas of the cavernous sinus are rare lesions. Complete removal through a transcranial route often causes ocular motor palsies. Because the cranial nerves in the cavernous sinus are lateral to the carotid, a medial approach to the cavernous sinus may be less traumatic to the cranial nerves.

Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique.

Study Design: We report the case of a 50 year-old woman with os odontoideum and posterior atlantoaxial subluxation, who underwent an occipitocervical fusion followed by endonasal endoscopic anterior decompression of the cervicomedullary junction (CMJ).

Objective: To describe the feasibility of performing endonasal endoscopic anterior decompression of CMJ pathology in conjunction with occipitocervical fusion in 1 operative setting.

Summary Of Background Data: The recommended management of symptomatic atlantoaxial instability secondary to os odontoideum with irreducible ventral compression is occipitocervical fusion with anterior decompression.

Endoscopic pituitary surgery: a systematic review and meta-analysis.

Object: Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design.

Predictors of short-term outcomes following endoscopic pituitary surgery.

Objective: Refinement of endoscopic pituitary surgery requires an understanding of the impact of demographic and surgical variables on outcomes.

Methods: Multivariate logistic regression and ANOVA models were used to explore variables for association with outcomes in a consecutive series of 57 patients undergoing endoscopic pituitary surgery.

Results: The mean duration of surgery was 177 min and was longer in patients with larger tumor size (p=0.

"Gasket-seal" watertight closure in minimal-access endoscopic cranial base surgery.

Objective: Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented.

Endoscopic cranial base surgery: classification of operative approaches.

Objective: Endoscopic cranial base surgery is a minimal access, maximally aggressive alternative to traditional transfacial, transcranial, or combined open cranial base approaches. Previous descriptions of endoscopic approaches have used varying terminology, which can be confusing to the new practitioner. Indications for surgery are not well defined.

Endonasal endoscopic resection of the odontoid process in a nonachondroplastic dwarf with juvenile rheumatoid arthritis: feasibility of the approach and utility of the intraoperative Iso-C three-dimensional navigation. Case report.

The authors report a case of a nonachondroplastic dwarf with severe basilar invagination and compression of the cervicomedullary junction (CMJ) due to juvenile rheumatoid arthritis. Initially excellent reduction of the invagination and decompression of the CMJ was achieved using posterior fixation. However, 1 month postoperatively symptoms recurred and the authors found imaging evidence of recurrence as well.

The rhinology experience in otolaryngology residency: a survey of chief residents.

Objectives: The development of rhinology as a distinct subspecialty is based on recent advances in the research, clinical, and surgical aspects of the field. The impact of this evolution on the rhinologic experience in otolaryngology residency programs is not currently understood.

Methods: An anonymous, web-based survey of chief residents in otolaryngology residency programs was performed.

Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery.

Objective: Intraoperative identification of cerebrospinal fluid (CSF) leakage is critical in successful closure after endoscopic cranial base surgery. Intrathecal injection of fluorescein is quite useful in identifying CSF leaks. However, complications have been reported with various doses and the technique has fallen out of favor.

Role of perioperative antibiotics in endoscopic skull base surgery.

Objectives/hypothesis: Direct connection between the sinonasal and intracranial cavities and passage of multiple instruments and graft materials through a contaminated field occur routinely during endoscopic pituitary and skull base surgery. Despite the theoretical risk of intracranial contamination with sinonasal flora, the incidence of central nervous system (CNS) infection following such procedures is not well documented, and the ideal antibiotic regimen has yet to be determined.

Study Design: Prospective case series of 24 to 48 hours of single-agent perioperative antibiotics in patients undergoing endoscopic skull base surgery.

Intrathecal fluorescein in endoscopic skull base surgery.

Objectives: Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid the morbidity of postoperative cerebrospinal fluid (CSF) leak. The impact on outcomes of CSF visualization with intrathecal fluorescein, however, is unknown.

Study Design: A retrospective review of patients undergoing endoscopic skull base surgery with intrathecal fluorescein.

Algorithm for reconstruction after endoscopic pituitary and skull base surgery.

Introduction: The expanding role of endoscopic skull base surgery necessitates a thorough understanding of the indications, techniques, and limitations of the various approaches to reconstruction. The technique and outcomes of endoscopic skull base reconstruction remain incompletely described in the literature.

Study Design And Methods: Patients undergoing endoscopic skull base surgery underwent an algorithmic approach to reconstruction based on tumor location, defect size, and presence of intraoperative cerebrospinal fluid (CSF) leak.

Outpatient intravenous antibiotics for methicillin-resistant Staphylococcus aureus sinusitis.

Background: The widespread use of broad-spectrum antibiotics has resulted in an increase in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Its presence in sinonasal cultures in patients with sinusitis suggests its pathogenicity. However, the efficacy and safety of treatment modalities for MRSA sinusitis remain incompletely described.

Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions.

Object: The extended transsphenoidal approach is a less invasive method for removing purely suprasellar lesions compared with traditional transcranial approaches. Most advocates have used a sublabial incision and a microscope and have reported a significant risk of cerebrospinal fluid (CSF) leakage. The authors report on a series of purely endoscopic endonasal surgeries for resection of suprasellar supradiaphragmatic lesions above a normal-sized sella turcica with a low risk of CSF leakage.

Mitomycin C and endoscopic sinus surgery: where are we?

Purpose Of Review: Mitomycin C has been used successfully in various ophthalmologic and, more recently, otolaryngologic procedures. Its modulation of fibroblast activity allows for decreased scarring and fibrosis. Several recent trials have examined the efficacy of mitomycin C in reducing synechia and stenosis following endoscopic sinus surgery.

Inflammatory pathway gene expression in chronic rhinosinusitis.

Background: The main objective in this preliminary experiment was to compare gene expression in the sinus mucosa of patients with chronic hyperplastic rhinosinusitis (CRS) against normal subjects, using gene microarray technology. The specific aim was to examine alterations in inflammatory mediator expression in patients with CRS. We performed a prospective experimental study.

Endoscopic transphenoidal pituitary surgery with real-time intraoperative magnetic resonance imaging.

Background: The aim of this study was to report and show the technique, results, and complications of combined endoscopic and intraoperative magnetic resonance imaging (IMRI) surgical treatment of pituitary disease from both a technical and a surgical perspective.

Methods: We performed a retrospective chart review of 10 endoscopic, endonasal resections of 10 pituitary macroadenomas using the Polestar N-10 IMRI system in a tertiary health care facility. The patient demographics, tumor measurements, and postoperative symptoms and complications were assessed.

Radiation dosimetry of the FluoroCAT scan for real-time endoscopic sinus surgery.

Objective/hypothesis: The FluoroCAT platform of the GE InstaTrak 3500 Plus reconstructs images acquired from the GE OEC 9800 Plus fluoroscope into triplanar images which allow the surgeon to perform real-time endoscopic sinus and skull-base surgery. The radiation dosimetry for the new scanning protocol required by the FluoroCAT has not been reported. This study was designed to measure the radiation dose of a FluoroCAT scan and compare this to the dosimetry of an InstaTrak CT scan.