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Intervention: Nanotechnology in Reconstructive Intervention and Surgery
Published in Harry F. Tibbals, Medical Nanotechnology and Nanomedicine, 2017
Skull base surgery and transnasal approaches are relevant to both neuro-surgery and otolaryngology. The endonasal route has been adopted as a useful approach for transsphenoidal surgery targeting the pituitary. An image-guided robotics system for skull base access has been developed at the University of Erlangen-Nuremberg and tested experimentally with a reproducible navigation accuracy of 1.53 mm, based on redundant navigational controls. The system was designed for use in skull base surgery using telemanipulation as well as automated image-guided procedures. Tests in which sphenoidotomies were successfully performed were conducted on cadaveric heads [231].
Endocrine system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
MRI is established as the modality of choice for imaging the pituitary gland and its relational anatomy. MDCT is utilised when the patient is contraindicated for MRI. It facilitates the identification of calcification, bony erosion of the sella floor and as a pre-operative examination for transsphenoidal surgery [1].
Surgical applications of intracorporal tissue adhesive agents: current evidence and future development
Published in Expert Review of Medical Devices, 2020
Nicholas Gillman, David Lloyd, Randy Bindra, Rui Ruan, Minghao Zheng
DuraSeal® (Integra) [103] and Adherus® (Stryker) are FDA-approved PEG co-polymer dural sealants. DuraSeal® is composed of cross-linked PEG ester and trilysine amine while Adherus® is composed of a PEG-polyethyleneimine (PEI) co-polymer. RCTs of DuraSeal® showed the sealant system achieves a statistically significant increase in watertight spinal dural closure compared to standard sutures [103,106]. However, an RCT and a two-armed prospective study involving 429 cases of spinal dural repair showed reductions in CSF leakage and post-operative infection to not be statistically significant [107,108]. Moreover, there are pilot case studies broadening its versatility of DuraSeal® (Integra) in other neurological produces, such as endonasal transsphenoidal surgery [109] and deep brain stimulation procedures [110]. Case studies report that the use of DuraSeal® may lead to cauda equina syndrome, cervical cord compression, and paralysis [111–113]. On the other hand, Adherus® has a limited volumetric expansion compared to other commercially available dural sealants [114]and thus may theoretically reduce the risk of these complications. However, Adherus® has been shown to possess non-inferior clinical effectiveness to DuraSeal® in an RCT comparing the two agents as an adjunct to standard dural repair [115] and in cranial dural repair in a case series study [116]. In addition, the Adherus® sealant has shown potential antimicrobial advantage [117,118].
Dural sealants for the management of cerebrospinal fluid leakage after intradural surgery: current status and future perspectives
Published in Expert Review of Medical Devices, 2019
Ahmet Kinaci, Tristan P.C. Van Doormaal
Although there is no straightforward method of CSF leakage prevention management, the cornerstone of preventing CSF leakage seems to be watertight closure, especially after infratentorial surgery. Sufficient time, attention and effort have to be paid to suture the dura watertight. Also, small dural defects should be prevented. Overstretching of the dura to close it has to be avoided because tension by stitches will cause micro-ruptures that can result in CSF leakage. If a dural defect appears, grafts and/or sealants can be used to achieve watertightness. In general, we prefer the use of a sealant over the total dural surface (not only the suture line) to close defects smaller than 3 mm. Larger dural defects need a dural graft. We consider autologous tissue such as pericranium or fascia ideal grafts. For small defects sometimes fat or muscle can be used. In case autologous tissue is not easily available in sufficient quantity an allograft is also an option. Preventive external lumbar drain placement is usually not considered due to its disadvantages such as hospitalization, immobilization, and risk of infection. We consider preventive external drain placement only in case of obvious CSF leakage during transsphenoidal surgery. In case of postoperative leakage, first, an external lumbar drain is applied under local anesthesia. If there is no immediate effect and the wound is not fully dry during 3 days of immobilization and CSF drainage, the wound should be surgically revised.
Work-related musculoskeletal disorders among endoscopic transsphenoidal surgeons: a systematic review of prevalence and ergonomic interventions
Published in International Journal of Occupational Safety and Ergonomics, 2022
Filippo Marciano, Pier Paolo Mattogno, Anna Codenotti, Paola Cocca, Marco Maria Fontanella, Francesco Doglietto
In the last 20 years, a new surgical approach for the treatment of various pathologies of the skull base has been developed [1,2]: endoscopic transsphenoidal surgery (ETS). ETS provides minimally invasive and adequate access to different skull base lesions, e.g., pituitary tumours [3,4].