Tumours of the skull base
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
It is fundamental that adequate access to the pathology is realized. This may involve the use of craniofacial osteotomies although with experience their use is rationalized and tailored to the individual patient. A short straight line of sight to the pathology is necessary to create space for surgical manoeuvres and avoid brain retraction. Access should not compromise reconstructive options, e.g., preservation of the superficial temporal and supraorbital vessels. Damage to the temporal muscle should be avoided unless its resection is mandatory. Ideally, osteotomies should be pedicled, if post-operative radiotherapy is planned. Endoscopic surgery can be employed on its own or in addition to open surgery (endoscopic assisted) in selected individuals and specific pathologies.
Extended Anterior Skull Base Approaches
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
For patients with sinonasal malignancy, oncological principles can be preserved with EES.2 The goal of surgery is complete oncological resection with the least morbidity. With such cases, the endoscope is only a surgical tool and resection margins should not be compromised in order to perform an endoscopic resection. Although it is often promoted, en bloc resection is not achievable with an ‘open’ approach in many patients, due to proximity of the tumour to critical neural and vascular structures and fracturing of the tumour specimen. There is also abundant evidence that en bloc resection is not necessary as long as final resection margins are negative (e.g., inverted papilloma, Moh’s surgery for skin cancer, and laser resection of pharyngeal and laryngeal squamous cell carcinoma). For sinonasal malignancy that involves the cribriform plate with risk of intra-cranial extension along olfactory filia to the olfactory bulb, bilateral wide resection of the anterior cranial base is recommended including dura, olfactory bulbs, and olfactory tracts.3 Potential benefits of endoscopic surgery include better visualization of resection margins with better local control, no transgression of normal tissue planes with risk of tumour seeding, absence of frontal lobe manipulation, and faster recovery with early institution of adjunctive therapies.
Neuroendocrine disease
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
NFPAs are frequently invasive, with extension into the cavernous sinuses. As such, they present a particular challenge to the surgeon. The standard treatment for NFPAs is transsphenoidal surgery. Visual impairment can be expected to improve in the majority of patients who undergo surgery within a year of the onset of symptoms.40 A recent study has demonstrated improved surgical outcome at 1 year, after endoscopic surgery, compared with conventional microscopic surgery.59 The problem is that even with good surgical clearance, there is a high recurrence rate. This high rate may in part be due to dural invasion, microscopic evidence of which has been demonstrated in 88% of intrasellar macroadenomas and in 94% of suprasellar tumors.60 A recent retrospective review of 155 patients in Oxford, United Kingdom, who underwent surgical treatment between 1984 and 2007 demonstrated relapse rates of 23%, 47%, and 68% at 5, 10, and 15 years, respectively, indicating the need for prolonged follow-up. Recurrence rates were higher in patients with visible residual tumor after surgery and in younger patients61 (Figure 1.18). Radiotherapy reduces tumor recurrence after surgery and may be considered for patients at high risk of recurrence.62
A comparative study of the acute and long-term prognosis for mouse models undergoing laparoscopic surgery under continuous intra-abdominal perfusion with either CO2 gas or saline
Published in Cogent Medicine, 2018
Hisayo Jin, Takuro Ishii, Shiroh Isono, Tatsuo Igarashi, Tomohiko Aoe
Minimally invasive surgical techniques are an essential component of enhanced recovery after surgery (ERAS). Endoscopic surgery is a potent tool that reduces postoperative complications and pain while providing the additional advantages of a small incision size, a minimally invasive approach, and reduced hospital stays. Conventional laparoscopic surgery and robot-assisted surgery routinely apply carbon dioxide (CO2) gas to widen the body cavity and obtain an adequate surgical field. Although both CO2 insufflation and liquid irrigation may have some adverse effects, liquid irrigation would provide us with the opportunity to perform lavage that would help to maintain an appropriate local/body temperature, avoid the desiccation of organs, and would allow us to use a favorable navigation system that permits simultaneous monitoring by both ultrasonography and laparoscopic imaging. Laparoscopic surgery under continuous intra-abdominal perfusion may be a possible alternative method for minimally invasive surgical techniques.
Nerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Wei Shu, Haipeng Wang, Hongwei Zhu, Yongjie Li, Jiaxing Zhang, Guang Lu, Bing Ni
The aim of surgical treatment is to dissect the tethering nerve roots and to repair the dural defect. Endoscopic surgery could be used to explore the surgical site, distinguish etiology and provide uncomplex treatment. For this case, endoscopic surgery provides a helpful visual angle to observe the pseudomeningocele at the ventrolateral of the dural sac which would be probably broken in the traditional surgery. However, untethering and suturing are much more difficult to complete under an endoscope, the microsurgical technique is the preferred approach for entrapped nerve root. Any entrapped nerve root should be freed and relocated into the dura. Either Gelfoam or muscle alone placed over the dural breach is ineffective in stopping the leak. Use of non-absorbable suture to close the dural defect is recommended. In addition, artificial dura, tissue glue, free fat grafts and myofascial grafts have also been used to enhance the dura.16
Comparing the effectiveness of laser vs. conventional endoforehead lifting
Published in Journal of Cosmetic and Laser Therapy, 2018
Cheng-Jen Chang, De-Yi Yu, Shu-Ying Chang, Yen-Chang Hsiao
During surgery, identification of the supratrochlear, supraorbital neurovascular bundle and frontal branch of the facial nerves is important to avoid injury that causes numbness and/or bleeding. Therefore, the indications for this combined technique are the same as for the endoscopic forehead surgery, and the same difficulties also arise in this group of patients using the endoscopic approach. Advantages of standard endoscopic surgery include diminished incidence of scarring, less numbness, bleeding and oedema. The major advantage of endoscopic surgery in the forehead area is the minimization of scarring. This advantage is preferable to the traditional coronary approach, as such a method has often resulted in long scars behind the hairline. In addition to this, the coronary approach is unable to effectively control bleeding complications caused by incision. These disadvantages are considerably reduced in this endoscopic technique (20–24). Combining the laser and the endoscope achieved the ablation of hyperactive muscles in our series. As this procedure requires no significant incisions, it allowed for an even greater reduction of bleeding, and as a result, less bleeding-related complications.
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