ANZCTR: ACTRN12610000155099. https://www.anzctr.org.au/registry/trial_review.aspx?ID=335162.
Background: Combined transorbital and transnasal endoscopic surgery for access to the skull base has contributed to the gradual expansion of the remit of the endoscopic skull base surgeon. Method: We present our technique of Silastic® sheet aided combined transorbital and transnasal endoscopic resection of anterior skull base malignancies, with a description of surgical technique and our method of safeguarding the orbital contents with appropriate suggested indications. Results: Patient underwent resection of non-intestinal type adenocarcinoma. There were no immediate or delayed postoperative complications related to transorbital access. Conclusion: In cases where tumour infiltrates medial orbital wall and there is an indication to remove the lamina papyracea and/ or periorbita, we find the initial transorbital approach advantageous to find a dissection plane in healthy tissue and to achieve partial devascularisation of tumour by cauterisation of anterior and posterior ethmoidal artery. Moreover, this approach can be combined with intraorbital placement of Silastick sheet to prevent a prolapse of orbital contents into the nasal cavity during transnasal resection which may lead to its damage.
Editor-Although we applaud the continued investigation by Fredrickson and colleagues 1 of a single infraclavicular injection in comparison with concomitant infraclavicular plus distal median, radial, and ulnar nerve block, we question the necessity of this study. In the infraclavicular only group, most patients (26/30) received an additional median, radial, or ulnar nerve block. The success rate is much less than the published results of other control studies (85-100%). 2 -4 A possible explanation may be an imperfect block technique. 5 On the other hand, according to our clinical practice, we believe that 15 min is not long enough to assess the block effects. The durations for evaluation in most studies were 30 min or more. And we can find that the success rate increases significantly from 15 to 30 min. 2 3 6 7 Another potential problem for the combined technique could be the increased risk of nerve injuries and infections which was not indicated in the article. The only message worth of note was that procedure-related paraesthesia was higher in the combined group (5 vs 1). Although the authors believed that ultrasound guidance can avoid the mechanical trauma caused by needles, we remind that high injection pressures, local anaesthetic neurotoxicity, and ischaemic injury caused by epinephrine and neural oedema may also result in nerve injuries. 8 9 As for the primary aim of this study (tourniquet analgesia, surgical anaesthesia, early return of upper arm motor function, and prolonged postoperative analgesia), we agree that different concentration and amount of drugs infused through a brachial plexus perineural catheter may be helpful, but a detailed infusion proposal needs further investigation. So we suggest that the accelerated onset time of 6 min may not deserve the risk of nerve injuries. If waiting another 15 min can improve the block effects, why should not we do that? Declaration of interestNone declared.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.