Isolated sphenoid sinusitis (ISS) is a group of pathologies characterized by inflammation in one or both sphenoid sinuses. The gold standard for analyzing and diagnosing ISS is computer tomography. Many researchers have discussed the treatment of patients with ISS variants such as fully opacified sinus, mostly with surgery. A retrospective analysis of clinical data of 59 patients (21 male (35%), 38 female (65%)) with ISS, who were treated in the Otorhinolaryngological Department of Pavlov First Saint Petersburg State Medical University between January 2017 and January 2020, was conducted. All patients were in the first stage of the same medical therapy. In cases where there was no recovery, these patients were referred to surgery. For the control group, we analyzed patients without any disorders according to CT-scan examination. After analyzing the obtained clinical and radiological data, we found indicators that were common in patients who did not recover after medical therapy. According to the reverse regression method statistical model, in male patients with a diffuse headache and nasal discharge it was shown that medical therapy was highly effective (more than 78%). The presence of nasal septum deviation and adenoids in male and female patients leads to the highest risk of surgical treatment (83% probability of the logistic model). The detailed analysis of CT-scans and the complaints of patients with ISS can be the key to determining the preferred therapy choice. Not all cases need to have an endoscopic opening of the sphenoid sinus, according to our research.
Spontaneous nasal liquorrhea is a pathological condition associated with defects between the nasal cavity and the intracranial structures, which results in CSF leak from the nasal cavity. Diagnostic criteria include: anamnesis, examination of the nasal fluid, endoscopic examination of the nasal cavity, and CT-and MRI-cisternography. Conservative therapy is applicable to small fistulas. In the case of the inefficiency of this method, surgical method is then applied to the defect closure. Purpose of the study: To evaluate the effectiveness of endoscopic endonasal approach in the CSF leak treatment. Materials and methods: For the period from 2008 to 2018 at the Pavlov First Saint Petersburg State Medical University, at the clinic of neurosurgery of the Kirov Medical Institute and the Medical Research Center Almazov, 38 patients with spontaneous nasal liquorrhea were treated. All patients underwent plastic surgery of the CSF fistula by endoscopic endonasal approach. Results: In 4 cases, there was a large defect requiring secondary surgical intervention 1-2 weeks after the initial operation. Conclusions: The use of auto tissues (muscle or fat) is the method of choice for repeated surgical plastics of the cerebrospinal fluid fistula or in the case of a large size defect.
Benign pituitary gland tumors (or adenomas) constitute the vast majority of all chiasmosellar tumors. There are various approaches in surgical treatment of the sella turcica pathology. Endonasal transsphenoidal approach is the method of preference. Choosing the approach to the skull base, the surgeon should carefully study the results of magnetic resonance imaging and computer-aided tomography. If there are anatomic features preventing the approach to the operated area, first of all the patient undergoes the correction of these structures. The surgical excision of pituitary adenoma through endonasal access is conditionally divided into three stages: nasal, sphenoidal and sellar. The final stage of surgical treatment is the stage-by-stage plastic surgery of the bottom of sella turcica with the layer-by-layer implantation of glue compositions and sealing the intracranial space. 12 patients diagnosed with pituitary adenoma with infra- and suprasellar growth were examined at the Chairs of Otorhinolaryngology and Neurosurgery with the participation of cytological laboratories. All the patients were examined by an otorhinolaryngologist on the 7th, 30th and 90th days after surgery. Endoscopic visualization of the surgical intervention area was performed and cytological examination of the nasal cavity secretion was made at the indicated time intervals. Therefore, it has been found that the reactive inflammatory phenomena associated with irrigation therapy were stopped by the 30th-40th day after the surgery. In 8 patients the treatment was supplemented with local antibacterial therapy, which provided the removal of the reactive inflammatory phenomena in the surgical intervention area. Therefore, all patients after endonasal transsphenoidal removal of pituitary adenoma are recommended the 30-day otorhinolaryngologists’ follow-up with the purpose of control of regeneration processes dynamics.
Isolated sphenoid sinus disease (ISSD) is where there is a group of pathologies characterized by inflammation in one or both sphenoid sinuses. Although computer tomography (CT)-based 3D reconstruction remains the gold standard among noninvasive approaches to ISSD diagnostics, no standardized techniques for direct intraoperative measurements of the sphenoid sinus volume in ISSD patients have been documented. We suggest a novel technique for the intraoperative measurement of the sphenoid sinus volume. Our technique is based on filling the sinus with 0.01% methylene blue solution after an endoscopic endonasal sphenoidotomy. The proposed technique was applied to 40 ISSD patients during surgery. Obtained intraoperative measurements were compared to noninvasive measurements from 3D reconstructions based on preoperative CT scans. Our results demonstrated that the obtained measurements did not exhibit significant differences exceeding 0.4 cm3, with CT-scan-based measurements in 39 out of 40 cases (p < 10−6, Wilcoxon sign-rank nonparametric test), thus confirming the accuracy of the proposed technique. Disagreements between direct intraoperative and CT-based measurements in a single case have been attributed to the presence of remaining pathological masses in the sinus, which was further confirmed during the secondary check of the operated sinus. Accordingly, we suggest that the agreement between the CT-based and intraoperative volume measurements can be used as an indicator of the successful elimination of all pathological masses from the sinus without having to perform an adequate exposure of the entire sphenoid sinus to reduce intraoperative bleeding. The proposed technique is accurate and does not require the involvement of specialized intraoperative CT scanners and avoids additional radiation exposure for the patient during an additional postoperation CT scan to confirm the success of the surgery.
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