Quantitative analysis of progressive removal of nasal structures during endoscopic suprasellar approach

Notaris, Matteo de; Prats-Galino, Alberto; Enseñat, Joaquim; Topczewski, Thomaz E.; Ferrer, Enrique; Cavallo, Luigi Maria; Cappabianca, Paolo; Solari, Domenico

doi:10.1002/lary.24693

Cited by 24 publications

(15 citation statements)

References 45 publications

(103 reference statements)

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“…Previous authors have attempted to quantify change in the dimensions of the sinonasal corridor following resection of various intranasal structures through evaluating ability to reach preselected targets or by measuring change in access to both fixed and variable anatomic landmarks. 3,6 The most consistent finding from anatomic based studies is that unilateral middle turbinectomy provides the largest improvement in access to the midline skull base. 3,6 While our results are in agreement with this finding, we also found a significant improvement in working space following both bilateral middle turbinectomy and wide posterior septectomy.…”

Section: Discussionmentioning

confidence: 95%

“…3,6 The most consistent finding from anatomic based studies is that unilateral middle turbinectomy provides the largest improvement in access to the midline skull base. 3,6 While our results are in agreement with this finding, we also found a significant improvement in working space following both bilateral middle turbinectomy and wide posterior septectomy. We are not advocating that both maneuvers be performed in all circumstances; however, when a wider surgical field is required, this may facilitate enhanced operative freedom.…”

Section: Discussionmentioning

confidence: 95%

“…The most common methods include performing unilateral/bilateral partial middle turbinectomy and varying extents of posterior septectomy, ethmoidectomy, and sphenoidotomy. [3][4][5][6][7] Some authors suggest that a trade-off exists between maximizing operative working space through selective removal of intranasal structures and postoperative quality of life outcomes. 7 Although recent data demonstrate that a reduction in sinonasal quality of life measures on standardized assessments is observed in the immediate postoperative period, by 2 to 4 months, the scores have returned to baseline.…”

Section: Introductionmentioning

confidence: 99%

“…A second study attempted to better address this issue by calculating "working area" and "surgical freedom." 6 Working area was defined by evaluating visualization of fixed and variable anatomic landmarks at the level of the sella and calculating the two-dimensional surface area formed after capturing each site using neuronavigation. Surgical freedom was determined by measuring predefined landmarks reached by a surgical instrument (microdebrider), and points were only captured if able to fully rotate the instrument at that landmark.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative Analysis of Surgical Working Space During Endoscopic Skull Base Surgery

et al. 2018

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Objectives Selective dissection of intranasal anatomy may improve visualization and maneuverability at the skull base. We aimed to quantify the dimensions of working space and angles achieved following sequential removal of intranasal structures using an endoscopic transphenoidal approach to the skull base. Methods Cone beam computed tomography scans of four cadaveric heads were obtained for registration of an optical tracking system. Each head was sequentially dissected: (1) sphenoidotomy and limited posterior septectomy, (2) unilateral partial middle turbinectomy, (3) bilateral partial middle turbinectomy, and (4) wide posterior septectomy. The maximal craniocaudal and mediolateral distance (mm) and angle (degrees) reached were calculated at the sphenoid face and sella. Data were analyzed using descriptive statistics and tests of statistical significance. The significance level was set at p ≤ 0.05. Results A significant improvement in both dimensions of working space was observed with each stage of dissection at the level of the sphenoid face. Maximal working space was achieved following bilateral middle turbinectomy and wide posterior septectomy with a 38 and 29% increase in working space in the mediolateral and craniocaudal dimensions, respectively. The largest stepwise increase in working space was observed with unilateral middle turbinectomy (mediolateral: 24 ± 3 mm and craniocaudal: 20 ± 3 mm). A trend toward improved degrees of visualization was observed with each stage of dissection but was not statistically significant. Conclusion Approaches to the skull base can be enhanced by selective unilateral/bilateral partial middle turbinectomy and posterior septectomy being performed to improve visualization and maximize surgical working freedom.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative Analysis of Surgical Working Space During Endoscopic Skull Base Surgery

et al. 2018

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“…u.) ausgeführt -eine vorsorgliche Kauterisation der A. sphenopalatina muss unterbleiben[18,56,60,63,85,89,112,119,120,134,135,137,188,203,307,308,321,331,339,344,349,356,[404][405][406][407][408][409][410][411][412]. Es kann im Einzelfall hilfreich sein, erste Schritte wie z.…”

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Rhino-Neurochirurgie

Hosemann

Schroeder

2015

Laryngo-Rhino-Otol

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In the past 2 decades, an innovative and active field of surgical collaboration has been evolved and established combining the expertise of Neurosurgery and Rhinosurgery in treatment of different lesions affecting the anterior skull base together with the adjacent intranasal and intradural areas. Important prerequesites for this development were improvements of technical devices, definitions of transnasal surgical corridors and approvements in endonasal reconstruction e. g. by use of pedicled nasal mucosal flaps. Interdisciplinary surgical teams have been established constituting specialized centers of "rhino-neurosurgery". With growing experience of these groups, it could be shown that oncological results and perioperative complications were comparable to traditional surgery while at the same time, patient's morbidity could be reduced.The present review encompasses the recent literature focussing on the development, technical details, results and complications of "rhino-neurosurgery".

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