Laterally located mucocele in a hyperpneumatized frontal sinus causing exophthalmos: A total endoscopic approach

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Charikleia Maiou ◽  
◽  
Christos Korais ◽  
Eleni Gkrinia ◽  
Athanasios Saratziotis ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Bone Erosion ◽  
Current Treatment ◽  
Endoscopic Drainage ◽  
Endoscopic Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Disease Extension ◽  
Slow Growing ◽  
Draf Iii

Frontal sinus mucoceles are mucous secretory lesions within the sinus, presenting a slow – growing pattern, mostly behaving like a space-occupying mass with subtle symptoms until a bone erosion of the surrounding structures takes place. Intracranial and intraorbital expansion are regarded as the most considerable complications, demanding adequate surgical management in order to avoid recurrence. Endoscopic drainage is thought to be the current treatment of choice, with external approaches or combined approaches being considered for more severe cases where anatomy and disease extension restricts adequate endoscopic visualization of the lesion. We present a case of a 31-year-old female patient with a left frontal sinus mucocele, demonstrating with an unusual lateral frontal expansion and orbit invasion, causing exophthalmos and ophthalmoplegia. She was adequately managed by a Draf III endoscopic procedure achieving wide marsupialization and enough drainage of the mucocele. No sign of recurrence was noticed during the last 6-month follow-up. Giant mucoceles of the frontal sinus are a rare pathology. To our knowledge, endoscopic endonasal approach is a treatment modality that can provide an adequate drainage pathway, thus resulting in optimal clinical outcomes, compared with external approaches. Keywords: Frontal sinus; Mucocele; Exophalmos; Pneumosinus dilatans; Pneumocele.

scholarly journals Excision of Greater Superficial Petrosal Nerve Schwannoma Via a Pure Endoscopic Endonasal Approach

2021 ◽  
pp. 014556132110263
Author(s):  
Zhenlin Wang ◽  
Siyuan Zhang ◽  
Yan Qi ◽  
Lianjie Cao ◽  
Pu Li ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Clinical Features ◽  
Middle Cranial Fossa ◽  
Nerve Sheath Tumor ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Greater Superficial Petrosal Nerve ◽  
Clinical Records

Greater superficial petrosal nerve (GSPN) schwannomas are an exceedingly rare nerve sheath tumor. The current literature search was conducted using Medline and Embase database by key search terms. Only 31 cases have been reported in the literature so far. Facial palsy, hearing loss, and xerophthalmia accounted for 48.4% (15), 41.9% (13), and 29% (9) of all cases, respectively. The middle cranial fossa approach was used in all previous reports. A retrospective review of 2 GSPN schwannomas patients treated by endoscopic endonasal approach (EEA) in our center was collected. Clinical records, including clinical features, pre- and postoperative images, surgery, and follow-up information, were reviewed. In all cases, clinical features including facial numbness and headache were found, with tinnitus in case 1, hearing loss, xerophthalmia in case 2. Imaging studies showed a solid mass that originated in the anterior of the petrous bone. Two patients were treated by EEA. Furthermore, no recurrence was found during the follow-up period (15-29 months) in both of the 2 cases after the operation. Complete resection of GSPN schwannomas can be achieved via the pure EEA. Endoscopic endonasal approach for radical removal of tumors is safe and feasible.

scholarly journals Endoscopic endonasal removal of a large fibrous dysplasia of the paranasal sinuses and skull base

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Ali A AlMomen ◽  
Fadel M Molani ◽  
Moath A AlFaleh ◽  
Ahmed K AlMohisin
Keyword(s):  
Skull Base ◽  
Fibrous Dysplasia ◽  
Paranasal Sinuses ◽  
Frontal Sinus ◽  
Facial Pain ◽  
Rare Condition ◽  
Endoscopic Endonasal ◽  
Image Guided ◽  
Long Duration

Abstract Fibrous dysplasia is a rare condition. We present a case of a 34-years-old man presented with left-sided facial pain, headache and nasal obstruction for a long duration. CT scan of the sinuses showed a mass occupying the left ethmoidal region abutting the orbit and skull base obstructing the left frontal sinus. The patient was treated successfully by image-guided endoscopic endonasal removal of the tumor with no recurrence after 3 years of follow-up. This report aims to show the usefulness of endoscopic endonasal removal of a large fibrous dysplasia of paranasal sinuses and skull base.

scholarly journals Management and Surveillance of Frontal Sinus Violation following Craniotomy

2019 ◽  
Vol 81 (01) ◽  
pp. 001-007 ◽  
Author(s):  
Alexander Farag ◽  
Marc R. Rosen ◽  
Natalie Ziegler ◽  
Ryan A. Rimmer ◽  
James J. Evans ◽  
...  
Keyword(s):  
Literature Review ◽  
Frontal Sinus ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Incomplete Removal ◽  
Intraoperative Management

Objectives In the setting of craniotomy, complications after traversing the frontal sinus can lead to mucocele formation and frontal sinusitis. We review the etiology of frontal sinus violation, timeline to mucocele development, intraoperative management of the violated sinus, and treatment of frontal mucoceles. Design Case series in conjunction with a literature review. Participants A total of 35 patients were included in this meta-analysis. Nine of these patients were treated at a tertiary academic medical center between 2005 and 2014. The remaining patients were identified through a literature review for which 2,763 articles were identified, of which 4 articles met inclusion criteria. Main Outcomes Measures Etiology of frontal violation, timeline to mucocele development, and method of management. Results The overall interval from initial frontal sinus violation until mucocele identification was 14.5 years, with a range of 3 months to 36 years. The most common cause of mucocele formation was obstruction of the frontal recess with incomplete removal of the frontal sinus mucosa. The majority of patients were successfully managed with an endoscopic endonasal approach. Conclusions Violation of the frontal sinus during craniotomy can result in mucocele formation as an early or late sequela. Image guidance may help avoid unnecessary frontal sinus violation. Mucoceles may develop decades after the initial frontal sinus violation, and long-term follow-up with imaging is recommended. While the endoscopic endonasal approach is usually the preferred method to treat these lesions, it may be necessary to perform obliteration or cranialization in unique situations.

scholarly journals Machine learning–based prediction of outcomes of the endoscopic endonasal approach in Cushing disease: is the future coming?

2020 ◽  
Vol 48 (6) ◽  
pp. E5
Author(s):  
Matteo Zoli ◽  
Victor E. Staartjes ◽  
Federica Guaraldi ◽  
Filippo Friso ◽  
Arianna Rustici ◽  
...  
Keyword(s):  
Machine Learning ◽  
Area Under The Curve ◽  
Complex Data ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Cushing Disease ◽  
Endoscopic Endonasal ◽  
Internal Validation

OBJECTIVEMachine learning (ML) is an innovative method to analyze large and complex data sets. The aim of this study was to evaluate the use of ML to identify predictors of early postsurgical and long-term outcomes in patients treated for Cushing disease (CD).METHODSAll consecutive patients in our center who underwent surgery for CD through the endoscopic endonasal approach were retrospectively reviewed. Study endpoints were gross-tumor removal (GTR), postsurgical remission, and long-term control of disease. Several demographic, radiological, and histological factors were assessed as potential predictors. For ML-based modeling, data were randomly divided into 2 sets with an 80% to 20% ratio for bootstrapped training and testing, respectively. Several algorithms were tested and tuned for the area under the curve (AUC).RESULTSThe study included 151 patients. GTR was achieved in 137 patients (91%), and postsurgical hypersecretion remission was achieved in 133 patients (88%). At last follow-up, 116 patients (77%) were still in remission after surgery and in 21 patients (14%), CD was controlled with complementary treatment (overall, of 131 cases, 87% were under control at follow-up). At internal validation, the endpoints were predicted with AUCs of 0.81–1.00, accuracy of 81%–100%, and Brier scores of 0.035–0.151. Tumor size and invasiveness and histological confirmation of adrenocorticotropic hormone (ACTH)–secreting cells were the main predictors for the 3 endpoints of interest.CONCLUSIONSML algorithms were used to train and internally validate robust models for all the endpoints, giving accurate outcome predictions in CD cases. This analytical method seems promising for potentially improving future patient care and counseling; however, careful clinical interpretation of the results remains necessary before any clinical adoption of ML. Moreover, further studies and increased sample sizes are definitely required before the widespread adoption of ML to the study of CD.

Endoscopic Surgery of a Sinonasal Inverted Papilloma: Surgical Strategy, Follow-up, and Recurrence Rate

2017 ◽  
Vol 31 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Xiao-Dan Jiang ◽  
Qing-Zhe Dong ◽  
Shen-Ling Li ◽  
Tian-Qiao Huang ◽  
Nian-Kai Zhang
Keyword(s):  
Recurrence Rate ◽  
Endoscopic Surgery ◽  
Inverted Papilloma ◽  
Surgical Strategy ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Sinonasal Inverted Papilloma ◽  
Significant Difference

Background Sinonasal inverted papilloma (SNIP) is noted for its high rate of recurrence and malignant transformation. Although many clinical studies have demonstrated the effectiveness of the endoscopic approach for SNIP, the surgical strategy has been the subject of much debate. Objective To evaluate the effectiveness of the endoscopic endonasal approach in SNIP. Methods A systematic review of patients with a diagnosis of SNIP and who had surgery at our institution from June 2005 to March 2013 was performed. All the patients who had postoperative follow-up for >2 years were enrolled. Each case was categorized into one of four stages as reported by Krouse. Demographic and tumor date, operative approach, complications, and recurrence rates were collected. Results A total of 125 patients were included in this study. There were 17 patients in stage 1, 40 in stage 2, 57 in stage 3, and 11 in stage 4. The overall recurrence rate was 8.0%. There was no significant difference in recurrence among the stages (all p > 0.05). Recurrence after endoscopic endonasal approach (8.4%) and a combined endoscopic and open exposure procedure (5.6%) were not significantly different (p > 0.05). The recurrence rate was significantly (p < 0.05) higher in patients with revision (15.6%) than in patients in the primary cases (3.8%). A common site of tumor origin was recorded to be from the maxillary sinus (40.2%). Twenty percent of recurrences were observed up to 5 years after surgery. Conclusion Endoscopic surgery may be preferred for treating SNIP. The elevated recurrence rate after revision emphasized the significance of the first surgery. We encourage a follow-up period of at least 5 years.

Combined Supraciliary and Endoscopic Endonasal Approach for Resection of Frontal Sinus Mucoceles: Technical Note

2009 ◽  
Vol 52 (03) ◽  
pp. 149-151 ◽  
Author(s):  
J. Knopman ◽  
D. Sigounas ◽  
C. Huang ◽  
A. Kacker ◽  
T.H. Schwartz ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Technical Note ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

scholarly journals Long terms results of Draf type III (modified endoscopic Lothrop) frontal sinus drainage procedure in 122 patients: a single centre experience

2011 ◽  
Vol 49 (2) ◽  
pp. 195-201
Author(s):  
C. Georgalas ◽  
F. Hansen ◽  
W.J.M. Videler ◽  
W.J. Fokkens
Keyword(s):  
Revision Surgery ◽  
Frontal Sinus ◽  
Symptom Burden ◽  
Drainage Procedure ◽  
Type Iii ◽  
Sinus Drainage ◽  
Sinus Obliteration ◽  
Revision Operations ◽  
Draf Iii

Objectives: To assess the effectiveness and factors associated with restenosis after Draf type III (Endoscopic Modified Lothrop) frontal sinus drainage procedure. Design: Retrospective analysis of prospectively collected data. Patients: A hundred and twenty two consecutive patients undergoing Draf III procedure for recalcitrant chronic frontal rhinosinusitis (CRS) (71%), frontal sinus mucocoele (15%), benign frontal sinus tumours (9%) and cystic fibrosis with severe CRS (5%) were followed up for an average of 33 months. Outcome measures: Symptom burden (Visual Analogue Scale and Rhinosinusitis Outcome Measure), patency of neo-ostium and revision surgery. Results: At the end of follow up, ninety percent of patients had a patent neo-ostium, while 88% were either clinically better or completely asymptomatic. Thirty-nine patients required endoscopic revision surgery and 9 eventually underwent frontal sinus obliteration. Sixty percent of revision operations were performed during the first two years. RSOM showed a significant improvement in both general and nasal symptoms while on a VAS, headache improved significantly. The only factor weakly associated with re-stenosis was the presence of allergy. There were no major complications during any of the procedures. Conclusion: Draf III Procedure is safe and effective for patients who have failed conventional frontal sinus procedures and a valid alternative to frontal sinus obliteration. Although the revision rate may appear to be quite significant, it can often be performed as an outpatient procedure and needs to be balanced against the reduced morbidity and the ease of follow-up.

scholarly journals Frontal mucopyocele with bone erosion in a 7-year-old child - exclusively endoscopic endonasal approach - a case report

2021 ◽  
Vol 4 (4) ◽  
pp. 108-112
Author(s):  
A.W.D. Felippu ◽  
A.J.S. Cunha ◽  
A.C.S. Oliveira ◽  
T.P. Morsch ◽  
M.P. Limongi ◽  
...  
Keyword(s):  
Slow Growth ◽  
Bone Erosion ◽  
Benign Lesion ◽  
Endoscopic Endonasal Approach ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Slow Growth Rate ◽  
Important Complication ◽  
Safe Approach

A mucocele is a benign lesion that predominantly affects the paranasal sinuses, with a slow growth rate and expansive pattern. When infected, it is known as mucopyocele. Presentation of a frontal mucopyocele can be found more frequently in adults. In contrast, it is rarely seen in children since pneumatization of the sinuses usually takes place after age 7. This report aims to present one case of a frontal mucopyocele as an important complication of a pansinusitis in a 7-year-old child and discuss the diagnosis, surgical approach, and differentials. Endoscopic endonasal surgery is a safe approach and must be taken into consideration in these situations.

Endonasal Frontal Sinusotomy in Surgical Management of Chronic Sinusitis: A Critical Evaluation

1997 ◽  
Vol 11 (1) ◽  
pp. 1-10 ◽  
Author(s):  
W. Hosemann ◽  
Th. Kühnel ◽  
P. Held ◽  
W. Wagner ◽  
A. Felderhoff
Keyword(s):  
Surgical Management ◽  
Frontal Sinus ◽  
Nasal Polyposis ◽  
Critical Evaluation ◽  
Endoscopic Endonasal ◽  
Minimum Diameter ◽  
Patient Complaints ◽  
Safety And Reliability ◽  
Frontal Sinuses

Frontal sinusotomy was performed on 110 patients undergoing routine endoscopic endonasal ethmoidectomy and the minimum diameter of the frontal sinus neo-ostium was determined intraoperatively. A total of 82 patients could be subjected to follow-up and redetermination of the neo-ostium diameter 13 months later. A postoperative CT was scheduled in 62 cases. The average minimum diameter of the frontal sinus neo-ostium, measured intraoperatively, was 5.6 mm (0–11 mm). After completion of wound healing, 81% of the frontal sinuses could be explored by probing or even inspected by rigid endoscopy. The average minimum diameter of the neo-ostia determined postoperatively was 3.5 mm (0–11 mm). Patients exhibiting aspirin sensitivity or diffuse nasal polyposis showed a more pronounced scarred constriction of the frontal sinus access compared to other cases. Neo-ostia exceeding 5 mm intraoperatively were preserved with a considerably higher percentage than those with diameters of less than 5 mm. Radiologically, the fenestrated frontal sinuses frequently showed continued or even increasing mucosal congestion. No conclusive relationship was found to exist between such post-operative clouding and frontal sinus accessibility (endoscopy and/or probing) or patient complaints. The investigations confirm the safety and reliability of frontal sinusotomy in surgical management of chronic paranasal sinusitis. The mucosa of the frontal sinus often reacts to surgery in the form of persistent or even newly developing mucosal swelling to which a specific pathophysiological significance cannot always be attributed.

scholarly journals Expanding indications for the extended endoscopic endonasal approach to hypothalamic gliomas: preliminary report

2014 ◽  
Vol 37 (4) ◽  
pp. E11 ◽  
Author(s):  
Matteo Zoli ◽  
Diego Mazzatenta ◽  
Adelaide Valluzzi ◽  
Gianluca Marucci ◽  
Nicola Acciarri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tumor Resection ◽  
Small Sample ◽  
Anterior Communicating Artery ◽  
Moderate Increase ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Object In the last decade the indications for the endoscopic endonasal approach have been progressively expanded to include lesions that have not been traditionally considered amenable to resection through the transsphenoidal route. In this study, the authors analyze their experience with hypothalamic gliomas treated via the endoscopic endonasal approach. Methods Consecutive cases of hypothalamic gliomas treated since 2007 via an endoscopic endonasal approach were reviewed. Preoperative and postoperative neuroimaging as well as endocrinological, neurological, and visual symptoms were analyzed to assess the surgical outcome. Signs and symptoms of hypothalamic dysfunction including body mass index (BMI), memory, sleep-wake rhythm, and polyphagia were prospectively collected pre- and postoperatively to assess hypothalamic function. Quality of life was evaluated using the Katz scale. Results In the initial phase the endoscopic endonasal approach was adopted in 3 cases with a palliative intent, to obtain a biopsy sample or for debulking of the mass followed by radio- or chemotherapy. In 2 later cases it was successfully adopted to achieve gross-total tumor resection. Complications consisted of 2 postoperative CSF leaks, which required an endoscopic endonasal reintervention. Visual deficit improved in 3 cases and normalized in the other 2. Four patients developed diabetes insipidus, and 3 an anterior panhypopituitarism. All patients had a moderate increase in BMI. No patients presented with any other signs of hypothalamic damage, and their quality of life at follow-up is normal. Conclusions Despite the limitations of a short follow-up and small sample, the authors’ early experience with the endoscopic endonasal approach has revealed it to be a direct, straightforward, and safe approach to third ventricle astrocytomas. It allowed the authors to perform tumor resection with the same microsurgical technique: dissecting the tumor with 2 hands, performing a central debulking, and controlling the bleeding with bipolar coagulation. The main limitations were represented by some anatomical conditions, such as the position of the chiasm and the anterior communicating artery complex and, finally, by the challenge of watertight plastic repair. To definitively evaluate the role of this approach in hypothalamic gliomas, a comparison with transcranial series would be necessary, but due to the rarity of these cases such a study is still lacking. The authors observed that more aggressive surgery is associated with a worse endocrinological outcome; thus they consider it to be an open question (in particular in prepubertal patients) whether radical removal is an advisable goal for hypothalamic gliomas.

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