-
Gland Surgery Oct 2020Pituitary adenomas (PAs) are tumors that arise from the cells of the anterior pituitary gland. PAs are the most common tumors to occur in the sella area and the third...
BACKGROUND
Pituitary adenomas (PAs) are tumors that arise from the cells of the anterior pituitary gland. PAs are the most common tumors to occur in the sella area and the third most common intracranial neoplasm in surgery. Due to developments such as microscopy and neuroendoscopy, the curative effect of PA surgery continues to improve. However, postoperative complications may still occur. PA surgery can result in iatrogenic trauma, which is a primary cause of cerebrospinal fluid (CSF) rhinorrhea. PA surgery can affect the posterior pituitary gland, causing decreased antidiuretic hormone secretion and increased urine output, which can lead to hyponatremia. The nasal cavity and sphenoid sinuses may also be damaged during PA surgery, causing the sphenoethmoidal recess to be blocked. This increases the risk of infection. The purpose of this study was to analyze quality of life in PA patients post-resection, and to provide references for the development of early targeted risk assessment programs and intervention measures.
METHODS
We selected patients who underwent neuroendoscopic transnasal PA resection at the Affiliated Hospital of Nantong University between January 2017 and October 2019. These patients' hospital records were retrospectively obtained, including details of any postoperative complications. The patients were followed up by telephone 12 weeks following discharge, and we used the EuroQol 5 Dimensions (EQ-5D) health scale to assess the patients' quality of life.
RESULTS
At follow-up 3 months after discharge, 68 people (41.72%) had experienced at least one common complication, including 7 cases of infection (4.29%), 56 cases of hypopituitarism (34.36%), 18 cases of CSF rhinorrhea (11.04%), 28 cases of diabetes insipidus (17.18%), and 25 cases of hyponatremia (15.34%). Patients that experienced complications reported having more serious problems on the dimensions of the EQ-5D descriptive system (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) than patients without complications. The scores of patients with complications on the EQ-5D visual analog scale (EQ-VAS) were lower than that of patients without complications.
CONCLUSIONS
Postoperative complications are negatively associated with quality of life in PA patients. Actively preventing common complications could therefore improve these patients' quality of life and reduce their burden of disease.
PubMed: 33224827
DOI: 10.21037/gs-20-690 -
World Journal of Otorhinolaryngology -... Apr 2021To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential...
OBJECTIVE
To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.
METHODS
Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.
RESULTS
In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery.
CONCLUSION
Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.
PubMed: 33997716
DOI: 10.1016/j.wjorl.2021.01.003 -
Journal of Neurological Surgery. Part... Dec 2023Cerebrospinal fluid (CSF) leaks of the anterior cranial base are frequently repaired with endonasal, multilayered reconstructions. Vascularized tissue flaps are...
Cerebrospinal fluid (CSF) leaks of the anterior cranial base are frequently repaired with endonasal, multilayered reconstructions. Vascularized tissue flaps are superior to free mucosal grafts and biomaterials in many cases. Limitations of previously described flaps include reach, rotation, pedicle availability, and postoperative sinonasal morbidity. The objective of this study is to describe the superiorly based middle turbinate flap, a novel vascularized mucosal reconstruction option, and to present a case series demonstrating flap utility. Cadaveric feasibility study with technical description and illustrative case series. Tertiary medical center. Three silicone-injected cadaveric specimens (6 sides); 7 patients with CSF rhinorrhea from bony dehiscence of the anterior cranial fossa repaired with a superiorly based middle turbinate flap. Cadaveric feasibility, in vivo repair outcomes, sinonasal symptoms, and postoperative healing. Cadaveric dissection demonstrated a consistent vascular plexus arising from the anterior and posterior ethmoid arteries, originating at the superior attachment of the middle turbinate and traveling inferiorly to supply the mucosa of the middle turbinate. Mean surface area of the flap was 776.67 ± 114.60 mm . The clinical series of 7 patients involved leaks around the cribriform plate and fovea ethmoidalis. There were no instances of repair failure. All cases showed rapid and complete remucosalization without significant sinonasal morbidity. The superiorly based middle turbinate flap is a reliable, versatile, and effective option for a vascularized mucosal flap onlay that can be used in anterior skull base reconstruction. This flap is particularly useful in the repair of defects involving the cribriform plate and fovea ethmoidalis.
PubMed: 37854540
DOI: 10.1055/a-1934-9095 -
Surgical Neurology International 2022Postoperative cerebrospinal fluid (CSF) leakages are well documented, but pituitary adenoma with spontaneous CSF rhinorrhea as the initial symptoms are extremely rare....
BACKGROUND
Postoperative cerebrospinal fluid (CSF) leakages are well documented, but pituitary adenoma with spontaneous CSF rhinorrhea as the initial symptoms are extremely rare. The objective of this study is to report two rare cases of pituitary adenoma with spontaneous CSF rhinorrhea successfully operated by endoscopic transsphenoidal approach with vascularized nasoseptal flap (NSF).
CASE DESCRIPTION
A 70-year-old woman presented with a 6-month history of watery rhinorrhea and posterior nasal drip that worsened when her head leaning forward. Sella magnetic resonance image (MRI) demonstrated pituitary macroadenoma (3.4 × 2.7 cm) invading cavernous sinus, clivus, and sphenoid sinus. A 47-year-old woman presented with a 10-month history of watery rhinorrhea and posterior nasal drip. Sella MRI demonstrated pituitary macroadenoma (6.3 × 4.6 cm) invading cavernous sinus, clivus, sphenoid sinus, and middle fossa. Both patients underwent endoscopic endonasal transsphenoidal operation and skull base reconstruction with vascularized NSF. The postoperative clinical course was uneventful and CSF rhinorrhea disappeared completely.
CONCLUSION
Pituitary adenoma should be suspected if there is a watery CSF rhinorrhea that occurs without a history of trauma or nasal disease. In addition, effective treatment can be performed using NSF, a technique for endoscopic skull base reconstruction.
PubMed: 35855160
DOI: 10.25259/SNI_61_2022 -
Cureus Mar 2022Background and objective Knowledge about sphenoid sinus pneumatization is critical for skull base surgeries and functional endoscopic sinus surgery (FESS) in order to...
Background and objective Knowledge about sphenoid sinus pneumatization is critical for skull base surgeries and functional endoscopic sinus surgery (FESS) in order to avoid serious complications like postoperative meningitis, sinusitis, cerebrospinal fluid (CSF) rhinorrhea, and intracranial hematoma. In this study, we aimed to assess the proportion of anatomical variants in sphenoid sinus pneumatization and to determine the common sphenoid pneumatization pattern in a South Indian population. Methods This retrospective study was conducted over a period of six months from July 2019 to December 2019 among 573 patients who underwent non-contrast CT (NCCT) or contrast-enhanced CT (CECT) of the brain, paranasal sinuses (PNS), orbit, and face. Results Most of the patients were in the age group of 20-39 years. The male-to-female ratio was 2.45:1. Among the posterior extensions, the most common variant was type D, followed by type C, type B, and type A. Among the clival extensions, the most common variant was Cliv-A, followed by Cliv-B, Cliv-C, and Cliv-D. The most common lateral wall pneumatization was bilateral lateral wall pneumatization followed by unilateral sinus wall pneumatization. Lat-A was the most common lateral wall pneumatization pattern followed by Lat-D, Lat-B, and Lat-C. Conclusion Our study intends to classify the sphenoid sinus pneumatization pattern and identify the most common variant among them, thereby guiding the skull base and FESS surgeons in choosing the correct mode of the operative procedure and also anticipating and avoiding complications of surgery.
PubMed: 35433147
DOI: 10.7759/cureus.23174 -
Olfactory changes after endonasal endoscopic cerebrospinal fluid fistula repair: long-term outcomes.The Journal of Laryngology and Otology Apr 2023This study aimed to evaluate odour measurements after endoscopic repair of cerebrospinal fluid fistulas.
OBJECTIVE
This study aimed to evaluate odour measurements after endoscopic repair of cerebrospinal fluid fistulas.
METHOD
Demographic characteristics, cerebrospinal fluid leak location, surgical procedure, aetiology and smell test results were retrospectively reviewed.
RESULTS
A total of 27 patients were included. The mean age was 43.52 years. The aetiology was spontaneous in 13 patients (48.1 per cent) and traumatic in 14 patients (51.9 per cent). The skull base defect was at the cribriform plate in 15 patients (55.6 per cent), the frontal sinus posterior wall in 4 patients (14.8 per cent), the sphenoid sinus posterior wall in 4 patients (14.8 per cent), around the anterior ethmoid artery in 2 patients (7.4 per cent), at the ethmoid roof in 1 patient (3.7 per cent) and at the sphenoid sinus posterolateral wall in 1 patient (3.7 per cent). After the comparison of pre-operative and post-operative values in identification, discrimination and threshold categories, a statistically significant difference was seen only in the threshold category ( 0.014).
CONCLUSION
The results demonstrated that endoscopic repair of cerebrospinal fluid leak is safe in terms of olfactory functions.
Topics: Humans; Adult; Cerebrospinal Fluid Rhinorrhea; Smell; Retrospective Studies; Endoscopy; Cerebrospinal Fluid Leak; Skull Base; Frontal Sinus; Fistula
PubMed: 35673778
DOI: 10.1017/S0022215122001335 -
The Journal of Medical Investigation :... 2024Surgical treatment is recommended for patients with severe allergic rhinitis (AR) refractory to medical treatment. Endoscopic posterior nasal neurectomy (PNN) is...
BACKGROUND
Surgical treatment is recommended for patients with severe allergic rhinitis (AR) refractory to medical treatment. Endoscopic posterior nasal neurectomy (PNN) is primarily performed to improve rhinorrhea in severe perennial AR, however studies on its long-term prognosis are lacking.
AIMS/OBJECTIVES
This study aimed to investigate the long-term prognosis of PNN.
MATERIALS AND METHODS
A questionnaire survey was administered to 17 patients (12 men and 5 women) at least 1 year after PNN. Nasal symptoms and medications, as well as patient satisfaction with surgery at the time of survey, were scored. Furthermore, scores were compared between patients with postoperative periods of >5 years and <5 years.
RESULTS
Nasal symptoms and medication scores significantly improved after surgery. There was no significant difference between patients with a postoperative period of >5 years and <5 years in both preoperative and postoperative nasal symptoms and medication scores. No correlation was found between patient satisfaction with surgery and postoperative period.
CONCLUSIONS AND SIGNIFICANCE
PNN improved nasal symptoms and medication scores in patients with severe perennial AR. Furthermore, the study results suggest that the long-term effect of PNN for perennial AR lasts for >5 years. J. Med. Invest. 71 : 62-65, February, 2024.
Topics: Humans; Female; Male; Adult; Middle Aged; Rhinitis, Allergic, Perennial; Denervation; Young Adult; Surveys and Questionnaires; Patient Satisfaction; Nose
PubMed: 38735726
DOI: 10.2152/jmi.71.62 -
The Open Dentistry Journal 2016We report a case of chronic maxillary sinusitis caused by denture lining material entering through an oroantral fistula after tooth extraction. The patient was an...
We report a case of chronic maxillary sinusitis caused by denture lining material entering through an oroantral fistula after tooth extraction. The patient was an 80-year-old female who visited us with a complaint of pus discharge from the right posterior maxilla. She had extraction of the upper right second molar and had her upper denture relined with silicone lining material. The patient noticed swelling of the right cheek and purulent rhinorrhea 20 days before her first visit to our clinic. Oral examination showed an oroantral fistula with a diameter of 3 mm in the posterior alveolar ridge of the right maxilla. Computed tomography revealed a hyperdense foreign body in the right maxillary sinus and thickening of the mucosal lining. Under diagnosis of maxillary sinusitis caused by a foreign body, endoscopic maxillary surgery was performed simultaneously with the removal of the foreign body. The foreign body removed was 12 × 6 mm in size, oval in shape, light pink in color, and compatible with silicone denture lining material. During the follow-up it was observed that the oroantral fistula closed spontaneously after the removal of the foreign body. The maxillary sinus was in a good shape without recurrence of sinusitis seven months after surgery.
PubMed: 27386012
DOI: 10.2174/1874210601610010261 -
Otolaryngologia Polska = the Polish... Aug 2020<b>Objectives:</b> To determine the incidence of smell and taste disorders in our health department and to analyse the factors that could be associated with...
<b>Objectives:</b> To determine the incidence of smell and taste disorders in our health department and to analyse the factors that could be associated with these symptoms in patients with COVID-19. <br><b>Methods:</b> We conducted an observational descriptive study of all patients with COVID-19 in our health area diagnosed between 2020/03/10 and 2020/04/14. Factors related to smell and taste disorders were analysed. <br><b>Results:</b> A total of 126 patients, 63 women and 63 men, aged 16-80 years, were included. As many as 69 patients (62.7%) presented hyposmia, and 58 (46%) of them had anosmia. A total of 75 patients (59.5%) presented hypogeusia, and 57 (45.2%) of them had ageusia. The risk factors that were most commonly associated with these disorders were the female sex (adjusted odds ratio, aOR 2.43 for smell disorders and 2.44 for taste disorders), allergic rhinitis (aOR 3.34 for smell disorders) and a younger age. A protective factor was arterial hypertension (aOR 0.51 for smell disorders and 0.35 for taste disorders). A history of tonsillectomy was the risk factor for taste disorder (aOR 5.23). <br><b>Conclusion:</b> Our results indicate that these sensory disorders occurred more frequently in female patients and in young patients with mild to moderate COVID-19 infection who progressed with mild nasal congestion, posterior rhinorrhoea and without anterior rhinorrhoea. The recovery of taste occurred before the recovery of smell.
Topics: Adult; Age Distribution; Aged; COVID-19; Comorbidity; Female; Humans; Incidence; Male; Middle Aged; Olfaction Disorders; Poland; Risk Factors; Smell; Surveys and Questionnaires; Taste; Taste Disorders; Young Adult
PubMed: 33724231
DOI: 10.5604/01.3001.0014.3451 -
Indian Journal of Otolaryngology and... Apr 2023Tension Pneumocephalus and spontaneous CSF rhinorrhea are very rare associations in clinical practice. We report a case of 65 years old male with clear rhinorrhea,...
Tension Pneumocephalus and spontaneous CSF rhinorrhea are very rare associations in clinical practice. We report a case of 65 years old male with clear rhinorrhea, severe frontal headache, vomiting and lethargy for a week. MR Cisternography and CT Paranasal sinuses showed significant Tension Pneumocephalus with defect in the posterior wall of sphenoid sinus and CSF pooling in the sphenoid sinus. Endoscopic trans-sphenoidal CSF leak repair was done without any delay followed by complete resolution of Tension Pneumocephalus with in 4 post op days. Prompt precise diagnosis and early intervention of Tension Pneumocephalus is vital to avoid neurological complications.
PubMed: 37206754
DOI: 10.1007/s12070-022-03223-w