New ‘ZISIS’ (Zigzag Incision–Suction–Irrigation System) Technique for Endoscopic-Assisted Forehead Tumour Excision

Abstract

Endoscopic-assisted excision of forehead tumours like osteomas and lipomas is well established, but the conventional techniques suffer from many limitations like inadequate access, fogging of the endoscope and unclear vision due to collection of blood and debris. Three simple modifications of the conventional endoscopic forehead technique for benign tumour excisions are described by the acronym ‘ZISIS’. ZI Zigzag scalp incision increases the surface area of the opening permitting easy insertion of multiple instruments along with the endoscope. S Suction tubing made from a disposable suction catheter tube is taped along the endoscope sheath for continuous suctioning and good vision. IS Irrigation system of warm saline made with an infant feeding tube is also taped along the endoscope just opening in the front of the suction tube. ZI Zigzag scalp incision increases the surface area of the opening permitting easy insertion of multiple instruments along with the endoscope. S Suction tubing made from a disposable suction catheter tube is taped along the endoscope sheath for continuous suctioning and good vision. IS Irrigation system of warm saline made with an infant feeding tube is also taped along the endoscope just opening in the front of the suction tube. A total of 12 consecutive patients underwent endoscopic excision of forehead benign tumours in 2 years. This included 2 lipomas and 10 osteomas cases. All patients achieved excellent hidden scars in the scalp. All patients rated their results as excellent with respect to the hidden scar and aesthetic result. No early or late complications were reported with follow-up ranging from 6 months to 2 years. A new simple modification called ‘ZISIS’ endoscopic forehead excision technique is described for benign forehead tumours excision making it easier, efficient and ergonomic. Evidence obtained from multiple time series with or without the intervention, such as case studies.