Paolo Castelnuovo

Different Endoscopic Surgical Strategies in the Management of Inverted Papilloma of the Sinonasal Tract: Experience with 47 Patients

Objective: To demonstrate the potentials and limitations of three different endoscopic procedures employed for treatment of inverted papilloma (IP) of the sinonasal tract.

Endonasal Endoscopic Repair of Sternberg's Canal Cerebrospinal Fluid Leaks

Objectives: Management of cerebrospinal fluid leaks or encephaloceles of Sternbergs canal is challenging. Transnasal visualization of this area is difficult, especially when large pneumatization is present. External approaches to this region involve aggressive surgery and are often associated with significant morbidity. The aim of the study was to assess the real effectiveness of an endoscopic endonasal approach for treating cerebrospinal fluid leaks of the lateral recess of the sphenoid sinus.

Endoscopic repair of cerebrospinal fluid rhinorrhea: learning from our failures.

Endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea is becoming a common procedure. The purpose of this study was to perform a literature analysis centering cases of treatment failure and to review our 31 cases with a 1-year minimum follow-up. An extensive search of the literature was conducted, which focused on success rate, follow-up, diagnostic techniques, graft material used, failure rate, and comments on failures. A retrospective analysis of our 31 patients was carried out, and all cases were treated with the endoscopic approach with a 1-year minimum follow-up. From the literature analysis, the median success rate at the first endoscopic attempt is 90%. Our success rate was 87.1%. Failures were analyzed. A unique protocol for CSF leak diagnosis does not exist; we suggest our diagnostic algorithm. Graft material used depends on the authors’ experience, and based on this review of cases to date, did not significantly influence the success rate. The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures.

ENDONASAL ENDOSCOPIC RESECTION AND RADIOTHERAPY IN OLFACTORY NEUROBLASTOMA: OUR EXPERIENCE

Our aim was to evaluate the efficacy of a bimodal method of treatment consisting in endoscopic resection followed by radiotherapy in patients with olfactory neuroblastoma (ON).

Endoscopic transnasal intraorbital surgery: our experience with 16 cases.

The objective of the study is to present our multicentric experience on intraorbital lesions managed by means of an endonasal endoscopic approach. The study design used was multi-institutional retrospective review. We collected data on 16 intraorbital medially-located lesions, all managed by means of an endonasal route, treated in four different skull base centers. We retrospectively reviewed the technical details, complications, histology, and general outcome. The endoscopic endonasal approach was effective in removing completely intraorbital extra-intraconal tumors in 8 cases, in performing biopsies for histological diagnosis in 6 intraorbital intraconal tumors, and in draining 1 extraconal abscess. No major complications were observed; in particular, there was no optic nerve damage. Minor, temporary complications (diplopia) were seen in 3 cases; only 2 patients experienced a permanent diplopia related to medial rectus muscle impairment, in 1 case associated with enophthalmos. Our preliminary multi-centric clinical experience suggests that medially located intraorbital lesions, and in particular the infero-medial ones, can be successfully and safely managed by such an approach. The well-known advantages of the endoscopic techniques, namely the lack of external scars, less bleeding, shorter hospital stay, and fewer complications, are confirmed.

Endoscopic approaches to the cranial base: perspectives and realities

Abstract We describe the development of transnasal endoscopic approaches to the cranial base in an interdisciplinary series of 103 patients, including 13 in the pediatric age group. Our aim was to define, with the aid of different case reports, the possibilities of endoscopic techniques in tumor resection, fistula repair, the treatment of mucoceles and meningoceles, and of combined intracranial and endoscopic approaches. The advantages of these minimally invasive approaches are panoramic visualization, rapidity and reduction of the cosmetic and functional disabilities in comparison with other conventional approaches, and a better capacity for identifying and developing key landmarks for surgery. On the other hand, endoscopic surgery requires an exsanguine operation field, technical improvements in instruments, and specific skills. Interdisciplinary collaboration in endoscopic approaches has proved useful in integrating experiences without overlap between fields, and in broadening possibilities: in our opinion endoscopic approaches will certainly be important in the future of cranial base surgery.

Endoscopic extraction of a metal foreign body from the maxillary sinus

INTRODUCTION Metal foreign bodies are occasionally found in the sinuses. The literature reports cases in which the foreign body was of dental origin or the result of a war injury or accident.1-6 The problem has grown since the middle of the 1980s because of the development of techniques using osteointegrated implants to treat edentulousness; one of the complications of this form of treatment is the malpositioning of metal fixtures within the maxillary sinus. The classic surgical technique for their removal is the Caldwell-Luc procedure, which involves opening the anterior wall of the maxillary sinus. The development of diagnostic and surgical techniques using nasal and sinus endoscopy has provided a much less invasive method for direct visualization of the internal structure of the sinuses. The first endoscopically controlled removal of a foreign body from the maxillary sinus was reported as long ago as 1904 by Binder7; Imhoffers subsequently reported a similar case in 1910. Mladina has reported three cases of projectiles lodged in the ethmoidal and sphenoidal sinuses that were removed by means of endoscopic techniques.9 Connolly and Whitelo extracted a projectile from the maxillary sinus using endoscopically controlled inferior meatohmy, In this article we describe the removal of metal implant furtures from the maxillary sinus by means of sinus endoscopy through the canine fossa.

Nasopharyngeal endoscopic resection in the management of selected malignancies: ten-year experience

OBJECTIVE To evaluate the feasibility of endoscopic surgery in the management of selected nasopharyngeal cancers. Three different types of nasopharyngeal endoscopic resections (NER) are described. METHOD OF STUDY From January 1997 to October 2008, 17 consecutive patients (mean age: 50 years) with previously untreated (5) or recurrent nasopharyngeal tumours (12) were treated with curative intent by pure endoscopic resection. The extent of surgical resection was classified as follows: type I NER: resection limited to the postero-superior nasopharyngeal wall; type 2 NER: resection superiorly extended to the sphenoid sinus; type 3 NER: resection with lateral extension including the cartilaginous portion of the Eustachian tube and parapharyngeal space. RESULTS Type 1 NER was performed in 4 cases, type 2 in 6, and type 3 in 7. No intra- or post-operative complications were observed. Mean hospitalization time was 4 days (range: 1-7). Follow-up ranged from 10 to 138 months (mean: 41.2±38). At the time of writing, 12 (71/%) patients were free of disease, 3 (17%) alive with disease, and 2 (12%) dead of disease. CONCLUSIONS NER is a feasible surgical technique that can be tailored in relation to tumour extension. Larger series and longer follow-up are needed to further validate the long-term results.

Endoscopic endonasal surgery for malignancies of the anterior cranial base

OBJECTIVE Data from several centers worldwide have demonstrated that transnasal endoscopic surgery performed with or without a transcranial approach is capable of achieving radical resection of selected sinonasal malignancies. We report our experience with endoscopic management of sinonasal cancers, with emphasis on naso-ethmoidal malignancies encroaching on the anterior skull base. METHODS Major series reporting results concerning the endoscopic endonasal approach with or without craniectomy for treatment of sinonasal and anterior skull base cancers were reviewed. Preoperative work-up, indications and exclusion criteria, surgical techniques, postoperative management, and adjuvant therapy are reported. RESULTS In the 2 largest series analyzed, the most common malignancies were adenocarcinoma (28%), olfactory neuroblastoma (14.5%), and squamous cell carcinoma (13.5%). The 5-year disease-specific survival rate ranged from 81.9%-87%, with no major differences in the mean follow-up time (34.1 months vs. 37 months). CONCLUSIONS Endoscopic endonasal resection performed with or without a transcranial approach, when properly planned and in expert hands, has an accepted role with precise indications in the surgeons armamentarium for the treatment of sinonasal and skull base malignancies.

Endoscopic endonasal management of encephaloceles in children: An eight-year experience

OBJECTIVE Skull base encephaloceles are difficult to diagnose and to treat. Traditionally, they are approached externally via craniotomic routes. Endoscopic management of skull base defects is the standard treatment in adults. Our aim is to evaluate the efficacy and safety of endoscopic endonasal repair of basal encephaloceles in the paediatric population. METHODS Retrospective evaluation of paediatric encephaloceles managed endoscopically at a tertiary referral centre. RESULTS Eleven subjects fitted the criteria of the study. Mean age at surgery was 6.1+/-4.6 SD years, while mean follow-up was 46.5+/-28 SD months. Most of the defects were located in the anterior cranial fossa. All patients were managed successfully with no complications. CONCLUSIONS Endonasal endoscopic management of congenital encephaloceles is feasible in paediatric patients. Meticulous pre-op neuroimaging is of paramount importance when dealing with such cases.