Wolfgang Koele

Intraoperative medialization of medial rectus muscle as a new endoscopic technique for approaching intraconal lesions.

Background Intraconal tumors of the orbit are rare entities and surgical treatment is challenging. Endoscopic transnasal approaches to the orbit offer a new perspective for surgery, although only few reports exist in literature. This study displays the Graz experience with endoscopic approaches to intraorbital tumors between 2006 and 2010 introducing a novel endoscopic technique for temporary medialization of the medial rectus muscle facilitating access to the orbital cone. Methods A retrospective analysis of patients’ charts was performed. Results For approaches to intraconal lesions a special endoscopic temporary medialization technique of the medial rectus muscle through applying transseptal sutures was developed. Six patients (four male and two female patients) have been included in this study presenting with intraconal/intraorbital tumors. Three patients underwent endoscopic surgery for two hemangiomas and one Schwannoma, respectively, and three patients were successfully biopsied endoscopically revealing one malignant melanoma, one malignant lymphoma, and one optic glioma each. Both hemangiomas were completely resected without any deterioration of vision. The Schwannoma was partially resected with postoperative imaging showing no tumor progression within 3 months. No intraoperative complications occurred. Five cases were performed with computer assisted surgery using CT/MR fusion navigation. Conclusion Although technically challenging, the endoscopic approach to the orbit, even for intraconal lesions with medialization of the medial rectus muscle, can be safe and promising for well-selected cases. Good postoperative results and sufficient material acquisition for proper histological examination can be obtained. Advantages are good visualization of the surgical field and avoidance of external scars. Limitations to endoscopic techniques are tumors in the lateral superior and lateral inferior quadrant of the orbit.

Endoscopic removal of an intraorbital "tumor": a vital surprise.

We present the first case report of an endoscopic removal of a living worm, species Dirofilaria repens, from the orbital cavity. As of today, over 410 cases of Dirofilaria repens infections in man are recorded in world literature, six of which were localized in the orbital cavity. In Austria we know of four cases of an infection with this parasite, but none in the orbit. Dirofilaria repens is widespread only in the Old World, particularly in Southern and Eastern Europe, in Asia Minor, and in Central and Southern Asia. The highest prevalence of the disease is recorded in Italy (181 cases). In clinical practice, the infections have mostly been misdiagnosed as a neoplasia, usually benign but sometimes malignant. Under the assumption of an intraorbital tumor, the endoscopic transnasal revision of the orbital cavity was performed, as this approach promised to be least traumatic and best suited for the lesion, resulting in complete removal of the live worm. In unclear lesions in the head and neck, an infection with Dirofilaria repens should be considered as a differential diagnosis.

Ethmoid roof CSF-leak following frontal sinus balloon sinuplasty.

INTRODUCTION Though clear indications for its clinical application are not established yet, balloon sinuplasty technology per se is considered safe and very few severe complications have been mentioned in literature as of today. CASE REPORT We report the case of a 36-year-old female patient who presented with right sided rhinorrhea from a CSF-leak in the ethmoidal roof after balloon sinuplasty, aimed at her right frontal sinus. Apparently, the surgeon was unaware of having penetrated the skull base through the lateral lamella of the cribriform plate intraoperatively. CSF rhinorrhea became evident 3 weeks postoperatively only when fever, headaches and moderate nausea developed. Upon revision, diameter, size and shape of the bony defect exactly matched with the tip of a standard sinus balloon catheter device, as could be demonstrated and documented. A small posttraumatic encephalocele had intermittently blocked the leak. Endoscopic surgery and duraplasty were performed under intrathecal fluorescein control, applying CT image-guided navigation. Since two-layer fascia lata closure of the defect, the patient has remained free of symptoms without any evidence of CSF leakage. CONCLUSION Balloon sinuplasty per se is considered a safe technique, though in inexperienced hands or wrongly applied, complications may occur, as with any surgical tool rigid enough to breach through skull base.

Establishment of clival chordoma cell line MUG-CC1 and lymphoblastoid cells as a model for potential new treatment strategies

Chordomas are rare malignant tumors that develop from embryonic remnants of the notochord and arise only in the midline from the clivus to the sacrum. Surgery followed by radiotherapy is the standard treatment. As chordomas are resistant to standard chemotherapy, further treatment options are urgently needed. We describe the establishment of a clivus chordoma cell line, MUG-CC1. The cell line is characterized according to its morphology, immunohistochemistry, and growth kinetics. During establishment, cell culture supernatants were collected, and the growth factors HGF, SDF-1, FGF2, and PDGF analyzed using xMAP® technology. A spontaneous lymphoblastoid EBV-positive cell line was also developed and characterized. MUG-CC1 is strongly positive for brachyury, cytokeratin, and S100. The cell line showed gains of the entire chromosomes 7, 8, 12, 13, 16, 18, and 20, and high level gains on chromosomes 1q21–1q24 and 17q21–17q25. During cultivation, there was significant expression of HGF and SDF-1 compared to continuous chordoma cell lines. A new, well-characterized clival chordoma cell line, as well as a non-tumorigenic lymphoblastoid cell line should serve as an in vitro model for the development of potential new treatment strategies for patients suffering from this disease.

Potential correlations of dentogenic factors to the development of clinically verified fungus balls: A retrospective computed tomography–based analysis

Fungus balls are a common disease of the paranasal sinuses, usually involving the maxillary sinus. To clarify the pathology, we analyzed patients treated for maxillary sinus fungus balls to see whether the latter correlated with dentogenic factors.

Feasibility of Piezoelectric Endoscopic Transsphenoidal Craniotomy: A Cadaveric Study

Objective. Endoscopic transsphenoidal approach has become the gold standard for surgical treatment of treating pituitary adenomas or other lesions in that area. Opening of bony skull base has been performed with burrs, chisels, and hammers or standard instruments like punches and circular top knives. The creation of primary bone flaps—as in external craniotomies—is difficult.The piezoelectric osteotomes used in the present study allows creating a bone flap for endoscopic transnasal approaches in certain areas. The aim of this study was to prove the feasibility of piezoelectric endoscopic transnasal craniotomies. Study Design. Cadaveric study. Methods. On cadaveric specimens (N = 5), a piezoelectric system with specially designed hardware for endonasal application was applied and endoscopic transsphenoidal craniotomies at the sellar floor, tuberculum sellae, and planum sphenoidale were performed up to a size of 3–5 cm2. Results. Bone flaps could be created without fracturing with the piezoosteotome and could be reimplanted. Endoscopic handling was unproblematic and time required was not exceeding standard procedures. Conclusion. In a cadaveric model, the piezoelectric endoscopic transsphenoidal craniotomy (PETC) is technically feasible. This technique allows the surgeon to create a bone flap in endoscopic transnasal approaches similar to existing standard transcranial craniotomies. Future trials will focus on skull base reconstruction using this bone flap.

Influence of Topical Antifungal Drugs on Ciliary Beat Frequency of Human Nasal Mucosa: An In Vitro Study

Topical antifungal treatment is a subject of discussion in the treatment of chronic rhinosinusitis. The aim of this research was to study the effects of antifungal drugs on ciliary beat frequency (CBF) of human nasal mucosa under in vitro conditions.

A piezoelectric device for bone work in endoscopic anterior skull base surgery ‐ a feasibility study in 15 patients

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.12760 This article is protected by copyright. All rights reserved. Received Date : 07-Jun-2016 Revised Date : 04-Sep-2016 Accepted Date : 23-Sep-2016 Article type : Our Experience