Therapeutic endoscopy of the paranasal sinuses

Recent advances in Otology: Current landscape and future direction

Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.

["Radical" versus "functional" surgery of the paranasal sinuses-A contradiction?]

BACKGROUND AND OBJECTIVE

The terms "functional" and "radical" paranasal sinus surgery were often considered to be different operations which were mutually exclusive. This overview aims to look at the basics of these terms and surgical procedures and to work out the resulting surgical concepts for clinically relevant indications.

MATERIAL AND METHODS

Selective literature analysis using the data base PubMed, corresponding textbooks and resulting secondary literature regarding functional and radical or extended paranasal sinus surgery. Similarly, the current literature regarding clinically relevant indications for sinus surgery were analyzed.

RESULTS AND CONCLUSION

Modern pathophysiological knowledge, anatomically and pathophysiologically substantiated endoscopic surgical procedures and the usage of up to date technical possibilities have resulted in concepts which combine functional and so-called radical or extended surgery of the paranasal sinuses that complement each other and sometimes even overlap. The preoperative diagnosis and definition of underlying diseases are decisive and should be as precise as possible, as the extent and surgical details mainly depend on them: a sole creation of free drainage pathways, an additional creation of anatomical access for subsequent topical treatment or a complete (radical) removal of a pathological process.

The Evolution of Pituitary Gland Surgery from the Ancients to the Millennials

Located at the base of the skull, the pituitary gland has a long and controversial history, not only in terms of its anatomy, but especially in the functions it performs and in the attempt to approach it surgically. Considered by Galen of Pergamon to have a role in releasing waste products of the brain, a theory accepted until the 17th century, the pituitary gland became a separate entity once with the anatomical descriptions of the famous Andreas Vesalius. At the beginning of the 18th century, researches of the time began to be more and more interested in this gland, trying to identify its functions, and at the same time correcting the traditional theories that were wrong or incomplete. Later, they turned their attention to experimental animal studies that represented the germinal nucleus for the transcranial and endoscopic pituitary surgery. In this review, an attempt has been made to record the entire history of anatomy, physiology and surgery of the pituitary gland, from antiquity to the current day's surgical techniques.

The 100 Most Cited Articles in Endoscopic Endonasal Skull Base Surgery: A Bibliometric Analysis

BACKGROUND

The accelerated growth of endoscopic endonasal skull base surgery has led to an abundance of highly cited works that have helped shape the field into its current state. Highlighting these works can serve as a guide for trainees and facilitate evidence-based clinical decision making and operative techniques.

METHODS

Elsevier's Scopus database was used to generate a list of the 100 most cited articles on endoscopic endonasal skull base surgery in September 2022. Results were categorized based on pathology, approach, study design, and study objective. A citation per year analysis was conducted to highlight later publications that may not have had the time to accumulate as many citations as older publications.

RESULTS

The average number of citations for the 100 most cited articles was 210 per article (range 104-1285). Publication dates ranged from 1997 to 2019, with the highest number of articles among the 100 most cited being published in 2008 (15 articles). The journal with the greatest number of publications was Neurosurgery (30 articles). Of the 100 most cited articles, 77 were published between 2000 and 2010. Moreover, 40 of the 100 articles reported surgical outcomes and related complications, and the most common pathology was pituitary adenoma (25 articles).

CONCLUSIONS

This article provides a list of highly influential articles in the field of endoscopic endonasal skull base surgery, highlighting its rapid evolution over the last 3 decades and demonstrating its leap from small descriptive series confined to certain pathologies to larger cohorts exploring possible boundaries and other pathologies.

Systematic review of endoscopic-assisted surgical management for congenital nasolacrimal duct obstruction

OBJECTIVES

Epiphora is a common presenting complaint in infants affecting up to 6% of infants in the United States. It is most frequently due to congenital anomalies of the nasolacrimal duct system, termed congenital nasolacrimal duct obstruction (CNLDO). Nasolacrimal duct probing is widely accepted as the primary surgical intervention in cases that fail conservative management. Recently, nasal endoscopy has been combined with traditional probing to improve success rates and outcomes. Several studies have been conducted, but the results have been inconclusive overall. The goal of this systematic review is to examine the existing literature on the role of nasal endoscopy during nasolacrimal duct probing and evaluate patient outcomes.

METHODS

A systematic search was performed in PubMed, MEDLINE, The Cochrane Library, ClinicalTrials.gov, LILAC, and EMBASE to identify peer-reviewed research. Eligible studies were those containing original peer-reviewed research in English addressing nasolacrimal duct probing for congenital nasolacrimal duct obstruction in conjunction with nasal endoscopy. Two investigators independently reviewed all articles and extracted data. Bias was assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa Assessment scale, and the NIH Quality Assessment scale.

RESULTS

A literature review ultimately yielded 11 articles that were selected and included in our analysis. Of the seven case series, the success rate was 92.5% for a total of 492 eyes. Of the four cohort/case-control studies, the success rate in conventional probings was 75.3% for a total of 293 eyes. In probings with nasal endoscopy, the success rate was 95.3% for 162 eyes. Overall, there was a high risk of bias and variation in data reporting amongst studies.

CONCLUSION

Infants with congenital nasolacrimal duct obstruction that does not resolve with conservative treatment often require surgical intervention. Based on this systematic review of the current literature, nasal endoscopy is a useful adjunct for nasolacrimal duct probing.

A golden experience: Fifty years of experience managing the frontal sinus

OBJECTIVES/HYPOTHESIS

The frontal sinus is one of the most anatomically complex and inaccessible of the paranasal sinuses. As a result, surgeons have continually tried to improve surgical management of the frontal sinus. The senior author (c.w.g.) shares 50 years of experience managing the frontal sinus.

DATA SOURCES

PubMed literature search.

REVIEW METHODS

Review of the literature regarding landmark innovations in frontal sinus surgery.

RESULTS

Open approaches established that the frontal sinus is accessible, and in certain circumstances, such as with large osteoma or papilloma, are still required. The endoscope changed the surgical landscape and allowed for greater finesse and decreased morbidity. Sinus balloon dilation is the newest change in frontal sinus management and shows promise in properly selected cases.

CONCLUSION

Surgery of the frontal sinus continues to evolve and improve. Although there are new techniques, the older techniques are still pertinent.

Pituitary surgery: legacies from the past

Pituitary surgery is a recent development in neurosurgery and most of the surgical techniques concerned have been described within the last century. We provide a historical perspective by reviewing the major steps in the development of this neurosurgical subspecialty through the ages. We concentrate on the most important figures whose advances in the study of the physiology and anatomy of the pituitary are most significant. This journey into the past will demonstrate that our current knowledge is the summation of a long road of investigation.

Endoscopic endonasal skull base surgery: past, present and future

Endoscopic techniques have undergone tremendous advancement in the past years. From the management of phlogistic pathologies, we have learned to manage skull base lesions and even selected intracranial diseases. Current anatomical knowledge plus computer-aided surgery has enabled surgeons to remove large lesions in the paranasal sinuses extending beyond the boundaries of the sinuses themselves. In this sense, management of benign diseases via endoscopic routes is nowadays well accepted whilst the role of endoscopic techniques in sinonasal malignancies is still under investigation. Nowadays, it is possible to tackle different pathologies placed not only in the ventral skull base, but also extended laterally (infratemporal fossa and petrous apex) and even, in really selected cases, within the orbit. The ability to resect and reconstruct has improved significantly. At the moment, the improvement in surgical techniques, like the four-handed technique, has rendered endoscopic procedures capable of managing complex pathologies, according the same surgical principles of the open approaches. From now onwards, frameless neuronavigation, modular approaches, intraoperative imaging systems and robotic surgery are and will be an increasingly important part of endonasal surgery, and they will be overtaken by further evolution.

Clinical validation of percutaneous cochlear implant surgery: initial report

OBJECTIVE

Percutaneous cochlear implant surgery consists of a single drill path from the lateral mastoid cortex to the cochlea via the facial recess. We sought to clinically validate this technique in patients undergoing traditional cochlear implant surgery.

STUDY DESIGN

Prospective clinical trial.

METHODS

After institutional regulatory board-approved protocols, five ears were studied via the following steps. 1) In the clinic under local anesthesia, bone-implanted anchors were placed surrounding each mastoid. 2) Temporal-bone computed tomography (CT) scans were obtained. 3) On the CT scans, paths were planned from the lateral mastoid cortex, through the facial recess, to the basal turn of the cochlea both "manually" and "automatically" using computer software. 4) Customized microstereotactic frames were rapid-prototyped to serve as drill guides constraining the drill to follow the appropriate path. 5) During cochlear implant surgery, after drilling of the facial recess, drill guides were mounted on the bone-implanted anchors. 6) Accuracy of paths was assessed via intraoperative photodocumentation.

RESULTS

All surgical paths successfully traversed the facial recess and hit the basal turn of the cochlea. Distance in millimeters (average +/- SD) from the midpoint of the drill to the facial nerve was 1.18 +/- 0.68 for the "manual" path and 1.24 +/- 0.44 mm for the "automatic" path and for the chorda tympani 0.986 +/- 0.48 for the "manual" path and 1.22 +/- 0.62 for the "automatic" path.

CONCLUSIONS

Percutaneous cochlear implant access using customized drill guides based on preoperative CT scans and image-guided surgery technology can be safely accomplished.

Minimally invasive surgery in otorhinolaryngology

Otorhinolaryngology has always strived to improve the diagnostic and therapeutic possibilities of managing afflicted organs by developing technically and conceptually new and advanced treatment techniques. The endeavor to develop methods with minimized patient discomfort during interventional surgery in the head and neck region was an essential motive which gave rise to the discipline of ENT medicine. Since fairly recently, the term "minimally invasive surgery" has become firmly established in the domain of general surgery. The possibility for replacing a substantial number of routine operations by endoscopic procedures with low levels of discomfort for the patient and shorter periods of hospitalization has given the term "minimally invasive" even further wide-ranging significance. The present review endeavors to provide an assessment of the current state-of-the-art in otorhinolaryngology, giving special attention to the historical development and pathophysiological fundamentals of this field.

Telescopic videorhinoscopy: a useful addition to the clinical practice of rhinology

Telescopic videorhinoscopy using a rigid telescope and a color video camera is an effective method of demonstrating and documenting the anatomy and pathology of the nose. Its chief value is in making an accurate diagnosis. It is also an excellent method of teaching endoscopic surgery of the nose and sinuses. The authors present a useful method of telescopic videography of intranasal structures using Hopkins rigid telescopes and a reasonably priced video home system color camera. Telescopic videorhinoscopy is a useful addition to the daily practice and teaching of rhinology.