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Endoscopic endonasal resection of a recurrent infrasellar craniopharyngioma
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
P189 Lateral Tympanoplasty with Graft Fixed in Tympanic Cavity Alejandro Perez, MD (presenter) Santiago Chile
Objectives: To describe an alternative method of lateral tympanoplasty that is fixed in the tympanic cavity. Methods: Under local anesthesia, a transcanal approach was made, anterior and posterior incisions just above the annulus. After cleaning the epithelial layer, a perichondral graft was placed on the tympanic remanent and inserted both extremes inside the middle ear and fixed by contact in the lateral wall of the tympanic cavity. Small pats of gel foam inside the canal were placed. A follow-up of 36 months was carry out. Results: Twenty-four patients (14 women and 10 men) with average age of 27 years were operated on; a complete good healing graft was presented in 23 patients (95.8%). The PTA after 3 years was 22 patients with air-bone gap completely closed, and just 1 patient with 5 decibels of gap. All patients 30 days postsurgery returned to normal activity including water exposition. Conclusion: This method of tympanoplasty with its surgical indications is easy to perform with good hearing results.
P301
P190 Endoscopic Endonasal Resection of a Recurrent Infrasellar Craniopharyngioma Emily Frances Rudnick, MD (presenter); Laurence J DiNardo, MD Richmond VA; Richmond VA
Objectives: Craniopharyngiomas most commonly occupy in the sellar and suprasellar intracranial spaces. However, occasional accounts are made of infrasellar lesions. Recent endoscopic management of these tumors has challenged traditional microsurgical excision that involves more invasive transseptal or craniotomy approaches. We report a case of a recurrent nasopharyngeal-based craniopharyngioma that was completely resected using an endonasal endoscopic technique. We evaluate the efficacy of this approach in treating infrasellar lesions and its morbidity when compared to more traditional resection. Methods: A 31-year old man who presented with a recurrent nasopharyngeal craniopharyngioma underwent imageguided endoscopic endonasal resection. The complexity of the lesion, the operative techniques applied, and the patient’s outcome are described and supported with perioperative diagnostic images and intraoperative photographs. Results: Resection of this patient’s recurrent craniopharyngioma was carried to the level of bone along all aspects of the clival cavity and sphenoid sinus. Application of an imageguided system intraoperatively assisted in protection of the pituitary sella, carotid arteries, and optic nerves. The patient experienced no perioperative sequelae. He remains diseasefree 1 year following resection and postoperative radiation therapy. Conclusion: Recurrent infrasellar craniopharyngiomas can be successfully managed using an image-guided endoscopic endonasal technique. This minimally invasive approach facilitated the resection of a recurrent tumor that had failed a microsurgical transseptal approach.
P191 Superior Orbital Fissure Syndrome Caused by Sinusitis Fabio De Rezende Pinna, MD (presenter); Daniel L Dutra, MD; Maura C Neves, MD; Fabrizio Ricci Romano, MD; Richard L Voegels, MD; Ossamu Butugan, MD PhD Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: The potential morbidity and mortality of sphenoid sinus infectious processes are related to its proximity to vital structures within the orbit, such as the cavernous sinus and the brain. Involvement of the posterior orbit can result in superior orbital fissure syndrome (SOFS), a rare entity that comprehends dysfunction of the structures that cross this anatomical region. Early recognition of this syndrome is mandatory. Delays on adequate treatment may compromise the patient’s prognosis. The purpose of this report is to
POSTERS
curs in less than 0.008% of patients, yet the mortality associated with this complication is 42%. Consequently, physicians must possess the ability to recognize and appropriately manage this complication. We describe a case of hypopharyngeal perforation following intraoperative insertion of a TEE probe and review the English-language literature regarding this condition. Transesophageal echocardiography performed intraoperatively is associated with a slightly higher incidence of perforation. Postoperative symptoms are often vague and diagnosis can be delayed. This results in significant morbidity and mortality. We discuss identification of risk factors, diagnosis, and treatment protocols for hypopharyngeal perforation following TEE. Methods: We reviewed the English-language literature regarding hypopharyngeal perforation following intraoperative insertion of a TEE probe. Results: Perforation of the orogastric pathway occurs in less than 0.008% of patients undergoing intraoperative TEE. Conclusion: Although the incidence of orogastric perforation following intraoperative TEE is rare, significant mortality is associated with this complication. Thus, clinicians must be aware of this complication to prevent delay in diagnosis.
Scientific Posters
P189 Lateral Tympanoplasty with Graft Fixed in Tympanic Cavity Alejandro Perez, MD (presenter) Santiago Chile
Objectives: To describe an alternative method of lateral tympanoplasty that is fixed in the tympanic cavity. Methods: Under local anesthesia, a transcanal approach was made, anterior and posterior incisions just above the annulus. After cleaning the epithelial layer, a perichondral graft was placed on the tympanic remanent and inserted both extremes inside the middle ear and fixed by contact in the lateral wall of the tympanic cavity. Small pats of gel foam inside the canal were placed. A follow-up of 36 months was carry out. Results: Twenty-four patients (14 women and 10 men) with average age of 27 years were operated on; a complete good healing graft was presented in 23 patients (95.8%). The PTA after 3 years was 22 patients with air-bone gap completely closed, and just 1 patient with 5 decibels of gap. All patients 30 days postsurgery returned to normal activity including water exposition. Conclusion: This method of tympanoplasty with its surgical indications is easy to perform with good hearing results.
P301
P190 Endoscopic Endonasal Resection of a Recurrent Infrasellar Craniopharyngioma Emily Frances Rudnick, MD (presenter); Laurence J DiNardo, MD Richmond VA; Richmond VA
Objectives: Craniopharyngiomas most commonly occupy in the sellar and suprasellar intracranial spaces. However, occasional accounts are made of infrasellar lesions. Recent endoscopic management of these tumors has challenged traditional microsurgical excision that involves more invasive transseptal or craniotomy approaches. We report a case of a recurrent nasopharyngeal-based craniopharyngioma that was completely resected using an endonasal endoscopic technique. We evaluate the efficacy of this approach in treating infrasellar lesions and its morbidity when compared to more traditional resection. Methods: A 31-year old man who presented with a recurrent nasopharyngeal craniopharyngioma underwent imageguided endoscopic endonasal resection. The complexity of the lesion, the operative techniques applied, and the patient’s outcome are described and supported with perioperative diagnostic images and intraoperative photographs. Results: Resection of this patient’s recurrent craniopharyngioma was carried to the level of bone along all aspects of the clival cavity and sphenoid sinus. Application of an imageguided system intraoperatively assisted in protection of the pituitary sella, carotid arteries, and optic nerves. The patient experienced no perioperative sequelae. He remains diseasefree 1 year following resection and postoperative radiation therapy. Conclusion: Recurrent infrasellar craniopharyngiomas can be successfully managed using an image-guided endoscopic endonasal technique. This minimally invasive approach facilitated the resection of a recurrent tumor that had failed a microsurgical transseptal approach.
P191 Superior Orbital Fissure Syndrome Caused by Sinusitis Fabio De Rezende Pinna, MD (presenter); Daniel L Dutra, MD; Maura C Neves, MD; Fabrizio Ricci Romano, MD; Richard L Voegels, MD; Ossamu Butugan, MD PhD Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: The potential morbidity and mortality of sphenoid sinus infectious processes are related to its proximity to vital structures within the orbit, such as the cavernous sinus and the brain. Involvement of the posterior orbit can result in superior orbital fissure syndrome (SOFS), a rare entity that comprehends dysfunction of the structures that cross this anatomical region. Early recognition of this syndrome is mandatory. Delays on adequate treatment may compromise the patient’s prognosis. The purpose of this report is to
POSTERS
curs in less than 0.008% of patients, yet the mortality associated with this complication is 42%. Consequently, physicians must possess the ability to recognize and appropriately manage this complication. We describe a case of hypopharyngeal perforation following intraoperative insertion of a TEE probe and review the English-language literature regarding this condition. Transesophageal echocardiography performed intraoperatively is associated with a slightly higher incidence of perforation. Postoperative symptoms are often vague and diagnosis can be delayed. This results in significant morbidity and mortality. We discuss identification of risk factors, diagnosis, and treatment protocols for hypopharyngeal perforation following TEE. Methods: We reviewed the English-language literature regarding hypopharyngeal perforation following intraoperative insertion of a TEE probe. Results: Perforation of the orogastric pathway occurs in less than 0.008% of patients undergoing intraoperative TEE. Conclusion: Although the incidence of orogastric perforation following intraoperative TEE is rare, significant mortality is associated with this complication. Thus, clinicians must be aware of this complication to prevent delay in diagnosis.
Scientific Posters