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      Paranasal sinus CT and 3 kinds of nasal endoscopic sphenoid sinus surgical approaches : Retrospective analysis of 128 cases

      research-article
      , MM , , MM, , MD
      Medicine
      Lippincott Williams & Wilkins
      body section radiography, nasal endoscopic surgery, sphenoid sinus

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Even being equipped with advanced surgical navigation systems, thorough analysis of patient's imaging diagnosis before procedures is still of great necessity for the operators. This study aimed to explore the morphological changes of sphenoid sinus lesions as observed on computed tomography (CT), and further carry out the fenestration of sphenoid sinus under guidance of the CT.

          A retrospective analysis of the characteristics of CT images was performed. The outcomes of three kinds of nasal endoscopic surgeries on benign lesions of sphenoid sinuses were investigated. For the 128 patients included, nasal-cavity-olfactory cleft pathway was performed in 64 patients, the Messerklinger pathway was adopted in 54 patients, while Wigand pathway was performed in the rest 10 patients.

          After follow-up visit, the drainage at the fenestration site of sphenoid sinus was found to be smooth, the symptoms were completely controlled, and no severe complication was reported during or after the surgery. No significant difference was observed in the curative effects among the 3 groups.

          CT of the paranasal sinus can guide the procedures of sphenoid sinus fenestration. No statistically significant differences were exhibited in terms of the amount of bleeding, surgical time and days of hospitalization among the 3 groups.

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          Most cited references15

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          The extended endoscopic endonasal approach to the clivus and cranio-vertebral junction: anatomical study.

          Lesions located in the retroclival area and at the level of the cranio-vertebral junction are typically approached through a variety of anterior, antero-lateral and postero-lateral skull-based approach, either alone or in combination. The aim of this anatomical study was to demonstrate the possibility of an endoscopic endonasal approach to the clivus and cranio-vertebral junction. Five fresh cadaver heads injected with colored latex were used. A modified endonasal endoscopic approach was made through two nostrils in all cases. Endoscopic dissections were performed using rigid endoscopes, 4 mm in diameter, 18 cm in length, with 0 degrees lenses. Access to the clivus was possible using a lower trajectory when compared to that necessary for the sellar region. The sphenoid sinus is entered, and its inferior wall is completely removed, permitting the union of the sphenoidal and rhinopharyngeal parts of the clivus. The entire clivus can be removed, and the cranio-vertebral junction is opened, removing the anterior arch of atlas and the odontoid process. After the opening of the dura, the anterior surface of the pons and upper spinal cord with corresponding nerves and vasculature are visible. The endoscopic endonasal approach to the clivus and cranio-vertebral junction could be a valid alternative for surgical treatment of anterior lesions of these regions. Adequate endoscopic skill, lab training on cadavers and dedicated tools are required for clinical applications of the approach.
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            European position paper on the anatomical terminology of the internal nose and paranasal sinuses.

            The advent of endoscopic sinus surgery led to a resurgence of interest in the detailed anatomy of the internal nose and paranasal sinuses. However, the official Terminologica Anatomica used by basic anatomists omits many of the structures of surgical importance. This led to numerous clinical anatomy papers and much discussion about the exact names and definitions for the structures of surgical relevance. This European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses was conceived to re-evaluate the anatomical terms in common usage by endoscopic sinus surgeons and to compare this with the official Terminologica Anatomica. The text is a concise summary of all the structures encountered during routine endoscopic surgery in the nasal cavity, paranasal sinuses and at the interface with the orbit and skull base but does not provide a comprehensive text for advanced skull base surgery. It draws on a detailed review of the literature and provides a consensus where several options are available, defining the anatomical structure in simple terms and in English. It is recognised that this is an area of great variation and some indication of the frequency with which these variants are encountered is given in the text and table. All major anatomical points are illustrated, drawing on the expertise of the multi-national and multi-disciplinary contributors to this project.
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              Endoscopic transsphenoidal vidian neurectomy.

              The purpose of this report is to describe a novel technique for endoscopic vidian neurectomy (EVN) based on preoperative computed tomography (CT) classification of the vidian canal (VC), and to present anatomical and surgical findings from an initial series. Retrospective study, consisting of medical chart review and patient interviews, of all preoperative CT-guided EVN procedures was performed from 2006 to 2010 at a tertiary-care medical center. A total of 89 patients with intractable rhinorrhea (77 males and 12 females, mean age 29 years, age range 16-57 years) underwent bilateral EVN. Configuration of the VC was classified into three types based on preoperative CT findings. The technique for surgical access of each of these configurations is presented. The most common configuration of the VC was type 2 (47%). A wide, direct, and safe exposure of the vidian nerve was achieved in all cases. 84 of 89 patients completed the questionnaires regarding the postoperative improvement in quality of life. Follow-up ranged from 2 to 42 months, with an average of 19.6 months. 77 of 84 (91.7%) patients were satisfied with their surgical result. Two patients underwent revision ETSVN due to relapsed symptoms. With the help of a preoperative CT scan of the paranasal sinuses, the vidian nerve can be identified precisely via an endoscopic intrasphenoidal or transsphenoidal approach, which provides an easy and reliable way to perform vidian neurectomy.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                16 October 2020
                16 October 2020
                : 99
                : 42
                : e22835
                Affiliations
                Department of Otorhinolaryngology-Head and Neck Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, China.
                Author notes
                []Correspondence: Shidong Chu, Department of Otorhinolaryngology-Head and Neck Surgery, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang Province, China (e-mail: csd95119@ 123456126.com ).
                Article
                MD-D-20-00531 22835
                10.1097/MD.0000000000022835
                7571876
                33080763
                72554c0e-4b72-4978-8e49-d9219d27ffa2
                Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 21 January 2020
                : 3 June 2020
                : 20 September 2020
                Funding
                Funded by: Zhejiang Provincial Health Committee Innovative Talent Support Fund
                Award ID: 2020RC097
                Award Recipient : chu shidong
                Categories
                7100
                Research Article
                Observational Study
                Custom metadata
                TRUE

                body section radiography,nasal endoscopic surgery,sphenoid sinus

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