Endoscopic sinus surgery to remove brain tumors

Pituitary tumors represent 10-15% of all intracranial tumors. Although they are often benign, surgical excision is indicated when they produce significant clinical symptoms through mass effect and hormonal hyper-secretion. The surgical approach to the pituitary has undergone significant changes since first being performed in the late 1800’s. Today the endoscopic nasal, transsphenoidal approach is commonly performed with a multidisciplinary team with Neurosurgeons and Otolaryngologists working together. This combined approach has led to improved outcomes and decreased complication rates as Otolaryngologists provide expertise in endoscopic techniques and knowledge in sinus and anterior skull-base anatomy while neurosurgeons perform the excision of pituitary tumor intracranially.

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Decompressing the orbit for thyroid eye disease using endoscopic sinus surgery techniques

Thyroid eye disease (TED) includes a number of orbital complications that arise as a result of thyroid autoimmune disease, most commonly related to Graves disease. TED can lead to both cosmetic disfigurement and functional deficits, including exophthalmos, diplopia, and vision loss. Perhaps the most feared manifestation of TED is optic neuropathy. Optic neuropathy is usually diagnosed by a combination of clinical and radiologic findings and can be managed by medical or surgical intervention. Most current treatment algorithms for this condition utilize either oral or intravenous corticosteroids as a first-line therapy with surgical orbital decompression reserved for recalcitrant disease. Orbital decompression can also help address other manifestations of thyroid eye disease, including diplopia, ocular surface damage, proptosis, lid retraction, chemosis, lid edema, and fat prolapse. A variety of techniques for orbital decompression have been described, although few studies have compared these techniques. The objective of the present chapter is to provide an overview of optic neuropathy and orbital decompression in TED and review relevant literature.

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Making endoscopic sinus surgery safer

Administration of topical 1:1000 epinephrine is commonly used in practice to achieve vasoconstriction during endoscopic sinus surgery and skull base surgery; however real-time effects on cardiovascular changes from systemic absorption have not been well studied. This may by significant in patients with cardiovascular disease.  This study utilized hemodynamic monitoring through intra-operative arterial line placement to provide a continuous measurement of a patient’s blood pressure, pulse, and mean arterial pressure.

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Traditional treatment of Chronic Rhinosinusitis - an update

Sinusitis is categorized by duration of sinonasal inflammation. Sinonasal inflammation with sudden onset of symptoms lasting up to 4 weeks is considered acute rhinosinusitis (ARS).6 Key diagnostic symptoms include purulent nasal drainage, nasal congestion, and facial pain or pressure. One of the challenges in the diagnosis of ARS is differentiating viral from bacterial etiologies. This distinction is important as viral causes of ARS will largely resolve spontaneously whereas bacterial episodes may benefit from antibiotics. The most recent Clinical Practice Guideline from the American Academy of Otolarynology-Head and Neck Surgery suggests a diagnosis of bacterial ARS be considered when symptoms persist longer than 10 days or worsen after a period of initial improvement.6

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New Technology Gives Surgeons Unprecedented Views of Patients’ Bodies

When could a video game possibly save your life?  A new imaging technology, now being used at Methodist Hospital in Houston, Texas,  has direct links to video games.  It can provide detailed views of patients’ bodies -- helping surgeons plan and execute complicated operations with much more confidence. 

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WHY ARE DOCTORS STILL USING 2D IMAGING (CT AN MRI SCANS) WHEN 3D IS READILY AVAILABLE?

Two dimensional imaging, such as the standard cat scan (CT scan) or magnetic resonance imaging (MRI) has been around since 1972.  It was invented by British engineer Godfrey Hounsfield of EMI Laboratories, England, and independently by South African born physicist Allan Cormack of Tufts University, Massachusetts.  Since that time, although the resolution of the images have improved, it remains relatively the same technology.  Doctors continue to use the "slices" shown on 2 dimensional CT scans  to educate medical students, surgical residents, and even patients.  As the images are in 2D, it can be quite disorienting even to medical residents, let alone patients who are trying to learn about their own pathology.  As such, we are making push to bring 3D technology into the main stream.

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