Polymicrobial Skull Base Osteomyelitis Related to Chronic Sphenoiditis and Endoscopic Sinus Surgery

2020 ◽  
Author(s):  
Zachary Shellman ◽  
Matthew Coates ◽  
Naveed Kara
Keyword(s):  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Skull Base Osteomyelitis

Initial Presentation of Granulomatosis with Polyangiitis as Progressive Skull Base Osteomyelitis

ORL ◽  
2021 ◽  
pp. 1-5
Author(s):  
Hannan A. Qureshi ◽  
Anshu Bandhlish ◽  
Robert P. DeConde ◽  
Ian M. Humphreys ◽  
Waleed M. Abuzeid ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Granulomatosis With Polyangiitis ◽  
Abducens Nerve ◽  
Sinus Surgery ◽  
High Dose ◽  
Laboratory Findings ◽  
Skull Base Osteomyelitis ◽  
Antibody Positivity ◽  
Fluid Collections

A healthy man in his 30s presented with a 2-week history of severe bitemporal pain and pressure. He was initially treated for presumed acute rhinosinusitis, but his symptoms continued to worsen and underwent endoscopic sinus surgery at an outside community facility. He developed left abducens nerve palsy postoperatively, and magnetic resonance imaging (MRI) demonstrated evidence of extensive skull base osteomyelitis. He was initiated on intravenous (IV) broad-spectrum antibiotics but was subsequently found to have prostatic and submandibular sterile fluid collections. The patient subsequently developed new right abducens and left vagal nerve palsies and underwent revision endoscopic sinus surgery. Pathology revealed extensive inflammation, necrotizing granulomas, and evidence of small and medium vessel vasculitis. Extensive laboratory workup was negative, except for anti-PR-3 antibody positivity. Given the characteristic findings on pathology and laboratory findings, the patient was diagnosed with granulomatosis with polyangiitis (GPA). High-dose glucocorticoid therapy as well as rituximab infusion were promptly initiated. He had marked improvement in his symptoms and resolution of his right CN VI palsy but left-sided CN VI and CN X palsies persisted. This patient presented without the typical rhinologic manifestations of GPA, and rather presented with progressive sinusitis, skull base osteomyelitis with associated cranial neuropathies, and aseptic systemic abscesses. Prompt diagnosis of GPA is particularly important in those with otorhinolaryngological manifestations, as early initial immunosuppressive therapy has been linked to lower relapse and mortality rates. Vigilance and early differentiation between GPA and other forms of sinusitis is of critical importance, particularly when symptoms are refractory to standard rhinosinusitis therapies.

Endoscopic sinus surgery the art of new era

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Wasam A Albusalih
Keyword(s):  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Chronic Infection ◽  
Malignant Tumour ◽  
Sinus Surgery ◽  
Skull Base Tumor ◽  
Short Hospital Stay ◽  
Gland Tumor ◽  
New Era ◽  
Skull Base Defect

Endoscopic sinus surgery is one of the fastest technique for treatment of sinonasal diseases which includes acute and chronic infection and resection of benign and malignant tumour; soon it extend for management of more deep area and deal with lesions in the pterygopalatine and infratemporal fossae then extended for management of skull base tumor which include pituitary gland tumor clival tumor and skull base defect leading to csf rhinorrea and its complications…in this lecture i cited the success which achieved in Diwanyia teaching hospital in this growing branch of medicine and illustrate some of my procedures pre and postoperatively with brief discussion for each.Endoscopic sinus surgery and its extended applications now play a major role in management of sinonasal And Skull base diseases with minimum complications and short hospital stay without the need for external devastating approach.

Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations

2021 ◽  
pp. 194589242110205
Author(s):  
Gian Luca Fadda ◽  
Alessio Petrelli ◽  
Federica Martino ◽  
Giovanni Succo ◽  
Paolo Castelnuovo ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Horizontal Plane ◽  
Uncinate Process ◽  
Cribriform Plate ◽  
Sinus Surgery ◽  
Evaluation Methodology ◽  
Anatomic Variations ◽  
Imaging Evaluation ◽  
Plane Passing

Background Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. Objective To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation. Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). Results The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. Conclusions According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.

scholarly journals The Swansea Floating Endoscopic Assistant: A Surgical Handling Aid

Reports ◽  
2018 ◽  
Vol 1 (3) ◽  
pp. 22
Author(s):  
Jayan George ◽  
Amir Farboud ◽  
Hassan Elhassan ◽  
Heikki Whittet
Keyword(s):  
Lumbar Spine ◽  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Skull Base Surgery ◽  
Mechanical Effect ◽  
The Other ◽  
Muscular Fatigue ◽  
Sinus Surgery ◽  
Double Loop ◽  
Repetitive Movements

Endoscopic sinus surgery is a rapidly advancing area of Otolaryngology. Operations can be lengthy and are often performed by a single surgeon. Repetitive movements can also lead to muscular fatigue. To mitigate against this, we regularly deploy two retractable Flexi™ compact leads, one bigger than the other connected together and suspended from the theatre operating light arm using velcro ties. The leads are then wrapped around the endoscope using a cotton crepe bandage, in a double loop with a reef knot. The larger lead attaches to the focus/zoom adjustment part of the endoscopic camera, and the smaller lead attaches to the scope 20 cm from the tip allowing the scope to float when suspended, with a slight downward tilt towards the patient. The mechanical effect this produces allows an advantageous reduction in the scope’s weight from 404 g un-suspended, to 65 g with the setup described. This subsequently reduces stress on the elbows, shoulders neck and lumbar spine. The Swansea Floating Endoscopic Assistant adheres to basic ergonomic principles and has the potential for application in other areas of Otorhinolaryngology and Skull Base Surgery.

Incidence, risk factors, and outcomes of endoscopic sinus surgery after endoscopic skull‐base surgery

2020 ◽  
Vol 10 (4) ◽  
pp. 521-525
Author(s):  
Ravi R. Shah ◽  
Ivy W. Maina ◽  
Neil N. Patel ◽  
Vasiliki Triantafillou ◽  
Alan D. Workman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Skull Base Surgery ◽  
Sinus Surgery ◽  
Endoscopic Skull Base Surgery ◽  
Incidence Risk

Don't sue the surgeon: remineralisation of the skull base or a defect that never existed?

2011 ◽  
Vol 125 (12) ◽  
pp. 1294-1297
Author(s):  
C Hopkins ◽  
S Dhillon ◽  
G Rogers ◽  
D Roberts
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Semicircular Canals ◽  
Time Frame ◽  
Sinus Surgery ◽  
Operative Exploration ◽  
Intracranial Complications ◽  
Operative Findings ◽  
The Right

AbstractIntroduction:Intracranial complications are recognised as rare, but serious, sequelae of endoscopic sinus surgery.Case report:A 56-year-old woman was referred after developing meningitis following elective functional endoscopic sinus surgery. Computed tomography demonstrated a significant defect of the skull base in the right posterior ethmoid, clearly visible on both coronal and sagittal sections. Operative exploration demonstrated the skull base to be intact in the posterior ethmoid area identified on the scan, and the overlying mucosa appeared undisturbed. Scans were reviewed in the light of operative findings; coronal and sagittal images were found to be reconstructions. Directly acquired coronal computed tomography, undertaken three weeks after surgery, demonstrated a complete bony plate in the right posterior ethmoid at the site previously identified as dehiscent.Discussion and conclusion:We speculate that the posterior ethmoid defect was actually an artefact of reconstruction. We cannot exclude the alternative possibility of remineralisation, but given the time frame this seems unlikely. This case highlights the need for caution when interpreting reconstructed images of the thin bony plates of the skull base and lamina papyracea, as regards both clinical significance and medicolegal reporting. While virtual defects have been reported in the superior semicircular canals as a result of reconstructed images, we believe this to be the first reported case demonstrating a similar problem in the anterior skull base.

Frontal skull base surgery combined with endonasal endoscopic sinus surgery

2005 ◽  
Vol 64 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Motohiro Morioka ◽  
Jun-ichiro Hamada ◽  
Shigetoshi Yano ◽  
Yutaka Kai ◽  
Norihisa Ogata ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Skull Base Surgery ◽  
Sinus Surgery ◽  
Frontal Skull Base

Height and Shape of the Skull Base as Risk Factors for Skull Base Penetration during Endoscopic Sinus Surgery

2007 ◽  
Vol 116 (3) ◽  
pp. 199-205 ◽  
Author(s):  
Jong Cheol Lee ◽  
Yong Jin Song ◽  
Yoo-Sam Chung ◽  
Bong-Jae Lee ◽  
Yong Ju Jang
Keyword(s):  
Risk Factors ◽  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery
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