Keywords : Endonasal
A CLINICAL EXPERIENCE IN ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL HYPOPHYSECTOMY IN SKULL BASE CENTER OF BASRAH
Basrah Journal of Surgery,
2021, Volume 27, Issue 1, Pages 12-16
Endoscopic Endo-nasal Trans-Sphenoidal (EETS) approach is a minimally invasive technique that has gained increased acceptability for removal of sellar and parasellar tumors. This prospective study was carried out on 50 patients in Basrah skull base center at Al-Sader Teaching Hospital between August 2017 and July 2019. The technique involved a unilateral, endoscopic, endonasal approach to the sella turcica via an anterior sphenoidotomy which is performed as a joint procedure by a consultant otolaryngologist and a consultant neurosurgeon The most common presenting symptom for pituitary tumor was; headache which present in 80% (40 patients) of the patients, followed by visual disturbance in 56% (28 patients). Infertility and hemiparesis are the least symptoms 2% for each (one patient). The MRI study of brain and sellar region showed that forty six patients (92%) was diagnosed as pituitary adenomas and one patient (2%) have Rathke’s cyst and another one have meningioma. Tumor location and extension which was assessed by MRI revealed that 70% (35 patients) had tumor located in sella with extension to suprasellar region, where only 2% (one patient) had sellar with supra- and parasellar extension. Eighty percent (40 patients) were virgin cases (not operated before), while only 20% (10 patients) were revised cases (operated before either open or transsphenoidal). We achieved complete resection of the tumor in 82% cases (41 patients). The most common method used for reconstruction of the surgical defect was underlay multilayers which was used in 62% (31 patients), while in 10%, posterior based middle turbinate flaps were used in reconstruction. We noticed that 3 patients (6%) developed significant epistaxis, CSF rhinorrhea in 3 patients (6%), and unfortunately 3 patients (6%) died postoperatively. In conclusion, this study shows that endoscopic, endonasal, transsphenoidal hypophysectomy is a minimally invasive, effective and safe procedure to remove pituitary tumors. Key words: Hypophysectomy, Endonasal, Endoscopy, Transsphenoidal.
IS IT NECESSARY TO INSERT A SILICONE TUBE AFTER ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY? AND FOR HOW LONG? A COMPARATIVE PROSPECTIVE STUDY
Basrah Journal of Surgery,
2019, Volume 25, Issue 2, Pages 84-88
This study aimed to evaluate the necessity for silicone tube insertion following endonasal endoscopic dacryocystorhinostomy (DCR), and the optimal time for its removal.
A prospective study was done at Al-sadr Teaching and Al-Shafaa General Hospitals in Basrah, Iraq on seventy two patients with nasolacrimal duct obstruction diagnosed and referred from ophthalmologist to ENT clinic. Preoperative assessment with investigations were done and all patients were subjected to endoscopic endonasal DCR. The patients were divided into three groups; the first group included those with long period stenting (silicone tube removed three months or more), the second group included those patients with short period stenting (tube removed 2-3 weeks after surgery), and the last group included those with no silicone tube stenting. The success rate and complications after surgery were studied in each group for more than one year.
The 72 patients were; 63 females (87.5%) who affected more than males (9, 12.5%). the most common age group was 21-45 years. Left side of disease 41(56.9%) is more than right side 31(43.1%). Sixty eight operations (94.4%) out of 72 were primary surgery while four (5.6%) were revision surgery. Ancillary procedures were done also; 13 (18%) septal surgery and 3(4.1%) endoscopic sinus surgery. Success rate was more among short period stenting group 22 out of 24 (91.6%), then without stenting group 19 (82.6%) and those with long period stenting was only 20 from 25 (80%).
In conclusion, no statistical significant difference (benefit) about the usage or not of the silicone tube and also about how long keeping the tube, but it is preferable to use silicone tube (for 2-3 weeks only) to improve success rate.
Keywords: Silicone tube, Insertion, Endonasal, Endoscopic, Surgery