An Alternative Method of Endoscopic Intrasphenoidal Vidian Neurectomy

Abstract

ObjectiveTo develop an easy surgical approach to facilitate clinical management.Study DesignA novel transnasal endoscopic 3-step surgical method for vidian neurectomy was designed and tried in 91 cases with a mild-to-severe degree of allergic and nonallergic rhinitis refractory to routine medical therapy.SettingEndoscopic vidian neurectomy requires accurate localization of the vidian canal. However, it is not easy to localize during surgery because of its deep location and the complex anatomy of the pterygopalatine fossa.Subjects and MethodsThis technique consists of 3 steps, including transnasal endoscopic perforation of the anterior wall of the sphenoidal sinus as the first step and removal of the anterior wall until the exposure of the vidian canal in the junction between the anterior wall and the floor of the sphenoid sinus as the second step. The last step is the accurate resection and cauterization of the vidian nerve. In some cases in which the sphenoid sinus developed well with a big lateral space, an extended procedure of posterior ethmoidectomy was included to allow good exposure of the vidian canal.ResultsUsing this technique, successful endoscopic vidian neurectomy in this series of patients was confirmed by both histology and Schirmer test, showing its distinct advantages of easy localization of the vidian canal and less risk of injury to the nerve and vessel bundles within the pterygopalatine fossa.ConclusionTaken together, this novel 3-step procedure of endoscopic vidian neurectomy plus an extended procedure guarantees good exposure of the vidian canal and therefore accurate vidian neurectomy.

Comparison of endoscopic and microscopic tympanoplasty in patients with chronic otitis media

“…The endoscope for middle ear surgery has been a highly contentious subject with the introduction of high-quality narrow-diameter endoscopes, ultra-high-definition cameras and screens, and cold light sources [ 5 ]. In contrast to the microscope, the endoscope has a cone-shaped source of illumination, which ensures optimal visualization and allows a wider field of view of the surgical area [ 6 ]. Endoscopic ear surgery permits a wide-angle view throughout the external ear canal, including magnification of the middle ear structures and direct visualization of hidden areas [ 7 ], such as the sinus tympani, hypotympanum, posterior part of the mesotympanum, and epitympanum [ 8 ].…”

Antagonism of m3 Alleviates Type 2 Inflammation in Allergic Rhinitis Mice

“…[13][14][15] We and others demonstrated that vidian neurectomy under nasal endoscopy improved nasal allergic symptoms and quality of life in patients with AR. 16,17 Our previous animal experiments demonstrated that ipratropium bromide, a nonspecific cholinergic nerve receptor antagonist, alleviated nasal symptoms and Th2 cytokines in the nasal mucosa in AR. 8,9 However, the role of m3 in AR remains unclear.…”

Clinical Efficacy and Possible Mechanism of Endoscopic Vidian Neurectomy for House Dust Mite-Sensitive Allergic Rhinitis

“…With the rapid development of computed tomography examination technology and endoscopic technology, the localization of the vidian canal has become more accurate, and the vision of endoscopic vidian neurectomy (EVN) clearer [10]. EVN for AR has been found to have good clinical effects [11, 12]. However, the pathophysiological basis of the effect of EVN on AR is still poorly understood.…”