Thirty years of endoscopic sinus surgery: What have we learned?

Tajudeen, Bobby A.; Kennedy, David W.

doi:10.1016/j.wjorl.2016.12.001

Cited by 67 publications

(47 citation statements)

References 60 publications

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“…Optimal endoscopic sinus surgery (ESS) is dependent on good visualization of anatomical structures and landmarks in the surgical field . The sinonasal mucosa is well vascularized, and as such, surgery in this region may be associated with significant bleeding, thus obstructing surgical field visibility .…”

Section: Introductionmentioning

confidence: 99%

“…Optimal endoscopic sinus surgery (ESS) is dependent on good visualization of anatomical structures and landmarks in the surgical field. 1 The sinonasal mucosa is well vascularized, and as such, surgery in this region may be associated with significant bleeding, thus obstructing surgical field visibility. 2 This is often the case when operating close to vital structures such as the skull base, orbit, and associated neurovasculature, which highlights the need for optimal bleeding control and unobstructed vision of the surgical field.…”

Section: Introductionmentioning

confidence: 99%

“…Such techniques need to do so without interruption to intraoperative patient hemodynamic stability. 1,3 They include local anesthesia at the site of surgery, topical agents such as decongestants, positional changes including reverse Trendelenburg, and controlled hypotension. [4][5][6] One anesthetic technique is total intravenous anesthesia (TIVA), which theoretically has the potential to reduce cardiac output without peripheral vasodilation and therefore reduce blood in the surgical field, in contrast to inhalational anesthesia (IA) techniques, which can increase risk of poor visibility by not affecting vasodilation.…”

Section: Introductionmentioning

confidence: 99%

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Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta‐analysis

Phan

2019

The Laryngoscope

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Objective Achieving optimal intraoperative surgical field visibility and minimizing blood loss are two important parameters in endoscopic sinus surgery (ESS). The aim of this meta‐analysis was to compare two total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) to determine if either conferred superior outcomes of these and other parameters based on randomized control trials (RCTs) only. Methods The recommended Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines were followed, and searches of electronic databases from inception to September 2018 identified 157 articles for screening. Data were extracted and analyzed using meta‐analysis of proportions. Results In total, we identified 15 RCTs that satisfied our selection criteria. There were 828 ESS cases described, with 391 (47%) and 437 (53%) being managed by TIVA and IA, respectively. Pooled analysis demonstrated significantly superior visibility scores for TIVA compared to IA based on 10‐point grading scores (P = 0.049, visual analog scale; P = 0.009, Wormald scale) and 5‐point grading scores (P = 0.002, Boezaart scale). Blood loss was significantly less following TIVA (P = 0.003), with no significant difference in intraoperative heart rate (P = 0.70) or mean arterial pressure (P = 0.96). Additionally, duration of surgery (P = 0.16) and anesthesia (P = 0.39) were comparable between the two approaches. Conclusion This meta‐analysis indicates that TIVA has the potential to confer superior surgical field visibility and reduce intraoperative blood loss compared to IA in ESS. Currently, there are significant heterogeneity concerns in this meta‐analysis, which temper any expectations that either approach is absolutely superior to the other. Caution should be exercised when interpreting these results until further validation can be achieved. Level of Evidence 1A Laryngoscope, 130:575–583, 2020

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta‐analysis

Phan

2019

The Laryngoscope

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“…An endoscopic approach via natural orifices allows for less tissue disruption, no external incisions, and less brain manipulation, ultimately leading to shorter hospital admissions and quicker recoveries. [1][2][3][4] EEAs have been well established in the adult population with a small yet growing literature base on this approach in pediatrics. 2,5,6 Our group recently published a study reporting that EEAs are safe and efficacious in the very young pediatric population under 6 years old.…”

Section: Introductionmentioning

confidence: 99%

Approaching the Sella through the Nonpneumatized Sphenoid in Pediatric Patients

2019

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Objective The purpose of this study is to specifically assess pediatric patients with nonpneumatized sphenoid sinuses who have undergone transsphenoidal resections of skull base tumors and assess the complications and outcomes. Methods Data was collected by a retrospective chart review done on children ages 7 and under who underwent endoscopic tumor resection and had a partially or completely nonpneumatized sphenoid sinus on preoperative computed tomography imaging. Surgical data collected included surgical corridor, gross total versus subtotal resection, repair method, use of septal flap, intraoperative and postoperative cerebrospinal fluid leak, and estimated blood loss. Results Six patients were identified that fit our inclusion criteria who underwent surgery between November 2015 and April 2018 (3 males, 3 females; average age = 4.28 years). Tumor pathologies include three craniopharyngiomas, Rathke cleft cyst, meningocele, and neuroblastoma. All cases involved varying percentages of sphenoid sinus pneumatization. All cases except one craniopharyngioma and the neuroblastoma required removal of cancellous bone to access pathology. Degree of sphenoid pneumatization tended to be greater with age and resulted in less intraoperative bleeding. The two youngest patients with completely nonpneumatized sphenoid sinuses lost 61.73 and 17.52% of their total blood volume intraoperatively. Procedures were able to be adequately performed and pathology completely addressed with minimal postoperative complications and no postoperative CSF leaks. Conclusions Intraoperative challenges including hemorrhage are likely in nonpneumatized patients, and thus surgeons should be prepared with adequate vascular access and blood products. Hemorrhage and total blood volume loss are increased in the younger patients with no sphenoid pneumatization. Despite the additional challenges, a nonpneumatized sphenoid sinus is not a contraindication for an endoscopic resection in the pediatric population.

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“…Since the emergence of endoscopic sinus surgery, surgeons have pushed the boundaries of endoscopic endonasal surgical techniques, expanding the breadth of applications beyond functional endoscopic sinus surgery for inflammatory disease to sinonasal tumor, skull base, and orbital surgeries . Regardless of the indication, proper identification of anatomic boundaries remains paramount to navigating the sinonasal tract and skull base via the endoscope.…”

mentioning

confidence: 99%