[Endoscopic endonasal diagnosis and treatment of skull base meningoencephalocele]

Endoscopic nasal surgery for mucocele and pyogenic mucocele of turbinate: Three case reports

BACKGROUND

Cases of turbinate mucocele or pyogenic mucocele are extremely rare. During nasal endoscopy, turbinate hypertrophy can be detected in patients with turbinate or pyogenic mucocele. However, in many instances, differentiating between turbinate hypertrophy and turbinate mucocele is difficult. Radiological examinations, such as computed tomography (CT) or magnetic resonance imaging (MRI), are essential for the accurate diagnosis of turbinate mucocele. Herein, we report three cases of mucocele or pyogenic mucocele of turbinate, including their clinical presentation, imaging findings, and treatments, to help rhinologists understand this condition better.

CASE SUMMARY

Three cases of turbinate and pyogenic mucocele were encountered in our hospital. In all patients, nasal obstruction and headache were the most common symptoms, and physical examination revealed hypertrophic turbinates. On CT scan, mucocele appeared as non-enhancing, homogeneous, hypodense, well-defined, rounded, and expansile lesions. Meanwhile, MRI clearly illustrated the cystic nature of the lesion on T2 sequences. Two patients with inferior turbinate mucocele underwent mucocele lining removal, while the patient with pyogenic mucocele underwent endoscopic middle turbinate marsupialization. The patients were followed up on the first, third, sixth month, and 1 year after discharge, and no complaints of headache and nasal congestion were reported during this period.

CONCLUSION

In conclusion, both CT and MRI are helpful in the diagnosis of turbinate or pyogenic mucocele. Additionally, endoscopic nasal surgery is considered to be the most effective treatment method.

[Skull base defects multilayer plasty in patients with spontaneous cerebrospinal fluid leak: our experience]

Spontaneous cerebrospinal fluid (CSF) leak is one of the types of non-traumatic CSF leaks in which the etiologic factor is unknown. Skull base defects transnasal endoscopic plasty is the initial method of surgical repair of spontaneous cerebrospinal fluid leaks. METHODS: Forty-five patients with spontaneous CSF leaks were managed using multilayer transplant technique. The basic choice criteria of endoscopic transnasal surgical approach and materials to reconstruction of skull base defects were the size of defect and its localization. In all cases pediculated flaps in combination with free graft were used. RESULTS: In 43 (96%) cases CSF leaks was successfully managed in primary surgery, which indicates high efficiency of the described surgical interventions.

[Lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa in surgery for meningoencephalocele of the lateral sphenoid recess]

Meningoencephalocele is a hernial protrusion of the medulla and meninges through a defect in the skull bones. Due to poor accessibility of meningoencephalocele located in the lateral sphenoid recess region, modern surgical treatment of this pathology prefers to use endoscopic transsphenoidal approaches.

MATERIAL AND METHODS

The study included 4 patients with meningoencephalocele of the lateral recess of the sphenoid sinus (1 male and 3 females; mean age, 46.8 years). All patients underwent resection of meningoencephalocele and repair of a skull base defect using the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach).

RESULTS

In all patients, meningoencephalocele was resected to the bone defect level. There was no postoperative liquorrhea. Complications included bacterial meningitis (1 case), asymptomatic imbibition of the temporal lobe pole (1 case), and temporary numbness in the V₂ innervation area of the trigeminal nerve (1 case).

CONCLUSION

The paper describes and demonstrates advantages of the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach) for surgical treatment of patients with meningoencephalocele of the lateral sphenoid recess.

[The rhinological simulator: the upgrade and validation study with the evaluation of the effectiveness of its application]

The objective of the present study was to upgrade the rhinological simulator employed as a tool for the teaching of the basic technical skills in endoscopic sinus surgery (ESS). The new ESS simulator providing a model of the nasal cavity consists of the replaceable cylinders and the adaptable table stand. It includes a set of 3D printed nasal models. Each of them is the elliptical tube of a specific size. The participants of the study performed different tasks depending on the structural properties of the tubes. A wide variety of surgical instruments and esndoscopes could be fitted to the simulator. 16 otorhinolaryngologists having no previous experience with ESS were recruited into the study to evaluate the effectiveness of the training procedures. After a brief tutorial, the participants practiced an one hour-long exercise per day during 5 days. The pre-training and post-training performances were videotaped. The task-performance time and the number of technical errors made by the operators were estimated immediately before and after the training session. To assess the subjective attitudes of the operators toward the new technology, the participants of the study were asked to complete the model questionnaire soon after the termination of the training course. The questionnaire contained 34 items. The correctness of the answers was assessed based on the 5-point Likert scale, with score 1 meaning 'totally disagree' and score 5 - 'totally agree'. The statistically significant reduction of the performance time and the number of technical mistakes was documented within the first 5 hours after the onset of teaching (p<0.05) which suggests the effectiveness of the training procedures. The questionnaire study has demonstrated the positive attitude of the trainees toward the proposed technology. The average score based on the Likert scale was higher than 3 for all kinds of questions. It is concluded that the results of this study give evidence of the positive assessment of the upgraded rhinological simulator as an effective tool for the teaching of the basic skills necessary to operate various surgical instruments and endoscopes by the novice surgeons in the field of endoscopic sinus surgery .