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Bartier S, Fieux M, Carsuzaa F, Coste A, Legré M, Alexandru M, Favier V, Fath L. Perception of endoscopic endonasal surgery training by French otolaryngology residents: A STROBE analysis of expectations. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:61-67. [PMID: 38081760 DOI: 10.1016/j.anorl.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To analyze the perception of endoscopic endonasal surgery training by French otolaryngology residents. MATERIAL AND METHODS A multicenter retrospective observational study was conducted from March to April 2023. Otolaryngology residents from 7 French regions filled out a 27-item questionnaire on their training in endoscopic endonasal surgery. RESULTS Out of 283 residents contacted, 126 (45%) filled out the questionnaire. Seventy-four (59%) had already partially or completely performed the surgeries specified in their diploma course. The level of mastery of the main steps of endonasal surgery and the level of autonomy were higher in the consolidation stage group than in the basic and advanced stages. Seventy residents (56%) felt they had gaps in their level of training. To improve training, 94 (75%) wished for more dissection sessions, surgical skills assessments each semester and simulation sessions. Eighty-nine (71%) felt they needed to find their own teaching aids and other methods to complete their training. One hundred and thirteen (90%) felt that the lack of funding available for congresses and training courses was detrimental. CONCLUSION This study highlighted the overall satisfaction of residents with their training in endoscopic endonasal surgery. They expressed a desire for more dissection, simulation and evaluation.
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Affiliation(s)
- S Bartier
- Service d'ORL, de chirurgie cervico-faciale, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France, université Paris Est Créteil, Inserm, IMRB, CNRS EMR 7000, 94010 Créteil, France.
| | - M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite cedex, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
| | - F Carsuzaa
- Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, centre hospitalier universitaire de Poitiers, laboratoire inflammation tissus épithéliaux et cytokines (LITEC), UR15560, université de Poitiers, 86000 Poitiers, France
| | - A Coste
- Service d'ORL, de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, université Paris Est Créteil, Inserm, IMRB, CNRS EMR 7000, 94010 Créteil, France
| | - M Legré
- Service ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - M Alexandru
- Service d'Orl et chirurgie cervico-faciale, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Institut national de la santé et de la recherche médicale, France Sorbonne université,UMR_S933, hôpital Armand-Trousseau, 75012 Paris, France
| | - V Favier
- Département d'ORL, chirurgie cervico-faciale et maxillo-faciale, centre hospitalier universitaire de Montpellier, hôpital Gui-de-Chauliac, ICAR Research Team, Laboratory of Computer Science, Robotics, Microelectronics of Montpellier (LIRMM), University of Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - L Fath
- Service d'ORL, de chirurgie cervico-faciale, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France; Unité Inserm 1121, biomatériaux et bioingénierie, 1, rue Eugène-Boeckel, Strasbourg, France
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Wang F, Cui S, Yang S, Guo L. Intravascular Guidewire Residue After Endovascular Embolization for Intractable Epistaxis: A Case Report. Ear Nose Throat J 2024; 103:NP85-NP88. [PMID: 34427152 DOI: 10.1177/01455613211040581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endovascular embolization (EE) has become an effective method for the treatment of intractable epistaxis (IE). However, complications such as facial pain, headaches, aphasia, hemiplegia, and transient blindness can also occur during or after surgery. In this article, we report a rare case of IE with residual intravascular guidewire after EE. Open surgery was used to remove the guidewire. However, to avoid serious complications such as massive hemorrhage, only part of the guidewire was removed.
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Affiliation(s)
- Fei Wang
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Shijun Cui
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Shengjia Yang
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
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El Naamani K, Morse C, Ghanem M, Barbera J, Amllay A, Severance G, Ruiz R, Sweid A, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Nyquist GG, Tjoumakaris S. Endovascular Embolization for Epistaxis: A Single Center Experience and Meta-Analysis. J Clin Med 2023; 12:6958. [PMID: 38002574 PMCID: PMC10672438 DOI: 10.3390/jcm12226958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The optimal treatment for intractable epistaxis is still controversial. Various studies have demonstrated high success rates and low complication rates for endovascular embolization. Herein, the authors report an institutional experience and meta-analysis in terms of efficacy and safety of endovascular embolization of intractable epistaxis. This was a retrospective observational study of 35 patients with epistaxis who underwent 40 embolization procedures between 2010 and 2023. The primary outcome was immediate success defined by immediate cessation of epistaxis at the end of the procedure. Immediate success was achieved in most of the procedures (39, 97.5%). During follow-up, three (7.5%) patients experienced a rebleed. Forty-one studies from 3595 articles were identified for inclusion in the meta-analysis and comprised 1632 patients. The mean pooled age was 57.5 years (95% CI: 57.2-57.8) and most patients were males (mean: 70.4, 95% CI: 69.8-71.0). Immediate success was achieved at a pooled mean of 90.9% (95% CI: 90.4-91.4) and rebleeding was observed at a pooled mean of 17% (95% CI: 16.5-17.5). In conclusion, endovascular embolization proved to be both safe and effective in treating intractable epistaxis carrying a low risk of post-operative stroke.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Charles Morse
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Marc Ghanem
- School of Medicine, Lebansese American University, Beirut 1102-2801, Lebanon;
| | - Julie Barbera
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Abdelaziz Amllay
- School of Medicine, Hassan II University, Casablanca 8118, Morocco;
| | - Grace Severance
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ramon Ruiz
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Michael R. Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Nabeel A. Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Robert H. Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Gurston G. Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
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Bonnici M, Orabi NA, Gannon M, Williams N, Stokes CM, Ramadan HH, Turner MT, Makary CA. Complications and Outcomes of Endovascular Embolization for Intractable Epistaxis: A Systematic Review and Meta-analysis. Ann Otol Rhinol Laryngol 2023; 132:1233-1248. [PMID: 36582148 DOI: 10.1177/00034894221143187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. METHODS This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. RESULTS Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. CONCLUSIONS Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.
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Affiliation(s)
| | - Norman A Orabi
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Michael Gannon
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Nathan Williams
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Cara M Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Meghan T Turner
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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Liu X, Wang P, Li M, Chen G. Incidence, risk factors, management and prevention of severe postoperative epistaxis after endoscopic endonasal transsphenoidal surgery: a single center experience. Front Surg 2023; 10:1203409. [PMID: 37564115 PMCID: PMC10410146 DOI: 10.3389/fsurg.2023.1203409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Objective Postoperative epistaxis is a very rare but severe complication after endoscopic endonasal transsphenoidal surgery (EETS) that can lead to catastrophic consequences. However, the incidence, risk factors, management and prevention of postoperative epistaxis remain unclear. Patients and methods Consecutive patients with pituitary adenoma (PA), Rathke's cleft cyst, craniopharyngioma, or clival chordoma who received EETS in our department between September 2020 and November 2022 were retrospectively analyzed. The incidence, risk factors, management and prevention of postoperative epistaxis were investigated and analyzed. Results A total of 557 consecutive patients who received EETS were included in this study. Eight patients (1.4%) (7 PAs and 1 Rathke's cleft cyst) experienced severe postoperative epistaxis. The size of the PAs was 9.6 mm-46.2 mm, with a median size of 22.1 mm. Epistaxis occurred 4 h to 30 days (median 14.5 days) postoperatively. Bleeding was stopped in 3 patients after nasal packing with iodoform gauze. The remaining 5 patients for whom nasal packing was insufficient were all sent to the operating room, and posterior nasal septal artery (PNSA) bleeding was identified and successfully treated with endoscopic bleeding artery electrocauterization under general anesthesia. In the EETS, all 8 patients had downward extension of the septal mucosal incision, in which 6 had intraoperative bleeding of PNSA that were cauterized by bipolar diathermy. Four patients had causative factors, including administration of antiplatelet agents, Valsalva-like manoeuvre, nose blowing and removal of nasal packing, respectively. No patients had recurrent epistaxis during the follow-up period. Conclusion Post-EETS epistaxis is a rare but severe complication that could lead to catastrophic consequences, and one of the most common bleeding sources is the PNSA. Endoscopic bleeding artery electrocauterization under general anesthesia may be a safe, economic and effective measure for epistaxis refractory to nasal packing. Avoiding excessive downward extension of the septal mucosal incision could contribute to the prevention of postoperative epistaxis.
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Affiliation(s)
- Xiaohai Liu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Pengfei Wang
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
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Hoffman H, Ashok Kumar A, Raventhiranathan N, Masoud HE, Gould GC. Endovascular embolization for the treatment of epistaxis: Systematic review and meta-analysis. Interv Neuroradiol 2023; 29:172-182. [PMID: 35238666 PMCID: PMC10152829 DOI: 10.1177/15910199221081715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endovascular embolization (EE) is a treatment option for epistaxis refractory to first-line interventions. Data regarding embolization is limited to small case series and a meta-analysis has not been performed. METHODS PubMed, Scopus, and EMBASE were used to identify studies that reported outcomes for at least 10 patients undergoing EE for epistaxis. Outcomes included procedural success, rebleeding, and complications. Pooled rates for each outcome were obtained with random effects models. RESULTS A total of 44 studies comprising 1664 patients met the inclusion criteria. The mean age ranged from 28.1 to 67 years and there were 28.4% females. The pooled procedural success rate was 87% (95% CI 83.9-89.6, I2 = 53%). Age (OR 0.95, 95% CI 0.91-1) and hereditary hemorrhagic telangiectasia ([HHT], OR 0.97, 95% CI 0.96-0.99) were associated with decreased odds of success. The pooled rebleeding rate was 16.4% (95% CI 13.6-19.6, I2 = 48%), and HHT was associated with greater odds of rebleeding (OR 1.02, 95% CI 1-1.03). The pooled overall complication rate was 14.4% (95% CI 9.8-20.6, I2 = 85.8%). The pooled rates of stroke and vision loss were 2.1% (95% CI 1.5-3.1, I2 = 1.5%) and 1.8% (95% CI 1.2-2.6, I2 = 0%), respectively. CONCLUSION EE for epistaxis has a high rate of procedural success. Interventionalists should be aware of the risk for rebleeding, especially among patients with HHT.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State
University of New York Upstate, Syracuse, NY, USA
| | - Apeksha Ashok Kumar
- Department of Neurosurgery, State
University of New York Upstate, Syracuse, NY, USA
| | | | - Hesham E Masoud
- Department of Neurology, State
University of New York Upstate, Syracuse, NY, USA
| | - Grahame C Gould
- Department of Neurosurgery, State
University of New York Upstate, Syracuse, NY, USA
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Xu X, Gopinathan A, Thong MKT, Loh KS, Ong YK. Endovascular embolisation of external carotid artery system haemorrhage in radiated nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2022; 279:5851-8. [PMID: 35792916 DOI: 10.1007/s00405-022-07491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To review the effectiveness and safety of embolisation in managing haemorrhage from the external carotid artery (ECA) system in radiated nasopharyngeal carcinoma (NPC) patients. METHODS Radiated NPC patients who presented with severe oronasal bleeding and underwent digital subtraction angiography that excluded blowouts from the internal carotid artery from 2011 to 2021 were reviewed. Those who subsequently underwent embolisation of the ECA system were analysed for technical success rate, post-embolisation re-bleeding rate and complications. RESULTS Seventeen embolisations were performed in fifteen patients during the 10-year period. The technical success rate was 100%, however the early haemostatic rate (no re-bleed within 7 days of embolisation) was 70.6% (12/17) and the overall long-term haemostatic rate was 58.8% (10/17). The re-bleed rates of targeted and empiric embolisations were 33.3% (3/9) and 50.0% (4/8), respectively. The re-bleed rates with liquid agents, coils and particles were 0% (0/7), 33.3% (1/3) and 85.7% (6/7), respectively. Amongst the embolisations utilising liquid agents, 71.4% (5/7) were targeted, distal embolisations. All re-bleeds underwent surgical ligation or repeat embolisation; half of them further experienced recurrent bleeding. There were no significant complications with embolisation. CONCLUSION Although embolisation of the ECA system in NPC has a high technical success rate and is safe, re-bleeding appears to be common. Targeted, distal embolisation with liquid embolics appear to have good haemostatic effect. Clinicians should be aware that patients may need repeated procedures to secure haemostasis.
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Trau G, Venkatasamy A, Djennaoui I, Renaud M, Fath L, Ciftci S. An image-guided (CT) assessment of a new asymmetric balloon for the treatment of epistaxis. Eur Arch Otorhinolaryngol 2021; 278:4823-4830. [PMID: 33755780 DOI: 10.1007/s00405-021-06758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The main objective was to perform an image-guided (CT) assessment of the efficacy of the CAVI-T™ balloon to compress the sphenopalatine artery (SPA) on cadaver heads, for the management of epistaxis. The secondary objectives were to analyse the deployment and stability of this balloon according to the volume injected into the nasal cavity, to optimise its use. METHODS A descriptive anatomical study was performed. The catheterization of the SPA was performed on four fresh-frozen heads with a SPA approach through the maxillary sinus, leaving the nasal cavity unscathed. Computed Tomography images were acquired without and with the balloon, inflated by injections of progressive volumes of diluted iodine, for optimal contrast with the surrounding tissues. We evaluated the positioning of the balloon according to two predetermined markers on the device. RESULTS Out of 68 image-guided acquisitions, the CAVI-T™ balloon compressed the SPA in 88% of cases. The other nasal cavity structures were compressed in 86% to 100% of the cases, depending on the positioning of the CAVI-T™ balloon, therefore allowing a complete obstruction of the nasal cavity. The device remained stable upon inflation and did not obstruct the nasopharynx. CONCLUSION The CAVI-T™ balloon provided effective compression of the SPA and the different structures of the nasal cavity.
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Affiliation(s)
- Guillaume Trau
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre UF 6701, Service Oto-Rhino-Laryngologie et chirurgie cervico-faciale, 1 avenue Molière, 67200, Strasbourg, France.
| | - Aina Venkatasamy
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, Strasbourg, France
| | - Idir Djennaoui
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre UF 6701, Service Oto-Rhino-Laryngologie et chirurgie cervico-faciale, 1 avenue Molière, 67200, Strasbourg, France.,ICube-Laboratoire des Sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube) UMR 7357, Strasbourg, Illkirch, France
| | - Marion Renaud
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre UF 6701, Service Oto-Rhino-Laryngologie et chirurgie cervico-faciale, 1 avenue Molière, 67200, Strasbourg, France
| | - Léa Fath
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre UF 6701, Service Oto-Rhino-Laryngologie et chirurgie cervico-faciale, 1 avenue Molière, 67200, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale, INSERM, UMR-S 1121, "Biomatériaux et Bioingénierie", Strasbourg, France
| | - Saït Ciftci
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre UF 6701, Service Oto-Rhino-Laryngologie et chirurgie cervico-faciale, 1 avenue Molière, 67200, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale, INSERM, UMR-S 1121, "Biomatériaux et Bioingénierie", Strasbourg, France
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Affiliation(s)
- Hadi Seikaly
- From the Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
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Franke M, Franke J, Saager C, Barthel S, Riemann R, Mueckner K. Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications. Radiol Res Pract 2020; 2020:5710313. [PMID: 32884844 DOI: 10.1155/2020/5710313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/21/2022] Open
Abstract
Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.
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Abstract
Epistaxis is not uncommon, with up to 60% of the population suffering from at least one episode in their lifetime and as many as 6% presenting for medical attention. An analysis of emergency room (ER) visits in the United States between 2009 and 2011 identified 1.2 million encounters for epistaxis, accounting for 0.32% of ER visits. Approximately 6% of patients will require more aggressive, invasive management in the form of transnasal ligation of the sphenopalatine artery or endovascular embolization. This article reviews the epidemiology, rationale for endovascular treatment, strategy for treatment, endovascular technique, postprocedural follow-up, and complications and their management.
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Affiliation(s)
- Joan C Wojak
- Department of Radiology, Our Lady of Lourdes Regional Medical Center, Lafayette, Louisiana.,Department of Radiology, Louisiana State University School of Medicine, New Orleans, Louisiana
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