Endoscopic Endonasal Approach to the Orbit: A Case Series and Clinical Experience Emphasizing the Advantages of the Ipsilateral Mononostril Technique

BACKGROUND

Lesions situated within the orbit pose significant challenges in management due to the confined space they occupy and their proximity to critical anatomical structures. The objective of our study is to assess the feasibility of the ipsilateral endoscopic endonasal approach for orbital cavernous hemangiomas and to comprehend the surgical anatomy of the orbital apex and inferomedial orbital structures.

METHODS

Thirteen patients (8 women, 5 men), with ages ranging from 25 to 54 years (mean 35.2 ± 8.3 years), with orbital cavernous hemangioma who underwent surgery via the ipsilateral mononostril endoscopic endonasal approach between August 2018 and August 2023 were retrospectively evaluated. Demographic characteristics, clinical data, radiographic images, and clinical outcomes of the patients were collected from digital medical records.

RESULTS

The left orbit was more commonly affected (9 left, 4 right). The average postoperative follow-up duration was 22.2 months (range: 6-50 months). Among the 13 cases of orbital cavernous hemangioma, 1 (7.7%) was located in the extraconal compartment, and 12 (92.3%) were situated in the intraconal compartment. Complete surgical resection of the tumor was successfully achieved in all patients.

CONCLUSIONS

Our study highlights the potential advantages of employing a purely ipsilateral mononostril endoscopic endonasal approach for orbital surgery, particularly for accessing the orbital apex and managing medial and inferomedial orbital lesions. This technique holds promise for reducing morbidity and enhancing outcomes, especially when combined with careful patient selection, preoperative planning, and advanced endoscopic skills.

Endonasal endoscopic approach for sellar metastatic pathologies: a national observation

PURPOSE

Sellar metastases are rare lesions. Recent improvements in diagnosis and treatment strategies have prolonged survival but increased the probability of metastatic tumors. Evaluation with clinical symptomatology and meticulous laboratory examination is crucial. We present our multicenter national study on sellar metastases to evaluate and underline the main clinical, endocrine, and radiological considerations regarding the diagnosis and endonasal endoscopic management of such rare lesions.

METHODS

A medical literature-based retrospective study was planned across 13 neurosurgical centers in Turkey, where a data survey was conducted to collect information regarding sellar metastases surgically treated using the endoscopic endonasal approach, including clinical presentation, radiographic features, primary tumor origin, histopathological confirmation, time to metastasis, treatment, and patient outcomes.

RESULTS

Between 2010 and 2020, 54 patients (22 women [40.7%] and 32 men [59.3%]) who underwent surgery with the endonasal endoscopic approach and had pathologically proven sellar metastases (overall incidence, 0.54%) were included. Of the patients, 59.3% had no known malignancy and presented with new-onset symptoms, 79.6% reported headache, 51.9% complained of some degree of visual deficits, and 50% had cranial nerve symptoms. Tissue biopsy was performed in 7.4% of the patients, whereas gross or subtotal resection was achieved in the remaining patients.

CONCLUSION

To our knowledge, this is the largest series of patients surgically treated with the endonasal endoscopic approach for sellar metastases. For these patients, the treatment focus should be on management modalities for increasing quality of life instead radical treatment options with survival benefit.

Pituitary apoplexy: An emergent and potential life-threatening complication of pituitary adenomas

BACKGROUND

Pituitary apoplexy is an emergent and potential life-threatening complication of pituitary adenomas if not managed properly. The aim of our study is to present our series of pituitary adenomas and to focus on the clinical, radiological, and surgical characteristics of this rare complication.

METHODS

In this study, a total of 143 patients with pituitary adenoma underwent surgical treatment between 2016 and 2018. All patients were operated using endoscopic endonasal transsphenoidal (EET) technique. The data of pituitary apoplexy cases were recorded. Resection rates, hormonal results, and visual outcomes of patients with pituitary apoplexy were evaluated.

RESULTS

Of the 143 patients, 8 (5.59%) were presented with the symptoms and radiological findings of pituitary apoplexy. The mean age was 26.75 years, and 4 (50%) of them were male and 4 were female. Pre-operative mean Knosp grading score was 2.1 All of eight patients underwent emergent surgical intervention and total resection was achieved in 75% of patients with apoplexy. Hormone levels were significantly decreased after surgery (p<0.05), except prolactin (p>0.05). Cerebrospinal fluid leakage occurred in one pa-tient. None of the patient with pituitary apoplexy died in our series.

CONCLUSION

Pituitary apoplexy is an important complication of pituitary adenomas. Early diagnosis and surgical intervention provide excellent ophthalmological and hormonal outcomes. Emergent EET approach is crucial for patients with ophthalmological findings and macroadenomas.

Comparison of home-based and outpatient clinic-based intravaginal electrical stimulation for the treatment of urinary incontinence

AIM

Aim of the study was to compare the effects of outpatient clinic-based versus home-based intravaginal electrical stimulation (ES) for the treatment of urinary incontinence.

METHODS

Women applying with the complaint of urinary incontinence and offered ES treatment were divided into outpatient clinic-based or home-based ES. Patients were instructed about home-based ES at the outpatient clinic by certified physiotherapy nurses. Bladder diary, 1-hour pad test, and King's-Health-Questionnaire (KHQ) were performed before and after treatment. ES was applied for 20 minutes, 6-8 weeks with pulses of 10-50 Hz square waves at a 300 μs or 1 ms pulse duration and a maximal output current of 24 to 60 mA with 5-10 Hz frequency, three times/week.

RESULTS

Twenty-four patients received outpatient clinic-based, 22 patients received home-based ES. Pad test, bladder diary and pelvic floor muscle strength parameters in both groups improved significantly after treatment, with no significant difference between the two groups. Seven patients (31.8%) were cured, six patients (27.3%) were much improved, and seven patients (31.8%) were improved in the home-based ES group. Nine patients (37.5%) were cured, six patients (25%) were much improved, and six patients (25%) were improved and in the outpatient clinic-based ES group. There was an improvement in quality of life in all domains in both groups when the pretreatment and post-treatment KHQ results were compared, with no significant difference between the two groups.

CONCLUSION

Home-based ES is as effective in the treatment of urinary incontinence as outpatient clinic-based ES with significant improvement in objective and subjective parameters.