Atlas of Endoscopic Sinus and Skull Base Surgery

Cover......Page 1
ATLAS of Endoscopic Sinus and Skull Base Surgery......Page 2
Copyright......Page 3
Dedication......Page 4
Contributors......Page 5
Preface......Page 9
Video Contents......Page 10
Radiographic Considerations4,12......Page 12
Pearls and Potential Pitfalls......Page 13
Step 3: Swinging Door/Doorstop Techniques......Page 14
Step 4: Closure of the Septal Pocket and Incision......Page 15
Step 3: Replacement of Flaps......Page 17
REFERENCES......Page 18
Preoperative Considerations......Page 21
Step 1......Page 22
Inferior Turbinate Soft Tissue Reduction......Page 23
Step 5......Page 24
Step 5......Page 25
Step 2......Page 26
Postoperative Considerations......Page 27
Anatomy......Page 30
Anatomy of the Sphenopalatine Artery......Page 31
Instrumentation (Fig. 3.4A and Fig. 3.4B)......Page 32
Step 4 (Fig. 3.9)......Page 33
Conclusions......Page 35
Endoscopic and Open Anterior/Posterior Ethmoid Artery Ligation......Page 37
Instrumentation......Page 38
Potential Pitfalls......Page 39
Step 5. Ligate the PEA in the Same Fashion (Fig. 4.7)......Page 40
Step 5: Continue the Dissection Posteriorly Until the AEA and PEA Are Identified......Page 42
Special Considerations......Page 43
Orbital Hematoma......Page 44
Pearls......Page 46
Step 1: Incise the Mucosa, Drawing the Flaps......Page 47
Step 2: Remove the Posterior Nasal Septum......Page 48
Final Considerations......Page 49
Preoperative Considerations......Page 53
Pearls......Page 57
Step 2: Outfracture the Inferior Turbinate to Better Visualize the Middle Meatus......Page 58
Step 6: Enlarge the Antrostomy by Removing the Posterior Fontanelle (Fig. 6.13)......Page 59
Postoperative Considerations......Page 61
Special Considerations......Page 62
Basal Lamellae......Page 63
Radiographic Considerations......Page 65
Instrumentation (Fig. 7.7)......Page 66
Potential Pitfalls......Page 67
Step 5......Page 68
Postoperative Considerations......Page 69
Preoperative Considerations......Page 71
Pearls and Potential Pitfalls......Page 72
Step 2......Page 73
Special Considerations—Onodi Cell......Page 75
INTRODUCTION......Page 78
Anatomy......Page 80
Frontal Recess Cell......Page 81
Instrumentation......Page 83
Pearls......Page 86
Potential Pitfalls......Page 87
Step 3: Removing the Posterior Wall of the Agger Nasi Cell......Page 88
Step 7: Performing the Finishing Touches......Page 89
Step 8: Placing a Frontal Sinus Stent (Optional)......Page 91
Frontal Sinus......Page 93
Preoperative Considerations......Page 94
Radiologic Considerations......Page 96
Step 2: Localization of the Anterior Ethmoid Arteries......Page 97
Step 6: Further Bone Removal......Page 98
Complications......Page 99
Postoperative Management......Page 100
Frontal Sinus Rescue Procedure......Page 101
Anatomy......Page 102
Preoperative Considerations......Page 103
Step 3: Exposing the Nasofrontal Beak and Defining the Posterior Limit of Dissection (the First Olfactory Neuron)......Page 104
Step 4: Creation of the Septal Window......Page 105
Step 5: Drilling to Define the Lateral Limits......Page 106
Step 6: Drilling Away the Nasofrontal Beak......Page 107
Pearls and Pitfalls......Page 108
Postoperative Care......Page 109
Pearls......Page 111
Step 6......Page 112
Postoperative Medical Therapy......Page 113
Special Considerations......Page 114
Preoperative Considerations......Page 116
Pearls and Potential Pitfalls......Page 117
Step 8......Page 119
Balloon Hybrid Procedure......Page 121
Special Considerations......Page 123
Radiographic Considerations......Page 124
Step 1: Debulk Polyps in the Nasal Cavity With a Microdébrider......Page 125
Step 6: Enlarge the Sphenoidotomy......Page 126
Postoperative Considerations......Page 128
Radiographic Considerations......Page 133
Step 4: Create a Nasal Floor Mucosal Flap......Page 135
Step 9: Make the Posterior Cut of the Medial Maxillary Wall......Page 136
Postoperative Considerations......Page 137
Special Considerations......Page 141
Anatomy......Page 144
Preoperative Radiographic Considerations......Page 145
Step 2: Harvest a Short Pedicled Nasoseptal Flap (Figs. 16.4 and 16.5)......Page 146
Step 1: Raise a Single Pedicled Nasoseptal Flap......Page 147
Step 5: Remove the Sphenoid Intersinus Septum (Fig. 16.9)......Page 148
Step 6: Repeat Aforementioned Steps on Contralateral Side If Necessary......Page 149
Postoperative Considerations......Page 151
Instrumentation......Page 153
Step 2: Raise the Mucosal Flap......Page 154
Step 6: Marsupialize the Lacrimal Sac......Page 155
Postoperative Considerations......Page 156
Revision Surgery......Page 157
Preoperative Considerations......Page 160
Surgical Procedure......Page 162
Step 4: Downfracture of the Orbital Floor......Page 163
Step 5: Incision of the Periorbita (Fig. 18.5)......Page 165
Outcomes......Page 166
Conclusions......Page 167
Indications and Contraindications for Optic Nerve Decompression......Page 169
Radiographic Considerations......Page 170
Instrumentation (FIG. 19.8)......Page 171
Step 5: Remove Bone Overlying the Intracanalicular Segment of the Nerve......Page 174
Step 6: Consider the Need to Incise the Optic Sheath......Page 175
Postoperative Considerations......Page 176
Preoperative Considerations......Page 177
Instrumentation......Page 179
Step 1: Perform a Complete Ethmoidectomy, Maxillary Antrostomy, and Sphenoidectomy......Page 180
Postoperative Considerations......Page 181
Preoperative Considerations......Page 184
Potential Pitfalls......Page 185
Step 3: Identify the Hasner Valve......Page 187
Step 4: Perform a Subtotal Inferior Turbinectomy......Page 188
Step 7: Adjunctive Approaches: Inferior Meatal Window, Septal Window, Canine Fossa Puncture, Anterior Maxillotomy, and the Denke.........Page 189
Step 9: Ethmoid Involvement......Page 192
Postoperative Considerations......Page 193
Step 1: Mucosal Cuts......Page 195
Step 3: Bony Cuts to the Maxilla......Page 196
“Cross-Court”/Transseptal Approaches......Page 198
Complications......Page 199
Conclusions......Page 202
Pearls and Potential Pitfalls......Page 204
Step 4: Apply Bone Wax......Page 205
Postoperative Considerations......Page 206
Anatomy......Page 209
Preoperative Considerations......Page 210
Radiographic Considerations......Page 211
Step 1: Wide Maxillary Antrostomy and Sphenoidotomy......Page 212
Step 2: Elevation of Mucosa of the Posterior Wall of the Maxillary Sinus and Drilling......Page 213
Step 7: Removal of the Disease Process in the PPS......Page 214
Introduction......Page 215
Anatomy......Page 216
Pearls and Potential Pitfalls......Page 217
Step 2: Expose the Sphenopalatine and/or Maxillary Artery......Page 219
Step 5: Dissect the Intranasal Portions of the Tumor From the Surrounding Tissues......Page 220
Postoperative Considerations......Page 221
Conclusion......Page 223
Anatomy......Page 226
Radiographic Considerations......Page 227
Pearls and Potential Pitfalls......Page 228
Step 7......Page 229
Step 11......Page 232
Postoperative Considerations......Page 233
Special Considerations......Page 235
Anatomy......Page 237
Radiographic Considerations......Page 238
Surgical Procedure......Page 239
Special Considerations......Page 245
Anatomy......Page 248
Clinical Diagnosis......Page 249
Magnetic Resonance Imaging......Page 250
Pearls......Page 251
Step 5......Page 252
Step 8......Page 253
Antibiotics......Page 254
Special Considerations......Page 255
Anatomy5......Page 259
Radiographic Considerations......Page 260
Surgical Procedure......Page 261
Step 3: Posterior Septectomy......Page 262
Step 6: Neurosurgical Resection of the Tumor......Page 264
Step 8: Application of Absorbable Packing......Page 265
Special Considerations......Page 268
Anatomy......Page 270
Preoperative Considerations......Page 271
Radiographic Considerations......Page 272
Pearls......Page 274
Step 3: Nasoseptal Flap Elevation......Page 275
Step 5: Completion of the Sphenoidotomy and Removal of the Sphenoid Keel......Page 276
Step 7: Removal of the Sella Wall......Page 277
Transplanum Approach......Page 278
Postoperative Considerations......Page 282
Clival Chordomas: Background......Page 285
Anatomic Considerations and Relationships for the Clivus......Page 286
Preoperative Considerations for Endoscopic Transclival Work......Page 287
Pearls and Potential Pitfalls......Page 289
Step 1: Complete the Preoperative Setup......Page 291
Step 3: Harvest a Nasoseptal Flap (Optional)......Page 292
Step 6: Perform a Posterior Septectomy......Page 293
Step 8: Identify the Vertical Component of Both Internal Carotid Arteries......Page 295
Step 10: Drill the Clivus Bone Until the Lesion Is Resected or the Clival Dura Is Exposed......Page 296
Step 11: Incise the Dura to Expose the Posterior Fossa for Intracranial Lesions (Optional)......Page 297
Postoperative Considerations......Page 298
Special Considerations......Page 299
INTRODUCTION......Page 302
Anatomy......Page 303
Preoperative Considerations......Page 304
Radiographic Considerations......Page 305
Pearls and Potential Pitfalls......Page 306
Step 1: Defining the Flap......Page 308
Step 2: Raising the Flap......Page 309
Step 4: Reconstruction of Dural Defect......Page 310
Step 5: Positioning of Intranasal Flap......Page 311
Middle Turbinate Flap......Page 312
Free Grafts......Page 313
Postoperative Considerations......Page 314
Anatomy......Page 318
Radiographic Considerations......Page 319
Step 1: Incision......Page 320
Step 3: Drilling of the Trephination......Page 321
Conclusion......Page 322
Preoperative Considerations......Page 327
Pearls and Pitfalls......Page 328
Surgical Procedure......Page 329
Postoperative Considerations......Page 332
B......Page 336
C......Page 337
E......Page 338
F......Page 340
J......Page 341
M......Page 342
O......Page 343
P......Page 344
S......Page 345
W......Page 347