Quantitative analysis of progressive removal of nasal structures during endoscopic suprasellar approach. (3rd June 2014)

• Record Type: Journal Article
• Authors: de Notaris, Matteo; Prats‐Galino, Alberto; Enseñat, Joaquim; Topczewski, Thomas; Ferrer, Enrique; Cavallo, Luigi Maria; Cappabianca, Paolo; Solari, Domenico
• Is Part Of: Laryngoscope. Volume 124:Number 10(2014:Oct.)
• Page Start: 2231
• Page End: 2237
• Publication Date: 2014-06-03
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24693
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24693-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>Following recent studies measuring working area and surgical freedom of transcranial approaches, we aimed to quantify the gain achieved with progressive removal of nasal structures during the endoscopic endonasal suprasellar approach.</p> </sec> <sec id="lary24693-sec-0002" sec-type="section"> <title>Study Design</title> <p>Human cadaveric anatomic study.</p> </sec> <sec id="lary24693-sec-0003" sec-type="section"> <title>Methods</title> <p>The width of the endoscopic endonasal corridor to the suprasellar area was obtained and measured in five cadaver heads using a computerized tracking system with six steps: 1) standard approach with monolateral lateralization of middle turbinate; 2) standard bilateral lateralization of the middle turbinates; 3) monolateral middle turbinectomy; 4) bilateral middle turbinectomy; 5) monolateral ethmoidectomy; 6) bilateral ethmoidectomy.</p> </sec> <sec id="lary24693-sec-0004" sec-type="section"> <title>Results</title> <p>The progressive removal of nasal structures offers a nonlinear increasing of the working area during the first steps of the procedure. The maximum advantage is offered by bilateral lateralization of the middle turbinates (102.7% increase in exposure), whereas a moderate increase is observed with each following step. Surgical freedom mainly increased during the first part of the approach, that is, with a monolateral right middle turbinectomy (17.9% raise of maneuverability), whereas additional steps did not increase surgical freedom enough to justify an aggressive nasal disruption.</p> </sec> <sec id="lary24693-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Monolateral turbinectomy on the side of endoscope docking represents the best solution, optimizing working area and surgical freedom (offering increases of 116.9% and 17.9%, respectively). Bilateral turbinectomy, together with a monolateral anterior and posterior ethmoidectomy, can be reserved for selected cases (increases of 148.5% and 24.7%, respectively). Bilateral ethmoidectomy does not significantly improve surgical freedom (0.81%).</p> </sec> <sec id="lary24693-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>N/A. <italic>Laryngoscope</italic> 124:2231–2237, 2014</p> </sec> </abstract>