BOOK
Atlas of Endoscopic Sinus and Skull Base Surgery E-Book
Alexander G. Chiu | James N. Palmer | Nithin D Adappa
(2018)
Additional Information
Book Details
Abstract
Gain a clear understanding of the entire spectrum of today’s rhinology and anterior skull base surgery with Atlas of Endoscopic Sinus and Skull Base Surgery, 2nd Edition. This thoroughly updated title increases your knowledge and skill regarding both basic or advanced procedures, taking you step by step through endoscopic approaches to chronic sinus disease, nasal polyps, pituitary tumors, cerebrospinal fluid leaks, sinonasal tumors, and more.
- Covers the full range of modern rhinology and anterior skull base surgery , from septoplasty and sphenoethmoidectomy to extended frontal sinus procedures, endoscopic craniofacial resections and complex skull base reconstructions.
- Clearly conveys the anatomy and detailed steps of each procedure with concise, step-by-step instructions; visual guidance features high-definition, intraoperative endoscopic photos paired with detailed, labeled anatomic illustrations.
- Includes new content on anterior skull base surgery that reflect new developments in the field.
- Helps you provide optimal patient care before, during, and after surgery with detailed information on relevant anatomy and surgical indications, instrumentation, potential pitfalls, and post-operative considerations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| ATLAS OF Endoscopic Sinus and Skull Base Surgery | i | ||
| ATLAS OF Endoscopic Sinus and Skull Base Surgery | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| CONTRIBUTORS | vii | ||
| PREFACE | xi | ||
| CONTENTS | xiii | ||
| VIDEO CONTENTS | xv | ||
| 1 - Nasal Surgery | 1 | ||
| 1 - Septoplasty | 3 | ||
| INTRODUCTION | 3 | ||
| ANATOMY7–9 | 3 | ||
| PREOPERATIVE CONSIDERATIONS | 3 | ||
| RADIOGRAPHIC CONSIDERATIONS4,12 | 3 | ||
| INSTRUMENTATION (FIG. 1.3) | 4 | ||
| PEARLS AND POTENTIAL PITFALLS | 4 | ||
| SURGICAL PROCEDURES | 5 | ||
| Traditional Septoplasty5,7,11 | 5 | ||
| Step 1: Initial Incision | 5 | ||
| Step 2: Elevation of Mucoperichondrial Flaps | 5 | ||
| Step 3: Removal of Offending Cartilage and Bone | 5 | ||
| Step 4: Closure of the Septal Pocket and Incision | 5 | ||
| Caudal Septal Deformities5,7,11,16 | 5 | ||
| Step 1: Initial Incision and Elevation of Mucoperichondrial Flaps | 5 | ||
| Step 2: Reduction of Cartilage Memory | 5 | ||
| Step 3: Swinging Door/Doorstop Techniques | 5 | ||
| 2 - Basics of PrimaryEndoscopic Sinus Surgery | 39 | ||
| 6 - Maxillary Antrostomy | 41 | ||
| INTRODUCTION | 41 | ||
| ANATOMY (FIGS. 6.1, 6.2, AND 6.3) | 41 | ||
| Radiographic Considerations | 41 | ||
| INSTRUMENTATION (FIG. 6.6) | 41 | ||
| PREOPERATIVE CONSIDERATIONS | 41 | ||
| PEARLS AND POTENTIAL PITFALLS | 45 | ||
| Pearls | 45 | ||
| Potential Pitfalls | 46 | ||
| SURGICAL PROCEDURE | 46 | ||
| Step 1: Medialize the Middle Tubinate | 46 | ||
| Step 2: Outfracture the Inferior Turbinate to Better Visualize the Middle Meatus | 46 | ||
| Step 3: Remove the Uncinate Process and Identify the Natural Ostium | 47 | ||
| Step 4: Reflect and Remove the Superior Uncinate Process (Fig. 6.11) | 47 | ||
| Step 5: Remove the Inferior Uncinate Process (Fig. 6.12) | 47 | ||
| Step 6: Enlarge the Antrostomy by Removing the Posterior Fontanelle (Fig. 6.13) | 47 | ||
| Step 7: Débride Polyps Within the Maxillary Sinus (If Present; Fig. 6.14) | 49 | ||
| POSTOPERATIVE CONSIDERATIONS | 49 | ||
| SPECIAL CONSIDERATIONS | 50 | ||
| 7 - PARTIAL AND COMPLETE ETHMOIDECTOMY | 51 | ||
| INTRODUCTION | 51 | ||
| ANATOMY | 51 | ||
| Anterior Ethmoids | 51 | ||
| Posterior Ethmoids | 51 | ||
| Basal Lamellae | 51 | ||
| Onodi Cell | 53 | ||
| PREOPERATIVE CONSIDERATIONS | 53 | ||
| Radiographic Considerations | 53 | ||
| Cribriform Plate and Skull Base | 54 | ||
| INSTRUMENTATION (FIG. 7.7) | 54 | ||
| PEARLS AND POTENTIAL PITFALLS | 55 | ||
| Pearls | 55 | ||
| Potential Pitfalls | 55 | ||
| SURGICAL PROCEDURE | 56 | ||
| Step 1 | 56 | ||
| Step 2 | 56 | ||
| Step 3 | 56 | ||
| Step 4 | 56 | ||
| Step 5 | 56 | ||
| Step 6 | 57 | ||
| Step 7 | 57 | ||
| Step 8 | 57 | ||
| POSTOPERATIVE CONSIDERATIONS | 57 | ||
| 8 - SPHENOIDOTOMY | 59 | ||
| INTRODUCTION | 59 | ||
| ANATOMY | 59 | ||
| Sphenoid | 59 | ||
| Onodi Cell | 59 | ||
| Vasculature | 59 | ||
| PREOPERATIVE CONSIDERATIONS | 59 | ||
| INSTRUMENTATION | 60 | ||
| PEARLS AND POTENTIAL PITFALLS | 60 | ||
| SURGICAL PROCEDURES | 61 | ||
| Transnasal Sphenoidotomy | 61 | ||
| Step 1 | 61 | ||
| Step 2 | 61 | ||
| Transethmoid Sphenoidotomy | 63 | ||
| Dilation of the Natural Os | 63 | ||
| Bolger Box Method | 63 | ||
| SPECIAL CONSIDERATIONS—ONODI CELL | 63 | ||
| 9 - FRONTAL SINUSOTOMY—DRAF I AND IIA | 67 | ||
| INTRODUCTION | 67 | ||
| ANATOMY | 69 | ||
| Cells of the Frontal Recess | 70 | ||
| Agger Nasi Cell | 70 | ||
| Interfrontal Sinus Septal Cell | 70 | ||
| Supraorbital Ethmoid Cell | 70 | ||
| Suprabullar Cell | 70 | ||
| Frontal Bullar Cell | 70 | ||
| Frontal Recess Cell | 70 | ||
| PREOPERATIVE CONSIDERATIONS | 72 | ||
| Radiographic Considerations | 72 | ||
| INSTRUMENTATION | 72 | ||
| PEARLS AND POTENTIAL PITFALLS | 75 | ||
| Pearls | 75 | ||
| Potential Pitfalls | 76 | ||
| SURGICAL PROCEDURE | 77 | ||
| Step 1: Identifying the Anterior Ethmoid Artery | 77 | ||
| Step 2: Identifying the Natural Drainage Pathway | 77 | ||
| Step 3: Removing the Posterior Wall of the Agger Nasi Cell | 77 | ||
| Step 4: “Enlarging the Box”—Remove Surrounding Bony Partitions to Widen the Frontal Recess | 78 | ||
| Step 5: Removing the Cap of the Agger Nasi Cell | 78 | ||
| Step 6: Expanding the Posterior Frontal Recess | 78 | ||
| Step 7: Performing the Finishing Touches | 78 | ||
| Step 8: Placing a Frontal Sinus Stent (Optional) | 80 | ||
| 10 - FRONTAL SINUSOTOMY—DRAF IIB | 83 | ||
| INTRODUCTION | 83 | ||
| ANATOMY | 83 | ||
| Frontal Sinus | 83 | ||
| Anterior Fossa and Cribriform Plate | 84 | ||
| Middle Turbinate | 84 | ||
| INDICATIONS AND CONTRAINDICATIONS FOR EXTENDED FRONTAL SINUS SURGERY | 84 | ||
| PREOPERATIVE CONSIDERATIONS | 84 | ||
| Radiologic Considerations | 86 | ||
| INSTRUMENTATION | 87 | ||
| SURGICAL PROCEDURE | 87 | ||
| Preparation | 87 | ||
| Surgical Technique | 87 | ||
| Step 1: Anterior Ethmoid and Frontal Recess Dissection | 87 | ||
| Step 2: Localization of the Anterior Ethmoid Arteries | 87 | ||
| Step 3: Enlargement of the Frontal Sinus Ostium | 88 | ||
| Step 4: Partial Resection of the Anterior Middle Turbinate | 88 | ||
| Step 5: Initial Frontal Recess Floor Removal | 88 | ||
| Step 6: Further Bone Removal | 88 | ||
| Step 7: Cavity Optimization | 89 | ||
| PEARLS AND POTENTIAL PITFALLS | 89 | ||
| Pearls | 89 | ||
| Potential Pitfalls | 89 | ||
| POSTOPERATIVE CONSIDERATIONS | 89 | ||
| Complications | 89 | ||
| POSTOPERATIVE MANAGEMENT | 90 | ||
| Frontal Sinus Rescue Procedure | 91 | ||
| 11 - FRONTAL SINUSOTOMY—DRAF III | 93 | ||
| ENDOSCOPIC COMMON FRONTAL SINUSOTOMY | 93 | ||
| Introduction | 93 | ||
| ANATOMY | 93 | ||
| INDICATIONS AND CONTRAINDICATIONS | 94 | ||
| Indications | 94 | ||
| Contraindications | 94 | ||
| PREOPERATIVE CONSIDERATIONS | 94 | ||
| INSTRUMENTATION | 95 | ||
| SURGICAL PROCEDURE | 95 | ||
| Step 1: Patient Positioning and Preparation | 95 | ||
| Step 2: Anterior Ethmoid Dissection and Defining the Medial Orbital Wall | 95 | ||
| Step 3: Exposing the Nasofrontal Beak and Defining the Posterior Limit of Dissection (the First Olfactory Neuron) | 95 | ||
| Step 4: Creation of the Septal Window | 96 | ||
| Step 5: Drilling to Define the Lateral Limits | 97 | ||
| Step 6: Drilling Away the Nasofrontal Beak | 98 | ||
| Step 7: Closure and Dressing | 99 | ||
| PEARLS AND PITFALLS | 99 | ||
| POSTOPERATIVE CARE | 100 | ||
| REFERENCES | 100 | ||
| 12 - POSTOPERATIVE DÉBRIDEMENT | 101 | ||
| INTRODUCTION | 101 | ||
| ANATOMY | 101 | ||
| PREOPERATIVE CONSIDERATIONS | 101 | ||
| INSTRUMENTATION | 101 | ||
| PEARLS AND POTENTIAL PITFALLS | 101 | ||
| Pearls | 101 | ||
| SURGICAL PROCEDURE | 102 | ||
| Step 1 | 102 | ||
| Step 2 | 102 | ||
| Step 3 | 102 | ||
| Step 4 | 102 | ||
| Step 5 | 102 | ||
| Step 6 | 102 | ||
| Step 7 | 103 | ||
| Step 8 | 103 | ||
| POSTOPERATIVE CONSIDERATIONS | 103 | ||
| Postprocedure Epistaxis | 103 | ||
| Postoperative Medical Therapy | 103 | ||
| SPECIAL CONSIDERATIONS | 104 | ||
| REFERENCES | 104 | ||
| 13 - BALLOON DILATATION OF THE MAXILLARY, FRONTAL, AND SPHENOID SINUSES | 105 | ||
| INTRODUCTION | 105 | ||
| PREOPERATIVE CONSIDERATIONS | 105 | ||
| INSTRUMENTATION | 106 | ||
| PEARLS AND POTENTIAL PITFALLS | 106 | ||
| SURGICAL PROCEDURES | 108 | ||
| Balloon-Only Procedure | 108 | ||
| Step 1 | 108 | ||
| Step 2 | 108 | ||
| Step 3 | 108 | ||
| Step 4 | 108 | ||
| Step 5 | 108 | ||
| Step 6 | 108 | ||
| Step 7 | 108 | ||
| Step 8 | 108 | ||
| Balloon Hybrid Procedure | 110 | ||
| POSTOPERATIVE CONSIDERATIONS | 112 | ||
| SPECIAL CONSIDERATIONS | 112 | ||
| 3 - Revision Endoscopic Sinus Surgery: forInflammatory Disease | 113 | ||
| 14 - Revision Functional Endoscopic Sinus Surgery: Completion Sphenoethmoidectomy | 115 | ||
| INTRODUCTION | 115 | ||
| ANATOMY | 115 | ||
| PREOPERATIVE CONSIDERATIONS | 115 | ||
| Radiographic Considerations | 115 | ||
| INSTRUMENTATION | 116 | ||
| SURGICAL PROCEDURE | 116 | ||
| Step 1: Debulk Polyps in the Nasal Cavity With a Microdébrider | 116 | ||
| Step 2: Revise the Maxillary Antrostomy | 117 | ||
| Step 3: Remove the Posterior Maxillary Air Scoop | 117 | ||
| Step 4: Skeletonize the Medial Orbital Wall | 117 | ||
| Step 5: Dissect the Remaining Posterior Ethmoid Air Cells Down to the Sphenoid Face | 117 | ||
| Step 6: Enlarge the Sphenoidotomy | 117 | ||
| Step 7: Skeletonize the Skull Base of Superior Ethmoid Partitions | 119 | ||
| Step 8: Remove the Superior Uncinate Process | 119 | ||
| POSTOPERATIVE CONSIDERATIONS | 119 | ||
| REFERENCES | 121 | ||
| 15 - MODIFIED MEDIAL MAXILLECTOMY FOR RECALCITRANT MAXILLARY SINUSITIS | 123 | ||
| INTRODUCTION | 123 | ||
| ANATOMY | 123 | ||
| PREOPERATIVE CONSIDERATIONS | 123 | ||
| Radiographic Considerations | 123 | ||
| INSTRUMENTATION | 125 | ||
| PEARLS AND POTENTIAL PITFALLS | 125 | ||
| Pearls | 125 | ||
| Potential Pitfalls | 125 | ||
| SURGICAL PROCEDURE | 125 | ||
| Step 1: Perform a Maxillary Antrostomy With Complete Removal of the Uncinate Process | 125 | ||
| Step 2: Resect the Posterior Two-Thirds of the Inferior Turbinate (Fig. 15.3) | 125 | ||
| Step 3: Resect the Inferior Turbinate and Cauterize the Inferior Turbinate Remnant | 125 | ||
| Step 4: Create a Nasal Floor Mucosal Flap | 125 | ||
| Step 5: Identify the Location of the Anterior Cut of the Medial Maxillary Wall | 126 | ||
| Step 6: Create an Inferior Osteotomy | 126 | ||
| Step 7: Make the Anterior Osteotomy in the Medial Maxillary Wall | 126 | ||
| Step 8: Reflect the Wall Medially | 126 | ||
| Step 9: Make the Posterior Cut of the Medial Maxillary Wall | 126 | ||
| Step 10: Remove the Medial Maxillary Wall (With or Without the Inferior Turbinate; Fig. 15.12) | 127 | ||
| Step 11: Drill the Remainder of the Inferior Maxillary Ridge Flush With the Nasal Floor If Necessary | 127 | ||
| Step 12: Replace the Nasal Floor Mucosal Flap | 127 | ||
| POSTOPERATIVE CONSIDERATIONS | 127 | ||
| SPECIAL CONSIDERATIONS | 131 | ||
| REFERENCES | 131 | ||
| 16 - EXTENDED SPHENOID SINUS ANTROSTOMY AND RADICAL SPHENOIDECTOMY | 133 | ||
| ANATOMY | 133 | ||
| PREOPERATIVE CONSIDERATIONS | 134 | ||
| Preoperative Radiographic Considerations | 134 | ||
| INSTRUMENTATION | 135 | ||
| PEARLS | 135 | ||
| POTENTIAL PITFALLS | 135 | ||
| SURGICAL STEPS, VARIATION 1: UNILATERAL EXTENDED SPHENOID ANTROSTOMY | 135 | ||
| Step 1: Identify the Natural Sphenoid Ostium | 135 | ||
| Step 2: Harvest a Short Pedicled Nasoseptal Flap (Figs. 16.4 and 16.5) | 135 | ||
| Step 3: Widely Open the Sphenoid | 136 | ||
| Step 4: Irrigate the Sphenoid Sinus | 136 | ||
| Step 5: Place the Nasoseptal Flap Across the Inferior Bony Opening of the Sphenoid Sinus (Figs. 16.6 and 16.7) | 136 | ||
| SURGICAL STEPS, VARIATION 2: BILATERAL EXTENDED SPHENOID ANTROSTOMY (SPHENOID “DRILL-OUT”) | 136 | ||
| Step 1: Raise a Single Pedicled Nasoseptal Flap | 136 | ||
| Step 2: Perform Bilateral Wide Sphenoid Antrostomies as Previously Described | 137 | ||
| Step 3: With Both Sphenoid Sinuses Opened, a Posterior Septectomy Can Be Performed | 137 | ||
| Step 4: Remove the Sphenoid Rostrum and Connect the Right and Left Sphenoid Openings | 137 | ||
| Step 5: Remove the Sphenoid Intersinus Septum (Fig. 16.9) | 137 | ||
| Step 6: Remove All Disease From the Sphenoid Sinus | 138 | ||
| Step 7: Place the Pedicled Nasoseptal Flap Across the Inferiorly Exposed Bone of the Newly Created Unisphenoid Sinus (Fig. 16.10... | 138 | ||
| RADICAL SPHENOIDECTOMY OR SPHENOID MARSUPIALIZATION | 138 | ||
| Step 1: Apply Local Anesthesia and Perform an Ethmoidectomy on the Diseased Side | 138 | ||
| Step 2: Identify and Ligate the Nasoseptal Artery | 138 | ||
| Step 3: Create a Nasopharyngeal Mucoperiosteal Flap (Figs. 16.11 and 16.12) | 138 | ||
| Step 4: Remove Bone of the Sphenoid Sinus Floor (Fig. 16.13) | 138 | ||
| Step 5: Set the Nasopharyngeal Mucoperiosteal Flap (Fig. 16.14) | 138 | ||
| Step 6: Repeat Aforementioned Steps on Contralateral Side If Necessary | 138 | ||
| POSTOPERATIVE CONSIDERATIONS | 140 | ||
| REFERENCES | 140 | ||
| 4 - Orbital Surgery | 141 | ||
| 17 - Endoscopic Dacryocystorhinostomy | 143 | ||
| INTRODUCTION | 143 | ||
| ANATOMY | 143 | ||
| PREOPERATIVE CONSIDERATIONS | 143 | ||
| Radiographic Considerations | 143 | ||
| INSTRUMENTATION | 143 | ||
| PEARLS AND POTENTIAL PITFALLS | 144 | ||
| SURGICAL PROCEDURE | 144 | ||
| Step 1: Create a Posteriorly Based Mucosal Flap to Expose the Lacrimal Bone and Frontal Process of the Maxilla | 144 | ||
| Step 2: Raise the Mucosal Flap | 144 | ||
| Step 3: Remove Overlying Bone | 145 | ||
| Step 4: Use a Hajek-Koffler Punch to Remove the Hard Bone of the Frontal Process of the Maxilla Overlying the Anterior-Inferior ... | 145 | ||
| Step 5: Expose the Agger Nasi Cell | 145 | ||
| Step 6: Marsupialize the Lacrimal Sac | 145 | ||
| Step 7: Trim the Mucosal Flap to Appose the Lacrimal Sac Mucosa | 146 | ||
| Step 8: Pass Crawford Silastic Tubes | 146 | ||
| POSTOPERATIVE CONSIDERATIONS | 146 | ||
| SPECIAL CONSIDERATIONS | 147 | ||
| Revision Surgery | 147 | ||
| REFERENCES | 147 | ||
| 18 - ENDOSCOPIC ORBITAL DECOMPRESSION | 149 | ||
| INTRODUCTION | 149 | ||
| ANATOMY | 149 | ||
| Maxillary Sinus Landmarks | 149 | ||
| Ethmoid Sinus Landmarks | 149 | ||
| Sphenoid Sinus Landmarks | 149 | ||
| PREOPERATIVE CONSIDERATIONS | 149 | ||
| INSTRUMENTATION (FIG. 18.2) | 151 | ||
| PEARLS AND POTENTIAL PITFALLS | 151 | ||
| Pearls | 151 | ||
| Potential Pitfalls | 151 | ||
| SURGICAL PROCEDURE | 151 | ||
| Step 1: Resection of the Middle Turbinate, Maxillary Antrostomy, Complete Ethmoidectomy, and Sphenoidotomy | 152 | ||
| Step 2: Penetration of the Medial Orbital Wall | 152 | ||
| Step 3: Removal of Medial Orbital Wall Fragments | 152 | ||
| Step 4: Downfracture of the Orbital Floor | 152 | ||
| Step 5: Incision of the Periorbita (Fig. 18.5) | 154 | ||
| Step 6: Orbital Fat Prolapse Into the Ethmoid and Maxillary Cavities | 155 | ||
| Hemostasis | 155 | ||
| POSTOPERATIVE CONSIDERATIONS | 155 | ||
| Postoperative Care | 155 | ||
| Outcomes | 155 | ||
| SPECIAL CONSIDERATIONS | 156 | ||
| CONCLUSIONS | 156 | ||
| REFERENCES | 156 | ||
| 19 - OPTIC NERVE DECOMPRESSION | 157 | ||
| INTRODUCTION | 157 | ||
| ANATOMY | 157 | ||
| Orbit and Orbital Apex | 157 | ||
| Optic Nerve | 157 | ||
| Sinus | 157 | ||
| INDICATIONS AND CONTRAINDICATIONS FOR OPTIC NERVE DECOMPRESSION | 157 | ||
| PREOPERATIVE CONSIDERATIONS | 158 | ||
| Radiographic Considerations | 158 | ||
| INSTRUMENTATION (FIG. 19.8) | 159 | ||
| PEARLS AND POTENTIAL PITFALLS | 162 | ||
| Pearls | 162 | ||
| Potential Pitfalls | 162 | ||
| SURGICAL PROCEDURE | 162 | ||
| Step 1: Perform a Complete Ethmoidectomy | 162 | ||
| Step 2: Perform a Wide Sphenoidotomy | 162 | ||
| Step 3: Identify the Optic Nerve, Carotid Prominence, and Opticocarotid Recess (Fig. 19.9) | 162 | ||
| Step 4: Fracture the Lamina in the Posterior Ethmoid | 162 | ||
| Step 5: Remove Bone Overlying the Intracanalicular Segment of the Nerve | 162 | ||
| Step 6: Consider the Need to Incise the Optic Sheath | 163 | ||
| Step 7: Dressings | 164 | ||
| COMPLICATIONS | 164 | ||
| Postoperative Considerations | 164 | ||
| 20 - ENDOSCOPIC APPROACH AND REMOVAL OF ORBITAL TUMORS | 165 | ||
| INTRODUCTION | 165 | ||
| ANATOMY | 165 | ||
| INDICATIONS AND CONTRAINDICATIONS | 165 | ||
| PREOPERATIVE CONSIDERATIONS | 165 | ||
| INSTRUMENTATION | 167 | ||
| PEARLS AND POTENTIAL PITFALLS | 168 | ||
| Pearls | 168 | ||
| Potential Pitfalls | 168 | ||
| SURGICAL PROCEDURE | 168 | ||
| Step 1: Perform a Complete Ethmoidectomy, Maxillary Antrostomy, and Sphenoidectomy | 168 | ||
| Step 2: Fracture and Remove the Lamina Papyracea (See Fig. 20.5) | 169 | ||
| Step 3: Incise the Periorbita With a Sickle Knife (See Fig. 20.7) | 169 | ||
| Step 4: Dissect the Extraconal Fat (See Fig. 20.8) | 169 | ||
| Step 5: Identify the Inferior Border of the Medial Rectus Muscle and Retract It With a Double-Ball Probe (See Fig. 20.9) | 169 | ||
| Step 6: Identify the Oculomotor Nerve, the Inferomedial Trunk of the Ophthalmic Artery, and the Tumor | 169 | ||
| Step 7: Bluntly Dissect the Tumor Using a Binarial, 4-Handed Approach | 169 | ||
| Step 8: Gently Retract the Lesion Anteriorly in a Plane Parallel to the Optic Nerve (Fig. 20.10) | 169 | ||
| Step 9: Reconstruct the Orbit With a Nasoseptal Flap, If Required | 169 | ||
| Step 10: Nasal Packing May Be Cautiously Used | 169 | ||
| COMPLICATIONS | 169 | ||
| POSTOPERATIVE CONSIDERATIONS | 169 | ||
| REFERENCES | 170 | ||
| 5 - Sinonasal Tumors | 171 | ||
| 21 - Endoscopic Medial Maxillectomy | 173 | ||
| INTRODUCTION | 173 | ||
| ANATOMY5 | 173 | ||
| PREOPERATIVE CONSIDERATIONS | 173 | ||
| INSTRUMENTATION | 174 | ||
| PEARLS | 174 | ||
| POTENTIAL PITFALLS | 174 | ||
| SURGICAL STEPS | 176 | ||
| Step 1: Debulk the Tumor or Polyps | 176 | ||
| Step 2: Remove the Uncinate Process and Identify the Natural Ostium | 176 | ||
| Step 3: Identify the Hasner Valve | 176 | ||
| Step 4: Perform a Subtotal Inferior Turbinectomy | 177 | ||
| Step 5: Create a Nasal Floor Mucosal Flap | 178 | ||
| Step 6: Mega-Antrostomy | 178 | ||
| Step 7: Adjunctive Approaches: Inferior Meatal Window, Septal Window, Canine Fossa Puncture, Anterior Maxillotomy, and the Denke... | 178 | ||
| Step 8: Removal of the Tumor Pedicle | 181 | ||
| Step 9: Ethmoid Involvement | 181 | ||
| Step 10: Endoscopic Dacryocystorhinostomy (When Necessary) | 182 | ||
| POSTOPERATIVE CONSIDERATIONS | 182 | ||
| REFERENCES | 182 | ||
| 22 - ENDOSCOPIC DENKER APPROACH FOR ANTERIOR MAXILLA TUMORS | 183 | ||
| INTRODUCTION | 183 | ||
| GENERAL PRINCIPLES | 183 | ||
| SURGICAL TECHNIQUE | 183 | ||
| Step 1: Mucosal Cuts | 183 | ||
| Step 2: Soft Tissue Dissection Over the Maxilla | 184 | ||
| Step 3: Bony Cuts to the Maxilla | 184 | ||
| COMPARISON TO OTHER ENDOSCOPIC PROCEDURES | 186 | ||
| “Cross-Court”/Transseptal Approaches | 186 | ||
| ADVANTAGES OF THE ENDOSCOPIC DENKER APPROACH | 187 | ||
| COMPLICATIONS | 187 | ||
| SURGICAL INDICATIONS | 190 | ||
| CONCLUSIONS | 190 | ||
| REFERENCES | 190 | ||
| 23 - ENDOSCOPIC VIDIAN NEURECTOMY | 191 | ||
| INTRODUCTION | 191 | ||
| ANATOMY | 191 | ||
| PREOPERATIVE CONSIDERATIONS | 191 | ||
| INSTRUMENTATION | 191 | ||
| PEARLS AND POTENTIAL PITFALLS | 191 | ||
| SURGICAL PROCEDURE | 192 | ||
| Step 1: Perform a Wide Maxillary Antrostomy | 192 | ||
| Step 2: Raise a Mucosal Flap and Ligate the Sphenopalatine Artery | 192 | ||
| Step 3: Identify the Pharyngeal Nerves and the Vidian Nerve | 192 | ||
| Step 4: Apply Bone Wax | 192 | ||
| Step 5: Replace the Mucosal Flap and Dressing | 193 | ||
| POSTOPERATIVE CONSIDERATIONS | 193 | ||
| REFERENCES | 193 | ||
| 24 - PTERYGOPALATINE/PTERYGOMAXILLARY SPACE APPROACHES, MAXILLARY ARTERY LIGATION, AND APPROACH TO JUVENILE NASOPHARYNGEAL ANGIOFIBROMA | 195 | ||
| ANATOMY | 195 | ||
| PREOPERATIVE CONSIDERATIONS | 196 | ||
| Radiographic Considerations | 197 | ||
| INSTRUMENTATION | 198 | ||
| PEARLS AND POTENTIAL PITFALLS | 198 | ||
| SURGICAL PROCEDURE | 198 | ||
| Step 1: Wide Maxillary Antrostomy and Sphenoidotomy | 198 | ||
| Step 2: Elevation of Mucosa of the Posterior Wall of the Maxillary Sinus and Drilling | 199 | ||
| Step 3: Enlargement of the Window Into the PPS | 200 | ||
| Step 4: Incision of the Anterior Pterygopalatine Fossa Periosteum | 200 | ||
| Step 5: Identification of the Maxillary Artery | 200 | ||
| Step 6: Ligation of the Maxillary Artery | 200 | ||
| Step 7: Removal of the Disease Process in the PPS | 200 | ||
| Step 8: Access of the LSR | 201 | ||
| Step 9: Closure | 201 | ||
| APPROACH TO JUVENILE NASOPHARYNGEAL ANGIOFIBROMA | 201 | ||
| Introduction | 201 | ||
| Anatomy | 202 | ||
| Preoperative Considerations | 203 | ||
| Radiographic Considerations | 203 | ||
| Additional Instrumentation | 203 | ||
| Pearls and Potential Pitfalls | 203 | ||
| SURGICAL STEPS | 205 | ||
| Step 1: Perform a Wide Maxillary Antrostomy, Ethmoidectomy, and Sphenoidotomy | 205 | ||
| Step 2: Expose the Sphenopalatine and/or Maxillary Artery | 205 | ||
| Step 3: Perform a Sphenopalatine or Maxillary Artery Ligation | 206 | ||
| Step 4: Dissect the Posterior Nasopharyngeal Component Free From Surrounding Tissues | 206 | ||
| Step 5: Dissect the Intranasal Portions of the Tumor From the Surrounding Tissues | 206 | ||
| Step 6: Remove the Tumor Either Transnasally or Transorally Depending on Its Size | 207 | ||
| Step 7: Evaluate the Pterygoid Processes and Vidian Canal | 207 | ||
| Step 8: Cover the Surgical Defect | 207 | ||
| Postoperative Considerations | 207 | ||
| CONCLUSION | 209 | ||
| REFERENCES | 209 | ||
| 25 - ENDOSCOPIC CRANIOFACIAL RESECTION | 211 | ||
| INTRODUCTION | 211 | ||
| ANATOMY | 211 | ||
| PREOPERATIVE CONSIDERATIONS | 212 | ||
| Workup and Staging | 212 | ||
| Radiographic Considerations | 212 | ||
| INSTRUMENTATION | 213 | ||
| PEARLS AND POTENTIAL PITFALLS | 213 | ||
| SURGICAL PROCEDURE | 214 | ||
| Step 1 | 214 | ||
| Step 2 | 214 | ||
| Step 3 | 214 | ||
| Step 4 | 214 | ||
| Step 5 | 214 | ||
| Step 6 | 214 | ||
| Step 7 | 214 | ||
| Step 8 | 217 | ||
| Step 9 | 217 | ||
| Step 10 | 217 | ||
| Step 11 | 217 | ||
| POSTOPERATIVE CONSIDERATIONS | 218 | ||
| SPECIAL CONSIDERATIONS | 220 | ||
| REFERENCES | 220 | ||
| 6 - Skull Base Reconstruction | 221 | ||
| 26 - Repair of Cerebrospinal Fluid Leak and Encephalocele of the Cribriform Plate | 223 | ||
| INTRODUCTION | 223 | ||
| ANATOMY | 223 | ||
| PREOPERATIVE CONSIDERATIONS | 224 | ||
| Radiographic Considerations | 224 | ||
| INSTRUMENTATION | 225 | ||
| PEARLS AND POTENTIAL PITFALLS | 225 | ||
| SURGICAL PROCEDURE | 225 | ||
| POSTOPERATIVE CONSIDERATIONS | 231 | ||
| SPECIAL CONSIDERATIONS | 231 | ||
| REFERENCES | 232 | ||
| 27 - SPHENOID SINUS CEREBROSPINAL FLUID LEAK AND ENCEPHALOCELE REPAIR | 233 | ||
| INTRODUCTION | 233 | ||
| ANATOMY | 233 | ||
| PREOPERATIVE CONSIDERATIONS | 234 | ||
| Patient History | 234 | ||
| Clinical Diagnosis | 234 | ||
| Intrathecal Fluorescein Administration | 235 | ||
| Radiographic Considerations | 235 | ||
| Computed Tomography | 235 | ||
| Magnetic Resonance Imaging | 235 | ||
| Adjunctive Imaging | 236 | ||
| INSTRUMENTATION | 236 | ||
| PEARLS AND POTENTIAL PITFALLS | 236 | ||
| Pearls | 236 | ||
| Potential Pitfalls | 237 | ||
| SURGICAL PROCEDURE | 237 | ||
| Step 2 | 237 | ||
| Step 3 | 237 | ||
| Step 4 | 237 | ||
| Step 5 | 237 | ||
| Step 6 | 238 | ||
| Step 7 | 238 | ||
| Step 8 | 238 | ||
| Step 9 | 239 | ||
| POSTOPERATIVE CONSIDERATIONS | 239 | ||
| Packing | 239 | ||
| Antibiotics | 239 | ||
| Lumbar Drain | 240 | ||
| Acetazolamide | 240 | ||
| SPECIAL CONSIDERATIONS | 240 | ||
| REFERENCES | 241 | ||
| 7 - Anterior and Central Skull Base Approaches | 243 | ||
| 28 - Endoscopic Resection of Pituitary Tumors | 245 | ||
| INTRODUCTION | 245 | ||
| ANATOMY5 | 245 | ||
| PREOPERATIVE CONSIDERATIONS | 246 | ||
| Radiographic Considerations | 246 | ||
| INSTRUMENTATION (FIG. 28.5) | 247 | ||
| SURGICAL PROCEDURE | 247 | ||
| Step 1: Vasoconstriction | 248 | ||
| Step 2: Sphenoidotomy | 248 | ||
| Step 3: Posterior Septectomy | 248 | ||
| Step 4: Anterior Sphenoid Resection | 250 | ||
| Step 5: Removal of the Intersinus Septum | 250 | ||
| Step 6: Neurosurgical Resection of the Tumor | 250 | ||
| Step 7: Repair of Cerebrospinal Fluid Leak (If Necessary) | 251 | ||
| Step 8: Application of Absorbable Packing | 251 | ||
| POSTOPERATIVE CONSIDERATIONS | 254 | ||
| SPECIAL CONSIDERATIONS | 254 | ||
| REFERENCES | 254 | ||
| 29 - ENDOSCOPIC TRANSPLANUM AND SELLAR APPROACH | 255 | ||
| INTRODUCTION | 255 | ||
| ANATOMY | 255 | ||
| PREOPERATIVE CONSIDERATIONS | 256 | ||
| Radiographic Considerations | 257 | ||
| INSTRUMENTATION (FIG. 29.7) | 259 | ||
| PEARLS AND POTENTIAL PITFALLS | 259 | ||
| Pearls | 259 | ||
| Potential Pitfalls | 260 | ||
| SURGICAL PROCEDURES | 260 | ||
| Step1: Nasal Exposure of the Sphenoid | 260 | ||
| Step 2: Sphenoidotomy | 260 | ||
| Step 3: Nasoseptal Flap Elevation | 260 | ||
| Step 4: Contralateral Working Window | 261 | ||
| Step 5: Completion of the Sphenoidotomy and Removal of the Sphenoid Keel | 261 | ||
| Step 6: Removal of the Sphenoid Inner-Sinus Septum | 262 | ||
| Step 7: Removal of the Sella Wall | 262 | ||
| Step 8: Resection of the Sella Mass | 263 | ||
| Transplanum Approach | 263 | ||
| Skull Base Reconstruction | 267 | ||
| POSTOPERATIVE CONSIDERATIONS | 267 | ||
| REFERENCES | 268 | ||
| 30 - ENDOSCOPIC MANAGEMENT OF CLIVAL CHORDOMAS AND CHONDROSARCOMAS | 269 | ||
| INTRODUCTION | 269 | ||
| ADVANTAGES TO ENDOSCOPIC RESECTION OF CLIVAL LESIONS | 269 | ||
| DISADVANTAGES TO ENDOSCOPIC TRANSCLIVAL APPROACHES | 269 | ||
| CLIVAL CHORDOMAS: BACKGROUND | 269 | ||
| CLIVAL CHONDROSARCOMAS: BACKGROUND | 270 | ||
| ANATOMIC CONSIDERATIONS AND RELATIONSHIPS FOR THE CLIVUS | 270 | ||
| PREOPERATIVE CONSIDERATIONS FOR ENDOSCOPIC TRANSCLIVAL WORK | 271 | ||
| Radiographic Considerations for Transclival Surgery | 273 | ||
| INSTRUMENTATION FOR ENDONASAL TRANSCLIVAL SURGERY | 273 | ||
| PEARLS AND POTENTIAL PITFALLS | 273 | ||
| SURGICAL PROCEDURE | 275 | ||
| Step 1: Complete the Preoperative Setup | 275 | ||
| Step 2: Decongest and Provide Vasoconstriction to the Nasal Cavity | 276 | ||
| Step 3: Harvest a Nasoseptal Flap (Optional) | 276 | ||
| Step 4: Defining the Surgical Corridors to the Sphenoid Sinus and Clivus | 277 | ||
| Step 5: Perform Wide Bilateral Sphenoidotomies | 277 | ||
| Step 6: Perform a Posterior Septectomy | 277 | ||
| Step 7: Reduce the Floor of the Sphenoid Sinus and Begin Drilling the Superior Clivus | 279 | ||
| Step 8: Identify the Vertical Component of Both Internal Carotid Arteries | 279 | ||
| Step 9: Open the Nasopharyngeal Mucosa and Musculature to Expose the Clivus (Optional) | 280 | ||
| Step 10: Drill the Clivus Bone Until the Lesion Is Resected or the Clival Dura Is Exposed | 280 | ||
| Step 11: Incise the Dura to Expose the Posterior Fossa for Intracranial Lesions (Optional) | 281 | ||
| Step 12: Meticulous Decompression Versus Resection of Intradural Clival Lesions With Neurosurgery | 282 | ||
| Step 13: Skull Base Reconstruction of Clival Defects | 282 | ||
| POSTOPERATIVE CONSIDERATIONS | 282 | ||
| SPECIAL CONSIDERATIONS | 283 | ||
| REFERENCES | 283 | ||
| 31 - LARGE SKULL BASE DEFECT RECONSTRUCTION WITH AND WITHOUT PEDICLED FLAPS | 285 | ||
| INTRODUCTION | 285 | ||
| ANATOMY | 286 | ||
| PREOPERATIVE CONSIDERATIONS | 287 | ||
| Radiographic Considerations | 288 | ||
| INSTRUMENTATION | 289 | ||
| PEARLS AND POTENTIAL PITFALLS | 289 | ||
| SURGICAL PROCEDURE | 291 | ||
| Local Flaps | 291 | ||
| Posterior Nasoseptal Flap | 291 | ||
| Step 1: Defining the Flap | 291 | ||
| Step 2: Raising the Flap | 292 | ||
| Step 3: Storing the Flap | 293 | ||
| Step 4: Reconstruction of Dural Defect | 293 | ||
| Step 5: Positioning of Intranasal Flap | 294 | ||
| Inferior Turbinate Flap | 295 | ||
| Middle Turbinate Flap | 295 | ||
| Palatal Floor Flap | 296 | ||
| Regional Flaps | 296 | ||
| Pericranial Flap | 296 | ||
| Temporoparietal Flap | 296 | ||
| Free Grafts | 296 | ||
| POSTOPERATIVE CONSIDERATIONS | 297 | ||
| REFERENCES | 297 | ||
| 8 - Combined Endoscopic andOpen Approaches—FrontalSinus | 299 | ||
| 32 - Frontal Sinus Trephination | 301 | ||
| INTRODUCTION | 301 | ||
| ANATOMY | 301 | ||
| PREOPERATIVE CONSIDERATIONS | 302 | ||
| Indications for Trephination | 302 | ||
| Radiographic Considerations | 302 | ||
| INSTRUMENTATION | 303 | ||
| PEARLS AND POTENTIAL PITFALLS | 303 | ||
| SURGICAL PROCEDURE | 303 | ||
| Step 1: Incision | 303 | ||
| Step 2: Exposure of Bone | 304 | ||
| Step 3: Drilling of the Trephination | 304 | ||
| Step 4: Placement of Drains and Closure | 305 | ||
| POSTOPERATIVE CONSIDERATIONS | 305 | ||
| CONCLUSION | 305 | ||
| REFERENCES | 307 | ||
| 33 - OSTEOPLASTIC FLAPS WITH AND WITHOUT OBLITERATION | 309 | ||
| INTRODUCTION | 309 | ||
| ANATOMY | 309 | ||
| PREOPERATIVE CONSIDERATIONS | 309 | ||
| INSTRUMENTATION | 310 | ||
| PEARLS AND PITFALLS | 310 | ||
| SURGICAL PROCEDURE | 311 | ||
| POSTOPERATIVE CONSIDERATIONS | 314 | ||
| REFERENCES | 316 | ||
| INDEX | 317 | ||
| A | 317 | ||
| B | 317 | ||
| C | 318 | ||
| D | 319 | ||
| E | 319 | ||
| F | 321 | ||
| G | 322 | ||
| H | 322 | ||
| I | 322 | ||
| J | 322 | ||
| K | 323 | ||
| L | 323 | ||
| M | 323 | ||
| N | 324 | ||
| O | 324 | ||
| P | 325 | ||
| Q | 326 | ||
| R | 326 | ||
| S | 326 | ||
| T | 328 | ||
| U | 328 | ||
| V | 328 | ||
| W | 328 | ||
| IBC | ES2 |