What's New In Surgery

The excellent visualization of the surgical site has extended the surgical application of endoscopic sinus surgery from the management of inflammatory disease of the paranasal sinuses to the following indications which have had successful results. They include:

Endoscopic Orbital Decompression

This endoscopic application involves the surgical removal of the medial orbital wall's removal (shown at right), to accommodate the increased volume of the orbital muscles with the fat and vascular contents in the region of the anterior and posterior ethmoid sinuses. This can be further extended to partial removal of the orbital floor through the nasal cavity. The following schematic diagrams and endoscopic views will demonstrate the surgery. This procedure is valuable in treating patients having thyroid disease with exophthalmos where significant dramatic results could be obtained by surgery. This procedure is electively performed after consultation with an ophthalmologist. The visual fields and the visual acuity should be carefully checked in evaluating patients with this disorder prior to surgery.

Endoscopic Closure of C.S.F. Leaks / Resection of Base of Skull Tumors

The endoscopic closure of the cerebrospinal fluid leak from the anterior skull base can be successfully performed by direct visualization of the site of the leak. This is usually performed with computer-aided technology and tissue adhesives like the fibrin glue and tissue graft in the form of temporalis fascia and conchal cartilage. Our results have been very encouraging and the advantage is in the avoidance of a formal craniotomy and the attendant postoperative care. Because of the various techniques involved in the surgery, each patient must be evaluated on an individual basis preoperatively.

The following will illustrate the application of this technology (click for larger picture):

Endoscopic Decompresion of the Optic Nerve

The technique of optic nerve decompression is based on the identification of the optic nerve in the posterior ethmoid sinus or the sphenoid sinus. This should be performed by surgeons who are familiar with anatomy in this area, and special instrumentation is necessary for successful completion of sugery. The technique is most useful in optic nerve decompression secondary to thyroid ophthalmopathy, traumatic optic nerve entrapment or optic nerve injury with compression in tumor resections at the orbital apex.

Right endoscopic view revealing tumor in the right orbit extending posterior length to sphenoid sinus.	Right endoscopic view after removal of the medial orbital wall on the right side to the apex of the orbit.	Right endoscopic view after successful decompression of the medial orbital wall to the sphenoid sinus including the optic nerve canal.
Tri-Planar view of right spenoid sinus demonstrating orbital tumor compression of tight orbital apex. Probe is in the right sphenoid sinus.	Tri-Planar view demonstrating probe at the apex of the orbit decompressing the optic nerve canal.

Endoscopic Resection of Tumors of the Pituitary Gland

The endoscopic techniques in resection of tumors of the pituitary have been recently applied with exciting results. The technique is based on the transnasal use of the sphenoid sinus surgical approach and removal of the sella bony wall and resection of the tumor. The defect is usually closed well with fibrin glue and muscular tissue, thus decreasing the postoperative stay in the hospital and also the incidence of morbidity.