Endoscopic Repair of Frontal Sinus Cerebrospinal Fluid Leaks after Firearm Injuries: Report of Two Cases

Objectives To describe two cases of cerebrospinal fluid (CSF) leak repair after gunshot wound to the head.Design Retrospective review of two cases.Settings A large regional tertiary care facility.Participants Two patients with gunshot wounds to the skull base.Main Outcome Measures Preoperative and postoperative physical and radiologic findings.Results Patients in this series underwent endoscopic surgery, debridement, and repair of CSF leaks after gunshot wounds to the head. To date, the patients are without CSF leak.Conclusions Endoscopic closure of anterior skull base CSF leaks in patients with gunshot wounds can be safe and effective. Treatment should be decided by the severity of neurologic deterioration throughout the emergency period and the existence or absence of associated intracranial lesions. Timing for surgery should be decided with great care and with a multidisciplinary approach

To preserve or not to preserve the orbit in paranasal sinus neoplasms : A meta-analysis

Context The effect on survival of orbital evisceration on patients with paranasal sinus neoplasms has not been well established. Objective To review systematically the available literature concerning survival in patients who undergo surgery for paranasal sinus neoplasm with and without preservation of the eye. Data Source A retrospective meta-analysis of English and non-English articles using Medline and the Cochrane database. Eligibility Criteria Studies analyzing 5-year survival rates in patients who had orbital evisceration compared with orbital preservation for the treatment of paranasal sinus neoplasms were included in the final analysis. Data Extraction Independent review by two authors using predefined data fields. Data Synthesis A meta-analysis of four articles involving 443 patients was performed using the DerSimonian-Laird random-effects method. Results Our analysis revealed a total effect size of 0.964 in favor of preservation of the eye; however, these results are not robust, having a true effect size anywhere from 0.785 to 1.142 with a 95% confidence interval. Limitations Only retrospective observational studies were included because a prospective randomized study cannot be performed in this population. Conclusion Our study supports the notion that in select patients preservation of the eye may yield a different outcome when compared with orbital evisceration

Endoscopic Repair of Frontal Sinus Cerebrospinal Fluid Leaks after Firearm Injuries: Report of Two Cases

Objectives To describe two cases of cerebrospinal fluid (CSF) leak repair after gunshot wound to the head.Design Retrospective review of two cases.Settings A large regional tertiary care facility.Participants Two patients with gunshot wounds to the skull base.Main Outcome Measures Preoperative and postoperative physical and radiologic findings.Results Patients in this series underwent endoscopic surgery, debridement, and repair of CSF leaks after gunshot wounds to the head. To date, the patients are without CSF leak.Conclusions Endoscopic closure of anterior skull base CSF leaks in patients with gunshot wounds can be safe and effective. Treatment should be decided by the severity of neurologic deterioration throughout the emergency period and the existence or absence of associated intracranial lesions. Timing for surgery should be decided with great care and with a multidisciplinary approach

Vestibular schwannomas: An understanding of growth should influence management decisions

Background: Treatments for vestibular schwannomas include surgical removal and radiotherapy. Observation is a reasonable alternative, given the slow growth of these tumors. The goal of this study was to determine the 5-year no-growth rate in patients managed initially by observation in attempts to define indications for treatment

Surgical management of perineural spread of head and neck cancers

The surgical management of perineural spread of head and neck cancers has become an integral part in the contemporary treatment of this pathology. We now understand that tumour spreads within the epineurium and in a continuous fashion. We also can rely on the accuracy of magnetic resonance neurography in detecting and defining the extent of disease. With modern skull base techniques and a greater understanding of the anatomy in this region, specific operations can be designed to help eradicate disease. We review the current approaches and techniques used that enable us to better obtain tumour free margins and hence improve survival

Anatomic analysis specific for the endoscopic approach to the inferior, medial and lateral orbit

Introduction: The endoscopic approaches to the medial and inferior orbital walls have continued to grow in popularity. The ability to provide a safe approach to the orbit through this technique has been described in a handful of studies. Even though metric analyses have been conducted on orbital anatomy, few have outlined the anatomical relations pertinent to endoscopic surgery. The goal is to provide improved understanding of the complex anatomy encountered through anatomical dissections and metric analysis of the orbit. This information could assist in approach selection during preoperative planning. Methods: Anatomical dissections via transantral and endonasal approaches were used to define the limits with current endoscopic sinus surgery instrumentation. The surface area was then calculated of the floor and medial wall to assess access created by the approaches. The path of the infraorbital canal was conducted to assess its placement within the orbital floor. Results: The transantral and endonasal approaches to the orbit provided an adequate surgical window inferiorly and medially. This was confirmed by the surface area calculations. Access laterally was also possible, however, it became limited as dissection advanced superior to the lateral rectus muscle. The infraorbital canal was located consistently at midline on the orbital floor. Conclusion: Endoscopic access to the medial and inferior parts of the orbit is feasible and creates adequate access with current instrumentation. Knowing the surgical boundaries and the amount of exposure created can assist the surgeon in deciding a minimally invasive approach

To preserve or not to preserve the orbit in paranasal sinus neoplasms : A meta-analysis

Context The effect on survival of orbital evisceration on patients with paranasal sinus neoplasms has not been well established. Objective To review systematically the available literature concerning survival in patients who undergo surgery for paranasal sinus neoplasm with and without preservation of the eye. Data Source A retrospective meta-analysis of English and non-English articles using Medline and the Cochrane database. Eligibility Criteria Studies analyzing 5-year survival rates in patients who had orbital evisceration compared with orbital preservation for the treatment of paranasal sinus neoplasms were included in the final analysis. Data Extraction Independent review by two authors using predefined data fields. Data Synthesis A meta-analysis of four articles involving 443 patients was performed using the DerSimonian-Laird random-effects method. Results Our analysis revealed a total effect size of 0.964 in favor of preservation of the eye; however, these results are not robust, having a true effect size anywhere from 0.785 to 1.142 with a 95% confidence interval. Limitations Only retrospective observational studies were included because a prospective randomized study cannot be performed in this population. Conclusion Our study supports the notion that in select patients preservation of the eye may yield a different outcome when compared with orbital evisceration