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Abstract
Nasal endoscopy is not a modem procedure; the first attempts at nasal and sinus endoscopy were performed by Hirschmann in 1901. However it was only popularized in the 1980s through the pioneering work of Stammberger and Kennedy, and since then nasal endoscopy has proven useful in the management of inflammatory sinonasal diseases.
As a further development of ”FES S”, a multitude of other indications can be surgically treated today under endoscopic guidance in a less traumatizing manner; from CSF fistulae to meningoencephaloceles, decompression of the orbit and optic nerve, all the way to tumor surgery of the skull base and of the pituitary gland. Here the endoscopic procedure does not represent a new idea but instead uses the possibilities of a less traumatizing procedure, based on proven and established surgical techniques, for which previously external access has been necessary.
The aim of this study is to evaluate the role of sinonasal endoscopic surgery in the management of non-inflammatory lesions of the paranasal sinuses and skull base. Five clinicopathological conditions were analyzed separately in order to asses the role of nasal endoscopy in their management. Two hundred-fifty eight patients were enrolled in this study and the data were collected both retrospectively from patients’ files and prospectively by direct patient interview and regular scheduled follow-up examinations.
Cerebrospinal fluid rhinorrhea occurs when there is an abnormal communication between the subarachnoid space and the sinonasal area. Nowadays, the wide spread popularity of endoscopic sinus surgery has resulted in an increased number of CSF rhinorrhea. This is in accordance with our results in which 67% of cases were iatrogenic and all occurred following endoscopic surgery for the treatment of diffuse nasal polyposis or chronic rhinosinusitis. All lesions were repaired with an overlay technique using temporalis fascia, free mucosal graft, pedicled mucoperiosteal flap or abdominal fat.
Successful repair was achieved in 22 (91.6%) of 24 patients after their first endoscopic repair. In one of the patients with failure of the initial procedure, the second repair had been successful for a follow-up period of 20 months. The other patient had a defect in the lateral wall of an extensively pneumatized sphenoid sinus that was repaired through an intracranial
approach. By their nature, lesions which extend into the posterior wall of the frontal sinus can not be treated endoscopically.
Orbital