Transcript Endoscopic endonasal surgery (ESS)

Development of endonasal surgery
in tumours of the PNS and
skullbase, why we use it more and
more?
M.Sičák
Klinika otorinolaryngológie a chirurgie hlavy a krku
ÚVN Ružomberok a LF SZÚ Bratislava
Rinologické dni, Orechová Potôň
Endoscopic endonasal surgery (ESS)
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Late 80´s- beginning of endoscopic
sinus surgery in Europe (Messerklinger,
Wigand,Stammberger..)
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Based on philosophy of functional
minimaly invasive surgery of
paranasals
Criticism about indications, risks,
results
Limited indications
Advanced endoscopic surgery....
Endoscopic endonasal surgery (ESS)
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Rising numbers :
 Experiences
 Safety
 New indications
Concentrations to centers
 Better results
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New technologies:
 Advanced surgery behind
borders
 Endoscopic duraplasty
 Orbital surgery
 Pituitary surgery
 Anterior skull base
surgery
 Anterior cranial fossa
 Infratemporal fossa
 Clivus
 Posterior fossa
CT/MRI navigation, full HD cameras, shavers,
drills, light source, endoscopes......
•safety
•orientation
•visibility
•time saving
endoscopic/microscopic endonasal tumor
surgery optimal conditions:
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early diagnosis allows early surgery
careful assesment of indication
experienced hands (endoscopic centers)
training center
technology support
preoperative embolisation possibility
precise imaging- surgical planning
When endoscopic approach ?
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almost any tumour limited to nasal
cavity and PNS
some expansive tumours growing
behind this anatomic landmarks
small invasive tumours infiltrating
borders of these landmarks
What else endoscopic
approach offers ?
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visibility : telescope+light+camera versus
naked eye
centripetal resection- identification of tumor
origin- minimalisation of resection
good endoscopic access of posterior part of
nasal cavity and sinuses –contrary to external
approach – where as deep as less visible
surgical field
pacient – no estetic mutilation
Imaging
Contrast CT , CT angio
Imaging
MRI , MR angio
Imaging
angiography, selective
embolisation
benign
angiomyoma
inverted papilloma
angiofibroma
adenóm hypofýzy
pituitary gland
adenoma
adenocarcinoma
esthezioneuroblastoma
SNUC -Intracranial spread
esthesioneuroblastoma
anatomic limits
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lateral wall of sphenoid sinus
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Carotid artery
Optic nerve
Cavernous sinus
floor of nasal cavity
intraconal orbital space
Technical limits due to
difficult access
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anterior wall of maxilary sinus
and zygomatic recess
lateral part of inferior orbital wall
frontal sinus-anterior, lateral
deep intracranial space
What helps?
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experience with an external approach for tumour
removal
experiences with complications solution:
 bleeding controll
 retrobulbar haemathoma
 optic nerve surgery
experiences with endoscopic duroplasty
hight quality technology backround (camera,
telescopes, self cleaning system, shaver as a
minimum)
staff familiar with CT/MRI guided navigation
invasive radiologist (preop embolisation, carotid
stenting...)
Complications solutions
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bleeding : hypotensy, prepared patient
(embolisation, novoSeven), bipolar
targetted coagulation, shaver
retrobulbary haemathoma – allways
endoscopic decompression (quicker,
effective, definitive)
CSF leak – endoscopic duroplasty
endoscopic tumor surgery
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widely accepted surgical modality
more precise visualisation
tumour origin identification
still objective limits :
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optic nerve, chiasma
intraconal orbital structures
carotid artery
cavernous sinus
large intracranial portion
thank you for your attention
„šukran“