MR-guided endoscopic sinus surgery.

We describe an interactive, intraoperative imaging-guided method for performing endoscopic sinus surgery (ESS) within a vertically open MR system. The procedure was performed with intraoperative imaging using a 0.5-T magnet with a 56-cm vertical gap. Interactive control of imaging planes was accomplished by optical tracking with two infrared light-emitting diodes mounted on an aspirator probe. The probe''s position defined the location of the orthogonal imaging planes. Twelve patients with varying degrees of sinus disease underwent ESS with MR imaging guidance. Patients had acute and chronic sinusitis, nasal polyposis causing airway obstruction, or tumor requiring tissue biopsy. All procedures were performed with the patients under general anesthesia. The integration of endoscopy with optical tracking and intraoperative interactive imaging allowed localization of anatomic landmarks during ESS. No complications were encountered.     

鼻窦内镜手术治疗儿童慢性鼻窦炎

目的：探讨鼻窦内镜下治疗儿童鼻窦炎的手术疗效及相关影响因素.方法：回顾性分析经鼻窦内镜下手术治疗的病例25例儿童鼻窦炎的临床资料.结果：随访半年至一年,按照海口会议1997鼻窦内镜手术标准进行评定,治愈20例,好转3例,无效2例.总有效率为92%.术后无1例出现严重并发症,术后主要并发症为术腔粘连.结论：鼻窦内镜下手术治疗儿童慢性鼻窦炎是一种理想的方式,术后定期随访和综合治疗影响手术远期疗效.     

鼻窦气压伤的研究进展

目的 回顾国内外有关鼻窦气压伤(sinuses barotrauma,SB)的研究进展,提出进一步的研究建议. 资料来源与选择 国内外公开发表的相关专著、研究论文、综述和标准. 资料引用 引用标准1项,公开发表文献57篇. 资料综合 阐述有关SB的历史演变和流行病学,比较了SB的发病率及各鼻窦SB的构成比;探讨SB病理损伤分级,结合临床航空医学,将SB分为轻、重两度,并依据原发性和继发性病变进行了分型;分析SB病因及病理生理学,概述SB临床表现、影响因素及并发症;总结SB的鉴别手段与诊断方法,如内窥镜广泛应用于SB的诊断及治疗,SB临床路径的提出及《职业性航空病诊断标准》的颁布,使SB诊治更加规范化;综述SB防治措施和航空医学鉴定方面的文献,对低压舱检查的注意事项和飞行人员SB航空医学鉴定原则进行了概括. 结论 SB的诊疗水平有了较大提高,航空医学鉴定趋于规范化,飞行人员停飞率明显降低,但有关不同升降高度和速率所致SB的发病特点有待进一步研究.     

鼻内镜手术的麻醉

目的:应用全凭静脉麻醉和控制性降压进行鼻内镜手术,探讨其方法的安全性。方法:将80例进行鼻内镜手术的病人随机分为两组行全凭静脉麻醉和静吸复合麻醉,术中进行控制性降压,对术野情况和术后清醒情况进行评估。结果:全凭静脉麻醉与静吸复合麻醉组应用于鼻内镜手术均取得良好的控制性降压效果,术野清晰。全凭静脉麻醉组病人清醒快,意识恢复好。结论:全凭静脉麻醉可安全应用于鼻内镜手术,患者清醒迅速,安全。     

Sphenoid sinus barotrauma with intracranial air in sella turcica after diving

We report the case of a diver who presented with air in the sella turcica after barotrauma to the sphenoid sinus during an ascent from a dive. To our knowledge, this is the first report of intracranial air after a barotrauma to the sphenoid sinus.     

MR imaging appearance of frontal sinus barotrauma

We present the case of a flight passenger who experienced acute and severe headache during landing. MR imaging was performed because the patient had a history of vascular malformation and revealed an incidental venous angioma. A mass lesion in the frontal sinus, consistent with submucosal hematoma secondary to barotrauma, was thought to be the cause of the headache. To our knowledge, this is the first case of sinus barotrauma described in the radiologic literature and the first to describe the associated MR imaging findings.     

Optimal CT evaluation for functional endoscopic sinus surgery.

PURPOSETo evaluate the optimal parameters for the CT examination of patients who are having functional endoscopic sinus surgery.METHODSCT scanning was performed on two fresh cadaveric heads in the direct coronal plane, varying the section thickness, intersection gap, scanner gantry angle, and amperage. The nasal cavity and paranasal sinuses were examined independently in a blinded fashion by four staff neuroradiologists and a staff otolaryngologist with special attention to 10 anatomic landmarks within the ostiomeatal unit that are considered important for preoperative planning. A score of 0 (nonvisualization/incomplete visualization) or 1 (clear/complete visualization) was assigned to each of these 10 landmarks. Analysis of variance was used in which reader, subject, and side were simultaneously controlled by "blocking." Multiple comparison methods (ie, Bonferroni) were used to compare the different protocols.RESULTSWe found a significant reduction in the delineation, and therefore the perception, of the ostiomeatal unit structures when the section thickness was greater than 5mm, any intersection gap was used, and the gantry angle was greater than 10 degrees from the plane perpendicular to the hard palate. However, a reduction in the radiation exposure from 200 mA to 80 mA did not affect the display of the anatomic landmarks.CONCLUSIONWe found the optimal screening CT protocol for the paranasal sinuses to be a section thickness of 3 mm, no intersection gap, and a section angle within 10 degrees from the plane perpendicular to the palate. Also, owing to inherent contrast between air, soft tissue, and bone in the paranasal sinuses, a reduction in the radiation exposure parameter to 80 mA did not affect image quality.     

Multislice CT-image-guided endoscopic sinus surgery using an electromagnetic tracking system

Our objective was to assess the practicability and accuracy of a computer-assisted multislice CT-guided frameless electromagnetic tracking for endoscopic sinus surgery. Eighty-two patients with various paranasal sinus diseases were evaluated. Prior to surgery, axial multislice spiral-CT scans with 2.5-mm collimation, 0.8-mm reconstruction increment, and a pitch of 3 were acquired. After Ethernet transfer of the CT data set to the guidance system, coronal and sagittal images were reconstructed. For intraoperative navigation the Insta Trak System (Visualization Technology, Boston, Mass.) was used. Navigational procedures are described in detail in the paper. Accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as on CT images. A second parameter for accuracy was calculated by the system itself as the root mean square (RMS). The system was able to display the position of the aspirating tip relative to anatomical structures with an average accuracy of 0.70±0.40 mm. Root mean square values showed a mean value of 0.40±0.20 mm. During surgical procedures the Insta Trak System provides the surgeon with additional image-based information to the endoscopic view. The device accuracy is high and the system proves to be practicable and efficient in ENT surgery. Electronic Publication     

Cataract surgery and intraocular lenses in military aviators.

We reviewed the medical records of 23 military aviators who were evaluated by the United States Air Force School of Aerospace Medicine (USAFSAM) after cataract extraction with intraocular lens implantation between 1979 and 1990. The 23 subjects were male Caucasians, with a mean age of 43 years. Of the subjects, 21 were pilots, and, of these, 8 were qualified in high-performance aircraft. There were a total of 28 operated eyes, 24 of which had received extracapsular cataract extractions (ECCE) with posterior chamber lenses. The best-corrected, postoperative vision was 20/20 or better in all eyes. Posterior capsule opacification occurred in 14 (60%) of the ECCE eyes, with five requiring Nd:YAG (Yttrium-Aluminum-Garnet) laser capsulotomies. One aviator was disqualified from flying duties because of ocular deficiencies, for a visually-qualified-to-fly rate of 96%. Eight aviators have actually flown since surgery. Although follow-up was short, the initial results are encouraging.     

Computed tomography scans of paranasal sinuses before functional endoscopic sinus surgery

This review aims to familiarize the radiologist with the common types of sinus surgery including their indications and techniques.We also illustrate how surgeons interpret 3D sinus anatomy when evaluating computed tomography(CT)studies.Preoperative evaluation by CT is mandatory for all patients undergoing functional endoscopic sinus surgery(FESS).In the past decade in particular,CT of the paranasal sinuses has become a roadmap for FESS.The radiologist’s goal is to report on five key points:the extent of sinus opacification,opacification of sinus drainage pathways,anatomical variants,critical variants,and condition of surrounding soft tissues of the neck,brain and orbits.We present a systematic approach to the use of coronal,axial,and sagittal images in CT evaluation before FESS.     

Partial resection of the middle turbinate at functional endoscopic sinus surgery

The middle turbinate is often carefully preserved at Functional Endoscopic Sinus Surgery (FESS). However there is no clear understanding of its importance and its presence may prevent good access to the middle meatus to the detriment of the surgical result. In addition its bulk may cause symptoms of nasal obstruction and prevent paranasal sinus drainage. Adhesions and stenosis have been reported at the middle meatus following its preservation. We undertook a prospective study of 50 consecutive patients all of whom underwent resection of the anterior half of the middle turbinate at the time of Functional Endoscopic Sinus Surgery. The patients were asked to complete a symptom score sheet before and ten weeks after surgery. The parameters considered were nasal obstruction, nasal congestion, discharge, facial pain and headache. Non parametric analysis of the results indicated a significant improvement in all patient symptom scores and no postoperative complications were noted. We conclude that partial resection of the middle turbinate is a useful modification of accepted endoscopic sinus surgery techniques.     

右旋美托咪啶辅助七氟烷控制性降压用于鼻内窥镜手术的可行性

目的 探讨鼻内窥镜手术中应用右旋美托咪啶辅助控制性降压的可行性.方法 择期行鼻内窥镜手术患者48例,ASA Ⅰ或Ⅱ级,随机均分为2组(n=24):对照组(Ⅰ组)和右旋美托咪啶组(Ⅱ组).两组均采用静脉注射咪达唑仑、丙泊酚、芬太尼和顺苯磺阿曲库铵麻醉诱导,麻醉维持采用丙泊酚、芬太尼、顺苯磺阿曲库铵辅以七氟烷吸入.桡动脉穿刺置管监测有创平均动脉压(MAP).Ⅰ组通过调整七氟烷的浓度施行控制性降压,Ⅱ组于麻醉诱导前15～30min内静脉泵注右旋美托咪啶0.8μg/kg,以0.4μg/(kg·h)维持,诱导后手术开始时调整七氟烷的吸人浓度,直到降至靶目标血压,维持MAP在65 ～ 75mmHg至手术结束.分别记录麻醉诱导前(T0)、控制性降压开始时(T1)、30min(T2)和拔管时(T3)的心率(HR)、MAP、血浆肾上腺素(E)和去甲肾上腺素(NE)浓度,术中抽取桡动脉血行血气分析和乳酸浓度测定.用Fromme术野质量评分法评定术野质量,同时记录丙泊酚、芬太尼和七氟烷的用量和MAC值,观察麻醉恢复情况和不良反应发生率.结果 与Ⅰ组比较,Ⅱ组丙泊酚、芬太尼、七氟烷用量和MAC值均明显减少(p＜0.01),术野质量提高,术野质量评定(SSFQ)评分明显降低(p＜0.05);与Ⅰ组比较,Ⅱ组T0-T3时点HR明显减慢;T0、T3时点MAP、E、NE明显降低(P＜0.05);两组术中的血气分析和乳酸测定结果以及苏醒时间、拔管时间均无统计学差异(p＞0.05);与Ⅰ组比较,Ⅱ组术后鼻部胀痛头痛、谵妄躁动、寒战的发生率也明显降低(p＜0.05),但Ⅱ组需要干预的心动过缓发生率较Ⅰ组高(P＜0.05),两组均无严重心血管不良事件发生.结论 右旋美托咪啶可以减少麻醉药用量,增强围术期心血管稳定性,改善麻醉恢复过程,用于辅助鼻内窥镜手术控制性降压安全、有效.     

长期口服小剂量罗红霉素治疗鼻内镜鼻窦手术后迁延不愈的临床观察

目的探讨长期口服小剂量罗红霉素治疗鼻内镜鼻窦手术后迁延不愈患者的疗效。方法对符合入选条件的53例鼻内镜鼻窦术后患者口服罗红霉素（150mg／d）3个月,停药后顺延随访3个月观察其疗效。结果按鼻内镜检查结果,术腔完全上皮化,无异常分泌物,窦口周边上皮化,窦口开放良好者15例（28．3％）;术腔部分上皮化,有少量粘性分泌物,窦口呈开放状态22例（41．5％）;术腔仍有明显水肿,无明显上皮化倾向,有息肉形成,水肿粘膜阻塞鼻窦开口或鼻窦口闭锁,窦腔粘连16例（30．2％）。结论罗红霉素作为十四元环大环内酯类药物有其很好的抗炎作用。对鼻内镜鼻窦术后迁延不愈的患者有很好的疗效。     

Orbital complications of functional endoscopic sinus surgery: MR and CT findings

AIM: To describe the radiological findings of ophthalmic complications during functional endoscopic sinus surgery (FESS) and correlate them with the clinical manifestations and mechanisms of injury. METHODS: This was a retrospective review of the clinical and cross-sectional imaging findings of 9 patients with orbital complications during FESS. RESULTS: The most common site of entry into the orbit during FESS was the lower medial orbital wall (7 of 9), followed by the inferior orbital wall, resulting in injury to the medial rectus (4 of 9) and, less frequently, the inferior rectus (2 of 9) or superior oblique muscles (1 of 9). Extensive scarring on imaging (3 of 9) was associated with global ocular motility dysfunction. In contrast, localized scarring (3 of 9) or extraocular muscle trauma (6 of 9) resulted in disturbance of eye movement in the direction of gaze from the injured site. CONCLUSIONS: Orbital magnetic resonance and computed tomography findings correlate very well with the abnormal eye movements clinically observed, and can assist in clarifying the cause of injury and guide surgical corrective management of patients suffering orbital complications from FESS. Radiologists should be familiar with the recent developments in FESS instrumentation as well as with the most commonly injured structures within the orbit.     

Sphenoid sinus barotrauma in diving: case series and review of the literature

About 50% of scuba divers have suffered from barotrauma of the ears and about one-third from barotrauma of paranasal sinuses. The sphenoid sinuses are rarely involved. Vital structures, as internal carotid artery and optic nerve, adjoin the sphenoid sinus. Thus, barotrauma could lead to serious neurologic disorders, including blindness. After searching the literature (Medline) and other sources (Internet), we present some cases of sphenoid sinus barotrauma, because these injuries may be underreported and misdiagnosed due to the lack of awareness and knowledge. Therefore, information is provided, e.g. on anatomical and pathophysiological features. Divers and physicians should have in mind that occasional headache during or after diving sometimes signals serious neurological disorders like vision loss. We show that injuries can develop from both negative and positive pressures in the sinuses. Because visual recovery depends on prompt diagnosis and proper therapy, physicians like otolaryngologists, ophthalmologists and neurologists need to closely collaborate.     

内窥镜鼻窦外科手术治疗后组筛窦及眼球后病变38例临床探讨

 目的 探讨内窥镜鼻窦外科手术治疗后组筛窦及眼球后病变的疗效.方法 使用国产内窥镜对38例(42侧)病人施行手术治疗,其中鼻窦炎鼻息肉30例(34侧)、外伤5例(5侧)、肿瘤3例(3侧).肿瘤病人术后结合放疗/化疗.结果 按照海口会议(1997)临床分型分期标准,鼻窦炎鼻息肉治愈率83.33%、好转10.0%、无效6.6%,外伤病人术后眼部症状消失、视力提高4.2～5.0,肿瘤病人术后随访24～48个月无复发.结论 内窥镜鼻窦外科手术是治疗后组筛窦及眼球后病变的理想方法.强调术前CT扫描检查、术中掌握技术操作及术后局部换药处理.     

功能性鼻内镜手术九步法标准化治疗慢性鼻窦炎临床疗效观察

目的 探讨功能性鼻内镜手术(FESS)九步法标准化治疗慢性鼻窦炎的临床疗效.方法 回顾性分析北部战区空军医院耳鼻喉科自2018年1月至2019年12月收治的慢性鼻窦炎并实施FESS九步法手术标准化治疗的93例患者的临床资料.记录并比较患者术前、术后3个月及术后6个月的症状视觉模拟量表(VAS)评分、鼻内镜Lund-Ke...     

Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.Correspondence to: M. Mantoni