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PURPOSE: Septal perforations (SPs) present a distinct challenge. There are many described surgical approaches with variable success rates. The goal of this study is to describe a new technique in repairing SP. METHODS: A case series of eighteen patients with anterior septal perforation who underwent endoscopic repair with the "tunnel technique" based on anterior ethmoid artery flap (AEA) were analyzed. Demographic data, etiology, size of perforation, and success rate were collected. RESULTS: Eighteen cases with male predominance (67%) were enrolled from 2019 to 2022. The average perforation size was 1.5 cm (0.5- 3.6 cm). The success rate of complete SP closure was 94% (n = 17/18) with no complications after surgery. The patients were followed up for 7 ± 5.2 months. CONCLUSIONS: AEA flap reconstruction with the tunnel technique is associated with favorable outcomes in SP closure. The tunnel technique provides a useful flap bolster and minimizes the use of other supportive measures. This technique offers an addition to other techniques for septal perforation repair. LEVEL OF EVIDENCE: Level 4.
RESUMEN
BACKGROUND: Pneumosinus dilatans (PSD) is a rare pathological paranasal sinus expansion. This condition is usually symptomatic or cosmetically apparent, requiring surgical intervention. Multiple hypotheses have been postulated as to the cause of this condition; however, the precise cause and pathogenesis remain obscure. CASE REPORT AND METHODS: An 11-year-old boy presented with right eye bulging and was subsequently found to have PSD of the maxillary sinus. A search was conducted of the PubMed electronic database, using the keywords "pneumosinus dilatans," "pneum(oco)ele," "pneum(oc)ele," "pneum(atoco)ele," and "air cyst." Articles published in English were reviewed. RESULTS: The literature review identified 29 cases of PSD involving the maxillary sinus. The mean age of presentation was 25 years old. Only the right maxillary sinus was affected in 16 cases, followed by the bilateral sinuses in 7 cases and the left sinus in 6 cases. In 5 cases, all paranasal sinuses, along with the maxillary sinus, were expanded. The most common presenting symptom was facial swelling, which was found in 55% of the cases, followed by proptosis and pain. Computed tomography is the gold standard radiological method for diagnosing PSD. CONCLUSIONS: Pneumosinus dilatans is a rare condition that is usually symptomatic and requires surgical intervention. The etiology of the disease is attributed to multiple hypotheses, but more studies are needed to explore this condition further.
RESUMEN
OBJECTIVE: To address the factors affecting recurrence after endoscopic surgical repairs of spontaneous cerebrospinal fluid leak, specifically the influence of using lumbar drains. METHODS: This study involved a retrospective data analysis, including a chart review of all spontaneous cerebrospinal fluid (CSF) leak cases who underwent endoscopic anterior skull base repair from 2012-2017 in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. RESULTS: Thirteen patients with spontaneous CSF leaks were identified and evaluated. The majority were females (92.3%) with an average body mass index of 34.9. All patients underwent endoscopic repair with intra-operative lumbar drain placement. Patients continued having post-operative lumbar drain for an average of 6.4 days. Four patients (30.8%) developed recurrence; however, only one of those had a documented high opening pressure. CONCLUSION: Spontaneous CSF leak repairs are at a higher failure risk and may have an underlying pathology involving CSF circulation. The use of lumbar drains and intracranial pressure lowering agents are controversial and seems to be reserved only for high risk patients; however, the higher risk of recurrence in this group may be better managed by proper pre-operative evaluation and selective, patient-specific management protocols.