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H Stammberger

Publications and source records attributed to H Stammberger.

At least 37 records · Page 2Linked to original sources
PubMed2000

[A new therapy concept in esthesioneuroblastoma].

BACKGROUND: We introduce a new concept in treatment of esthesioneuroblastomas, developed in the University Medical School of Graz, Austria. PATIENTS AND METHODS: Six patients suffering from esthesioneuroblastoma have been treated in the years 1993-1999; five of them with a curative aspect, one with a palliative one. Three tumours were classified according to Kadish as stage B, three as stage C. The selection criteria included tumours without deep infiltration into the orbit nor into the pterygopalatine fossa and without any involvement of the posterior wall of the frontal sinus. The treatment consists of endoscopic nasal and paranasal sinus surgery and consecutive stereotactic radiosurgery by means of the Gamma-Knife unit. RESULTS: Over an average follow-up period of 38 months all patients remained free of disease. Because of the minimally invasive character of our concept the complications and side effects are minimised and the patients are less traumatised in comparison to conventional treatment such as craniofacial resection or irradiation. CONCLUSION: Due to the excellent outcome of our six patients we recommend this new treatment concept, in selected cases, as an alternative to the usual therapeutic modalities for esthesioneuroblastoma.

Adult↗
PubMed2000

The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment.

OBJECTIVES: To describe a new treatment modality of olfactory neuroblastoma consisting of endoscopic nasal and paranasal sinus surgery and stereotactic radiosurgery. STUDY DESIGN: Retrospective review of three patients suffering from olfactory neuroblastoma. METHODS: Review of the charts, the computed tomography, and magnetic resonance imaging scans, the operation reports, radiosurgical data, and follow-up. RESULTS: All three patients remained free of disease with excellent quality of life in respective follow-up periods of 71, 50, and 39 months. CONCLUSION: The combination of two minimally invasive therapies, endoscopic sinus surgery and stereotactic radiosurgery, provide a reliable new approach to the treatment of a series of olfactory neuroblastomas that offers excellent quality of life, less injury to the patient, fewer side-effects, and fewer long-term effects than other treatment strategies.

Adult↗
PubMed2000

Nasopharyngeal angiofibroma: true neoplasm or vascular malformation?

Nasopharyngeal angiofibromas (NA) are rare tumor-like lesions characterized by architecturally irregular vessels set in a fibrous stroma. The unique morphology, the strong predilection for male adolescents, and the uncertainty about its etiology contributes to significant confusion regarding the classification of NA, which still has not been solved today. Based on immunohistochemical and electron microscopic examinations, we demonstrate in detail the various unusual vascular architectural features of NA. They represent discontinuous vascular basal laminae, focal lack of pericytes, and pronounced irregularity of the smooth muscle layers. In thick smooth muscle layers and pads, the orientation of muscle cells is frequently disturbed, and the individual cells differ in size and shape. Occasionally, the muscle layers disperse peripherally into individual cells, creating the impression of vessel-independent smooth muscle cells within the stroma. The summation of all morphological irregularities demonstrated in this paper allows the conclusion that NA represent vascular malformations.

Actins↗
PubMed2000

Management of acute surgical orbital haemorrhage: an otorhinolaryngological and ophthalmological perspective.

This retrospective report describes the management and outcome of seven patients who suffered an acute surgical orbital haemorrhage (ASOH), secondary to a surgical procedure performed on either the sinuses, orbits or eyelids. All patients but one recovered their pre-operative vision. A management plan is outlined on how to assess and tackle this complication, so that the ENT surgeon may be better prepared to meet such an acute surgical emergency, should it arise.

Adult↗
PubMed2000

Idiopathic sclerotic inflammation of the orbit with left optic nerve compression in a patient with multifocal fibrosclerosis.

We present the MR imaging findings in a 43-year-old male patient with bilateral idiopathic sclerosing inflammation of the orbit. Bilateral enhancing retrobulbar masses, with concentric compression of the retrobulbar segment of the left optic nerve, were seen. MR imaging proved to be the only means to distinguish between the different intraorbital structures and to determine the exact site of optic nerve compression. To our knowledge, this is the first documented case of MR imaging findings of this entity.

Adult↗
PubMed2000

Nasopharyngeal angiofibroma: an APC-gene-associated tumor?

Nasopharyngeal angiofibromas are extremely rare, locally invasive tumors of unknown cause exclusively occurring in male adolescents. Recently, 6 cases have been reported in patients with familial adenomatous polyposis coli (Gardners syndrome). Mutations or allelic loss of the adenomatous polyposis coli (APC) gene have therefore been implied in the pathogenesis of nasopharyngeal angiofibroma. The authors analyzed 11 cases of nasopharyngeal angiofibromas from 9 male patients for mutations in the mutation cluster region and allelic loss of the APC gene. Six were primary tumors; 2 first recurrences; and 1, primary tumor with 2 recurrences. Direct sequence analysis was performed on several overlapping polymerase chain reaction (PCR) products. Detection of allelic loss was performed by restriction length polymorphism analysis at a polymorphic locus. No mutation was detected in 11 tumors of 9 different patients. None of the 9 informative (heterozygous) cases carried an allelic loss. We conclude that alterations of the APC gene do not play a major role in the development of nasopharyngeal angiofibroma. The coincidence of nasopharyngeal angiofibromas and adenomatous polyposis coli in some families implies the possibility that another gene in this region might be responsible for the development of nasopharyngeal angiofibromas. HUM PATHOL 31:1411:1413.

Adolescent↗
PubMed1999

[Ultrasound investigation of cervical lymph node metastases: conception and results of a histopathological exploration].

BACKGROUND: Ultrasound (US) is one of the most important methods for detection of cervical lymph node metastases in malignancies of the head and neck. In our study, the specificity of ultrasound was explored by a special, histopathological exploration considering the anatomical regions of the neck. METHODS: Thirty-eight patients were studied (5 female, 33 male, age: 38-86 years) with different histology and incidence of metastatic spread of head and neck cancers. Forty-six neck dissections were performed (30 radical and 16 selective). Histological exploration was performed after pinning the neck soft tissue with needles to anatomical live drawings of the lymph node regions, a modification of the Medina procedure. This procedure allowed a correct topographical assignment of lymph node metastases and comparison of preoperative sonographical findings with histopathological results. RESULTS: We isolated 1333 lymph nodes, 137 of them infiltrated by metastases. These lymph node metastases were found in 28 of 46 neck dissections. The number of lymph nodes in radical neck dissections ranged from 21 to 60 (mean: 36), in selective neck dissection from 1 to 43 (mean: 16). Sensitivity, specificity, and accuracy of ultrasound reached 96%, 69%, and 78%, respectively. Seventy-two lymph node metastases (52%) of 12 neck dissections could not be evaluated by ultrasound. CONCLUSIONS: Our results confirm the reliability of ultrasound regarding sensitivity, specificity and accuracy of US-detectable cervical lymph nodes as reported in world literature. However, we were able to demonstrate in special histopathological explorations, that ultrasound did not detect more than 50% of present lymph node metastases in our series. We consider it essential to perform histopathological explorations of the soft tissue of the neck as described in our study to evaluate the efficacy and reliability of US, CT, and MRI in detecting lymph node metastases of head and neck malignancies.

Adult↗
PubMed1999

[Computer assisted localization in endoscopic sinus surgery--state of the art? The Insta Trak system].

BACKGROUND: Image-guided surgery is increasingly acknowledged as useful technology also for endoscopic sinus surgery. For many years our department has been involved in the development and testing of devices for image-guided endoscopic sinus surgery. Since January 1997 we have been testing the "Insta Trak" System, which is based on electromagnetic tracking and was especially designed for use in endoscopic sinus surgery. METHODS: We tested practicability and accuracy of the system in a wide range of cases from standard sphenoethmoidectomies to tricky frontal sinus surgery, from endoscopic tumour surgery to endoscopic repair of CSF fistulas. System accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as via computer screen. Additionally we measured the time for setting up the system, total operating time and rating of the subjective surgeon's assessment of the system's usefulness in each particular case. RESULTS: We present the results according accuracy and practicability in 45 patients, who were operated on under computer-aided guidance. Our overall experience with the "Insta Trak" system was very positive. It was no longer the indeed promising, but still rather circumstantial and not always reliable technique we were used to. Operating the system was relatively easy and did not require excessive computer skills. We measured an average accuracy of 0.69 mm with a maximum deviation of 2 mm in a single test measurement. Incorrect use of the device, however, may significantly increase the possible weight of system errors. CONCLUSIONS: The system accuracy was high and "Insta Trak" proved to be practicable and efficient in daily clinical routine. Especially in complicated cases like revision surgery "Insta Trak" proved to be extremely helpful. Whether a system like "Insta Trak" will be definitely able to lower complication rates in FESS is still an open question. Certainly in the near future no such navigational device will become a substitute for the surgeon's understanding of anatomy. In our opinion and experience "Insta Trak" is a significant development in sinus surgery. However, one must be aware of the fact that it cannot be more than yet another and indeed helpful tool.

Endoscopes↗
PubMed1999

Plasma adrenaline concentrations during functional endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: Vasoconstrictors (i.e., epinephrine) are routinely applied before functional endoscopic sinus surgery (FESS) but may have significant cardiac side effects. The controversy concerning clinical application of adrenaline is discussed. STUDY DESIGN: In a prospectively controlled study of 51 patients undergoing FESS we evaluated the absorption of adrenaline from standard cotton pledgets and submucous infiltration and the incidence of related side effects during surgery. Additionally, a control group of 12 patients undergoing tonsillectomy was investigated. METHODS: Plasma adrenaline concentrations were measured 1) before anesthesia, 2) after intubation, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1:1000) and submucous infiltration with 2 mL lidocaine with adrenaline 1:100,000 in each side, and 4) at end of surgery. The catecholamines were determined with a Merck-Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt, Germany). Pulse, electrocardiogram (ECG), and blood pressure were monitored. RESULTS: In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) (P < .001), whereas the heart frequency was unaffected during surgery. All patients in the adrenaline group showed significant increase in plasma adrenaline (AD) concentrations in the third and fourth sample (P < .001). The control group, however, showed a significant rise in blood pressure only at beginning of surgery (P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surgery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients. CONCLUSIONS: Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline-related side effects during FESS are extremely rare when the patient is monitored exactly.

Anesthesia, General↗
PubMed1999

Surgical treatment of nasal polyps: past, present, and future.

Considerable changes have taken place over the last two decades in the surgical approach to nasal polyposis. The advent of the endoscope has enabled earlier detection and less traumatic and more precise surgical treatment of diseases presenting with nasal polyps. The concept of functional endoscopic sinus surgery (FESS) offers individualized surgery according to the respective patient's disease, and routine radical surgical procedures can be avoided with good functional results. In patients with aspirin intolerance, allergic fungal sinusitis and asthma, nasal polyposis is histologically dominated by dense eosinophilic infiltration and requires a more aggressive approach, often involving combined therapy with corticosteroids. In these cases, extensive postoperative care and follow-up is required to preserve the good postoperative result and to prevent regrowth of polyps.

Humans↗
PubMed1999

Mucocele in an orbitoethmoidal (Haller's) cell (accidentally combined with acute contralateral dacryocystitis).

Haller's cells--according to recent terminology now called orbitoethmoidal cells (OEC)--are defined as anterior or posterior ethmoidal cells that have developed into the orbital floor. They can be excessively pneumatized and thus contribute to obstruction of the ostiomeatal complex area. We present the case of a 42 year old white male, who was admitted for treatment of an acute dacryocystitis on the right side. The CT scan revealed moderate sinusitis of the right ethmoid and maxillary sinuses and coincidentally a mucocele in an OEC on the left side. An endoscopic dacryocystorhinostomy on the right and a revision of the mucocele on the left side were performed in the same sitting. We consider both indications--stenosis of the nasolacrimal duct as well as mucoceles rewarding indications for endoscopic surgery. An external approach to the nasolacrimal duct in this case would have been problematic, as the external skin and soft tissue covering the duct already showed severe inflammatory changes. The operation of the up until that time asymptomatic mucocele was of prophylactic character. To our knowledge this is the first report of a mucocele developing in an OEC in the literature.

Acute Disease↗
PubMed1999

Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies.

Over the last decade, the use of rigid endoscopes in surgery of tumorous lesions of the nose, paranasal sinuses, nasopharynx and anterior skull base has extended and diversified. Endoscopic surgical approaches for malignant lesions are very controversially discussed as of today, yet. From 1989-1999 we have treated 43 patients with invasive/destructive tumors of the paranasal sinuses and the anterior skull base strictly endoscopically, transnasally. These included 5 patients with juvenile angiofibromas and 36 patients with various malignant tumors, one with a large invasive macroadenoma of the pituitary and one case of a craniopharyngeoma. The age range was 3 months to 82 years. Whereas the very first patients were approached endoscopically in a palliative intention, we have started endoscopic surgery for selected malignancies with curative intention in the last years. Histologically, patients with various carcinoma differentiation were operated (n = 18), as well as patients with malignant melanoma (n = 5), esthesioneuroblastoma (n = 8), clivus chordoma (n = 3), immature teratoma (n = 1) and leiomyosarcoma (n = 1). Our first results appear to indicate, that outcome is at least equal to standard external approaches, however with excellent functional terms and significantly better overall quality of life. The limitations result from the anatomical spread of the tumor, when extensive infiltration of orbit, dura/brain and other vital structures exist. However, in experienced hands, endoscopic surgery in this region can be rather radical, bone and even dura of the anterior skull base can be resected as can the periorbit, and all structures reconstructed in the same session. Endoscopic techniques lend themselves very well to cooperation with neighbouring specialities like neurosurgery. In individual cases, gamma-knife therapy has proven an extremely helpful adjunctive. With this combined approach, all 8 patients with esthesioneuroblastoma are alive and free of disease with a mean observation time of 37.2 months. We will therefore continue to use this procedure in selected cases as a reliable alternative to external approaches in the future. However we recommend, that these techniques are only applied at centers, where all other surgical approaches can be performed, should need for this arise.

Endoscopy↗
PubMed1998

Expression of CD34-antigen in nasopharyngeal angiofibromas.

Formalin-fixed, paraffin-embedded and frozen tissues of 24 patients with primary nasopharyngeal angiofibroma, of whom seven had recurrences, were studied immunohistochemically for the expression of CD34 antigen using two different antibodies (HPCA-1 and QBEND 10). In all cases, there was an exclusive staining of endothelial cells, while pericytes, smooth muscle cells and stromal fibroblasts were not reactive. The staining intensity, however, was more pronounced in small tumor vessels of capillary- and sinusoidal-type than in larger vessels, which were usually characterized by an irregular smooth muscle coat. This differential staining indicates an increased proliferative potential of the endothelium of the small vessel component of nasopharyngeal angiofibroma (neoangiogenesis) and an inhibitory influence of vascular smooth muscle cells on endothelial cell growth. Moreover, the positive immunoreaction of all endothelial cells for CD34 is indicative of the absence of lymphatic vessels, which confirms previous ultrastructural observations. No differences in the staining pattern were observed between primary versus recurrent tumors, formalin fixed, paraffin embedded versus snap-frozen acetone fixed material, or between both CD34 antibodies. Our findings indicate that nasopharyngeal angiofibroma is a vasoproliferative malformation.

Adolescent↗
PubMed1998

Endoscopic optic nerve decompression: the Graz experience.

Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management, medical therapy, surgical treatment, and medical therapy combined with surgical decompression. Traditional surgical approaches to optic nerve decompression (OND) are a neurosurgical or craniotomy approach, extranasal transethmoidal approach, transorbital approach, transantral approach, and intranasal microscopic approach. Recent advances in instrumentation and surgical techniques have made an endoscopic approach to OND possible. Since 1991 endonasal endoscopic decompression of the optic nerve has been the surgical approach of choice in patients requiring OND in the authors' hospital. The endoscopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction, rapid recovery time, more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children, and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The authors' technique of endonasal endoscopic approach to OND, medical management, and indications for surgery and the results in 22 patients undergoing this procedure are discussed.

Adolescent↗
PubMed1998

Transnasal endoscopic removal of an extensive immature teratoma in a three-month-old child.

The use of endoscopy in the paranasal sinuses has grown and diversified in the past few years. We present a case of an immature malignant teratoma originating from the sinuses, with intracranial extension to the middle and posterior fossae, that was managed and removed endoscopically. At the age of 2 months, the patient was hospitalized for respiratory instability. Diagnosis was made with biopsy, and chemotherapy was introduced. After 4 weeks, an endonasal endoscopic approach was performed, and a complete macroscopic removal of the tumor was achieved without complications. Follow-up for 10 months with magnetic resonance imaging and endoscopic examination has not revealed recurrence. In selected cases, the endonasal endoscopic technique may be a good alternative to the external approach, reducing the operative trauma and mortality.

Endoscopy↗
PubMed1997

Immunohistochemical and electron microscopical characterization of stromal cells in nasopharyngeal angiofibromas.

Twenty-eight cases of nasopharyngeal angiofibroma were studied immunohistochemically for cytoskeletal phenotyping of stromal cells. Electron microscopy was also used to study the ultrastructure of five of the tumors. All typical stromal cells showed intensive immunostaining for vimentin, but were negative for smooth muscle actin and desmin. Ultrastructurally, most of these cells appeared to be exclusively fibroblasts. However, in some areas stromal cells were seen that morphologically resembled myofibroblasts by their shapes and arrangement, and were characterized by the coexpression of vimentin and smooth muscle actin. Electron microscopy confirmed their myofibroblastic nature. The present study showed that the typical stromal cells in nasopharyngeal angiofibromas were fibroblasts and not myofibroblasts. In these tumors myofibroblasts occurred only focally, in connection with fibrotic areas and exclusively as a vimentin+/actin+cytoskeletal phenotype. This indicates that myofibroblasts are not primary stromal tumor cells in nasopharyngeal angiofibromas, but occur due to regressive changes.

Adolescent↗
PubMed1997

Endoscopic surgery of uni- and bilateral choanal atresia.

From 1992 to 1996 six children and one adult woman presented at our clinic with choanal atresia. In four newborns bilateral choanal atresia was found and in two older infants and one adult unilateral atresia was discovered. Although several different techniques for management of posterior choanal atresia (PCA) are described already in the literature, we decided to try a new approach using rigid endoscopes. This techniques enables the surgeon to visualize the whole atresia plate directly and to see the tips of his instruments. Under direct view it is possible to safely remove the bony plate and to allow immediately for an adequate and persistent airway. This technique is less traumatic and minimizes the risks of conventional surgery. Follow-ups after 1, 2 and 3 years still showed remaining opening of the posterior nose and normal physical development. A second surgical intervention was necessary after 9 months in one case of a newborn however, in whom the first procedure was performed as an emergency on the second day of his life.

Adenoidectomy↗