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Pete S Batra

Publications and source records attributed to Pete S Batra.

At least 19 recordsLinked to original sources
PubMed2007

Intraoperative surgical navigation for endoscopic sinus surgery: rationale and indications.

PURPOSE OF REVIEW: The present review discusses the rationale and indications for image-guided surgery through a critical discussion of registration concepts as well as clinical reports. RECENT FINDINGS: The surgical navigation accuracy achieved by commercially available image-guided surgery systems is best reported as target registration error. Clinically achievable target registration error is probably in the 1.5-2.0 mm range. Dry lab studies of registration serve to highlight the principles of registration, the process through which image-guided surgery systems calculate the one-to-one mapping relationship between the preoperative imaging data and the intraoperative surgical volume. Reports on image-guided surgery have highlighted its usefulness in primary and revision endoscopic sinus surgery, osteoplastic frontal sinusotomy, transsphenoidal hypophysectomy, endoscopic cerebrospinal fluid leak repair and endoscopic pterygomaxillary fossa biopsy. Both three-dimensional computed tomography angiography and computed tomography-magnetic resonance fusion images have been incorporated into IGS for advanced minimally invasive endoscopic skull base procedures. The American Academy of Otolaryngology-Head and Neck Surgery policy statement accurately summarizes the current consensus for image-guided surgery applications. SUMMARY: Image-guided surgery has emerged as an important technology, which both general otolaryngologists and subspecialty rhinologists can employ for a wide variety of procedures.

Endoscopy↗
PubMed2006

The role of endoscopy in the allergist's office.

The introduction of nasal endoscopy has revolutionized the diagnosis and management of patients with sinonasal disorders. The brilliant illumination and magnification afforded by the nasal endoscopes has markedly enhanced the current knowledge of sinonasal anatomy and understanding of patterns of mucociliary clearance. Nasal endoscopy facilitates accurate diagnosis of sinonasal pathology and assessment of response to medical and surgical therapy by serial examination. Rigid telescopes also facilitate office-based procedures, including cultures of purulent secretions and biopsy of sinonasal masses. Indeed, nasal endoscopy forms the foundation of the surgical paradigm of functional endoscopic sinus surgery. In this review, the rationale, technique and current state of endoscopic applications of nasal endoscopy are described, with special focus on the role of endoscopy in the allergist's office.

Allergy and Immunology↗
PubMed2006

Computer aided surgery: concepts and applications in rhinology.

Computer-aided surgery (CAS) has become relevant in a growing number of disciplines. This article will describe the history and principals of CAS and explain some of the technical issues, applications, and outcomes for CAS in the domain of rhinology.

Electromagnetic Phenomena↗
PubMed2006

Endoscopic management of sinonasal malignancy.

The advent of rigid telescopes has revolutionized the management of rhinologic disease. These instruments have been used as a diagnostic and therapeutic tool for paranasal sinus inflammatory diseases since the 1970s. Endoscopic techniques have been used for treating increasingly complex intranasal pathology, including nasolacrimal duct obstruction, cerebrospinal fluid leaks/encephaloceles, dysthyroid orbitopathy, and optic neuropathy. Recently, endoscopic techniques have also been used successfully to manage selected tumors, including inverted papilloma, angiofibromas, and hypophyseal tumors. This article reviews patient evaluation strategies, surgical techniques, and outcomes data for the minimally invasive endoscopic resection.

Craniotomy↗
PubMed2006

CT-MR image fusion for the management of skull base lesions.

OBJECTIVE: Image fusion software creates composite images from computed tomography (CT) and magnetic resonance (MR) images. STUDY DESIGN AND SETTING: CT-MR fusion studies between August 2004 to July 2005 were reviewed. CT scan images (1-mm axial) were obtained on a multi-detector CT scanner. MR images (1-mm axial) were obtained with a T1-weighted, volume acquisition technique. CT-MR fusion images were created on the Instatrak 3500 Plus or CBYON Suite. RESULTS: A total of 25 patients had 27 CT-MR image fusion studies. CT-MR fusion accuracy was 2 mm or better. During preoperative planning and intraoperative navigation, CT-MR fusion facilitated the delineation of the anatomic relationships between the lesion and the skull base. CONCLUSIONS: CT-MR image fusion yields composite images that combine features of each component imaging modality. Image fusion, when combined with surgical navigation, further enhances potential skull base applications for minimally invasive endoscopic surgery.

Adult↗
PubMed2006

Contour and paired-point registration in a model for image-guided surgery.

OBJECTIVES/HYPOTHESIS: This study assesses target registration error (TRE) of contour-based registration (CBR) and paired-point registration (PPR) for endoscopic sinus surgery. STUDY DESIGN: The experimental registration model consisted of a replica of a human head (Sawbones #1345-27; Pacific Research Laboratories, Vashon, WA). Twelve surface fiducial markers were affixed to the simulated skin on the model, and titanium screws were placed in the regions of the anterior ethmoid (AE) and sphenoid face (SF). An axial computed tomography scan (1-mm slice thickness) was then obtained. METHODS: Registration was then performed on the InstaTrak 3500 Plus (GE Surgical Navigation & Visualization, Lawrence, MA) with the standard PPR protocol with 12 points and CBR protocol with 500, 250, 125, 50, and 4 points. TRE was then calculated at the AE and SF targets. RESULTS: Target registration error was significantly lower for paired-point registration compared with contour-based registration (AE, 0.5 mm vs. 1.5 mm, P < .0001; SF, 0.8 mm vs. 1.5 mm, P < .0001). Among contour-based registration protocols, target registration error at the sphenoid face was lowest with 50 points (1.5 mm, P < .02). At the anterior ethmoid, contour-based registration with 50 points produced a lower target registration error than contour-based registration with 125 points (1.5 vs. 1.8 mm, P < .01). Other target registration error values for CBR were similar at both regions. The target registration error interquartile range was lowest with CBR-125 at both regions. CONCLUSIONS: Paired-point registration provided significantly lower target registration error. Contour-based registration with 125 points (and possibly as few as 50 points) produces clinically acceptable target registration error. This registration model elucidates important concepts about registration for surgical navigation for sinus surgery.

Bone Screws↗
PubMed2005

Image-guided sinus surgery: current concepts and technology.

Image-guided surgery (IGS) has gained considerable acceptance in rhinologic surgery. Principles of registration paradigms and registration error serve to define certain intrinsic limitations of this technology. Real-world experiences have further elucidated other concepts that may guide the appropriate use of IGS. With such knowledge, the rhinologic surgeon may incorporate IGS into a wide range of procedures.

Humans↗
PubMed2005

Isolated sphenoid sinus disease: etiology and management.

OBJECTIVE: To evaluate the diagnosis and management of isolated sphenoid sinus disease by using the current rhinologic standard of care. STUDY DESIGN: Retrospective chart review. RESULTS: Fifty sequential, symptomatic patients were studied. Presenting symptoms included headache or facial pain (88%), rhinorrhea (46%), and nasal congestion (26%). All patients underwent CT imaging, demonstrating bony changes or dehiscences (42%), a mass (24%), or complete opacification of the sphenoid sinus (22%). Eighty percent required surgical intervention. The most frequent diagnoses were as follows: sinusitis (38%), fungal ball (20%), neoplasm (16%), and mucocele (12%). Treatment resulted in clinical or endoscopic improvement or resolution in 87% of the patients. CONCLUSION: The presenting symptoms of isolated sphenoid sinus disease can be nonspecific and may result in an inordinate delay in diagnosis. Nasal endoscopy and radiologic imaging are central to making an accurate and timely diagnosis. Medical treatment or minimally invasive surgical techniques can successfully manage the majority of patients with persistent or refractory symptoms.

Adolescent↗
PubMed2005

Comparison of delivery of topical medications to the paranasal sinuses via "vertex-to-floor" position and atomizer spray after FESS.

INTRODUCTION: Topical nasal medications are frequently employed for persistent sinonasal symptoms after functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis patients. The optimal means for the delivery of these medications is unclear. In this study, the efficacy of the vertex to floor (VF) position compared to atomizer spray was evaluated in post-FESS patients. METHODS: Three trials were performed: two trials in which patients maintained the VF position for 1 and 5 minutes, respectively, after nasal drop administration were compared to a third trial utilizing an atomizer spray in the upright position. Two independent observers rated the distribution of fluorescein-dyed dexamethasone drops at 5 sinonasal sites: maxillary sinus (MS), ethmoid cavity (EC), frontal recess (FR), sphenoid sinus (SS), and olfactory cleft (OC). RESULTS: VF position consistently delivered nasal drops to the MS, EC, SS, and OC. The atomizer distributed drops to the MS, EC, SS, and FR. The greatest difference was noted with the nasal drops in the olfactory cleft in the VF position; statistical significance was achieved with ANOVA testing (P = 0.012). Student's paired t test comparing trial 1 to 2, 1 to 3, and 2 to 3 demonstrated greater distribution in the OC at 5 minutes compared with 1 minute and spray (P = 0.042 and 0.003). CONCLUSIONS: The VF position and atomizer spray were both effective in delivery of the dexamethasone drops to the paranasal sinuses. This has significant implications for management of patients suffering from recalcitrant chronic rhinosinusitis and/or sinonasal polyposis through the delivery of topical medications to the paranasal sinuses and olfactory cleft. EBM RATING: C.

Administration, Intranasal↗
PubMed2005

Transnasal endoscopic resection of lesions of the clivus: a preliminary report.

OBJECTIVE: To review our experience with transnasal endoscopic resection of clival lesions. BACKGROUND: Because of the surrounding vital structures and the difficulties in achieving wide surgical exposure, the treatment of clival lesions is challenging. In an effort to overcome these obstacles, many centers use facial incisions and osteotomies to approach clival lesions. Minimally invasive endoscopic techniques have the potential to minimize morbidity while yielding similar surgical results. STUDY DESIGN: Retrospective chart analysis. MATERIALS AND METHODS: Patients with tumors involving the clivus that underwent endoscopic resection between 2000 and 2004 were identified. Charts were reviewed for clinical characteristics, previous therapies, diagnosis, tumor extent, management modalities, length of hospital stay, complications, and outcome. RESULTS: A total of six patients were identified. There were four males and two females with a mean age of 50 years, ranging from 29 to 66 years. The most common presenting symptoms were visual disturbances. Three patients had prior craniotomy with subtotal tumor resection. The pathology included three clival chordomas, and one each of meningioma, adenoid cystic carcinoma, and sinonasal undifferentiated carcinoma. All patients were managed with computer-aided transnasal endoscopic tumor resection with neurosurgical standby or involvement. None of the patients required additional craniotomies. The mean follow-up was 13 (range, 8-24) months. Intensity-modulated radiation therapy was used in three patients, and two patients are currently undergoing proton beam radiation therapy (PBRT). The average length of hospital stay was 2 (range, 2-3) days. There were no major postoperative complications. At the last follow-up, five patients were alive with two patients being free of disease. Two patients with residual disease are currently undergoing PBRT, and one patient developed distant metastasis. One patient died of unrelated causes. CONCLUSIONS: This preliminary report suggests that transnasal endoscopic management of clival lesions is a viable option to traditional open approaches with acceptable morbidity and mortality. The use of computer-aided surgery further minimizes surgical risks while maximizing tumor resection.

Adult↗
PubMed2005

Three-dimensional computed tomography angiography of the internal carotid artery for preoperative evaluation of sinonasal lesions and intraoperative surgical navigation.

INTRODUCTION: Three-dimensional computed tomographic angiography (3DCTA) demonstrates the spatial relationships of the internal carotid artery (ICA) and adjacent skull base. This imaging modality may be incorporated into intraoperative surgical navigation during endoscopic skull base surgery. METHODS: The charts of patients who had undergone 3DCTA imaging between July 2002 and February 2005 were reviewed. For 3DCTA, 1 mm axial computed tomography (CT) scan images were obtained with simultaneous intravenous contrast bolus on a multidetector CT scanner (Somatom Sensation 16, Siemens, Munich, Germany). The CBYON Suite version 2.6 to 2.8 (Med-Surgical Services, Mountain View, CA) was also used for creating CTA images through its volume-rendering protocols. RESULTS: A total of 22 3DCTA studies were performed for diagnostic evaluation or preoperative planning. In 18 instances, the 3DCTA images were used during intraoperative surgical navigation. The specific indications for obtaining the 3DCTA study included neoplasm (11 cases), cerebrospinal fluid leak (3 cases), fibro-osseous lesion (2 cases), mucocele (2 cases), and other (4 cases). Images generated by 3DCTA facilitated the definition of the anatomic relationships between the ICA and skull base lesion. During intraoperative surgical navigation, the 3DCTA provided critical information about the ICA location and adjacent skull base anatomy in the operative field. CONCLUSIONS: 3DCTA is a useful means for assessing the ICA and its relationship to skull base lesions. Incorporation of 3DCTA into intraoperative surgical navigation facilitates the comprehension of operative field anatomy in the ICA region. As a result, this imaging technique, especially when combined with intraoperative surgical navigation, may extend the applications of minimally invasive endoscopic approaches to the skull base.

Adolescent↗
PubMed2005

Outcomes for endoscopic resection of sinonasal squamous cell carcinoma.

OBJECTIVES: Preliminary data suggest efficacy for the endoscopic approach for sinonasal malignancy. The purpose of this study is to evaluate the effectiveness of the endoscopic approach for the resection of sinonasal squamous cell carcinoma (SCC). STUDY DESIGN: Retrospective analysis of patients undergoing endoscopic resection of sinonasal SCC from August 1996 to May 2004. METHODS: Eleven patients were treated with curative intent. Demographic data, histopathology, extent of tumor involvement, and need for adjunctive radiation or chemotherapy were determined. Local recurrence (LR), distant metastasis, overall survival (OS), and disease-free survival (DFS) rates were calculated. RESULTS: The mean age for the patient population was 62.5 (52-85) years with a male:female ratio of 8:3. Multimodality therapy including radiation or chemotherapy was used in 8 of 11 (73%) patients. Seven patients were resected using strictly an endoscopic approach, whereas four required combined endoscopic and neurosurgical resection. LR and distant metastatic rates were 20% and 0%, respectively. OS and DFS were both 91%, with mean follow-up of 31.5 (range 6-88) months. CONCLUSIONS: Endoscopic resection in combination with multimodality therapy is an effective method for curative resection of sinonasal SCC. In this preliminary study, it facilitated complete resection with acceptable LR and DFS rates.

Aged↗
PubMed2004

Software-enabled CT analysis of optic nerve position and paranasal sinus pneumatization patterns.

OBJECTIVE: Delineate the relationships among the optic nerve (CN II), the sphenoid sinus, and the sphenoethmoid cell. STUDY DESIGN: High-resolution CT scans of 64 frozen human cadavers were obtained on a Siemens VolumeZoom CT scanner (Munich, Germany) and transferred to a CBYON Suite Doctor Station version 2.6 (CBYON, Mountain View CA) for standardized review. RESULTS: Pneumatization around CN II was categorized into 5 types: no adjacent pneumatization (type 0), pneumatization adjacent to CN II (type 1), adjacent pneumatization with indentation (type 2), pneumatization of <50% CN II circumference (type 3), and pneumatization of >50% CN II circumference (type 4). The prevalence of types 0 to 4 CN II position relative to the sphenoid sinus was 4.7%, 25.8%, 39.8%, 14.1%, and 15.6%, respectively. The prevalence of sphenoethmoid cells was 28.1%. The prevalences of types 0, 1, 2, 3, and 4 CN II positions relative to the sphenoethmoid cell was 5.6%, 58.3%, 25%, 2.8%, and 8.3% respectively. CONCLUSIONS: Software-enabled CT review facilitated precise study of the anatomic relationships of CN II. Caution must be exercised during sinonasal surgery to minimize the risk of inadvertent CN II injury. EBM RATING: D.

Adult↗
PubMed2004

Radiologic imaging in rhinosinusitis.

To diagnose rhinosinusitis, the history and physical examination usually suffice. However, imaging may be necessary to guide further treatment in patients whose condition is refractory to treatment and patients with chronic or recurrent acute rhinosinusitis or acute rhinosinusitis with complications. A brief review of current imaging options and their recommended use is presented.

Humans↗
PubMed2003

Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma.

OBJECTIVE: To investigate the efficacy of endoscopic sinus surgery (ESS) in the management of chronic sinusitis and asthma in patients with nasal polyps and steroid-dependent asthma. STUDY DESIGN: Retrospective chart review. METHODS: The study included 17 patients who underwent ESS with nasal polyps, steroid-dependent asthma with or without aspirin sensitivity and a minimum of 1 year postoperative follow-up. Nine patients were ASA sensitive, and eight patients were ASA tolerant. Chronic sinusitis and asthma were evaluated using subjective (patient complaints) and objective (computed tomography scans, pulmonary function tests, steroid doses) criteria. Preoperative data were compared with data obtained 12 to 18 months postESS. Tissue samples were graded for degree of inflammation and edema. RESULTS: Thirteen of the 17 (76.5%) patients reported improved clinical symptoms postESS. The postoperative Lund-Mackay scores were statistically lower for the 17 patients (P <.0001). The group experienced improvement in postoperative forced expiratory volume at 1 second (FEV1) (P <.014). Twelve of 17 (70.6%) experienced reduction in systemic steroid usage (P <.048). The ASA sensitive patients did not have a statistical improvement in postoperative FEV1 (P >.08) and sinonasal symptoms (P >.16) compared with the ASA tolerant group. Polyp tissue from the ASA sensitive patients demonstrated more edema and more inflammation on average than ASA tolerant polyps, but the results were not statistically significant. CONCLUSION: ESS demonstrates a beneficial effect on the sinonasal and asthma symptomatology in patients with nasal polyps and asthma using objective measures. Subset of aspirin-tolerant patients have statistically better outcome for sinonasal symptoms and pulmonary function testing than aspirin-sensitive patients.

Adult↗
PubMed2002

Auditory and facial nerve function following surgery for cerebellopontine angle meningiomas.

OBJECTIVE: To investigate the postoperative auditory and facial nerve function results after cerebellopontine angle meningioma removal. DESIGN: Retrospective chart review. SETTING: Tertiary care referral center. PATIENTS: Twenty-one patients undergoing surgical removal of cerebellopontine angle meningiomas by the senior author (R.J.W.). INTERVENTIONS: Translabyrinthine or retrosigmoid approach for tumor extirpation. MAIN OUTCOME MEASURES: Postoperative auditory (pure-tone average and speech discrimination score) and facial (House-Brackmann scale) function within 1 year of follow-up. RESULTS: Twenty-three operations were performed on 21 patients. Hearing preservation through the retrosigmoid approach was attempted in 11 patients (48%). Normal hearing (class A) was preserved in 9 of 10 patients. Normal postoperative facial nerve function (House-Brackmann grade I) was conserved in 11 (65%) of 17 patients. CONCLUSIONS: This review demonstrates that successful hearing preservation is possible with meningiomas. Therefore, the retrosigmoid approach should be used whenever serviceable hearing is present preoperatively. Normal facial nerve function can also be preserved in the majority of patients.

Adult↗
PubMedDate not supplied

Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations.

INTRODUCTION: Chronic rhinosinusitis (CRS) exacerbations due to methicillin-resistant Staphylococcus aureus (MRSA) are routinely encountered. Treatment often involves intravenous antibiotics that provide only transient benefits. Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved by the Food and Drug Administration for the eradication of nasal colonization with MRSA. OBJECTIVE: The aim of this study was to describe the use of mupirocin nasal irrigations for the treatment of CRS exacerbations due to MRSA. MATERIALS AND METHODS: Charts of patients who received mupirocin nasal irrigations for MRSA exacerbations of CRS between January 2000 and October 2003 were reviewed. RESULTS: Forty-two MRSA-positive cultures were obtained from 24 patients (mean age, 61 years; range, 38-82 years; 15 women and 6 men). Twenty-eight episodes were treated with mupirocin nasal irrigations and doxycycline; 4 were treated with mupirocin nasal irrigations and trimethoprim-sulfamethoxazole, and 7 episodes were treated with mupirocin nasal irrigations alone. Patients were reevaluated at approximately 4 to 6 weeks. Repeat cultures were not obtained in 12 patients (because of clinical and endoscopic resolution). Adequate follow-up was unavailable for 3 patients, and of the 27 repeat cultures, only 1 grew MRSA. Twelve patients had at least one recurrence, with a mean number of episodes of 1.75 (range, 1-8 episodes). The mean follow-up was 11.8 months (range, 3-27 months). CONCLUSIONS: Mupirocin nasal irrigations may avoid the need for intravenous antibiotics, which often provide temporary benefits and entail greater cost and morbidity. Thus, mupirocin nasal irrigations may provide a relatively simple means for the management of MRSA exacerbations of CRS.

Administration, Intranasal↗