Biomedical subjects

Robert E Sonnenburg

Publications and source records attributed to Robert E Sonnenburg.

9 recordsLinked to original sources

PubMed2004

Revision endoscopic frontal sinus surgery.

PURPOSE OF REVIEW: Recurrent or persistent frontal sinus disease after endoscopic sinus surgery poses formidable challenges owing to the frontal sinus outflow tract's complex variable anatomy, close proximity to vital structures, and predilection for scarring and stenosis. Frontal sinus obliteration used to be the preferred technique of most sinus surgeons for addressing difficult frontal sinus disease; however, several effective endoscopic techniques exist as excellent alternative procedures for addressing this difficult clinical problem. RECENT FINDINGS: Several endoscopic techniques have been described for addressing these problems including endoscopic frontal sinusotomy, the frontal sinus rescue procedure, endoscopic transseptal frontal sinusotomy, and the modified Lothrop procedure. Advances in treating recurrent frontal sinus disease have included recent articles reviewing the long-term outcomes of some of these techniques, the prevalence of frontal sinus cells, the optimization of medical management, and the spectrum of postoperative debridement regimens. SUMMARY: When used in the appropriate setting, these less invasive revision endoscopic techniques provide excellent results with low morbidity and several advantages. This article reviews recent developments in the treatment of recurrent or persistent frontal sinus disease including incorporation of these techniques.

Endoscopy↗

PubMed2004

Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach.

INTRODUCTION: Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic, minimally invasive pituitary surgery (MIPS) to our last 50 sublabial transseptal (SLTS) procedures. STUDY DESIGN: Retrospective case control study. METHODS: Fifty consecutive MIPS procedures and 50 consecutive SLTS procedures were reviewed retrospectively. Complication rates were analyzed and compared. RESULTS: Total complications per patient (P = .005), postoperative epistaxis (P = .031), lip anesthesia (P = .013), and deviated septum (P = .028) occurred more often in the SLTS group. No significant difference was seen in cerebrospinal fluid leak, meningitis, ophthalmoplegia, visual acuity loss, diabetes insipidus, intracranial hemorrhage, or death. In the MIPS group, length of stay (P < .001), use of lumbar drainage (P = .007), and nasal packing (P < .001) were also significantly reduced. CONCLUSIONS: Endoscopic endonasal pituitary surgery provides improved complication rates when compared with SLTS approaches. In addition, we note advantages of the MIPS approach, including reduced length of hospital stay and decreased use of lumbar drainage and nasal packing.

Adult↗

PubMed2002

Biophysics of cochlear implant/MRI interactions emphasizing bone biomechanical properties.

OBJECTIVE/HYPOTHESIS: The forces exerted during a 1.5-Tesla MRI evaluation on the internal magnet of a cochlear implant (CI) raise concern about the safety for CI recipients. This study determines the magnitude of force required to fracture the floor of a CI receiver bed. METHOD: Recessed CI beds were drilled to maximum uniform thinness into formalin-fixed and fresh-frozen human calvaria specimens. A Med-El stainless steel CI template mounted to the piston of an electrohydraulic testing device was used to fracture the floor of the implant beds. Force and displacement were measured as a function of time using a digital data acquisition system. RESULTS: Mean force to first failure, displacement to first failure, and minimum thickness, respectively, were: group 1 (formalin-fixed, 0.3-0.4-mm thick [n = 22]), 34.08 N (8.21-59.64 N, standard deviation [SD] 15.41 N), 1.09 mm (0.40-2.16 mm, SD 0.51 mm), 0.36 mm (0.3-0.4 mm, SD 0.05 mm); group 2 (formalin-fixed, 0.5-0.9 mm thick [n = 21]), 52.82 N (20.28-135.53 N, SD 25.29 N), 1.08 mm (0.50-2.28 mm, SD 0.47 mm), 0.58 mm (0.5-0.9 mm, SD 0.12 mm); group 3 (fresh-frozen [n = 9]), 134.13 N (86.44-190.70 N, SD 34.92 N), 1.96 mm (1.47-2.46 mm, SD 0.35 mm), 0.42 mm (0.3-0.6 mm, SD 0.11 mm). CONCLUSIONS: The mean magnitude of force required to fracture the floor of a CI bed is significantly greater than those that are generated when a Med-El Combi 40+, CII Bionic Ear CI, or Nucleus Contour CI is placed into a 1.5-Tesla MRI unit.

Adult↗

PubMedDate not supplied

Sellar reconstruction: is it necessary?

BACKGROUND: Sellar reconstruction is practiced routinely during the transsphenoidal approach to pituitary tumor resection. This practice exposes the patient to risks of donor site complications and may interfere with measuring postoperative tumor reduction. We propose that it is not a necessary component of transsphenoidal pituitary surgery in the absence of intraoperative cerebrospinal fluid (CSF) leak. METHODS: A retrospective chart review of 45 cases of minimally invasive pituitary surgery were reviewed. Twenty-eight cases were identified with no sellar reconstruction being performed. Age, sex, revision surgery, postoperative CSF leak, days with lumbar drain, meningitis, ophthalmoplegia, visual acuity loss, postoperative epistaxis, diabetes insipidus, development of empty sella syndrome, and length of stay were investigated in these cases. RESULTS: Twenty-three cases were the primary procedure and five cases were revision surgery. Complication rates were low and compared favorably with those reported in the literature. Five cases of transient diabetes insipidus occurred. There was one postoperative CSF leak that required 4 days with a lumbar drain. No cases of empty sella syndrome developed. There were no cases of meningitis. The average length of stay was 2.9 days. CONCLUSION: Sellar reconstruction during transsphenoidal approach to pituitary tumor resection is not required for patients without evidence of an intraoperative CSF leak. This practice exposes the patient to the risks of donor site complications without reducing the rate of postoperative complications.

Adenoma↗

PubMedDate not supplied

The learning curve in minimally invasive pituitary surgery.

BACKGROUND: Minimally invasive pituitary surgery (MIPS) is performed via an endoscopic transnasal transsphenoidal approach. This provides excellent illumination, visualization, and magnification of the operative field, in addition to avoiding complications associated with other approaches. In this study we examined the first 45 cases of MIPS to determine if a learning curve exists for this technique. METHODS: A retrospective chart review was performed of the first 45 cases of MIPS at a major academic medical center. Cases were divided into three groups of 15 patients each. Group characteristics including age, sex, and revision surgery were compared. Complication rates investigated included death, intracerebral hemorrhage, intraoperative cerebrospinal fluid leak, postoperative cerebrospinal fluid leak, use of lumbar drain, meningitis, postoperative epistaxis, ophthalmoplegia, visual impairment, and diabetes insipidus. Other factors examined included intraoperative blood loss, length of stay, and tumor histology. One way analysis of variance statistical analysis was used to determine the significance of differences between groups. RESULTS: Groups were comparable in respect to characteristics studied. Statistically significant (p < 0.05) differences in complication rates and other factors between groups were not shown. Complication rates are low. CONCLUSION: This study does not establish a learning curve for our first 45 cases of MIPS. This finding supports the concept that an otolaryngology/neurosurgery team skilled in endoscopic techniques and pituitary surgery can safely transition from open approaches to an endoscopic approach in pituitary surgery.

Adult↗

PubMedDate not supplied

Increased role of the otolaryngologist in endoscopic pituitary surgery: endoscopic hydroscopy of the sella.

BACKGROUND: The aim of this study was to discuss the use of nasal irrigation and suction systems in endoscopic pituitary surgery to examine the sella and facilitate tumor removal. We describe a new technique of sellar exploration. METHODS: Following the endoscopic approach to the pituitary by the otolaryngology team, pituitary masses are resected. Then, the ClearESS nasal irrigation and suction system is used by the otolaryngology team to visualize the sella ("hydroscopy"). The combination of this ClearESS technology and angled endoscopes is used to scrutinize previously inaccessible areas of the tumor bed. RESULTS: Over 50 patients have undergone minimally invasive pituitary surgery via the endoscopic approach with postresection hydroscopy of the sella. The use of angled endoscopes in combination with the ClearESS technology greatly increased visualization of the sella, thereby facilitating complete tumor removal. There have been no complications associated with the use of hydroscopy. CONCLUSION: The use of angled endoscopes in conjunction with hydroscopy increases visualization of the sella. The otolaryngologist plays a critical role in this examination with manipulation of the angled endoscopes. Therefore, the role of the otolaryngologist is extended beyond the approach to the pituitary.

Endoscopes↗

PubMedDate not supplied

Staged endoscopic and combined open/endoscopic approach in the management of inverted papilloma of the frontal sinus.

BACKGROUND: The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined. METHODS: We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004. RESULTS: A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months. CONCLUSION: The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.

Endoscopy↗

PubMedDate not supplied

Concordance of middle meatal swab and maxillary sinus aspirate in acute and chronic sinusitis: a meta-analysis.

BACKGROUND: The medical management of acute and chronic sinusitis is a therapeutic challenge. The use of endoscopic middle meatal cultures as a noninvasive method to determine the bacteriology of the maxillary sinus has not accurately been established. The aim of this study was to review the literature that compares cultures obtained by endoscopic middle meatal swabs with those obtained from maxillary sinus aspirates (MSAs). METHODS: We reviewed studies published between January 1966 and October 2003 that were identified from searches of multiple databases, bibliographies, and original articles. Studies were included for analysis if they compared the results of endoscopic middle meatal cultures to aspirate cultures. All clinical variables and test performances were independently extracted by two reviewers. RESULTS: Middle meatal culture had a per isolate accuracy of 82% (95% confidence interval, 0.64, 0.92) compared with MSA (excluding coagulase negative staphylococcus and fungal cultures). CONCLUSION: Endoscopic middle meatal cultures have a high concordance with MSAs.

Acute Disease↗

PubMedDate not supplied

Endoscopically guided aerobic cultures in postsurgical patients with chronic rhinosinusitis.

BACKGROUND: There is considerable amount of debate in the literature regarding the microbial flora of normal, acutely infected, and chronically infected paranasal sinuses. Few studies have specifically looked at the microbial flora of healthy and infected sinus cavities after functional endoscopic sinus surgery. METHODS: One hundred thirty-four cultures were studied. All cultures were obtained using a standard technique. The nasal cavities were decongested and anesthetized, and nasal endoscopy was performed. When purulent secretions were identified, specimens of purulent secretions were obtained for incubation. Sensitivities were tested according to microorganisms identified. Empiric therapy generally consisted of afluoroquinolone, amoxicillin/clavulanate, or a later-generation cephalosporin, and adjustment in individual instances when appropriate. RESULTS: Twelve cultures showed no growth, 86 grew a single microorganism, and 35 grew two or more microorganisms for a total of 151 microorganisms identified. The most common microorganisms were Staphylococcus aureus, coagulase-negative staphylococci, and Pseudomonas aeruginosa. Other organisms that were cultured <5% of the time included Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis, Serratia liquefaciens, Stenotrophomonas (Xanthomonas) maltophilia, alcaligenes, Fusobacterium, Escherichia coli, diphtheroids, Acinetobacter species, Klebsiella species, skin flora, and mixed Gram-negative and Gram-positives. CONCLUSION: Endoscopically guided aerobic cultures in postsurgical patients with acute exacerbations of chronic rhinosinusitis most commonly grew S. aureus, coagulase-negative staphylococci, and pseudomonal species. These cultures altered antibiotic treatment management decisions in a significant number of cases regardless of patients' clinical characteristics or history of previous culture.

Bacteria, Aerobic↗