Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Tomazic, P.
Subjective and Objective Assessment of Novel Adjuncts and Quality of Life in Endoscopic Transsphenoidal Skull Base Surgery
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medical University of Graz; 2021. pp. 73
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Gellner Verena
- Mokry Michael
- Thurnher Dietmar
- Altmetrics:
- Abstract:
- Introduction: In the last decades functional endoscopic sinus and skull base surgery has become the gold standard to approach this anatomically challenging region. Many advanced approaches have come up in the past years and technological advances has brought more safety to surgeons and patients when it comes to complications and comorbidities. The biggest advances lie in imaging and development of high resolution cameras as well as delicate instruments to allow minimal invasive surgery. This study aims to evaluate the feasibility and outcomes of novel 3D endoscopy as well as novel piezoelectric techniques to approach lesions at skull base. Material and Methods: The study comprises to parts. In the first part 15 patients have prospectively been enrolled for endoscopic skull base surgery where PETC has been applied. Following parameters were evaluated: age, diagnosis, size of the adenoma, success of piezoelectric surgery (yes/no) if an intact bone flap could be dissected, state of the dura after harvested bone flap, size of the bone flap, time for surgery and time for piezo application, intra- and postoperative complications, pre- and postoperative visual analogue score (VAS) for nasal blockage, post-nasal drip and smell. For part two 20 patients were prospectively enrolled undergoing FESS where operated sides were randomized to wither 2D and 3D. A questionnaire was filled out by the surgeon evaluating usability and imaging qualities of the respective technology as well as time needed for surgery. Results: Part one: In all patients (N=15) piezoelectric an intact bone flap could be harvested successfully and the dura remained intact. The mean size of the bone flap was 55.9 mm2 (SD: 20.1) which was sufficient in all cases. Mean time for piezoelectric craniotomy to harvest the bone flap and expose the dura was 4 min 22 sec (SD: 165 sec). Mean total time for surgery was 90 minutes (SD: 22.8 min) which was significantly (p=0.002) lower compared to our standard surgical procedures (mean: 112 minutes, SD: 82.8 min). Postoperative VAS did not deteriorate significantly apart form smell. Part two: Both techniques are successful without any complications. 3D is superior to 2D in depth perception, anatomical detail recognition and 3D effect. Conclusion: PETC is safe and effective enabling the surgeon to naturally reconstruct the skull base after endoscopic approaches where earlier bone had to be removed harboring the potential of CSF leaks. 3D technology is excellent for teaching and potentially reducing intraoperative complications since critical anatomic structures can better be identified and protected.