Open AccessUse of Fibrin Sealant (Vivostat) in Skull Base Surgery
Author(s) -
Baptista Peter,
Bejarano Bartolome,
Fernandez Secundino,
Manrique Raquel,
Jovellar Lourdes Montes
Publication year - 2010
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1016/j.otohns.2010.06.873
Subject(s) - sealant , fibrin , skull , fibrin tissue adhesive , art , medicine , surgery , materials science , composite material , immunology
sinusitis via TONES approach. METHOD: An anatomic cadaver study was performed on 4 adult specimens. We examined precaruncular (PC), superior eyelid crease (SLC) and/or lateral retrocanthal (LRC) approaches to the orbit, frontal sinus, and anterior skull base. The SLC and PC approaches were the most efficacious. A prospective outcome study was conducted in 7 patients (5 males, 2 females; mean age 40, range 21-80). These individuals underwent TONES for the management of orbital and CNS complications from sinusitis, including orbital, frontal and/or epidural abscesses as well as cavernous sinus thrombosis. RESULTS: The cadaver study demonstrated easy and direct access to the orbit, frontal sinus and anterior skull base using PC and SLC approaches, alone or in combination with transnasal routes. The clinical outcome study confirmed these findings, and further demonstrated postoperative improvement of initial clinical symptoms. The epidural space, orbit, and frontal sinus were all accessible through a single incision. Subsequent radiological studies correlated well with the resolution of the symptoms. The surgical scar was well hidden and minimal. There were no ophthalmologic or other significant complications. CONCLUSION: The transorbital neuroendoscopic surgery is a promising, effective and safe technique to manage various orbital and CNS complications of sinusitis. It can avoid more invasive craniotomy, reduces morbidity and facilitates quick post-operative recovery.