Transnasal Endoscopic Skull Base and Brain Surgery Surgical Anatomy and its Applications

Transnasal Endoscopic Skull Base and Brain Surgery Surgical Anatomy and its Applications

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This fully revised and updated second edition of Transnasal Endoscopic Skull Base and Brain Surgery: Surgical Anatomy and its Applications builds on the acclaimed first edition, focusing on the correlation between endoscopic skull base anatomy and state-of-the-art clinical applications. Among these are the transplanum/transtuberculum, transcribrifom, transclival, and craniocervical junction surgical approaches.

Renowned skull base surgeon Aldo Stamm and leading worldwide experts have compiled a comprehensive multidisciplinary textbook with 72 chapters in 14 sections, didactically organized by regions and diseases. Detailed descriptions of sinonasal, orbital, cranial base, and intracranial anatomy, imaging modalities, and in-depth surgical navigation techniques form the foundation of this remarkable book. The content reflects significant knowledge and diverse perspectives from masters in neurosurgery, otorhinolaryngology, head and neck surgery, neuroendocrinology, intensive care, neuro-anesthesiology, and other disciplines.

Key Highlights

Chapter summaries and highlights facilitate understanding and retention of complex concepts 1,500 beautiful anatomical, operative, and dissection illustrations and photographs enhance understanding of impacted areas 18 accompanying videos provide guidance on endoscopic transnasal approaches in patients with diverse skull base diseases Pearls, pitfalls, and nuances throughout this book provide invaluable insights on achieving optimal outcomes Neurosurgeons, otolaryngologists–head and neck surgeons, and others will greatly benefit from the step-by-step endoscopic procedural guidance and tips in this quintessential skull base surgical reference.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Surgical site infection risk factors

Surgical site infection risk factors

Of 16,513 patients in a study, 1.20% required at least one further operation to treat a surgical site infection (SSI). Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative time >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation 1).


It is still discussed if the dual use increases the risk of surgical site infections (SSI).Increase of extent of tumor resection using intraoperative magnetic resonance imaging (iMRI) is evident. SSI rate is within the normal range of neurosurgical procedures. A dual-use iMRI suite is a safe concept 2).


Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery 3).


Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust. Analysis of individual categories of data suggests that 72 h prophylaxis was the most important factor for minimizing the risk of wound infection in a study group 4).


Cassir et al. identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30).

For SSIs postspinal surgery, they identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22) 5).

References

1)

Patel S, Thompson D, Innocent S, Narbad V, Selway R, Barkas K. Risk factors for surgical site infections in neurosurgery. Ann R Coll Surg Engl. 2019 Mar;101(3):220-225. doi: 10.1308/rcsann.2019.0001. Epub 2019 Jan 30. PubMed PMID: 30698457; PubMed Central PMCID: PMC6400918.
2)

Wach J, Goetz C, Shareghi K, Scholz T, Heßelmann V, Mager AK, Gottschalk J, Vatter H, Kremer P. Dual-Use Intraoperative MRI in Glioblastoma Surgery: Results of Resection, Histopathologic Assessment, and Surgical Site Infections. J Neurol Surg A Cent Eur Neurosurg. 2019 Jul 4. doi: 10.1055/s-0039-1692975. [Epub ahead of print] PubMed PMID: 31272122.
3)

Peng W, Liang Y, Lu T, Li M, Li DS, Du KH, Wu JH. Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients: A single-center retrospective analysis. Medicine (Baltimore). 2019 Jun;98(23):e15935. doi: 10.1097/MD.0000000000015935. PubMed PMID: 31169714.
4)

Maciejczak A, Wolan-Nieroda A, Wałaszek M, Kołpa M, Wolak Z. Antibiotic prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols. J Hosp Infect. 2019 Apr 30. pii: S0195-6701(19)30186-0. doi: 10.1016/j.jhin.2019.04.017. [Epub ahead of print] PubMed PMID: 31051190.
5)

Cassir N, De La Rosa S, Melot A, Touta A, Troude L, Loundou A, Richet H, Roche PH. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period. Am J Infect Control. 2015 Aug 20. pii: S0196-6553(15)00756-7. doi: 10.1016/j.ajic.2015.07.005. [Epub ahead of print] PubMed PMID: 26300100.

Temporal epidural hematoma surgical technique

Temporal epidural hematoma surgical technique

Surgical safety checklist

Preoperative antibiotic prophylaxis

Skin Preparation

Positioning

The supine position is used with the patient‘s head rotated for temporal access. Extremes of head rotation can obstruct the jugular venous drainage, and a shoulder roll can combat this problem or lateral positioning (park bench position).

Skin incision

Craniotomy

Technical issues

1. clot removal: lowers ICP and eliminates focal mass effect. Blood is usually thick coagulum, thus exposure must provide access to most of clot. Craniotomy permits more complete evacuation of hematoma than e.g. burr holes.

2. hemostasis:coagulate bleeding soft tissue (dural veins & arteries). Apply bone wax to intradiploic bleeders (e.g. middle meningeal artery). Also requires large exposure

3. prevent reaccumulation: (some bleeding may recur, and dura is now detached from inner table) place dural tack-up sutures to edges of craniotomy and use central “tenting” suture.

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