Otolaryngologic clinics of North America
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Otolaryngol. Clin. North Am. · Oct 2011
ReviewReconstructive options for endoscopic skull base surgery.
This review describes the sequential learning from initial free tissue grafting reconstructive techniques to the current use of vascularized flaps. Outcomes and limitations of current endoscopic reconstructive techniques are discussed, including a systematic review of the outcomes of endoscopic endonasal techniques to reconstruct large skull base defects (ESBR). ⋯ The manuscripts selected were subject to full text review to extract data on perioperative outcomes for ESBR. Surgical technique was used for sub-group analysis.
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Otolaryngol. Clin. North Am. · Oct 2011
ReviewTraining in neurorhinology: the impact of case volume on the learning curve.
This article presents a current view of training in neurorhinology and focuses on the level of evidence for the clinical question of "how many cases are needed to achieve proficiency in endoscopic endonasal skull base surgery?" The authors discuss what defines surgical proficiency, what makes up the learning curve and how it shifts with increasing experience, comparisons of learning curves for different skull base surgeries, and conclude with a discussion and recommendations for achieving high-level proficiency.
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Carotid artery injury during endonasal surgery is the most feared and catastrophic complication. Internal carotid artery injury is more frequent during skull base surgery, and risk factors include acromegaly, previous revision surgery, and prior radiotherapy and bromocriptine therapy. ⋯ Endovascular techniques are recommended for vascular control and complication management. Coil or balloon embolization is preferred in patients with adequate collateral cerebral blood flow, and stent-graft placement or bypass surgery is indicated in those who do not.