International forum of allergy & rhinology
-
Chronic refractory vasomotor rhinitis (VMR) is a debilitating condition that causes significant impairment of quality of life. The purpose of this study is to investigate the efficacy and potential side effects of endoscopic vidian neurectomy as treatment for patients with VMR. ⋯ The data suggests that vidian neurectomy is an effective, safe, and definitive treatment for most patients with VMR refractory to medical treatment.
-
Int Forum Allergy Rhinol · Apr 2015
Update on endoscopic endonasal resection of skull base meningiomas.
The objective of this work was to report success rates as well as potential obstacles in transnasal endoscopic resection of anterior skull base meningiomas. ⋯ Using a 2-team approach, meningiomas of the skull base were successfully removed via an intranasal endoscopic technique. Although complete resection is typically possible even with large tumors, the lengthy resection required time for tumors larger than 60 cm(3) (diameter ≥4 cm) may obviate some of the advantages of this approach. The rate of postoperative CSF leak decreases when a synthetic dural substitute is added but does not approach zero.
-
Int Forum Allergy Rhinol · Apr 2015
Magnetic resonance cisternogram with intrathecal gadolinium with delayed imaging for difficult to diagnose cerebrospinal fluid leaks of anterior skull base.
Workup of cerebrospinal fluid (CSF) leaks can be challenging. Patients with intermittent or infrequent clear rhinorrhea that cannot be collected, those with questionable or multiple skull-base (SB) defects on imaging, and those with previous SB surgery can present diagnostic dilemmas. In this patient population, radiologic studies that allow repeat imaging over hours to days can increase the diagnostic yield. We report our experience with magnetic resonance cisternogram with intrathecal gadolinium (MRCgGd) in this patient population. ⋯ MRCgGd is a useful diagnostic test in the workup of patients with difficult CSF leaks, with delayed imaging providing valuable diagnostic information.
-
Int Forum Allergy Rhinol · Feb 2015
Case ReportsMedical reversal of chronic sinusitis in a cystic fibrosis patient with ivacaftor.
Chronic sinusitis is universal in cystic fibrosis (CF) and our current treatments are ineffective in reversing sinus disease. The objective of this work was to determine if increasing CF transmembrane conductance regulator (CFTR) activity by ivacaftor could treat CF sinus disease and assess its effect on primary sinus epithelial cultures. ⋯ This report documents the reversal of CF sinus disease. Based on our in vivo and in vitro results, we speculate that ivacaftor may reverse CF sinusitis by increasing ASL pH and decreasing ASL viscosity. These studies suggest that CFTR modulation may be effective in treating CF and perhaps non-CF sinusitis.
-
Int Forum Allergy Rhinol · Jan 2015
Perioperative continuous cerebrospinal fluid pressure monitoring in patients with spontaneous cerebrospinal fluid leaks.
Elevated intracranial pressure (ICP) is an inciting factor for cerebrospinal fluid (CSF) leaks and can be measured by CSF pressure (CSFP) monitoring. Current CSFP literature is limited to the assessments of opening pressure. This study reinvestigates a previously discussed monitoring approach that evaluates continuous CSFP parameters, physiologic measurements, and treatment outcomes in patients undergoing endoscopic repair of spontaneous CSF leaks. ⋯ Continuous perioperative CSFP monitoring provides valuable insight into multiple physiologic parameters. Systematic continuous CSFP monitoring can identify individuals in need of ICP-lowering therapy, possibly improving the outcomes in CSF leak repair surgeries.