Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4368_Библиотеки_им_академика_М_И_Перельмана

Autofluorescence endoscopy sequentially radiates both excitation light (370–470 nm) and green light (540–560 nm) which excites endogenous fluorophores (e.g., collagen). Dysplasia or early invasive malignancies are displayed as magenta on a pseudocolor image.

has a reported accuracy for distinguishing between hyperplastic colonic polyps and adenomas of up to 88.4%; however, it has been shown to have a high false-positive rate of up to 81%.

Finally, confocal laser endomicroscopy uses laser light focused through a pinhole to improve image resolution to a subcellular level and has a sensitivity and specificity that ranges between 76 and 97% and 72 and 99%, respectively.

Surgery also results in less morbidity than

which often produces significant complications and sequelae such as neck fibrosis, deafness, trismus, cranial neuropathies, endocrine dysfunction, and temporal lobe necrosis.

We have described an endoscopic endonasal approach to nasopharyngeal tumors; however, open and combined approaches are also viable options, depending on the tumor type, location, and extent. Castelnuovo et al have developed a grading system of surgical resection according to the extent of the disease (Table 26.1).45 Endonasal approaches have the advantage of utilizing the preexistent sinonasal air spaces and provide magnified access to the central skull base without the need for external incisions, translocation/disruption of the maxillofacial skeleton, and excessive dissection as part of the approach. Endoscopic nasopharyngectomy can achieve negative margins in up to 97% of appropriately selected patients. are extremely selected, as endoscopic approaches are limited by their relationship to critical neurovascular structures such as the ICA and optic nerves. A pure endoscopic approach is limited/contraindicated for tumors surrounding the parapharyngeal ICA or extending posterior to the parapharyngeal or petrous ICA. Some authors have suggested that there be a distance of at least 1 cm between the tumor and the ICA for it to be considered endoscopically resectable. Other authors have suggested only rT1, rT2, and select rT3 tumors with limited skull base, brain, or dural involvement are amenable to endoscopic resection. However, Al-Sheibani et al demonstrated that endoscopic approaches can be used for T3 and T4 tumors adjacent to but not involving the ICA. Therefore, there are no absolute guidelines regarding the approach chosen.

The endoscopic transnasal approach is generally com­bined to the transbasal (frontal)/subfrontal approach for addressing different pathologies involving the anterior cranial fossa, not amenable for an exclusive endonasal approach. such an approach are as follows:

• Extensive malignant tumors of the anterior skull base,

• Inflammatory diseases affecting the frontoethmoid-

representing the principal indication for the combined cranio-endoscopic approach. Small- to intermediate

-sized sinonasal cancers can be approached through an exclusive endoscopic transnasal transcribriform– transethmoidal approach.2 However, in cases of extensive anterior skull base involvement with massive infiltration of the dura over the orbital roof or brain parenchyma in­filtration, detected both in the preoperative or intraoper­ative settings, the pure endoscopic transnasal approach should be combined with a transcranial frontal/subfron­tal approach to obtain a radical resection.

al compartments with osteitis and/or osteomyelitis. In these cases, the diseased bone has to be removed through an extended approach to control the infection and limit the progression of the bony erosion.