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Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex : A technical note

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Title: Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex : A technical note
Authors: Ishi, Yukitomo Browse this author
Kobayashi, Hiroyuki Browse this author
Motegi, Hiroaki Browse this author
Endo, Shogo Browse this author
Yamaguchi, Shigeru Browse this author
Terasaka, Shunsuke Browse this author →KAKEN DB
Houkin, Kiyohiro Browse this author →KAKEN DB
Keywords: cholesterol granuloma
petrous apex
transsphenoidal surgery
nasoseptal flap
Issue Date: Nov-2016
Publisher: Elsevier
Journal Title: Neurologia i neurochirurgia polska
Volume: 50
Issue: 6
Start Page: 504
End Page: 510
Publisher DOI: 10.1016/j.pjnns.2016.08.006
PMID: 27575680
Abstract: Background: Compared with surgical resection, endoscopic transsphenoidal surgery (TSS) for cholesterol granuloma (CG) in the petrous apex (PA) is associated with local recurrence due to obstruction of the drainage route. We present a detailed procedure of an endoscopic TSS using pedicle vascularized nasoseptal flap (PVNF). Methods: A 40-year-old woman with a history of repeated surgery for left tympanitis was referred to our institution. Neurological examination revealed severe hearing loss in the left ear. Radiologic examination presented a round mass in the left PA and significant fluid collection in the mastoid air cells of the left temporal bone. CG was strongly suspected, and endoscopic TSS using PVNF was performed. Prior to endoscopic drainage, a PVNF was harvested from the mucosa of the ipsilateral nasal septum, with an attempt to preserve the sphenopalatine artery in the flap. Following this, puncture and adequate irrigation of the lesion was performed by endoscopic TSS, with neuro-navigation system assistance; the apex of PVNF was then placed into the lesion to prevent the obstruction of the drainage route. An absorbable polyglycolic acid sheet and fibrin glue were applied on the flap to prevent spontaneous deviation from the lesion. Results: The patient was discharged without any further neurological complications. Eight month postoperative computed tomography images showed no recurrence; the drainage route was patent and the fluid collection in the left mastoid air cells was resolved. Moreover, hearing loss was improved. Conclusions: Endoscopic TSS using PVNF may be one of available surgical options for PACG.
Rights: © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 伊師 雪友

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