 |
Daniele MARCHIONI
Professore Ordinario
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto
|
Home |
Curriculum(pdf) |
Didattica |
Pubblicazioni
2023
- Cadaver Homologous Banked Fascia Lata in Skull Base Reconstruction: Preliminary Multidisciplinary Experiences
[Articolo su rivista]
Alicandri-Ciufelli, M.; Serafini, E.; Pavesi, G.; Marchioni, D.; Mantovani, M.; Dallari, D.; Iaccarino, C.
abstract
Skull base reconstruction has been a widely debated issue. Both autologous and heterologous materials have been proposed, however the formers are usually preferred due to their optimal healing outcomes and integration. Nevertheless they are still associated with donor-site functional and aesthetic morbidity. The aim of this study is to report a preliminary experience of different sites defects skull base repair with Cadaver homologous banked fascia lata graft. Patients who underwent reconstruction of skull base defects with Cadaver homologous banked fascia lata between January 2020 until July 2021 were included in the study. Three patients were finally identified for the study. Patient 1 underwent combined craniotomic-endoscopic surgical access for extended anterior skull base neoplasm with subsequent repair with homologous cadaver fascia lata. Patient 2 underwent endoscopic transphenoidal surgery for sellar-parasellar neoplasm. After tumor debulking the surgical cavity was obliterated with homologous cadaver fascia lata. Patient 3 finally had politrauma with otic capsule-violating fracture with profused CSF leak. An endoscopic obliteration of external and middle ear was performed using homologous cadaver fascia lata with blind sac closure of external auditory canal. No graft displacement or reabsorption was observed in these patients at the last follow-up. Cadaver homologous banked fascia lata has proved safety, efficacy and ductility in reconstruction of different skull base defects. Level of Evidence: Level IV-retrospective cohort study.
2023
- Endoscopic closure with double stenting and autologous fascia lata graft of large tracheo-esophageal fistula
[Articolo su rivista]
Mattioli, Francesco; Serafini, Edoardo; Andreani, Alessandro; Cappiello, Gaia Francesca; Marchioni, Daniele; Pinelli, Massimo; Tonelli, Roberto; Clini, Enrico; Marchioni, Alessandro
abstract
Introduction: Radiotherapy and esophageal stenting are usually employed to manage esophageal localization of distant cancer. However, they are also related to the occurrence of an increased risk of tracheoesophageal fistula. Tracheoesophageal fistula management in these patients involves dealing with poor general conditions and short-term prognosis.This paper presents the first case in literature of bronchoscopic fistula closure through an autologous fascia lata graft placement between two stents.
Case report and aim: A 67-years-old male patient was diagnosed with pulmonary squamous cell carcinoma in the inferior lobe of the left lung with mediastinal lymph node metastasis. After a multidisciplinary discussion, bronchoscopic repair of tracheoesophageal fistula with autologous fascia lata was decided without the removal of the esophageal stent due to the high risk on the esophagus possibly related to such a procedure. Oral feeding was progressively introduced without the development of aspiration symptoms. Videofluoroscopy and esophagogastroduodenoscopy were performed at seven months showing no signs of tracheoesophageal fistula patency.
Conclusion: This technique might represent a low risks viable option for patients unsuitable for open surgical approaches.
2023
- Influence of Prior Endoscopic Sinus Surgery Extent on Dupilumab Effectiveness in CRSwNP Patients
[Articolo su rivista]
Alicandri-Ciufelli, M.; Marchioni, D.; Pipolo, C.; Garzaro, M.; Nitro, L.; Dell'Era, V.; Ferrella, F.; Campagnoli, M.; Russo, P.; Galloni, C.; Ghidini, A.; De Corso, E.; Lucidi, D.
abstract
Background: Guidelines recommend that the vast majority of patients with severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) should have at least one endoscopic sinus surgery (ESS) prior to starting biologics. Because ESS can be performed with a variable extension, the aim of this study would be to evaluate the association between surgical extensiveness, as measured by ACCESS score, and outcomes collected in patients treated with Dupilumab. Materials and Methods: This is a multicentric retrospective study; patients affected by CRSwNP who were subjected to Dupilumab therapy and who underwent at least one ESS prior to Dupilumab initiation were included. ACCESS score was assigned to each patient's pre-Dupilumab CT scan. Subjective and objective parameters (SNOT-22, NPS, VAS scores, Sniffin’ Sticks) were collected before and during the administration of therapy. Statistical correlations between ACCESS scores and clinical outcomes were investigated. Results: A total of 145 patients were included; mean time from last previous ESS was 68.6 months, and on average, patients were subjected to 2.2 surgeries. Many correlations with ACCESS scores were demonstrated: better NPS at all timepoints and subjective scores (30-days SNOT-22, VAS nasal obstruction, and rhinorrhea) were achieved in patients with low ACCESS score (more extensive ESS). On the other hand, significantly worse VAS loss of smell values were demonstrated in patients with lower ACCESS scores. Conclusion: Dupilumab patients subjected to a prior extensive ESS may have reduced size of polyps and improved subjective indicators, together with a decreased chance to recover smell, when compared with patients who underwent a minimal excision. Level of Evidence: Level 3 Laryngoscope, 2023.
2023
- Molecular biology and therapeutic targets of primitive tracheal tumors: focus on tumors derived by salivary glands and squamous cell carcinoma.
[Articolo su rivista]
Marchioni, Alessandro; Tonelli, Roberto; Samarelli, ANNA VALERIA; Cappiello, Gaia; Andreani, Alessandro; Tabbì, Luca; Livrieri, Francesco; Bosi, Annamaria; Nori, Ottavia; Mattioli, Francesco; Bruzzi, Giulia; Marchioni, Daniele; Clini, Enrico
abstract
2023
- Pericranial Flap-Based Multilayer Reconstruction of Endoscopic Transcribriform Craniectomy for Sinonasal Malignancies
[Articolo su rivista]
Calvaruso, F.; Lo Manto, A.; Bisi, N.; Cantaffa, C.; Basso, M.; Ferrulli, G.; Alicandri-Ciufelli, M.; Marchioni, D.
abstract
Objective: Diffusion of endoscopic techniques for the resection of ethmoid bone malignancies through a transcribriform approach (TA) has raised new challenges regarding reconstruction options to reduce post-operative complications. Although there is consensus on the advantages of vascularized flaps over free grafts for large defects, no standard protocol exists on reconstruction procedures. In addition, although the pedicled nasoseptal flap has been extensively discussed, few studies have been published on extranasal pedicled flaps. The aim of this manuscript is to provide a detailed description of a reconstruction technique for large anterior skull base defects with the pericranial flap as part of a multilayered reconstruction. Moreover, patients treated with this approach were retrospectively assessed for post-operative complications. Methods: A detailed description of the reconstruction procedure as performed in our departments is provided. Pictures depicting the main surgical steps are also included. In addition, preliminary functional results from a retrospective series of patients who underwent a TA and subsequent pericranial flap-based multilayer reconstruction for ethmoid roof malignancies between 2016 and 2022 at two institutional centers are reported. Results: 16 patients were included in the study. Nine patients (56.3%) underwent adjuvant radiotherapy. Two patients had a biochemically-confirmed postoperative CSF leak. Only one of the two patients required surgical revision. During follow-up (mean 13 months), no other early nor delayed complications were observed. Conclusion: A standardized surgical technique with pericranial flap as part of a multilayered reconstruction for large anterior skull base defects following resection of sinonasal malignancies is proposed, which appears to be a safe choice when endonasal flaps are not available. Level of Evidence: Level 4 Laryngoscope, 133:2942–2947, 2023.
2023
- Prognostic role of EAONO/JOS, STAMCO, and ChOLE Staging for Exclusive Endoscopic and Endoscopic-Microscopic Tympanoplasty
[Articolo su rivista]
Fermi, M.; Bassano, E.; Villari, D.; Capriotti, V.; Calvaruso, F.; Bonali, M.; Alicandri-Ciufelli, M.; Marchioni, D.; Presutti, L.
abstract
Objective: The aim of the study is to evaluate cholesteatoma's surgical outcomes in patients treated with endoscopic ear surgery (EES) or a combined endoscopic-microscopic approach (cEMA) according to STAM, STAMCO, ChOLE, and EAONO/JOS system (EJS) classifications and staging. Study Design: Retrospective study. Setting: Monocentric study in a tertiary referral center. Methods: One-hundred sixty-eight patients who underwent EES or cEMA for cholesteatoma between 2010 and 2018 were classified according to the abovementioned classification and staging. Data on cholesteatoma's recurrence and residual rates were collected. Inferential statistical analysis was performed to evaluate surgical outcomes and the prognostic value of classifications and staging. Results: The recurrence rate was significantly lower in cholesteatomas classified in EJS stage 1 (2.6%) and STAM stage 1 (0%). A comparison of the different stages of the disease showed a significantly lower recurrence only for stage 1 versus the superior stages of both classifications. Involvement of mastoid bone was associated with a higher risk of recurrence (odds ratio [OR]: 4.12; p =.031). Attical involvement was associated with a higher risk of residual cholesteatoma (OR: 1.165; p =.046). Conclusion: EES or cEMA represents an effective treatment for middle ear cholesteatoma. The STAM classification and the EJS have shown a prognostic value, with STAM 1 and EAONO-JOS 1 stages associated with a better prognosis. Mastoid involvement represents a risk factor for recurrence. Attic localization is associated with residual disease. Localization at difficult access sites did not implicate a higher risk for recurrence or residual. ChOLE classification, Ossicular chain status, and complication status did not provide prognostic information regarding recurrence or residual cholesteatoma.
2023
- The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study
[Articolo su rivista]
Mattioli, F.; Serafini, E.; Lo Manto, A.; Mularoni, F.; Abeshi, A.; Lionello, M.; Ferrari, M.; Paderno, A.; Lancini, D.; Mattavelli, D.; Confuorto, G.; Marchi, F.; Ioppi, A.; Sampieri, C.; Mercante, G.; De Virgilio, A.; Petruzzi, G.; Crosetti, E.; Pellini, R.; Giuseppe, S.; Giorgio, P.; Piazza, C.; Molteni, G.; Bertolin, A.; Succo, G.; Nicolai, P.; Alicandri-Ciufelli, M.; Marchioni, D.; Presutti, L.; Fermi, M.
abstract
Background: To retrospectively evaluate oncological outcomes in two groups of patients with pT4aN0 glottic SCC treated with total laryngectomy (TL) and neck dissection (ND) who underwent postoperative radiotherapy or exclusive clinical and radiological follow-up. Methods: It includes patients with pT4N0 glottic SCC who underwent TL and unilateral or bilateral ND with or without PORT. Divided in two comparison groups: the first group underwent adjuvant RT (TL-PORT); the second group referred to clinical and radiological follow-up (TL). Results: PORT was associated with a better OS while no differences were found in terms of DSS. A better local control is achieved when PORT is administered while no differences in terms of regional and distant control rates were found. Bilateral ND positively impacts on the regional control while the PNI negatively impact the regional control. Conclusions: A tailored PORT protocol might be considered for pT4N0 glottic SCC treated with TL and ND, both considering the ND's extent and presence of PNI.
2023
- Tumors of the Nose and Paranasal Sinuses: Promoting Factors and Molecular Mechanisms—A Systematic Review
[Articolo su rivista]
Lucidi, D.; Cantaffa, C.; Miglio, M.; Spina, F.; Alicandri Ciufelli, M.; Marchioni, A.; Marchioni, D.
abstract
Sinonasal neoplasms are uncommon diseases, characterized by heterogeneous biological behavior, which frequently results in challenges in differential diagnosis and treatment choice. The aim of this review was to examine the pathogenesis and molecular mechanisms underlying the regulation of tumor initiation and growth, in order to better define diagnostic and therapeutic strategies as well as the prognostic impact of these rare neoplasms. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between September and November 2022. The authors considered the three main histological patterns of sinonasal tumors, namely Squamous Cell Carcinoma, Intestinal-Type Adenocarcinoma, and Olfactory Neuroblastoma. In total, 246 articles were eventually included in the analysis. The genetic and epigenetic changes underlying the oncogenic process were discussed, through a qualitative synthesis of the included studies. The identification of a comprehensive model of carcinogenesis for each sinonasal cancer subtype is needed, in order to pave the way toward tailored treatment approaches and improve survival for this rare and challenging group of cancers.
2023
- Vestibular schwannoma removal through expanded transcanal transpromontorial approach: a multicentric experience
[Articolo su rivista]
Molinari, G.; Calvaruso, F.; Presutti, L.; Marchioni, D.; Alicandri-Ciufelli, M.; Friso, F.; Fernandez, I. J.; Francoli, P.; Di Maro, F.
abstract
Purpose: Expanded Transcanal Transpromontorial Approach (ExpTTA) is an endomicroscopic technique that allow surgical excision of small and symptomatic neuromas limited to the internal auditory canal (IAC) or minimally invasive the cerebellopontine angle (CPA). ExpTTA is a safer alternative to the exclusive endoscopic technique as it allows a wider surgical field and better management of the auditory porus and CPA. Methods: We report a retrospective case series of 34 patients who underwent ExpTTA between 2017 and 2022 at the ENT Departments of the University Hospital of Modena, Bologna and Verona. Tumor size was defined according to the Koos staging and hearing function was classified according to the AAOHNS. A clinical evaluation of facial nerve (FN) function was performed using the House and Brackman scale (HBs). Results: Our cohort consists of 34 patients. At time of surgery all patients had a normal preoperative facial function. Gross total resection was achieved in all patients, without intraoperative complications, and FN continuity was preserved in all cases. No major complications were observed. Regarding post-operative FN function, at hospital discharge ten patients had impairment equal or greater than IV grade according to H&Bs. At 6 months after surgery only two patients presented with moderate/severe facial paralysis (grade IV H&Bs) and finally at 12-month follow-up all patients had a satisfactory recovery of nervous function (grade < III H&Bs). Conclusions: ExpTTA is a safe and effectively technique for treatment of small VS (Koos I, II and selected cases of Koos III) with low postoperative morbidity.
2022
- Congenital Pyriform Sinus Fistula: Systematic Review and Proposal for Treatment Using a Novel Endoscopic Approach
[Articolo su rivista]
Soloperto, D.; Fulco, G.; Pera, B. L.; Confuorto, G.; Marchioni, D.
abstract
The pyriform sinus fistula (PSF) is a congenital developmental defect of the third or fourth branchial pouch. It presents as acute inflammatory swelling of the neck with recurrent deep neck abscesses, recurrent neck cystic lesions or suppurative thyroiditis. The literature reports various surgical approaches to treat this condition in children. A systematic review of the literature related to management protocols for PSF was conducted and we report a case exemplifying treatment in our department. Traditionally, treatment for PSF has been open surgery; however, in the last few decades, the minimally invasive transoral endoscopic approach has gained in importance, demonstrating long-term outcomes comparable to open surgery and with lower morbidity, and it has now become the first-choice treatment. We further describe a case of PSF treated by a transoral endoscopic approach with electric cauterization, fibrin glue obliteration of the fistula and Polydimethylsiloxane (Vox-Implants®, Bioplasty, Geleen, The Netherlands) submucosal injection. According to the authors, application of Vox-Implants® injection, in addition to standard techniques, may be helpful to reduce fistula recurrence rate after surgery.
2022
- Decompression of the geniculate ganglion and labyrinthine segments of the facial nerve through a middle cranial fossa approach using an ultrasonic surgical system: an anatomic study
[Articolo su rivista]
Marchioni, D.; Laura, E.; Rubini, A.
abstract
Purpose: The aim of this study is to evaluate the feasibility and the safety of a novel, alternative method for bone tissue management in facial nerve decompression by a middle cranial fossa approach. Several applications of Piezosurgery technology have been described, and the technique has recently been extended to otologic surgery. The piezoelectric device is a bone dissector which, using micro-vibration, preserves the anatomic integrity of soft tissue thanks to a selective action on mineralized tissue. Methods: An anatomic dissection study was conducted on fresh-frozen adult cadaveric heads. Facial nerve decompression was performed by a middle cranial fossa approach in all specimens using the piezoelectric device under a surgical 3D exoscope visualization. After the procedures, the temporal bones were examined for evidence of any injury to the facial nerve or the cochleovestibular organs. Results: In all cases, it was possible to perform a safe dissection of the greater petrosal superficial nerve, the geniculate ganglion, and the labyrinthine tract of the facial nerve. No cases of semicircular canal, cochlea, or nerve damage were observed. All of the dissections were carried out with the ultrasonic device without the necessity to replace it with an otological drill. Conclusion: From this preliminary study, surgical decompression of the facial nerve via the middle cranial fossa approach using Piezosurgery seems to be a safe and feasible procedure. Further cadaveric training is recommended before intraoperative use, and a wider case series is required to make a comparison with conventional devices.
2022
- Does Pregnancy Have an Influence on Otosclerosis?
[Articolo su rivista]
Fabbris, C.; Molteni, G.; Tommasi, N.; Marchioni, D.
abstract
Objectives: Otosclerosis affects women twice as often as men, especially during fertile age. A role of female hormones has been claimed but controversy still exists regarding the influence of pregnancy. The purpose of this research is to analyze the role of pregnancy on the course of otosclerosis. Design: In May 2019, on PubMed were searched the terms otosclerosis AND pregnancy, otosclerosis AND pregnant, otosclerosis AND parous, otosclerosis AND parity, and otosclerosis AND puerperium. Age at diagnosis, number of pregnancies, and the temporal relationship of the disease with childbearing were considered. Results: For 65 articles, 11 were chosen for review. They described 2323 women affected by otosclerosis: 1805 had at least 1 pregnancy, while 518 did not. During childbearing, otosclerosis began in 1% of pregnant women, worsening in 21%, and worsening during puerperium in 4%. Often, the authors reported hearing change with pregnancy, without details, so a further group has been considered composed of women belonging to any of the groups just mentioned or to another group of women not further characterized. Overall, hearing change occurred during pregnancy in 44%. A statistically significant correlation emerged between hearing change and number of pregnancies (p = 0.003). Conclusions: Due to wide data heterogeneity and the difficulty in analyzing a single factor, absolute statements couldnt be formulated. According to this review, pregnancy seems to have a worsening effect on the course of otosclerosis.
2022
- Does pregnancy have an influence on otosclerosis?
[Articolo su rivista]
Fabbris, C.; Molteni, G.; Tommasi, N.; Marchioni, D.
abstract
OBJECTIVE: Otosclerosis affects women twice as often as men, especially during fertile age. A role of female hormones has been claimed, but controversy still exists regarding the influence of pregnancy. The purpose of this research was to analyse the role of pregnancy on the course of otosclerosis. METHOD: PubMed was searched in May 2019 using the terms 'otosclerosis AND pregnancy', 'otosclerosis AND pregnant', 'otosclerosis AND parous', 'otosclerosis AND parity', and 'otosclerosis AND puerperium'. Age at diagnosis, number of pregnancies and the temporal relationship of the disease with childbearing were considered. RESULTS: From 65 articles, 11 were chosen for review. They described 2323 women affected by otosclerosis: 1805 had at least 1 pregnancy, while 518 did not. During childbearing, otosclerosis began in 1 per cent of pregnant women, worsened in 21 per cent and worsened during puerperium in 4 per cent. Often, the authors reported hearing change with pregnancy without details, so a further group has been considered composed of women belonging to any of the groups just mentioned or to another group of women not further characterised. Overall, hearing change occurred during pregnancy in 44 per cent. A statistically significant correlation emerged between hearing change and number of pregnancies (p = 0.003). CONCLUSION: Because of wide data heterogeneity and the difficulty in analysing a single factor, absolute statements could not be formulated. According to this review, pregnancy seems to have a worsening effect on the course of otosclerosis.
2022
- Donor site aesthetic and functional outcomes of radial forearm free flap: a comparison between full-thickness and split-thickness skin grafts
[Articolo su rivista]
Molteni, G.; Gazzini, L.; Bisi, N.; Nocini, R.; Ferri, A.; Bellanti, L.; Marchioni, D.
abstract
Background: The radial forearm free flap (RFFF) is one of the most common reconstructive choices for head and neck soft tissue defects worldwide. One of the techniques to cover up the donor site defect is based on the use of split-thickness (STSG) or full-thickness skin grafts (FTSG). Methods: Ours is a retrospective study including 36 RFFF reconstructive surgery patients at the University Hospitals of Verona and Parma treated between 2016 and 2020, with more than 6 months’ follow-up. Nineteen patients received a FTSG, locally harvested from the forearm, while 17 a STSG from the thigh. We used two already validated scales for the evaluation of the surgical scars. The first one is the Patient and Observer Scar Assessment Scale that rates vascularity, pigmentation, thickness, relief, pliability, and the surface area, and it incorporates the patient’s assessments of pain, itching, colour, stiffness, thickness, and relief. The second questionnaire was developed by Liu in 2011 to assess the functionality of the donor site from a patient’s perspective. Results: Pigmentation, thickness, relief, and surface area were statistically better in the FTSG than in the STSG group, while, according to the patients, the functional results turned out to be similar. Conclusions: From our experience, the locally harvested FTSG is to be considered the best alternative, with a better aesthetic outcome than the STSG harvested from the thigh and with a higher degree of protection provided to the forearm flexor tendons, without the need for an additional donor site. Level of evidence: Level III, therapeutic study.
2022
- Donor site aesthetic and functional outcomes: comparison between radial forearm free flap and anterolateral thigh free flap
[Articolo su rivista]
Molteni, G.; Gazzini, L.; Albi, C.; Fior, A.; Nocini, R.; Marchioni, D.
abstract
Background: The most commonly used free flaps are the anterolateral thigh (ALT) free flap and the radial forearm (RF) free flap, which often have overlapping indications. The aim of the present study is to compare the aesthetic and functional consequences for the donor site in patients undergoing ALT or RF flap harvesting. Methods: A questionnaire was administered to each patient to assess the functionality and aesthetics of the donor site. We used three different scales validated in the literature: the Patient and Observer Scar Assessment Scale (POSAS), the Manchester Scar Scale (MSS), and the donor site functionality questionnaire developed by Liu and colleagues. A total of 54 patients underwent ALT or RF free flap harvesting at the University Hospital of Verona in the period between February 2016 and September 2019. Of these, 14 had died at the time of the study. In addition, a complete follow-up was not available in 9 patients and they were therefore excluded from the study. Therefore, a total of 31 patients, 15 of whom underwent ALT flap harvesting (48%) and 16 RF flap harvesting (52%), were analyzed in the present study. Out of the 31 patients, 11 (36%) were female and 20 (64%) were male. The mean age at the time of surgery was 61 years (± 16 (SD), and ranging from 23 to 87 years). The flap size was on average 142.6 cm2 (90–198) in the ALT group and 36.5 cm2 (20–63) in the RFFF group. Results: Overall observer total score of the POSAS was 12 (8–15) for the ALT flap and 9.5 for the RF flap. For the patients’ opinion of the POSAS scale, the overall patient total score was 16 for the ALT flap and 9 for the RF flap. There was no difference in overall observer total score nor in patients opinion score between ALT and RF (12 (8–15) compared to 9.5 (8–12.25) and 16 (9.5–20) compared to 9 (7.75–15) (p = 0.28 and p = 0.13, respectively). For the MSS, the RF flap had a significantly better result with the VAS (visual analog scale) score (p = 0.04) compared with the ALT flap. In total, 94% of patients undergoing RF flap harvesting were satisfied with the appearance of the forearm against 73% of patients with the ALT flap. Conclusions: In this case series, the RF donor site achieved slightly better aesthetic and functional outcomes than the ALT donor site. Our results are discordant with the majority of published international studies, and are probably related to surgical management of the RF donor site using a locally harvested full-thickness skin graft (FTSG). Level of evidence: Level III, therapeutic/prognostic study.
2022
- Endoscopic Bronchopleural Fistula Repair Using Autologous Fat Graft
[Articolo su rivista]
Marchioni, Alessandro; Mattioli, Francesco; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Serafini, Edoardo; Stefani, Alessandro; Marchioni, Daniele; Clini, Enrico
abstract
Bronchopleural fistula (BPF) represents a not rare catastrophic complication of pulmonary resection with high mortality rates. While surgical treatments of BPF are often technically difficult and can only be tolerated by a limited number of patients, less invasive endoscopic approaches showed variable success rates, mainly related to the
size of the fistula. With this report, we describe for the first time the successful treatment of large BPF by means of endoscopic autologous fat implantation and we discuss the surgical technical details of the procedure.
2022
- Endoscopic treatment of paediatric subglottic stenosis and cyst (with video)
[Articolo su rivista]
Soloperto, D.; Sacchetto, A.; Dallari, V.; Pinter, P.; Marchioni, D.
abstract
Objective: The aim of this article is to describe step by step the endoscopic treatment of acquired subglottic stenosis (SGS) in an infant and to show the endoscopic results one month after surgery. Study design: Case presentation with instructional video. Setting: University Hospital of Verona, Italy. Methods: We present the case of a 6-month-old ex-26-week preterm female infant who required prolonged intubation in the neonatal period. She referred to our hospital for persistent inspiratory and expiratory stridor, and laboured breathing. The endoscopic dynamic examination of upper airway revealed the presence of type 3 laryngomalacia and subglottic stenosis grade III according to Myers-Cotton classification. An endoscopic balloon laryngoplasty was planned. Two laryngeal dilatations were performed. The endoscopic exploration after the first dilatation showed the presence of a subglottic cyst on the anterior surface of the subglottis. The treatment of subglottic cyst consisted of marsupialization of the cyst with cold microinstruments, and subsequent suction of its content. Results: An endoscopic check-up was carried out one month after surgery. The examination of the upper airway under spontaneous respiration didn't show significant subglottic stenosis. A very small subglottic cyst under the anterior commissure was observed. However, no more balloon dilatations or marsupialization of the cyst were performed in order to avoid the formation of synechiae. Conclusion: Treatment of SGS must be planned according to the extent of the stenosis and the history of the patient. Endoscopic procedures, such as balloon dilatation and cyst marsupialization, are best chosen for patients with isolated SGS without prior treatment failure.
2022
- Estimating survival after salvage surgery for recurrent salivary gland cancers: Systematic review
[Articolo su rivista]
Mannelli, G.; Comini, L. V.; Sacchetto, A.; Santoro, R.; Spinelli, G.; Bonomo, P.; Desideri, I.; Bossi, P.; Orlandi, E.; Alderotti, G.; Franchi, A.; Palomba, A.; Eccher, A.; Marchioni, D.; Nocini, R.; Piazza, C.; Molteni, G.
abstract
Recurrent salivary gland carcinomas (RSCs) are poorly characterized and their clinical features and treatment options have not yet been fully described. The goal of this study was to analyze the therapeutic strategies and oncological outcomes of RSC patients through a literature review analysis. This systematic review was performed according to the PRISMA statements. Inclusion criteria for the systematic review were based on the population, intervention, comparison, and outcomes according to (PICO) framework. Two thousand seven hundred and four records were selected and 1817 recurrences were studied. Three hundred and sixty-five patients underwent salvage surgery (20.1%) and their 5-year mortality rate, overall survival and disease-free survival were 35%, 70%, and 42%, respectively. RSCs are aggressive neoplasms with a high rate of distant metastases (28.9%). Salvage surgery can be considered in patients with limited local and/or regional recurrences, even in case of single distant relapse, appearing within the first 3 years of follow-up.
2022
- Expanded transcanal transpromontorial approach for vestibular schwannoma
[Articolo su rivista]
Marchioni, D.; Caiazza, N.; Dallari, V.; Sacchetto, A.
abstract
2022
- Frequency reallocation based on cochlear place frequencies in cochlear implants: a pilot study
[Articolo su rivista]
Di Maro, F.; Carner, M.; Sacchetto, A.; Soloperto, D.; Marchioni, D.
abstract
Purpose: The aim of this study is to evaluate speech perception outcomes after a frequency reallocation performed through the creation of an anatomically based map obtained with Otoplan®, a tablet-based software that allows the cochlear duct length to be calculated starting from CT images. Methods: Ten postlingually deafened patients who underwent cochlear implantation with MED-EL company devices from 2015 to 2019 in the Tertiary referral center University Hospital of Verona have been included in a retrospective study. The postoperative CT scans were evaluated with Otoplan®; the position of the intracochlear electrodes was obtained, an anatomical mapping was carried out and then it was submitted to the patients. All patients underwent pure tonal and speech audiometry before and after the reallocation and the audiological results were processed considering the Speech Recognition Threshold (SRT), the Speech Awareness Threshold (SAT) and the Pure Tone Average (PTA). The differences in the PTA, SAT and SRT values before and after the reallocation were determined. The results were statistically processed using the software Stata with a significance value of α < 0.05. Results: The mean values of SRT (61.25 dB versus 51.25 dB) and SAT (49 dB versus 41 dB) were significantly lower (p: 0.02 and p: 0.04, respectively) after the reallocation. No significant difference was found between PTA values (41.5 dB versus 39.25 dB; p: 0.18). Conclusions: Our preliminary results demonstrate better speech discrimination and rapid adaptation in implanted postlingually deaf patients after anatomic mapping and subsequent frequency reallocation.
2022
- Hearing Results in Patients with No Ossicular Chain Reconstruction and Factors Influencing the Outcome
[Articolo su rivista]
Alicandri-Ciufelli, M.; Cantaffa, C.; Presutti, M. T.; Villari, D.; Lucidi, D.; Marchioni, D.
abstract
Introduction Ossiculoplasty is aimed at improving or maintaining the conductive portion of hearing in patients subjected to otologic surgery. However, satisfying hearing is frequently observed after tympanoplasty even in the absence of ossicular chain reconstruction. Aims of this article would be to evaluate hearing outcomes, in terms of pure tone average air-bone gap (PTA-ABG), in patients subjected to tympanoplasty for middle ear disease whose ossicular chain has not been reconstructed, and then to investigate factors influencing those outcomes. Materials and Methods Retrospective chart review of patients who underwent ear surgery from year 2003 to 2021 at the Otolaryngology-Head and Neck surgery department of the University Hospital of Modena was performed. Audiometric test results from patients who did not receive any ossicular chain reconstruction were collected and analyzed. Setting Tertiary University referral center. Results The mean patients' follow-up was 34.1 months. Overall, mean PTA-ABG in the study population was 23.5 dB. Integrity of stapes superstructure, malleus handle and malleus head, together with the use of tragal cartilage graft over autologous temporalis fascia to reconstruct the tympanic membrane were found to be significantly associated with better hearing outcomes, as demonstrated by lower PTA-ABG values. Stapes superstructure was found to be associated with more favorable outcomes in multivariate analysis, net of confounding factors. Conclusion Good hearing performance can be obtained in patients subjected to middle ear surgery, even if the ossicular chain is not reconstructed. Presence of ossicular chain remnants and the use of a rigid material for tympanic membrane reconstruction are the factors that seem to most favorably influence hearing outcomes after surgery for middle ear disease.
2022
- Microsurgical training using an ex-vivo model: microscope vs 3D exoscope
[Articolo su rivista]
Molteni, G.; Ghirelli, M.; Sacchetto, A.; Fermi, M.; De Rossi, S.; Mattioli, F.; Presutti, L.; Marchioni, D.
abstract
Objective. The aim of this study is to evaluate the feasibility of the 3D exoscope in a mi-crovascular anastomosis training setting and compare it with the gold-standard technique using the operating microscope (OM). Methods. Participants were recruited among otorhinolaryngology head and neck surgery (OHNS) residents of two tertiary care hospitals. Trainees were asked to complete 4 micro-vascular end-to-end anastomoses on chicken thighs with the OM and VITOM 3D exoscope. The performances were scored by experienced microvascular surgeons; an objective evaluation of the anastomosis and a subjective assessment of the workload were conducted. Results. 8 OHNS residents were recruited. Considering the amount of time needed to complete (TTC) the anastomosis, an improvement was shown by all the participants throughout the training program. The objective evaluation of the anastomosis did not show a significant difference. No significant differences were found by analyzing the subjective workload with the different tools. Conclusions. This article represents the first attempt to compare the use of the OM and the 3D exoscope during training for microsurgery. The results of our study demonstrate the noninferiori-ty of microsurgical training obtained using the 3D exoscope compared to that offered by the OM.
2022
- Modular Approach to Open Partial Horizontal Laryngectomy: Step-by-Step Anatomic Dissection
[Articolo su rivista]
Molteni, G.; Bertolin, A.; Gazzini, L.; Sacchetto, A.; Marchioni, D.
abstract
Open partial laryngectomies still play an important role in contemporary conservative management of laryngeal cancer. A comprehensive and systematic classification of open partial horizontal laryngectomies (OPHLs) was presented by the European Laryngological Society working committee in 2014. The aim of this video is to show the main surgical steps in OPHL using a cadaveric dissection and to explain the modular approach for removal of laryngeal tumors.
2022
- Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults
[Articolo su rivista]
Marchioni, Alessandro; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Fermi, Matteo; Trentacosti, Fabiana; Castaniere, Ivana; Fantini, Riccardo; Tabbì, Luca; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Moretti, Antonio; Baroncini, Serena; Samarelli, ANNA VALERIA; Marchioni, Daniele; Pinelli, Massimo; DE SANTIS, Giorgio; Stefani, Alessandro; Mattioli, Francesco; Clini, Enrico
abstract
Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different etiology. Although iatrogenic etiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent etiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.
2022
- Occlusal splint therapy in patients with Ménière’s disease and temporomandibular joint disorder
[Articolo su rivista]
Monzani, D.; Baraldi, C.; Apa, E.; Alicandri Ciufelli, M.; Bertoldi, C.; Roggla, E.; Guerzoni, S.; Marchioni, D.; Pani, L.
abstract
SUMMARY Objective. This retrospective study aimed to verify the outcomes of stabilising occlusal splint therapy prescribed to 22 patients with unilateral definite Ménière’s disease and comorbid temporomandibular joint disorder. Methods. The results of a battery of audiometric and vestibular tests were recorded before and after 6 months of treatment, as well as the scores of disease-specific questionnaires. Results. The average hearing threshold in the affected ear and the acoustic immittance were unchanged. No spontaneous and positional nystagmus were recorded. Caloric hyporesponsiveness and vestibular myogenic evoked responses did not vary. No changes of stabilometric body sway parameters in eyes opened condition and with optokinetic stimulation delivered to the unaffected labyrinth were observed. A significant reduction was recorded in eyes closed condition and with the optokinetic stimulation toward the affected ear. The Tinnitus Handicap Inventory, the Situational Vertigo Questionnaire and the Numeric Pain Rating Scale scores improved. The number of vertigo attacks was reduced. Conclusions. Occlusal splint therapy is a favourable option to reduce aural symptoms of Ménière’s disease and comorbid temporomandibular joint disorder, even if its pathophysiological mechanism remains elusive.
2022
- Prosthetic voice rehabilitation after laryngoesophagectomy: surgical and functional outcomes
[Articolo su rivista]
Molteni, G.; Fulco, G.; Gazzini, L.; Laura, E.; Paiola, G.; Giacopuzzi, S.; Marchioni, D.; Pighi, G. P.
abstract
Purpose: Quality of Life (QoL) after extensive head and neck resections is of paramount importance, especially after pharyngolaryngectomy or pharyngolaryngoesophagectomy where complex digestive tract reconstruction is required (with gastric pull-up or colon transposition). Tracheodigestive puncture (TDP) is the only vocal restoration option in this group of patients. The aim of this study is to evaluate postoperative complications, vocal outcomes, voice-related and swallowing-related QoL after secondary TDP in this cohort of patients. Methods: A retrospective study was conducted in the tertiary referral center of Verona Hospital between June 2014 and June 2020. Patient demographics, clinical and surgical data were assessed. Speech objective and subjective evaluation was performed. QoL was assessed with Voice Handicap Index-10 (VHI-10) and M.D. Anderson Dysphagia Inventory (MDADI) questionnaires. Results: Seven patients met the inclusion criteria, but two had died before questionnaires were administered. No intraoperative complications were noted after TDP surgery. There were delayed complications in four cases (57.1%) and all were treated with restoration. Intelligible voice was restored in all patients. Maximum phonation time and maximal voice intensity recorded were 5.42 ± 3.27 s and 65.20 ± 5.45 dB, respectively. Acceptable average VHI-10 and MDADI scores were obtained in all patients. Conclusions: Secondary TDP performed after gastric pull-up or colon transposition reconstructions are feasible and effective procedures. An intelligible voice was restored in all patients, with satisfactory patient-perceived voice-related and dysphagia-related quality-of-life outcomes.
2022
- Quality of Life after Surgical Treatment for Chronic Otitis Media: A Systematic Review of the Literature
[Articolo su rivista]
Lucidi, D.; Cantaffa, C.; Nocini, R.; Martone, A.; Alicandri-Ciufelli, M.; Marchioni, D.; Presutti, L.; Molinari, G.
abstract
This systematic review aims to (a) define what instruments are available to measure quality of life (QoL) in patients undergoing tympanoplasty for chronic otitis media (COM) and what is the most commonly selected timing to do so; (b) compare outcomes from different surgical techniques; and (c) describe any reported correlation between subjective and functional results. This review was conducted following the PRISMA statement recommendations. Of the 151 articles screened, 24 were included. Most studies had a prospective design. The mean age at surgery was 44.5 years. A microscopic retroauricular approach was the most common surgical technique. Most articles included both primary and revision surgeries. The most commonly used questionnaire was the Glasgow Benefit Inventory (GBI), followed by the Chronic Ear Survey (CES), the Chronic Otitis Media Outcome Test 15 (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Questionnaires were administered about 12 months after surgery in most studies. Ten studies reported possible associations between hearing results and QoL. QoL assessment after COM surgery variably relies on disease-specific and non-specific questionnaires. Patients are usually evaluated 12 months after surgery, and this appears to be a suitable timing to contrast the possible bias effect of different tympanoplasty techniques associated with different healing times. A comparison between QoL outcomes in different surgical approaches cannot be made, as several influencing factors have not been detailed in the included studies. Few studies have investigated the correlation between subjective and objective outcomes of tympanoplasty for COM so far.
2022
- Quality of life in vestibular schwannoma: a comparison of three surgical techniques
[Articolo su rivista]
Lucidi, Daniela; Cristoforo, Fabbris; Raffaele, Cerullo; Stefano Di Gioia, ; Calvaruso, Federico; Monzani, Daniele; ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Presutti, Livio
abstract
Objective
Through years, interest in quality of life (QoL) among patients affected by vestibular schwannoma (VS) has increased. The expansion of the indications for endoscopic ear surgery allowed the development of the transcanal transpromontorial surgery (TTS) for VS removal. The objective of the present study was to assess QoL in a cohort of VS patients operated on by translabyrinthine (TL), retrosigmoid (RS) and TTS approach.
Methods
The study was conducted on 111 patients who underwent surgery for VS between January 2017 and January 2020 at two different institutions. Patients fulfilled three questionnaires during follow-up: Glasgow Benefit Inventory, Depression Anxiety Stress Scales-21 and Penn Acoustic Neuroma Quality-Of-Life. The association between sex, age, date of surgery, tumor size, post-operative facial nerve (FN) function and QoL outcomes was assessed.
Results
An overall subjective impairment was demonstrated in all groups. Age, Koos staging and FN functions were associated to distinct QoL outcomes.
Conclusions
QoL decreases in patients surgically treated for VS. The TTS may allow improved scores in many domains, confirming to be a subjectively well-tolerated technique.
2022
- Transcanal Transvestibular Endoscopic Neurectomy: First Experience
[Articolo su rivista]
Marchioni, D.; Caiazza, N.; Calabrese, C.; Soloperto, D.
abstract
Objective: Ménière's disease is an idiopathic inner ear disorder characterized by recurrent vertigo, fluctuating sensorineural hearing loss, and persistent tinnitus. In 10% to 30% of cases, conservative therapy fails, and Ménière's disease is defined as intractable. In these patients, ablative techniques with unilateral vestibular deafferentation are mandatory. Several approaches for vestibular neurectomy, which preserve hearing capability, are described. In patients presenting severe dizziness associated with high-grade sensorineural hearing loss, surgical labyrinthectomy, or selected vestibular neurectomy through a translabyrinthine approach are the treatments commonly considered. This study reports the first application of transcanal transvestibular endoscopic neurectomy in two patients with frequent disabling vertigo and high-grade sensorineural hypoacusia. Methods: This was a retrospective chart review including patients with intractable Ménière's disease who underwent vestibular neurectomy, performed in our ENT department between January 2017 and January 2020, selecting patients with disabling vertigo and high-grade sensorineural hypoacusia. We describe step-by-step the surgical technique of transcanal transvestibular endoscopic neurectomy. Results: Overall, two patients underwent transcanal transvestibular endoscopic neurectomy. We performed transcanal transvestibular neurectomy in all cases. No intraoperative complications were observed. On the 2nd postoperative day, one patient presented CSF leak, leading to surgical revision. A complete resolution of vertigo attacks was observed 6months after surgery. Conclusion: Even though this study presents a limited number of cases, transcanal transvestibular neurectomy is a promising, safe, and effective procedure in selected cases.
2022
- Value of a Multidisciplinary Approach in Sinonasal Inverted Papilloma with Extensive Ossification
[Articolo su rivista]
Barioglio, B.; Paolino, G.; Girolami, I.; Bariani, E.; Santonicco, N.; Marletta, S.; Ammendola, S.; Brunelli, M.; Marchioni, D.; Pisapia, P.; Eccher, A.; Molteni, G.
abstract
Objective: Background: Casa Report: Conclusions: Rare disease Inverted papilloma is a benign epithelial lesion of the nasal cavities. Although commonly encountered in clinical practice, it rarely presents with extensive ossification and few cases have been described in the literature. Herein, we describe the case of a 51-year-old man who presented to clinical attention for persistent right nasal obstruction. Magnetic resonance imaging (MRI) and computed tomography (CT) scans of the facial bones showed a lobated lesion with ossification occupying most of the right nasal cavity. The lesion was removed by endoscopic sinus surgery, leaving the surrounding bone structures intact. On pathological examination, mature bone tissue was found within an inverted papilloma. The pathologist contacted the surgeon, who confirmed that no healthy bone tissue was removed during the procedure. Therefore, a diagnosis of inverted papilloma with ossification could be made without the use of ancillary techniques. Inverted papilloma with ossification is a common lesion with a rare feature. Our report investigates the diagnostic difficulties of a paradigmatic case, highlighting the importance of multidisciplinary teamwork in reach-ing the final diagnosis.
2021
- Acquired subglottic cysts in children: A rare and challenging clinical entity. A systematic review
[Articolo su rivista]
Soloperto, D.; Spinnato, F.; Di Gioia, S.; Di Maro, F.; Pinter, P.; Bisceglia, A.; Marchioni, D.
abstract
Introduction: Subglottic cysts (SGCs) are a rare cause of laryngeal stenosis that mainly seem to affect preterm infants with an intubation history. Purpose: To review the related literature and compare different management protocols for patients presenting SGCs, as well as briefly report our clinical case treated at Verona University Hospital by Pediatric Airways Team. Methods: The articles resulting from a PubMed and MEDLINE search were analysed and selected using previously established criteria. A systematic review of the selected papers was conducted following PRISMA guidelines. Results: The search yielded 571 related articles; cross-checking of articles led to the identification and exclusion of 239 duplicates. The remaining 332 papers were screened according to previously established eligibility criteria. The final number of selected articles was 13. Conclusions: Well-planned teamwork, with active collaboration between the ENT specialists, pediatricians and anesthesiologists, is the key to achieve multidisciplinary management of patients diagnosed with SGCs. Long-term follow-up is crucial considering the high recurrence rate of this disease.
2021
- Advanced lung cancer inflammation index and its prognostic value in HPV-negative head and neck squamous cell carcinoma: a multicentre study
[Articolo su rivista]
Gaudioso, P.; Borsetto, D.; Tirelli, G.; Tofanelli, M.; Cragnolini, F.; Menegaldo, A.; Fabbris, C.; Molteni, G.; Marchioni, D.; Nicolai, P.; Bossi, P.; Ciorba, A.; Pelucchi, S.; Bianchini, C.; Mauramati, S.; Benazzo, M.; Giacomarra, V.; Di Carlo, R.; Sethi, M.; Polesel, J.; Fussey, J.; Boscolo-Rizzo, P.
abstract
Purpose: The aim of this study is to evaluate the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in patients with HPV-negative HNSCC undergoing up-front surgical treatment. Methods: The present multi-centre, retrospective study was performed in a consecutive cohort of patients who underwent upfront surgery with or without adjuvant (chemo)-radiotherapy for head and neck squamous cell carcinoma (HNSCC). Patients were stratified by ALI, and survival outcomes were compared between groups. In addition, the prognostic value of ALI was compared with two other indices, the prognostic nutritional index (PNI) and systemic inflammatory index (SIM). Results: Two hundred twenty-three patients met the inclusion criteria (151 male and 72 female). Overall and progression-free survival were significantly predicted by ALI < 20.4 (HR 3.23, CI 1.51–6.90 for PFS and HR 3.41, CI 1.47–7.91 for OS). Similarly, PNI < 40.5 (HR = 2.43, 95% CI: 1.31–4.51 for PFS and HR = 2.40, 95% CI: 1.19–4.82 for OS) and SIM > 2.5 (HR = 2.51, 95% CI: 1.23–5.10 for PFS and HR = 2.60, 95% CI: 1.19–5.67 for OS) were found to be significant predictors. Among the three indices, ALI < 20.4 identified the patients with the worst 5-year outcomes. Moreover, patients with a combination of low PNI and low ALI resulted to be a better predictor of progression (HR = 5.26, 95% CI: 2.01–13.73) and death (HR = 5.68, 95% CI: 1.92–16.79) than low ALI and low PNI considered alone. Conclusions: Our results support the use of pre-treatment ALI, an easily measurable inflammatory/nutritional index, in daily clinical practice to improve prognostic stratification in surgically treated HPV-negative HNSCC.
2021
- COVID-19 and ear endoscopy in otologic practices
[Articolo su rivista]
Ayache, S.; Kutz, W.; Isaacson, B.; Badr-El-Dine, M.; Nogueira, J. F.; Marchioni, D.; Presutti, L.
abstract
Purpose: Otolaryngologists have had to postpone the majority of surgical procedures in the current COVID-19 pandemic. Airborne transmission, beyond the projection of droplets from upper airways, expose healthcare workers to a risk of viral infection. Aerosol generating procedures (AGP) increase the risk of viral transmission to staff within the operating room. Methods: Surgery of middle ear and mastoid is also considered an AGP, particularly mastoidectomy performed using a high-speed drill. The authors report their experience in endoscopic ear surgery as an alternative technique to reduce AGP in otologic procedures. Results: Transcanal endoscopic ear surgery is a reliable technique used to manage many otologic conditions. Conclusion: The endoscopic approach may reduce the risk of viral transmission to operating room staff by reducing the need for mastoidectomy.
2021
- Endoscopic Assisted Lateral Skull Base Surgery
[Articolo su rivista]
Isaacson, B.; Killeen, D. E.; Bianconi, L.; Marchioni, D.
abstract
Pathology of the lateral skull base poses a unique challenge for the surgeon. An intimate knowledge of the anatomy and the various approaches used for accessing pathology of the lateral skull base is critical. Three novel, minimally invasive, transcanal approaches for the management of lateral skull base pathology are described herein along with their respective indications, advantages, and disadvantages.
2021
- Endoscopic Ear Surgery: Redefining Middle Ear Anatomy and Physiology
[Articolo su rivista]
Marchioni, D.; Rubini, A.; Soloperto, D.
abstract
Middle ear anatomy and physiology is highly complex, yet familiarity is important to perform middle ear surgery and understand surgically relevant ventilation pathways of the ear compartments. The middle ear is divided into five subspaces: the mesotympanum, the retrotympanum posteriorly, the epitympanum superiorly, the protympanum anteriorly, and the hypotympanum inferiorly. The Eustachian tube plays a crucial role in maintaining middle ear aeration and atmospheric pressure. There are two independent aeration routes of the epitympanum. Thanks to the advent of the endoscope, this anatomic and physiologic knowledge has allowed one to understand the pathophysiology of ear diseases, improving surgical concepts.
2021
- Ethmoidal osteoma in children: Literature review and presentation of a case report
[Articolo su rivista]
Soloperto, D.; Sacchetto, A.; Gazzini, L.; Marchioni, D.
abstract
2021
- Facial Nerve Neurophysiologic Assessment in Vestibular Schwannoma Removal with Transcanal Approach: A Pilot Clinical Study
[Articolo su rivista]
Sacchetto, L.; Fabbris, C.; Romito, S.; Bianconi, L.; Marchioni, D.
abstract
Background: The transcanal transpromontorial approach has been introduced to remove vestibular schwannomas. As with other techniques, preservation of the facial nerve (FN) is challenging. This pilot study described FN outcomes of patients preoperatively and postoperatively assessed with electromyography (EMG) and blink reflex (BR). Methods: Between September 2017 and December 2018, 10 patients (5 men; 5 women; mean age, 59.8 years; age range, 25–77 years) underwent removal of vestibular schwannoma via the transcanal transpromontorial approach. FN assessment using EMG/BR and clinical evaluation with the House-Brackmann (HB) grading scale was performed preoperatively and 2 months postoperatively. If facial impairment was present postoperatively, further analysis was performed 6 months after surgery. Results: All 10 patients had normal FN function on preoperative EMG/BR. After 2 months, 4 patients had normal FN function on EMG/BR, 4 patients showed a slight delay of FN responses, 1 patient had moderate dysfunction, and 1 patient had consistent damage. After 6 months, among the 6 patients with a pathologic neurophysiologic study, consistent EMG/BR improvement was shown, with complete recovery in 3 cases. At the last follow-up, 8 patients had HB grade I, 1 patient had HB grade II, and 1 patient had HB grade III in 1, showing progression toward healing in 9 of 10 cases. Conclusions: The transcanal transpromontorial approach is an effective procedure for vestibular schwannoma removal. EMG/BR represents an objective evaluation method to verify FN recovery after surgery and confirms the low impact of this surgical procedure on the FN.
2021
- Free flap head and neck microsurgery with VITOMⓇ 3D: Surgical outcomes and surgeon's perspective
[Articolo su rivista]
Molteni, G.; Nocini, R.; Ghirelli, M.; Molinari, G.; Fior, A.; Veneri, A.; Nocini, P. F.; Marchioni, D.
abstract
Objective: To report on the application of the 3D exoscopic system to microsurgery in a cohort of head and neck cancer patients; to analyse the performance of microvascular anastomoses, flap harvesting and insetting under exoscopic view and to evaluate the surgeon's feedback after procedures. Methods: An observational study was performed on 10 consecutive patients undergoing exoscopic microsurgical free flap reconstruction. The VITOMⓇ 3D system was applied to all procedures for microsurgical anastomoses, flap harvesting and insetting. Data about the type of resection and reconstruction, intraoperative and post-operative complications were recorded. Surgeon's feedback on exoscopic experience was collected through a questionnaire. Results: Reconstruction after oncologic demolition was performed by radial forearm flap in 3 cases (30%), antero-lateral thigh flap in 4 cases (40%), composite fibula flap in 2 cases (20%) and chimeric scapula flap in 1 case (10%). The mean surgical time for the microsurgical anastomoses (1 vein and 1 artery) was 34 min (range: 32–38). No intraoperative complications occurred and only two patients experienced pharyngo-cutaneous fistula in the post-operative time. There were neither cases of loss of flap, nor need of surgical revision. None of the cases had to be converted to OM technique. The surgeon never experienced back/neck pain, headache and nausea/vertigo. Occasionally, he felt tired and stressed and he reported eyestrain after one procedure only. Conclusions: VITOMⓇ 3D is easy to apply in the field of head and neck microsurgery and provides optimal stereoscopic view and anatomical details. Further studies are needed to validate indications and advantages of 3D exoscope as compared to OM.
2021
- International Survey of Operative Practices for Otologists and Neurotologists during the COVID-19 Crisis
[Articolo su rivista]
Ridge, S. E.; Chari, D. A.; Kozin, E. D.; Remenschneider, A. K.; Adunka, O. F.; Aristegui, M.; Chang, W. T.; Cheng, Y. -F.; Chung, J. W.; Cohen, M. S.; Crowson, M. G.; Golub, J. S.; Handzel, O.; Isaacson, B.; Iyer, A.; Kakehata, S.; Marchioni, D.; Nogueira, J. F.; Patel, N.; Quesnel, A. M.; Rivas, A.; Saeed, S. R.; Salzman, R.; Santos, F.; Saxby, A. J.; Tarabichi, M.; Verhaert, N.; Vincent, R.; Wanna, G.; Wolpert, S.; Lee, D. J.
abstract
Objective:To investigate the influence of the COVID-19 pandemic on operative practices of otology and neurotology providers internationally.Study Design:Cross-sectional survey.Methods:A 78-question survey was distributed to otologists and neurotologists between May 12, 2020 and June 8, 2020 to assess the impact of the pandemic on surgical practices. Sections within the survey delineated time periods: prior to the crisis, onset of the crisis, during the crisis, postcrisis transition.Results:Of 396 survey respondents, 284 participants from 38 countries met inclusion criteria.Respondents were 16.9% female and 82.4% male, with a most common age range of 40 to 49 years (36.3%). 69.8% of participants had been in practice for over 10 years and most respondents worked in an academic medical center (79.2%). The average operative weekly caseload was 5.3 (SD 3.9) per surgeon prior to the crisis, 0.7 (SD 1.2) during the COVID-19 crisis, and 3.5 (SD 3.3) for those who had begun a postcrisis transition at the time of survey administration (p < 0.001). 71.5% of providers did not perform an elective otologic or neurotologic operative procedure during the initial crisis period. 49.8% reported modifying their surgical technique due to the COVID-19 pandemic. Use of powered air-purifying respirators and filtering facepiece 2 or 3 (FFP2/FFP3) respirators were in minimal supply for 66.9% and 62.3% of respondents, respectively.Conclusion:The COVID-19 pandemic impacted the otology and neurotology community globally, resulting in significant changes in operative volume and case selection. Modification of surgical technique and shortages of personal protective equipment were frequently reported.
2021
- Prognostic value of H-index in patients surgically treated for squamous cell carcinoma of the larynx
[Articolo su rivista]
Boscolo-Rizzo, P.; Zanelli, E.; Giudici, F.; Boscolo-Nata, F.; Cristalli, G.; Deganello, A.; Tomasoni, M.; Piazza, C.; Bossi, P.; Spinato, G.; Menegaldo, A.; Emanuelli, E.; Nicolai, P.; Bandolin, L.; Ciorba, A.; Pelucchi, S.; Lupato, V.; Giacomarra, V.; Molteni, G.; Marchioni, D.; Canzi, P.; Mauramati, S.; Fortunati, A.; Tofanelli, M.; Borsetto, D.; Fussey, J.; Tirelli, G.
abstract
Objective: Recently, a novel host-related index, the Host-index (H-index), including both inflammatory and nutritional markers, has been described and observed to stratify prognosis in patients with squamous cell carcinoma (SCC) of the oral cavity more accurately than other host-related indexes This study aimed to investigate the prognostic performance of the H-index using pretreatment blood tests in patients receiving up-front surgery for SCC of the larynx. Methods: This retrospective observational study included a multicenter series of consecutive patients with SCC of the larynx diagnosed between 1 January 2009 and 31 July 2018, whose pretreatment blood tests were available and included the parameters necessary for the calculation of neutrophil to lymphocyte ratio (NLR) and the H-index. Their association with disease-free survival (DFS) and overall survival (OS) was measured. Results: A total of 231 patients were eligible for the present analysis (median [range] age, 68 [37-96] years; 191 [82.7%] men). The median follow-up was 73 months. In multivariable Cox proportional hazards regression models, increasing age (adjusted hazard ratio [aHR], 1.07 per year; 95% CI, 1.04-1.09), advanced pT stage (aHR = 1.71 95% CI: 1.07-2.71), and having close or positive surgical margins (aHR = 2.01; 95% CI: 1.21-3.33) were significantly associated with poor OS. Among blood parameters, a higher neutrophil count was a strong predictor of both worse DFS (aHR for recurrence/death = 2.34; 95% CI: 1.24-4.40) and OS (aHR for death = 2.67; 95% CI: 1.51-4.71). Among inflammatory blood indexes, while NLR was not significantly associated with DFS or OS, patients with H-index ≥8.37 showed a higher aHR for both recurrence/death (2.82; 95% CI: 1.65-4.79) and death (2.22; 95% CI: 1.26-3.89). Conclusion: In conclusion, the present study confirms the prognostic value of pretreatment H-index, an easily measurable inflammatory and nutritional index, in patients with SCC of the larynx. Level of Evidence: III.
2021
- Quality of Life Evaluation After Trans-Nasal Endoscopic Surgery for Skull Base Tumors
[Articolo su rivista]
Molteni, G.; Sacchetto, A.; Saccardo, T.; Gulino, A.; Marchioni, D.
abstract
Background: The excellent surgical results obtained with transnasal endoscopic approach to the anterior skull base (ASB) are universally recognized; less is known about the quality of life of patients after surgery. Objective: The aim of this study is to analyze the quality of life of patients after endoscopic transnasal surgery for the treatment of neoplasms of the ASB. Methods: We conducted a retrospective review of patients who underwent transnasal endoscopic surgery for treatment of ASB tumors at the Tertiary Referral Center University Hospital of Verona. All patients were asked to complete the Anterior Skull Base Questionnaire (ASBQ), the Skull Base Inventory (SBI), and the Sino-nasal Outcome Test – 22 Items (SNOT-22) after surgical treatment. The study population was divided into subgroups; a statistical analysis of the overall results and of the different questionnaire domains was performed. Results: 51 patients were enrolled in this study. The average score was 3.04 for ASBQ, 4.05 for SBI and 28.88 for SNOT-22. Analysis of the overall results for the ASBQ showed a lower quality of life in patients after recurrent surgery and in female patients. The SBI showed similar results in relation to recurrent surgery and radiotherapy. Similarly, the results for SNOT-22 highlighted the negative impact of recurrent surgery and radiotherapy. Conclusion: Our results confirmed that the endoscopic transnasal approach shows excellent results not only in terms of surgical outcome, but also for the possibility of ensuring a good QoL after treatment. Recurrent surgery and radiation treatments were the most important negative prognostic factors.
2021
- Role of the temporoparietal fascia free flap in salvage total laryngectomy
[Articolo su rivista]
Molteni, G.; Gazzini, L.; Sacchetto, A.; Nocini, R.; Marchioni, D.
abstract
The procedure for salvage total laryngectomy (STL) is burdened by a high rate of postoperative complications as a result of delayed wound healing in previously irradiated tissue. Several observational studies have investigated the role of prophylactic vascularized flaps to aid pharyngeal closure after STL and prevent the development of PCF. The use of a temporoparietal fascia free flap (TFFF) as an overlay flap for STL has been described previously in two published studies and both sets of authors agreed that the most obvious benefit of the TFFF in STL is a reduced PCF rate with low site morbidity and good functional outcomes. The aim of this video is to illustrate the use of the temporoparietal fascia flap to provide an adjunctive reinforcement layer in the reconstruction of the pharynx.
2021
- Salvage neck dissection for isolated neck recurrences in head and neck tumors: Intra and postoperative complications
[Articolo su rivista]
Molteni, G.; Comini, L.; Le Pera, B.; Bassani, S.; Ghirelli, M.; Martone, A.; Mattioli, F.; Nocini, R.; Santoro, R.; Spinelli, G.; Presutti, L.; Marchioni, D.; Mannelli, G.
abstract
Background and Objectives: The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. Methods: This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. Results: Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. Conclusions: IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.
2021
- Secondary tracheoesophageal puncture with the blind technique: 10 years’ experience
[Articolo su rivista]
Gazzini, L.; Laura, E.; Molteni, G.; Marchioni, D.; Pighi, G. P.
abstract
Propose: The aim of the present article is to propose an alternative technique to the traditional secondary tracheoesophageal puncture (TEP) for voice rehabilitation after total laryngectomy, describing the procedure step-by-step, analyzing the complications and long-term results. Methods: A retrospective study was conducted on patients who underwent secondary TEP with the blind technique using a rigid hysterometer. The main steps in this technique are described and illustrated. Patient demographics and surgical outcomes were assessed. Results: Thirty-two patients were enrolled in this study. In all but one case, risk factors that could hinder rigid esophagoscopy were identified (37.5% neopharyngeal/esophageal post-surgical issues, 81.3% prior radiotherapy, 21.9% cervical arthrosis, and 12.5% prior coloplasty or gastric transposition). No intra- or postoperative surgical complications were noted. Conclusion: The blind technique offers an alternative method to perform a secondary TEP safely and efficiently in patients with unfavorable anatomical or clinical conditions, lowering the risk of procedure-related complications.
2021
- Subcochlear canaliculus patterns in the pediatric and adult population: radiological findings and surgical implications
[Articolo su rivista]
Marchioni, D.; Gazzini, L.; Bisi, N.; Barillari, M.; Rubini, A.
abstract
Introduction: The pneumatization of the different regions of the temporal bone is strictly related to the age and the degree of development of the mastoid and the middle ear. Petrous apex pneumatization is the last step of the development of the petrous bone system. The subcochlear canaliculus is an anatomical cavity, originating in the space between the fustis and the finiculus, and connecting the round window area to the petrous apex. The aim of the present article is analyzing the trend of development of the subcochlear canaliculus pneumatization, classified through CT scan examination, in different age subgroups. Materials and methods: We conducted a retrospective review of patients who underwent temporal bone CT scans between 2014 and 2019. Pediatric and adult patients were included and divided into different age subgroups. The subcochlear canaliculus was examined through coronal view scans at the level of the round window niche and classified into 3 different groups (A, B and C) according to the degree of pneumatization. Results: A total of 270 Petrous bone CT scans was analyzed. The percentage of type A subcochlear canaliculus was significantly higher in the pediatric population if compared to the adult population (p = 0.001326). As far as type B subcochlear canaliculus is concerned, the difference between children and adults was not statistically significant (p = 0.2378). On the other hand, type C subcochlear canaliculus was predominant in the adult population (p = 0.000256). Conclusions: There is a constant increase in pneumatization of the subcochlear canaliculus from 0 to 19 years and then a progressive decrease. This discovery has relevant surgical implications and has to be borne in mind in particular for cholesteatoma surgery and cochlear implantation surgery in the age groups in which the subcochlear canaliculus is highly pneumatized.
2021
- The green indocyanine: the meaning of one tracer for the intra-peri operative imaging and vascular evaluation in the reconstructive surgery of head and neck: an experimental multidisciplinary study
[Articolo su rivista]
Nocini, R.; Molteni, G.; Giacopuzzi, S.; Marchioni, D.
abstract
The objective of this study was to evaluate the feasibility and reproducibility of a new diagnostic approach through the flow injection of green indocyanine such as the intraoperative and perioperative vascularization in the reconstruction of various anatomical areas with pedunculated or microsurgical free flaps, the identification of the sentinel lymph node in the latero cervical emptying or the assessment of the quality of anastomoses in organ transplantation. The study involved ten patients who underwent reconstructive procedures with different surgical approaches for reconstructive surgery of head and neck. An intraoperative check was performed in several stages to assess the real perfusion status of the treated area. Indocyanine green was used in all the patients in association with an intraoperative imaging diagnostic system. Indocyanine green showed in all the cases a full highlight of central and peripheral vascularization. Furthermore, this imaging system allowed a satisfactory and rapid intraoperative evaluation of the vascular tree and a high sensitivity in detection of the sentinel lymph node in latero cervical emptying. Despite the limited sample, the results suggest that the intraoperative administration of indocyanine green may represent a valid evaluating system for reconstructed flap perfusion and for sentinel lymph node identification in oncological surgery.
2021
- The risk of recurrence in surgically treated head and neck squamous cell carcinomas: a conditional probability approach
[Articolo su rivista]
Borsetto, D.; Sethi, M.; Polesel, J.; Tomasoni, M.; Deganello, A.; Nicolai, P.; Bossi, P.; Fabbris, C.; Molteni, G.; Marchioni, D.; Tofanelli, M.; Cragnolini, F.; Tirelli, G.; Ciorba, A.; Pelucchi, S.; Corazzi, V.; Canzi, P.; Benazzo, M.; Lupato, V.; Giacomarra, V.; Cazzador, D.; Bandolin, L.; Menegaldo, A.; Spinato, G.; Obholzer, R.; Fussey, J.; Boscolo-Rizzo, P.
abstract
Background: Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) experience locoregional recurrence, which is associated with poor outcome. In the course of follow-up for patients surviving primary surgery for HNSCC, one might ask: What is the probability of recurrence in one year considering that the cancer has not yet recurred to date? Materials and methods: To answer this question, 979 patients surgically treated for HNSCC (i.e. cancer of the oral cavity, oropharynx, hypopharynx or larynx) between March 2004 and June 2018 were enrolled in a multicenter retrospective cohort study, followed up for death and recurrence over a 5 year period. The conditional probability of recurrence in 12 months–i.e. the probability of recurrence in the next 12 months given that, to date, the patient has not recurred–was derived from the cumulative incidence function (Aalen-Johansen method). Results: Overall, the probability of recurrence was the highest during the first (17.3%) and the second years (9.6%) after surgery, declining thereafter to less than 5.0% a year thereafter. The probability of recurrence was significantly higher for stage III–IV HNSCCs than for stage I–II HNSCCs in the first year after surgery (20.4% versus 10.0%; p < 0.01), but not thereafter. This difference was most pronounced for oral cavity cancers. No significant differences were observed across different tumor sites. Conclusion: This dynamic evaluation of recurrence risk in patients surgically treated for HNSCC provides helpful and clinically meaningful information, which can be useful to patients in planning their future life, and to clinicians in tailoring post-treatment surveillance according to a more personalized risk stratification.
2021
- Transmeatal microsurgery for intralabyrinthine and intrameatal schwannomas: Literature review
[Articolo su rivista]
Marchioni, D.; Di Maro, F.; Presutti, L.
abstract
2020
- 3D exoscopic surgery of lateral skull base
[Articolo su rivista]
Rubini, A.; Di Gioia, S.; Marchioni, D.
abstract
Purpose: The aim of the study is to assess whether the 3D exoscopic surgery technique could be used in lateral skull base surgery and if it could ultimately replace the microscope in the future. Methods: This is a retrospective study in which were included 24 patients affected by lateral skull base pathologies, who underwent surgery using the 3D exoscope or the operative microscope at the Department of Otolaryngology—Head and Neck Surgery at the University Hospital of Verona. The exoscope and microscope groups each included 12 cases. The feasibility of all the surgical steps solely using the 3D exoscope was evaluated. The exoscope group and microscope group were compared taking into account the following factors: time of the surgery, facial and hearing functions outcomes, as well as the intraoperative and postoperative complications. Results: No intraoperative complication occurred during all the procedures. Postoperatively, only one minor complication emerged. The average operative time was 289 in the exoscope group and 313 min in the microscope one. No significant statistical differences were identified between the two groups (p > 0.05). The facial and hearing function outcomes were fully comparable. Conclusion: Our experience demonstrated that the exclusive use of the 3D exoscope, as that of the traditional microscope during lateral skull base surgery, is feasible for all open approaches. The use of the 3D exoscopic technique is very promising for future lateral skull base surgeries.
2020
- A snapshot of knowledge about oral cancer in italy: A 505 person survey
[Articolo su rivista]
Nocini, R.; Capocasale, G.; Marchioni, D.; Zotti, F.
abstract
Objectives: Patients’ knowledge about oral squamous cell carcinoma (OSCC) plays an important role in primary prevention, early diagnosis, and prognosis and survival rate. The aim of this study was to assess OSCC awareness attitudes among general population in order to provide information for educational interventions. Methods: A survey delivered as a web-based questionnaire was submitted to 505 subjects (aged from 18 to 76 years) in Italy, and the answers collected were statistically analyzed. Information was collected about existence, incidence, features of lesions, risk factors of oral cancer, and self-inspection habits, together with details about professional reference figures and preventive behaviors. Results: Chi-square tests of independence with adjusted standardized residuals highlighted correlations between population features (age, gender, educational attainment, provenance, medical relationship, or previous diagnoses of oral cancer in family) and knowledge about oral cancer. Conclusions: Knowledge about OSCC among the Italian population is limited, and it might be advisable to implement nudging and sensitive customized campaigns in order to promote awareness and therefore improve the prognosis of this disease.
2020
- American Neurotology Society, American Otological Society, and American Academy of Otolaryngology - Head and Neck Foundation Guide to Enhance Otologic and Neurotologic Care During the COVID-19 Pandemic
[Articolo su rivista]
Kozin, E. D.; Remenschneider, A. K.; Blevins, N. H.; Jan, T. A.; Quesnel, A. M.; Chari, D. A.; Kesser, B. W.; Weinstein, J. E.; Ahsan, S. F.; Telischi, F. F.; Adunka, O. F.; Weber, P.; Knoll, R. M.; Coelho, D. H.; Anne, S.; Franck, K. H.; Marchioni, D.; Barker, F. G.; Carter, B. S.; Lustig, L. R.; Bojrab, D. I.; Bhansali, S. A.; Westerberg, B. D.; Lundy, L.; Jackler, R. K.; Roland, J. T.; Chandrasekhar, S. S.; Antonelli, P. J.; Carey, J. P.; Welling, D. B.; Slattery, W. H.; Lee, D. J.
abstract
: This combined American Neurotology Society, American Otological Society, and American Academy of Otolaryngology - Head and Neck Surgery Foundation document aims to provide guidance during the coronavirus disease of 2019 (COVID-19) on 1) "priority" of care for otologic and neurotologic patients in the office and operating room, and 2) optimal utilization of personal protective equipment. Given the paucity of evidence to inform otologic and neurotologic best practices during COVID-19, the recommendations herein are based on relevant peer-reviewed articles, the Centers for Disease Control and Prevention COVID-19 guidelines, United States and international hospital policies, and expert opinion. The suggestions presented here are not meant to be definitive, and best practices will undoubtedly change with increasing knowledge and high-quality data related to COVID-19. Interpretation of this guidance document is dependent on local factors including prevalence of COVID-19 in the surgeons' local community. This is not intended to set a standard of care, and should not supersede the clinician's best judgement when managing specific clinical concerns and/or regional conditions.Access to otologic and neurotologic care during and after the COVID-19 pandemic is dependent upon adequate protection of physicians, audiologists, and ancillary support staff. Otolaryngologists and associated staff are at high risk for COVID-19 disease transmission based on close contact with mucosal surfaces of the upper aerodigestive tract during diagnostic evaluation and therapeutic procedures. While many otologic and neurotologic conditions are not imminently life threatening, they have a major impact on communication, daily functioning, and quality of life. In addition, progression of disease and delay in treatment can result in cranial nerve deficits, intracranial and life-threatening complications, and/or irreversible consequences. In this regard, many otologic and neurotologic conditions should rightfully be considered "urgent," and almost all require timely attention to permit optimal outcomes. It is reasonable to proceed with otologic and neurotologic clinic visits and operative cases based on input from expert opinion of otologic care providers, clinic/hospital administration, infection prevention and control specialists, and local and state public health leaders. Significant regional variations in COVID-19 prevalence exist; therefore, physicians working with local municipalities are best suited to make determinations on the appropriateness and timing of otologic and neurotologic care.
2020
- Authors' Reply to the Letter to the Editor: "Endoscopic Tympanoplasty in the Treatment of Chronic Otitis Media" a Comment to the Article: "The Management of Tympanic Membrane Perforation with Endoscopic Type I Tympanoplasty"
[Articolo su rivista]
Bianconi, L.; Di Maro, F.; Gazzini, L.; De Rossi, S.; Sacchetto, L.; Carner, M.; Marchioni, D.
abstract
2020
- Correction to: Multiple spontaneous skull base cerebrospinal fluid leaks: some insights from an international retrospective collaborative study (European Archives of Oto-Rhino-Laryngology, (2020), 277, 12, (3357-3363), 10.1007/s00405-020-06227-w)
[Articolo su rivista]
Dallan, I.; Cambi, C.; Emanuelli, E.; Cazzador, D.; Canevari, F. R.; Borsetto, D.; Tysome, J. R.; Donnelly, N. P.; Rigante, M.; Georgalas, C.; Alobid, I.; Molteni, G.; Marchioni, D.; Shahzada, A. K.; Scarano, M.; Seccia, V.; Pasquini, E.
abstract
In the original publication of the article, the following affiliation “Medical school, University of Nicosia, Nicosia, Cyprus” of the author “Christos Georgalas” was missed and included in this correction.
2020
- Covid-19 and ENT practice: Our experience: ENT outpatient department, ward and operating room management during the SARS-CoV-2 pandemic
[Articolo su rivista]
Marchioni, D.; Bisi, N.; Molteni, G.; Rubini, A.
abstract
Objectives: The current study aims at assessing the effectiveness of the guidelines set up by our clinic for the protection of patients and staff which enabled us to proceed with urgent and oncological surgery after the outbreak of the Covid-19 pandemic. Material and methods: Our ENT department devised specific equipment to be worn by the staff for personal protection when dealing with Covid-19 patients both in aerosol generating and non-generating procedures. Moreover, restrictive measures were enforced both for the outpatient department and for the ward where only urgent practices were carried out and visitors were not allowed, while non-urgent elective surgery was postponed. A codified scheme was followed to perform tracheostomy procedure in Covid-19 positive testing patients on the part of 3 specific teams of 2 surgeons each, while the resident educational program was reorganized to limit the spread of the infection. Results: In about a couple of months (from March 8th to May 3rd) a relevant amount of medical tests and surgical procedures were carried out on non COVID-19 patients and a certain number of tracheostomies were performed on COVID-19 patients. Consequently, all the ENT personnel were checked and found negative. Also, all the patients in the ward were swab tested and chest X-rayed, only one had a positive outcome and was adequately handled and treated. Conclusion: Our ENT guidelines regarding personal protection equipment and multiple simultaneous diagnostic procedures have proved to be an essential instrument for the management of patients with both known and unknown COVID-19 status.
2020
- Double free flaps in oral cavity and oropharynx reconstruction: Systematic review, indications and limits
[Articolo su rivista]
Mannelli, G.; Gazzini, L.; Comini, L. V.; Parrinello, G.; Nocini, R.; Marchioni, D.; Molteni, G.
abstract
The simultaneous use of two different free flaps, harvested from distinct donor sites, has demonstrated a reasonable degree of safety and success rates in head and neck composite defects reconstruction. Unfortunately, their relatively low frequent use, together with the lack of proper statistics on their management strategies, make their indications weak of robust conclusions to better define their role in common practice. The aim of the present study was to review the literature of the last 15 years regarding simultaneous free flap transposition, presenting advantages, disadvantages, and results of this technique, with the final purpose to propose an up-to-date panorama for the use of double free flap for complex head and neck defects reconstruction. Depending on which factors are present, surgeons may choose to select an approach that is theoretically safer, but yields less-than-ideal functional outcomes, such as local flap. Two free flaps may be necessary when the defect contains both a large, complex bony defect, large soft tissue needs, and proper surgical planning and meticulous monitoring continues to be the cornerstone of success.
2020
- Endoscopic Decompression of the Labyrinthine Segment of the Facial Nerve
[Articolo su rivista]
Cornu, N.; Marchioni, D.; Eliezer, M.; Verillaud, B.; Hautefort, C.; Green, A.; Marc, M.; Bresson, D.; Froelich, S.; Herman, P.; Kania, R.
abstract
OBJECTIVE: To describe the outcome and feasibility of an exclusive endoscopic transcanal transpromontorial approach (ETTA) for decompression of the labyrinthine segment of the facial nerve (LSFN). PATIENT: A 60-year-old man with a left-sided transverse fracture of temporal bone involving the LSFN, resulting in a grade VI House-Brackmann (HB) facial palsy, associated with ipsilateral total sensorineural hearing loss. INTERVENTION: Surgical decompression of the LSFN by ETTA. MAIN OUTCOME MEASURE: The patient underwent ETTA which allowed complete exposure and decompression of the LSFN. RESULTS: One year postoperatively, the patient had recovered with House-Brackmann grade II facial function. CONCLUSION: ETTA can be considered a valuable and appropriate technique for posttraumatic decompression of LSFN, associated with unilateral total sensorineural hearing loss. The procedure resulted in significant facial nerve function improvement. ETTA should be considered both a scarless, mastoid conserving and less invasive surgical technique for posttraumatic LSFN decompression associated with pre-existing cochlear impairment.
2020
- Endoscopic facial nerve decompression in post-traumatic facial palsies: pilot clinical experience
[Articolo su rivista]
Alicandri Ciufelli, M.; Fermi, M.; Di Maro, F.; Soloperto, D.; Marchioni, D.; Presutti, L.
abstract
Purpose: Post-traumatic facial nerve (FN) paralysis might need surgical decompression in selected patients. Different microscope-based surgical techniques are described in the literature such as the transmastoid, the middle cranial fossa and the translabyrinthine approach. The effectiveness of the transcanal endoscopic approach (TEA) in managing such condition has never been described and its possible indications has to be defined. Methods: Retrospective multi-centric case series of patients with post-traumatic FN paralysis surgically treated with TEA. From July 2013 to July 2017, 6 patients underwent TEA for post-traumatic FN paralysis with involvement of the second genu and/or the tympanic segment of the nerve. The surgical technique is described step by step, with focus on anatomic landmarks. Post-operative outcomes are specified in terms of FN postoperative function and audiologic results. Results: The TEA showed to recover a House–Brackmann grade I–II FN function in 83.2% of the patient. Post-operative air–bone gap significantly improved; whereas, the pure-tone average bone conduction did not differ significantly. Conclusions: TEA represents a viable option for the treatment of post-traumatic facial palsy in patients with radiologic evidence of tympanic segment and/or perigeniculate region involvement with no involvement of the mastoid segment of the FN. Transcanal endoscopic facial nerve decompression is a safe and effective approach in highly selected cases. Level of evidence: 4.
2020
- Endoscopic stapedotomy: safety and audiological results in 150 patients
[Articolo su rivista]
Bianconi, L.; Gazzini, L.; Laura, E.; De Rossi, S.; Conti, A.; Marchioni, D.
abstract
Objective: The most widely accepted treatment for otosclerosis is currently microscopic stapes surgery under either local or general anesthesia. The aim of the study is to describe the surgical steps in endoscopic stapes surgery and to evaluate the audiologic and surgical outcomes. Materials and methods: All patients who underwent exclusive endoscopic stapes surgery or revision surgery for previous stapedotomy between November 2014 and September 2018 were enrolled in this study. Demographic data, surgical information, preoperative and postoperative pure tone averages and air bone gaps, intraoperative and postoperative complications and follow-up data were summarized and gathered in a database for further consideration and analysis. Results: In the period examined, 181 stapes surgical procedures were performed and out of these 150 met the inclusion criteria. There were no cases of major intraoperative complications. Sensorineural hearing loss was observed in one case. In one patient a gusher effect occurred during surgery. The postoperative air–bone gap improved significantly compared to the preoperative gap (8 vs 29 dB HL, respectively), and the mean air–bone gap closure was 20 dB HL. In 78.7% of cases, the observed postoperative air–bone gap was less than 10 dB HL and in 14% it was between 11 dB HL and 20 dB HL. An ABG closure lower than 20 dB HL was achieved in a total of 92.7% of patients. Conclusions: Endoscopic stapes surgery is a safe procedure with a low risk of peri- or postoperative complications and is a possible alternative to the traditional microscopic surgical procedure in the treatment of otosclerosis.
2020
- Exclusive surgical treatment for vestibular schwannoma regrowth or recurrence: A meta-analysis of the literature
[Articolo su rivista]
Fabbris, C.; Gazzini, L.; Paltrinieri, D.; Marchioni, D.
abstract
Vestibular schwannomas can be treated in different ways, but for symptomatic or growing tumors, the gold standard is surgical removal of the lesion. In order to preserve neurovascular structures, partial removal is often performed, leaving a residual that may grow in subsequent years. To date, there is no consensus with regard to surgical treatment of vestibular schwannoma residuals, and so this review focuses on this topic. A structured search was performed on PubMed searching for all articles discussing vestibular schwannoma residuals and recurrences. Only articles discussing surgical treatment were included, focusing on studies which also examined facial nerve outcomes. A total of 51 articles were eligible for review and these included 375 patients. Statistical analysis was performed by correlating the following parameters: patients’ gender and age at first surgery, surgical approach adopted at first and subsequent surgeries, tumor and residual size, and extent of resection (gross total, near total, subtotal or others) at first and subsequent surgical procedures. Facial nerve function was also analyzed focusing on its performance when correlated with the different surgical approaches. The data were analyzed by linear regression but there were no correlations between any of the parameters chosen. There was a statistically significant difference between the first approach used (mainly the retrosigmoid route) compared with subsequent approaches (mainly the translabyrinthine route). In total, 8.5 % of patients needed further treatment due to residual regrowth. Facial nerve outcome was independent of the parameters chosen. Exclusive surgical treatment for vestibular schwannoma residuals had a very low failure rate in terms of requiring further treatment. The approach usually chosen for second surgery was the translabyrinthine technique, and this may be explained by the location of the residual, rather than its size. The choice of a particular surgical approach rather than another had no influence on facial nerve function. Complications rates are comparable to Gamma Knife Radiosurgery's as reported in the literature.
2020
- Leiomyosarcoma of the Larynx: A Complex Diagnosis
[Articolo su rivista]
Molteni, G.; Soloperto, D.; Fabbris, C.; Gazzini, L.; De Rossi, S.; Valotto, G.; Marchioni, D.
abstract
2020
- Multiple spontaneous skull base cerebrospinal fluid leaks: some insights from an international retrospective collaborative study
[Articolo su rivista]
Dallan, I.; Cambi, C.; Emanuelli, E.; Cazzador, D.; Canevari, F. R.; Borsetto, D.; Tysome, J. R.; Donnelly, N. P.; Rigante, M.; Georgalas, C.; Alobid, I.; Molteni, G.; Marchioni, D.; Shahzada, A. K.; Scarano, M.; Seccia, V.; Pasquini, E.
abstract
Purpose: Spontaneous skull base cerebrospinal fluid leaks occurring without any apparent cause are rare. But those patients that present such leaks simultaneously, or successively, in multiple locations are even rarer. Given the rarity of this condition, we collected data from other groups in a multicentre study to reach an adequate number of patients and draw some preliminary considerations. Methods: We carried out a multicentre retrospective study on a cohort of patients treated at third level hospitals in Italy, Spain, United Kingdom and Greece for multiple spontaneous-CSF leaks and we compared them with a control group of patients treated for recurrent spontaneous-CSF leaks. Data regarding clinical aspects, radiological findings, surgical techniques and outcome were collected and preliminary considerations on the results were discussed. Results: A total of 25 patients presented multiple simultaneous spontaneous CSF leaks while 18 patients fit with the criteria of recurrent spontaneous CSF leaks. Data analysis was conducted separately. Conclusions: Our understanding of the pathogenesis of this condition is currently very limited. A causative role of IIH may be present but the differences that emerged from the comparison with patients with recurrent fistulas seem to promote the possible role of other cofactors. A longer follow-up period is needed, and, in our opinion, prospective and multicentre studies are the only solution to seriously deal with such a complex topic.
2020
- Prevalence of PD-L1 expression in head and neck squamous precancerous lesions: a systematic review and meta-analysis
[Articolo su rivista]
Girolami, I.; Pantanowitz, L.; Munari, E.; Martini, M.; Nocini, R.; Bisi, N.; Molteni, G.; Marchioni, D.; Ghimenton, C.; Brunelli, M.; Eccher, A.
abstract
Background: Studies concerning programmed death-ligand 1 (PD-L1) expression in precancerous lesions of head and neck (HN) region have shown variable results. Methods: We systematically reviewed the published evidence on PD-L1 expression in HN precancerous lesions. Results: Of 1058 original articles, 14 were included in systematic review and 9 in meta-analysis. The pooled estimate of PD-L1 expression was 48.25% (confidence interval [CI] 21.07-75.98, I2 98%, tau2 0.18). PD-L1 expression appeared to be more frequent in precancerous lesions than in normal mucosa (risk ratio [RR] 1.65, CI 0.65-4.03, I2 91%, tau2 0.82) and less frequent than in invasive squamous cell carcinoma (RR 0.68, CI 0.43-1.08, I2 91%, tau2 0.22). Conclusions: PD-L1 expression could reflect a point of balance between host immune response and cancer escape ability. High heterogeneity and moderate quality suggest that further studies with larger sample size and more rigorous case selection will allow more precise assessment of PD-L1 expression in HN precancerous lesions.
2020
- Proposal of a timing strategy for cholesteatoma surgery during the COVID-19 pandemic
[Articolo su rivista]
George, M.; Alexander, A.; Mathew, J.; Iyer, A.; Waterval, J.; Simon, C.; Marchioni, D.; Maire, R.
abstract
Purpose: The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold’s abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? Methods: Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. Results: Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 sub-groups based on disease severity. Conclusions: Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic.
2020
- Reconstruction of Complex Oromandibular Defects in Head and Neck Cancer: Role of the Chimeric Subscapular Free Flap
[Articolo su rivista]
Molteni, G.; Gazzini, L.; Plotegher, C.; Lanaro, L.; Fior, A.; Marchioni, D.; Nocini, P. F.
abstract
The purpose of this study is to present the chimeric scapula tip-free flap as a reconstructive choice in composite head and neck defects and to highlight the experiences of the authors in this field.A retrospective study and a literature review were conducted. Data about preoperative condition, intraoperative images, and radiological and clinical documentation were collected.Excision of head and neck advanced cancers may result in large composite defects containing different types of soft tissue and bone. This topic is particularly challenging in salvage surgery after radiation therapy. In this setting, reconstructive techniques are very complex and traditionally require the use of multiple microvascular flaps. Chimeric free flaps, based on the subscapular system, allow complex reconstructions, providing both soft tissue and bone on a single vascular peduncle.The regional anatomy of the subscapular system and the possible chimeric flaps that can be harvested will be discussed, together with the reconstructive surgical technique used and the positioning of the patient. Two representative clinical cases of complex head and neck reconstruction after radiotherapy are presented.Different types of chimeric flap can be harvested from the subscapular system. These flaps can include different tissues: skin, bone, muscle on a single vascular peduncle. This characteristic is particularly useful in complex defects with different tissue types involved, following large en-bloc excision of advanced head and neck tumors.Free flaps based on the subscapular system can be an excellent reconstructive choice in complex head and neck defects.
2020
- Role of endoscopy in lateral skull base approaches to the petrous apex
[Articolo su rivista]
Marchioni, D.; Gazzini, L.; Bonali, M.; Bisi, N.; Presutti, L.; Rubini, A.
abstract
Objective: The aim of this article is to study the role and advantages of combined microscopic/endoscopic procedures or exclusive endoscopic approaches in the treatment of petrous apex pathologies. Methods: The study was designed as a retrospective case series analysis. We included patients affected by pathologies of the petrous apex, who underwent microscopic/endoscopic-assisted or exclusive endoscopic procedures. Patient and pathology characteristics and surgical data (focusing on the involvement of the internal carotid artery (ICA) and facial nerve by the disease) were collected. Residual disease, detected through the endoscopic check, and the feasibility of endoscopic residual tumor removal were also evaluated. Finally, facial nerve and hearing functions were assessed pre- and postoperatively. Results: The records of 75 patients undergoing lateral skull base surgery for petrous apex lesions, from May 2009 to March 2019, were collected. In 17 out of 75 patients, an exclusive endoscopic procedure was possible. The remaining 58 patients underwent a combined microscopic/endoscopic approach. In 15 cases, residual disease was found and removed endoscopically at the end of the microscopic procedure; in eight cases, the residual disease was medial and/or inferior to the horizontal segment of the ICA, while in two cases, it was located in the fundus of the internal auditory canal. In five cases, it involved the labyrinthine segment of the facial nerve. Conclusion: Petrous apex surgery remains a traditional microscopic-based surgery, but the recent advent of endoscopic surgery has permitted an improvement in radicality minimizing the manipulation of neurovascular structures.
2020
- Surgical anatomy of the facial nerve: from middle cranial fossa approach to endoscopic approach. A pictorial review
[Articolo su rivista]
Soloperto, D.; Di Maro, F.; Le Pera, B.; Marchioni, D.
abstract
Purpose: The pathology of the facial nerve is extremely varied and extensive knowledge of the surgical anatomy in different approaches is required to manage it. During the last 15 years, the development of endoscopic ear surgery has significantly changed anatomical concepts, introducing new surgical approaches. The aim of this review is to illustrate five different surgical approaches to the facial nerve: the endoscopic approach, the middle cranial fossa approach, two translabyrinthine approaches (one simple and one endoscopic-assisted) with decompression of the whole petrous portion of the facial nerve, and a transotic approach with temporal craniotomy. Methods: Representative cases of middle and/or inner ear pathologies, surgically treated at our ENT Department, were selected to illustrate each of the five different approaches involving the facial nerve throughout its course. Results: In all cases, the pathology was removed with effective decompression of the facial nerve. The surgical anatomy in each surgical approach is described and illustrated. Conclusions: Facial nerve surgery is challenging for ENT specialists. An excellent knowledge of facial nerve anatomy is needed to eradicate pathology, avoiding nerve injuries and providing a good outcome after surgery.
2020
- The Endoscopic Relationship of the Stapedius Muscle to the Facial Nerve: Implications for Retrotympanic Surgery
[Articolo su rivista]
Rubini, A.; Jufas, N.; Marchioni, D.; Saxby, A. J.; Kong, J. H. K.; Patel, N. P.
abstract
Objectives:The stapedius muscle, tendon, and pyramidal eminence are structures within the retrotympanum. In cholesteatoma surgery, the retrotympanum is a common site of residual disease. The removal of the pyramidal eminence during surgery is sometimes necessary to obtain better visualization of the superior retrotympanum during surgery. Understanding the relational anatomy of structures in the region to the facial nerve allows the surgeon to safely access regional disease. This study aims to better understand the anatomical relationship between the mastoid portion of the facial nerve, the pyramidal eminence, and the stapedius muscle. A secondary aim is to demonstrate that removal of the stapedius muscle in the cadaver model, can increase exposure to the retrotympanic space.Study Design:Anatomical cadaveric observation study.Methods:Endoscopic dissection of cadaveric heads was undertaken. Classification of the superior and inferior retrotympanic area was performed. The anatomy of the stapedius muscle was described including relationships, depth, course, and angle with respect to the facial nerve. The pyramidal eminence and stapedius muscle were removed in all specimens and the exposure of the retrotympanum re-evaluated to determine if exposure of the region was increased.Results:In all cases (11 ears), the stapedius muscle was located medial and anterior to the mastoid portion of the facial nerve, with the second genu superior. The mean antero-posterior distance from the apex of the pyramidal eminence, which the stapedius tendon enters, to the stapes itself was 4.10mm (range, 2.92-5.73mm; standard deviation [SD] 0.90mm). In all cases, irrespective of sinus tympani conformation, removal of the pyramidal eminence and stapedial bony crest in proximity to the facial nerve allowed exposure of the whole retrotympanic region, using a 0-degree endoscope.Conclusions:The pyramidal eminence and stapedius muscle have a relatively constant relationship to the facial nerve. Removal of the stapedius muscle in the human cadaver model increases the exposure of the sinus tympani and subpyramidal space. Increased visualization in this region, may reduce risk of residual cholesteatoma in patients.
2020
- The Management of Tympanic Membrane Perforation with Endoscopic Type i Tympanoplasty
[Articolo su rivista]
Marchioni, D.; Gazzini, L.; De Rossi, S.; Di Maro, F.; Sacchetto, L.; Carner, M.; Bianconi, L.
abstract
Objective:The objective of this study is to describe what we consider to be the state-of-the-art procedure for the treatment of tympanic membrane perforations, and to present the results attained in our institution.Study Design:A retrospective cohort study, using data of Verona University Hospital, Italy. This medical record includes the data of 98 patients who underwent 100 transcanal endoscopic type I tympanoplasties from November 2014 to October 2017.Setting:Tertiary referral center University Hospital of Verona, Italy.Patients:Were enrolled 109 patients, that underwent endoscopic type I tympanoplasty in the period considered. Out of the selected patients, 11 (10.1%) were lost to long-term follow-up, and were therefore excluded from our study. Other exclusion criteria were surgical approaches that included other procedures. Patients whose follow-up was shorter than 6 months were excluded from this study.Intervention:The technique is based on an endoscopic placement of underlay graft of temporal fascia or tragal cartilage. We consider the data of four surgeons from Verona University ENT department.Main Outcome Measure:In the study we considered the reduction of the Air Bone Gap as functional outcome and the integrity of the reconstruction as anatomical outcome of success.Results:No major intraoperative complications were observed. The closure rate was 86%. The mean surgery time was 48.6 minutes. The air bone gap was improved within 20 DB HL in 89% of patient. Only 8% of patients needed revision surgery, and none needed a third surgical evaluation.Conclusion:Endoscopic ear surgery is by now a reality that has replaced in many cases exclusive microscopic ear surgery. Transcanal endoscopic type I tympanoplasty can be considered nowadays as an alternative technique for tympanic membrane perforations.
2020
- Transcanal infrapromontorial approach for internal auditory canal surgery and cochlear implantation
[Articolo su rivista]
Rubini, A.; Bianconi, L.; Patel, N.; Marchioni, D.
abstract
Objective: To demonstrate the feasibility of a transcanal infrapromontorial approach for vestibular schwannoma surgery through an anatomical dissection study and the description of a clinical case. Methods: A microscopic and endoscopic dissection of cadaveric heads was undertaken through a transcanal infrapromontorial approach to the internal auditory canal (IAC), preserving the cochlea and the cochlear nerve. Description of the anatomy and surgical steps is reported as well as presentation of a clinical case in which a transcanal infrapromontorial approach was performed. Results: In all of the cadaveric dissections, a transcanal infrapromontorial route with near total cochlea preservation was performed, removing only the most posterior portion of the basal turn of the cochlea. The IAC was opened through removal of “cochlear-vestibular bone”. At the end of the dissection a cochlear implant array was placed. A transcanal infrapromontorial approach was also performed in a patient to allow a concurrent cochlear implant placement, with good postoperative results. Conclusion: The transcanal infrapromontorial approach permits the preservation of the cochlea and the cochlear nerve. This approach may be considered as an option in case of a small intracanalicular schwannoma removal (< 0.5 cm cerebellopontine angle spread), when concurrent cochlear implantation is indicated.
2019
- Correlation between pre-operative CT findings and intra-operative features in pediatric cholesteatoma: a retrospective study on 26 patients
[Articolo su rivista]
Molteni, G.; Fabbris, C.; Molinari, G.; Alicandri-Ciufelli, M.; Presutti, L.; Paltrinieri, D.; Marchioni, D.
abstract
Objective: To assess the predictive value of pre-operative CT imaging in pediatric patients affected by cholesteatoma of the middle ear, comparing pre-operative CT findings to intra-operative features. Methods: A retrospective study was performed on a population of 26 pediatric patients who underwent tympanoplasty for middle ear cholesteatoma at the Otorhinolaryngology Departments of Verona and Modena University Hospitals between December 2011 and June 2018. Comparison between pre-operative CT images and intra-operative findings (assessed from video recording) was made focusing on the involvement of specific structures: ossicular chain, tegmen tympani, labyrinthine fistula, facial nerve, and temporal bone involvement. CT sensitivity, specificity, positive and negative predictive values were calculated. Results: Overall, 28 surgical procedures were evaluated. No statistically significant differences were encountered between CT images and intra-operatory findings regarding the selected parameters. Conclusions: Based on our study, pre-operative temporal bone CT scan is a valuable tool for the assessment of pediatric patient candidates for cholesteatoma surgery given the absence of statistically significant differences between radiologic and intra-operative findings. The present findings might support the indication to routinely perform temporal bone CT scan in children with cholesteatoma as part of pre-surgical plan. Level of evidence: III.
2019
- Endoscopic Endonasal Surgery of Clival Chordomas: Preliminary Results
[Articolo su rivista]
Soloperto, D.; Fabbris, C.; De Rossi, S.; Musumeci, A.; Marchioni, D.
abstract
Chordomas are rare malignant tumors, often affecting the clival region. Traditionally, they are removed via craniotomic approach but the introduction of the endoscopic endonasal technique (EEA) allowed to control this area. This article shows a series of patients affected by clival chordomas treated with endoscopic approach. Patients who underwent EEA or transoral approach (TO) for clival chordomas at our Skull Base Referral Center, have been retrospectively examined. Clinical symptoms, preoperative neuroradiological evaluation, surgical approach, complications and postoperative results were evaluated. Nine patients (4 females and 5 males; age range 45–82 years, mean 61 years) were included. Chordomas involved upper clivus in 4/9 cases, with (2) or without (2) extension to the middle clivus, middle clivus alone in 2/9, lower clivus in 2/9, and the whole clivus in 1/9. Tumors were totally (4/9) or subtotally (5/9) removed. Skull base reconstruction was performed with a multilayer technique (6/9) or a gasket-seal closure (1/9), using pedicled nasoseptal flaps, middle turbinate and mucoperichondrial grafts, fascia lata and synthetic fascia. No reconstruction was performed in 2 cases. Recurrence occurred in 4 cases, who underwent a new operation. All the other patients underwent proton-beam radiotherapy with no documented tumor growth at the last follow-up (median: 24.9 months; range: 7–36 months). EEA and TO resulted to be safe procedures for treatment of clival chordomas. These approaches may be used as an alternative to the traditional approaches, according to the extension of the pathology.
2019
- Endoscopic-Assisted Cochlear Implantation in Children with Malformed Ears
[Articolo su rivista]
Carner, M.; Sacchetto, A.; Bianconi, L.; Soloperto, D.; Sacchetto, L.; Presutti, L.; Marchioni, D.
abstract
Objective: Complex middle and inner ear malformations are considered an important limitation for cochlear implant (CI) with traditional microscopic techniques. The aim of the present study is to describe the results of the endoscopic-assisted CI procedure in children with malformed ears. Study Design: Case series with chart review of consecutive patients. Setting: Two tertiary referral centers: University Hospital of Verona and University Hospital of Modena, Italy. Subjects and Methods: In total, 25 children underwent endoscopic-assisted cochlear implantation between January 2013 and January 2018. The audiologic and neuroradiologic assessment showed profound hearing loss and malformation of the middle and inner ear in all children. A complete review of anatomic features, surgical results, and audiologic outcomes was performed. The surgical technique is described step-by-step, and the outcomes are detailed. Results: All patients (mean age, 3.6 years; range, 2.8-9 years) underwent a transattical/endoscopic-assisted CI procedure. All children showed varying degrees of auditory benefit, as measured by routine audiometry, speech perception tests, and Categories of Auditory Performance scores (mean, 6). No immediate or late postoperative complications were noted. Conclusion: The endoscopic-assisted approach proved to be successful in cochlear implantation. The direct visualization and magnification allow (1) exploration of the tympanic cavity; (2) confirmation of all anatomic features, with strict control of the course of the facial nerve, round window area, and inner ear; and (3) performance of the cochleostomy with adequate insertion of the array.
2019
- Expanded Endoscopic Approach for Anterior Skull Base Tumors: Experience of a Multidisciplinary Skull Base Team
[Articolo su rivista]
Marchioni, D.; Gulino, A.; Sacchetto, L.; Pinna, G.; Musumeci, A.; Molteni, G.
abstract
The aim of this study is to describe the experience of a multidisciplinary skull base team with transnasal endoscopic surgery for anterior cranial base tumors.A retrospective chart review was conducted on patients who underwent an exclusive expanded transnasal approach to the anterior skull base in the period from December 2014 to November 2015. Data on patient demographics, tumor characteristics, surgical information, imaging, and postoperative complications were collected and analyzed.From a total of 120 patients with skull base diseases managed by the skull base team, 36 were admitted to this study. The overall complication rate in this series was 16.7%, gross total resection was achieved in 32 cases (88.9%) and postoperative CSF leakage occurred in 5 cases (13.9%).Our preliminary results confirm that an exclusive endoscopic transnasal approach to the anterior cranial base is a reliable technique with acceptable perioperative morbidity.
2019
- From fine-needle aspiration cytology to fluorescent in-situ hybridization in an unusual case of pharyngeal synovial sarcoma
[Articolo su rivista]
Paolino, G.; Girolami, I.; Bernasconi, R.; Beccari, S.; Marchioni, D.; Molteni, G.; De Robertis, R.; Ghimenton, C.; Calio, A.; Brunelli, M.; Eccher, A.
abstract
Synovial sarcoma arising in the pharynx is a rare entity, with very few cases described in literature, mainly as surgical-oriented case reports. We report the case of a healthy 20-year old man who presented with a painless right neck mass, clinically suspicious for a thyroid nodule. Ultrasound scan and fine-needle aspiration cytology failed to provide a definitive result, although suggesting a mesenchymal proliferation, in accordance with magnetic resonance imaging findings. Therefore, the lesion was removed with a minimally invasive surgical intervention. Definitive histologic and immunohistochemical examination of the surgical specimen revealed a biphasic synovial sarcoma, further validated by the detection of SS18 gene rearrangement on fluorescent in-situ hybridization examination. Although rarely, synovial sarcoma may arise in the pharynx. Radiological, cytological, histological and molecular findings are needed along each step of the diagnostic process.
2019
- IgG4-related pseudotumor affecting ethmoid, orbit and anterior skull base
[Articolo su rivista]
Soloperto, D.; Fabbris, C.; Di Maro, F.; Marchioni, D.
abstract
2019
- Is endoscopic inspection necessary to detect residual disease in acoustic neuroma surgery?
[Articolo su rivista]
Marchioni, D.; Gazzini, L.; Boaria, F.; Pinna, G.; Masotto, B.; Rubini, A.
abstract
Main goals: To analyze how and when the endoscope is used in vestibular schwannoma surgery and identify the benefits of using endoscopy in this type of surgery. Background: It is currently unclear if there is any benefit from using an endoscope in vestibular schwannoma surgery so this retrospective analysis set out to study this. Methods: All the patients who underwent vestibular schwannoma surgery at our clinic were included for all the vestibular schwannoma approaches taken. We studied when endoscopy was used during surgery and the goal of using endoscopy. Several pre- and postoperative factors were assessed such as complications, facial function, and hearing function in the case of techniques that allow hearing preservation. Results: From January 2015 to September 2018, 280 patients underwent lateral skull base surgery. Of these, 112 were included in this study. The endoscope was used in all 112 patients, and in eight cases it was possible to identify residual disease using the endoscope to check the surgical field, and then to remove the disease under endoscopic view. Moreover, in two other cases, the endoscope was used to resolve a vasculoneural conflict between the anterior inferior cerebellar artery (AICA) loop and facial nerve in one case, and for deafferentation of the superior and inferior vestibular nerves in the second case. No major intraoperative complications occurred in our series. There was no statistically significant difference in postoperative facial nerve function between patients in whom the endoscope was used as a diagnostic tool and patients in whom it was used as an operative tool (p = 0.3152). Conclusions: The endoscope may be useful, especially in surgical techniques where there is poor control of the internal auditory canal (IAC). An endoscopic support technique is strongly recommended to avoid residual disease, particularly in retrosigmoid and retrolabyrinthine approaches. Moreover, the recent introduction of the transcanal transpromontorial approach allows the endoscope to be used during all the procedures in patients affected by a vestibular schwannoma limited to the IAC or to support surgical procedures during an enlarged microscopic approach.
2019
- Keratocystoma of the parotid gland is rare and requires an integrated multidisciplinary approach: Report of a case and a literature review
[Articolo su rivista]
Aresta, A.; Girolami, I.; Paolino, G.; Molteni, G.; Sacchetto, L.; Marchioni, D.; El-Dalati, G.; Sina, S.; Brunelli, M.; Manfrin, E.; Eccher, A.
abstract
2019
- Non-traumatic pneumocephalus caused by increased depth of olfactory fossa
[Articolo su rivista]
Boninsegna, E.; Barillari, M.; De Rossi, S.; Marchioni, D.; Mansueto, G.
abstract
We report a case of unilateral Keros type III variant of the cribriform plate (olfactory fossa >7 mm deep) that caused non-traumatic pneumocephalus. A 61-year-old male patient presented to the emergency room complaining of acute-onset headache after blowing his nose. Computed tomographic (CT) examination showed a massive pneumocephalus; a CT scan from three months before showed a Keros type III variant. The defect was repaired endoscopically with mucoperichondrial and mucoperiostal grafts. Pneumocephalus that has developed in a Keros type III variant has been theorised about, but never reported to our knowledge. Radiologists should be familiar with the Keros classification so that they can identify patients who are at increased risk of fractures of the cribriform plate.
2019
- Oncological outcomes of parotid gland malignancies: a retrospective analysis of 74 patients
[Articolo su rivista]
Molteni, G.; Molinari, G.; Ghirelli, M.; Sprio, A. E.; Berta, G. N.; Malagoli, A.; Marchioni, D.; Presutti, L.
abstract
Introduction: Salivary gland malignancies are rare neoplasms whose management has been evolving over the last two decades. Nevertheless, patient outcomes have not improved accordingly. Objective: In the present paper, factors and variables that could influence Overall, Disease-Specific and Disease-Free Survival, and Loco-Regional Control were analyzed. Methods: Chart data from 74 patients who underwent parotid gland surgery were retrospectively analyzed and stratified for tumor histology, grading, size, pT stage, pN stage, extracapsular spread, involved salivary gland lobe, and age at diagnosis. Major outcomes were estimated at 5 years by Kaplan–Meier curves. Results: Advanced stage, high grade, and lymph nodes involvement greatly impaired patient outcomes. Furthermore, in our cohort, the age at diagnosis ≥ 55 was a cause of poorer disease survival likely due to a different distribution in tumor histotypes between older and younger patients. Despite the two groups were homogeneous for the numerosity of squamous cell carcinomas, older patients were more rarely affected by mucoepidermoid and acinic cell carcinomas, which have generally better prognosis. Finally, patients aged ≥ 55 had a more frequent pathological involvement of the deep lobe of the parotid gland if compared to the younger counterpart. Conclusion: The rarity of some salivary gland tumor histotypes requires further high-number series to fully understand the prognostic factors for both patient survival and recurrence development. In our cohort, the age at diagnosis ≥ 55 raises concerns that play crucial roles in disease survival shortening.
2019
- Pneumocephalus triggered by sneezing
[Articolo su rivista]
Gazzini, L.; Marchioni, D.
abstract
2019
- Rating surgical field quality in endoscopic ear surgery: proposal and validation of the "Modena Bleeding Score"
[Articolo su rivista]
Alicandri-Ciufelli, M; Pingani, L; Mariano, D; Anschuetz, L; Molinari, G; Marchioni, D; Bonali, M; Galeazzi, Gm; Presutti, L.
abstract
PURPOSE:
To develop and validate a bleeding score that could be applied in endoscopic ear surgery (EEarS).
METHODS:
A prospective validation study was performed. A new bleeding score, called "Modena Bleeding Score" (MBS), was created by the authors. It provides five grades for rating the surgical field during EEarS procedures (from grade 1-no bleeding to grade 5-bleeding that prevents every surgical procedure except those dedicated to bleeding control). A preliminary "face validity" was performed by 18 ENT specialists to assess possible misunderstandings in interpreting the scale. Then, 15 videos of endoscopic ear surgery procedures, each divided into three parts (t0, t1, and t2), were subsequently evaluated by 15 specialists, using MBS. The videos were randomly selected and assigned. Intra-rater reliability and inter-rater reliability were calculated. The clinical validity of the instrument was calculated using a referent standard (i.e., four ENT experts whose ratings were compared to those obtained by the former sample).
RESULTS:
The face validity showed a good consensus about the clarity and comprehension of the scale; both intra and inter-rater reliability demonstrated good performance (intra-rater reliability ranged from 0.741 to 0.991 and inter-rater reliability was 0.790); clinical validity also showed positive values, ranging from 0.75 to 0.93.
CONCLUSIONS:
MBS has proved to be an effective method to rate surgical field during EEarS, with good-to-excellent performances. Its use would possibly help comparisons of groups in clinical trials or comparisons between studies.
2019
- Surgery of the lateral skull base: A 50-year endeavour
[Articolo su rivista]
Zanoletti, E.; Mazzoni, Alberto; Martini, A.; Abbritti, R. V.; Albertini, R.; Alexandre, E.; Baro, V.; Bartolini, S.; Bernardeschi, D.; Bivona, R.; Bonali, M.; Borghesi, I.; Borsetto, D.; Bovo, R.; Breun, M.; Calbucci, F.; Carlson, M. L.; Caruso, A.; Caye-Thomasen, P.; Cazzador, D.; Champagne, P. -O.; Colangeli, R.; Conte, G.; D'Avella, D.; Danesi, G.; Deantonio, L.; Denaro, L.; Berardino, F. D.; Draghi, R.; Ebner, F. H.; Favaretto, N.; Ferri, G.; Fioravanti, A.; Froelich, S.; Giannuzzi, A.; Girasoli, L.; Grossardt, B. R.; Guidi, M.; Hagen, R.; Hanakita, S.; Hardy, D. G.; Iglesias, V. C.; Jefferies, S.; Jia, H.; Kalamarides, M.; Kanaan, I. N.; Krengli, M.; Landi, A.; Lauda, L.; Lepera, D.; Lieber, S.; Lloyd, S. L. K.; Lovato, A.; Maccarrone, F.; Macfarlane, R.; Magnan, J.; Magnoni, L.; Marchioni, D.; Marinelli, J. P.; Marioni, G.; Mastronardi, V.; Matthies, C.; Moffat, D. A.; Munari, S.; Nardone, M.; Pareschi, R.; Pavone, C.; Piccirillo, E.; Piras, G.; Presutti, L.; Restivo, G.; Reznitsky, M.; Roca, E.; Russo, A.; Sanna, M.; Sartori, L.; Scheich, M.; Shehata-Dieler, W.; Soloperto, D.; Sorrentino, F.; Sterkers, O.; Taibah, A.; Tatagiba, M.; Tealdo, G.; Vlad, D.; Wu, H.; Zanetti, D.
abstract
Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.
2019
- Transnasal devascularisation of a sinonasal hypervascular tumour (glomangiopericytoma) with direct injection of liquid polymer agent (Squid®)
[Articolo su rivista]
Ciceri, E. F.; Plebani, M.; Augelli, R.; Agnello, A.; Ghimenton, C.; Soloperto, D.; Marchioni, D.; Ricciardi, G. K.
abstract
The technique of direct intratumoral injection of permanent liquid agents has evolved significantly over the past few decades. The percutaneous direct puncture technique is being utilised more and more for embolisation of head and neck hypervascular lesions. We describe a case treated via the direct percutaneous transnasal (TN) puncture technique for embolisation of a sinonasal hypervascular tumour, performed in a 21-year-old male patient. Due to extensive vascularisation of the tumour, preoperative embolisation was requested by our otolaryngologist team in order to minimise intraoperative bleeding and reduce surgical morbidity. A primary attempt at trans-arterial embolisation through selective ophthalmic artery catheterisation was unsuccessful due to unfavourable anatomy. An extensive devascularisation of the nasal fossa lesion was obtained using a single injection of low-density polymeric embolic agent (SQUID®). Post-operative eradication was uneventful. Final histopathology exam revealed vascular tumour consistent with a rare sinonasal glomangiopericytoma. To our knowledge, this is the first reported case of a rare sinonasal glomangiopericytoma treated by direct TN injection, utilising the liquid polymer agent SQUID®.
2018
- Acquisition of surgical skills for endoscopic ear and lateral skull base surgery: A staged training programme
[Articolo su rivista]
Alicandri-Ciufelli, M.; Marchioni, D.; Pavesi, G.; Canzano, Federica; Feletti, A.; Presutti, L.
abstract
Endoscopic ear surgery is radically changing the treatment of several middle and inner ear pathology, but its learning presents well-known manual and technical difficulties. The aim of this paper is be to present a training programme based on a modular model of increased difficulties. The experience from 2007 to 2016 at the University Hospital of Modena and University Hospital of Verona was reviewed and analysed for further considerations and to establish stages of training. The increasing experience of expert surgeons who deal with this kind of surgery represented the main guide to establish the steps and progression of training. In addition, the potential risk of damage of vascular structures or nerves represents fundamental criteria for progression toward higher levels. Some not-mandatory skills were also suggested for stage of difficulty. Five stages of training were deemed appropriate for progressive learning of endoscopic ear and lateral skull base surgery, ranging from simple middle and external ear procedures to surgery of inner ear and internal auditory canal. Mastering of each level is suggested before attempting procedures at a higher level, in particular for procedures involving lateral skull base. Standardisation and adoption of modular incremental training are expected to facilitate improvement of otolaryngologists and neurosurgeons starting with endoscopic middle ear and lateral skull base surgery. Adherence to such a programme during the growth phase may potentially decrease the rate of complications, making the training programme safer.
2018
- Complications in endoscopic ear surgery
[Articolo su rivista]
Marchioni, Daniele; Rubini, Alessia; Gazzini, Luca; Alicandri-Ciufelli, Matteo; Molinari, Giulia; Reale, Marella; Presutti, Livio
abstract
Objective: The aim of this study was to examine the premise that endoscopic ear surgery (EES) is associated with a low rate of complications (intraoperative and postoperative). Study Design: Retrospective review at two institutions. Setting: Tertiary referral center. Patients: The study included 825 patients who underwent exclusive EES between 2008 and 2016 at the Otorhinolaryn-gology-Head and Neck Surgery Department of Modena University Hospital, and between 2014 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Verona University Hospital. Interventions: Exclusive endoscopic ear surgery between 2008 and 2016 (tympanoplasties, second look or revision tympanoplasties, myringoplasties, stapedoplasties, canalplasties, ossiculoplasties, and exploratory tympanotomies). All surgical procedures were performed by two experienced surgeons. Main Outcome Measure: For each procedure, intraoperative, and early and delayed postoperative complications were evaluated. Results: The most common ear pathologies for which patients were sent for EES were cholesteatoma (33.6%), chronic otitis media (36.3%) and otosclerosis (26.8%). There was no case of major intraoperative complications such as injury to the dura or vascular structures. We observed minor intraoperative complications in 4.1% of the cases. Only 1.3% of patients experienced early postoperative complications. Delayed complications affected less than 1% of the cohort. Conclusions: Data from this study confirm the safety of the endoscopic technique, with very low complication rates, indicating that EES is a reliable therapeutic option, in particular, for tympanoplasties, myringoplasties, and stapedoplasties, as well as second look procedures. We have reported our experience with EES morbidity so that it can be compared with data from other centers using the same sur gical technique.
2018
- Discovering middle ear anatomy by transcanal endoscopic ear surgery: A dissection manual
[Articolo su rivista]
Anschuetz, L.; Presutti, L.; Marchioni, D.; Bonali, M.; Wimmer, W.; Villari, D.; Caversaccio, M.
abstract
The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes. The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills.
2018
- Endoscopic Anatomy of the Tensor Fold and Anterior Attic
[Articolo su rivista]
Li, B.; Doan, P.; Gruhl, R. R.; Rubini, A.; Marchioni, D.; Fina, M.
abstract
Objectives: The objectives of the study were to (1) study the anatomical variations of the tensor fold and its anatomic relation with transverse crest, supratubal recess, and anterior epitympanic space and (2) explore the most appropriate endoscopic surgical approach to each type of the tensor fold variants. Study Design: Cadaver dissection study. Setting: Temporal bone dissection laboratory. Subjects and Methods: Twenty-eight human temporal bones (26 preserved and 2 fresh) were dissected through an endoscopic transcanal approach between September 2016 and June 2017. The anatomical variations of the tensor fold, transverse crest, supratubal recess, and anterior epitympanic space were studied before and after removing ossicles. Results: Three different tensor fold orientations were observed: vertical (type A, 11/28, 39.3%) with attachment to the transverse crest, oblique (type B, 13/28, 46.4%) with attachment to the anterior tegmen tympani, and horizontal (type C, 4/28, 14.3%) with attachment to the tensor tympani canal. The tensor fold was a complete membrane in 20 of 28 (71.4%) specimens, preventing direct ventilation between the supratubal recess and anterior epitympanic space. We identified 3 surgical endoscopic approaches, which allowed visualization of the tensor fold without removing the ossicles. Conclusions: The orientation of the tensor fold is the determining structure that dictates the conformation and limits of the epitympanic space. We propose a classification of the tensor fold based on 3 anatomical variants. We also describe 3 different minimally invasive endoscopic approaches to identify the orientation of the tensor fold while maintaining ossicular chain continuity.
2018
- Endoscopic transnasal surgery of clival lesions: our experience
[Articolo su rivista]
Marchioni, D.; Musumeci, A.; Fabbris, C.; De Rossi, S.; Soloperto, D.
abstract
Background: The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions. This is a preliminary report on patients treated endoscopically for clival lesions by the authors’ Skull Base Team. Patients and methods: This was a retrospective chart review of patients who underwent an endoscopic exclusive transnasal approach (EEA) or a transoral one (TO) for clival lesions between June 2015 and November 2017 at our Skull Base Referral Center. Patient characteristics and symptoms, preoperative neuroradiological evaluation, surgical approach, complications, and postoperative results were evaluated. Results: Nine patients (6 females and 3 males; age range 6–82 years, mean 50.8 years) underwent EEA or TO. From histological analysis, we found chordomas (6/9 subjects), chondrosarcoma (1/9), craniopharyngioma (1/9), and eosinophilic granuloma (1/9). Three patients had previously been operated for a parasellar chondrosarcoma (1/9), a pituitary macroadenoma (1/9), or a chondroid chordoma (1/9). The lesions were totally (2/9) or sub-totally (5/9) resected, debulked (1/9), or analyzed with a biopsy (1/9). Reconstruction was accomplished with a multilayer technique (7/9), or with a gasket–seal (1/9), using a mucoperichondrial graft, a single/double nasoseptal flap, a middle turbinate flap, a fascia lata, or a synthetic fascia. One patient (11.1%) was re-operated on due to cerebrospinal leakage, without further complications. Two patients (22.2%) were re-operated on due to chordoma regrowth. Adjuvant chemotherapy was administered to 1/9 patient with progressive healing. All of the other patients underwent proton-beam radiotherapy with no documented tumor growth (median follow-up: 20 months; range 5.1–29.9 months). Conclusions: Clival lesions represent a heterogeneous group of lesions located in a very complex and difficult area. EEA and TO approaches are safe and mini-invasive, with lower morbidity and with postoperative complications when compared to the traditional open approaches, according to the extent and type of pathology.
2018
- Expanded Transcanal Transpromontorial Approach: A Novel Surgical Technique for Cerebellopontine Angle Vestibular Schwannoma Removal
[Articolo su rivista]
Marchioni, Daniele; Carner, Marco; Soloperto, Davide; Bianconi, Luca; Sacchetto, Andrea; Sacchetto, Luca; Masotto, Barbara; Presutti, Livio
abstract
Objective Vestibular schwannoma (VS) is a benign tumor of the lateral skull base. Different microscopic surgical techniques are described in literature: the retrosigmoid and translabyrinthine approaches are used to treat big tumors located in the cerebellopontine angle, and the middle cranial fossa approach is utilized for small tumors with good hearing preservation. The expanded transcanal transpromontorial (ExpTT) approach is a combined microscopic-endoscopic technique previously indicated for Koos stage I and II VS and now proposed for larger VS, up to 3 cm in diameter, with linear progression into the cerebellopontine angle and touching the brainstem. Study Design The study was a retrospective case series of patients who underwent ExpTT surgery for VS in our ear, nose, and throat department. Setting We reviewed the surgical videos and electrophysiologic data recorded during the surgical operations. Subjects and Methods From January 2015 to January 2017, 20 patients affected by Koos stage II and III VS underwent surgery in our department with the ExpTT approach. This novel technique is described step by step, with a focus on the surgical procedure and anatomic landmarks; outcomes are detailed in terms of early and late complications. The mean follow-up was 15 months. Results The ExpTT approach permitted, in all patients, gross total resection of the tumor without any complication and with preservation of facial nerve function. All patients had a good postoperative recovery. Conclusion The ExpTT technique is a new approach that combines the advantages of a microscopic technique with the ones offered by the endoscope in removal of VS.
2018
- Facial sinus endoscopic evaluation, radiologic assessment, and classification
[Articolo su rivista]
Alicandri-Ciufelli, Matteo; Fermi, Matteo; Bonali, Marco; Presutti, Livio; Marchioni, Daniele; Todeschini, Alessandra; Anschuetz, Lukas
abstract
Objectives: To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification. Methods: Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve. Results: In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C facial sinuses were identified. In all the specimens (n = 39), the facial sinus could be assessed by means of an exclusive endoscopic transcanal approach, and anatomical variants of the chordiculus, previously known as chordal ridge, could be described: ridge (39%), bridge (18%), incomplete (15%), and absent (28%). Conclusion: Endoscopic exploration of the retrotympanum guarantees a very good exposure of the facial sinus, allowing detailed anatomic descriptions of its conformation and relationships with other structures. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Angled endoscopes (e.g. 45 °, 70 °) can guarantee a better view of the facial sinus. Level of Evidence: NA. Laryngoscope, 128:2397–2402, 2018.
2018
- Hearing restoration during vestibular schwannoma surgery with transcanal approach: Anatomical and functional preliminary report
[Articolo su rivista]
Marchioni, D.; Veronese, S.; Carner, M.; Sacchetto, A.; Sacchetto, L.; Masotto, B.; Bianconi, L.
abstract
Objective: Hearing restoration has always been a dream in vestibular schwannoma (VS) surgery. The aim of this study is to describe an endoscopic assisted transcanal retrocochlear approach to the internal auditory canal (IAC) with total removal of the VS; simultaneously we assessed the anatomical and functional aspects of hearing restoration with cochlear implant (CI). Study Design: A retrospective case series. Setting: Tertiary referral center. Patients: Six patients affected by VS involving the fundus of the IAC (Koos stage I–II) were included in this study. The patients already demonstrated symptoms of IAC involvement by the neuroma, with severe to profound hearing loss. Interventions: Transcanal microscopic, endoscopic assisted, approach was chosen for total tumor removal. Preoperative and intraoperative electrophysiological monitoring was performed using electrically evoked auditory brainstem responses (EABR) to evaluate preservation of cochlear function.Main Outcome and Measures: A retrospective evaluation of electrophysiological data collected during surgeries has been conducted; clinical outcomes, surgical complications, and postoperative radiological evaluations were also considered. Results: Total tumor removal was achieved in all patients with no major complications. One patient showed temporary facial palsy (HB stage II). We were able to preserve cochlear function in five out of six patients. In those patients intraoperative monitoring with EABR was performed after tumor removal with good responses. Conclusions: Transcanal retrocochlear approach for VS removal allows preservation of cochlea and cochlear nerve function. This is the first step towards developing an effective surgical technique for VS removal and hearing rehabilitation with CI.
2018
- Iatrogenic traumatic optic neuropathy: Report of an injury occurring during a choanal atresia correction surgery treatment
[Articolo su rivista]
Bertossi, D.; Marchioni, D.; Manuelli, M.; Tacchino, U.; Giampaoli, G.; Dall'Acqua, I.; De Santis, D.; Ricciardi, G.; Lanaro, L.; Kumar, N.; Nocini, R.; Nocini, P. F.
abstract
We report the case of a 36-year-old adult male patient who came to our attention for the evaluation of a possible iatrogenic injury suffered during the surgical correction of congenital choanal atresia. This case report retraces the patient's medical history and the events lapsed in the peri-operative time analyzing if any malpractice has occurred in causing the amaurosis.
2018
- Intralabyrinthine schwannomas: a new surgical treatment
[Articolo su rivista]
Marchioni, D.; De Rossi, S.; Soloperto, D.; Presutti, L.; Sacchetto, L.; Rubini, A.
abstract
Objective: To define a new surgical option, with lower morbidity, for the treatment of intralabyrinthine schwannomas. Study design: Retrospective case review. Setting: Tertiary referral centers. Patients: Eight patients affected by an intralabyrinthine schwannoma, with or without extension to the internal auditory canal, that underwent surgery with a transcanal transpromontorial approach, were included in the study. The average age at presentation was 47 years. Patients’ characteristics, symptoms, tumor features, and surgical results were analyzed. Interventions: All patients were diagnosed and evaluated pre-operatively with high-resolution, gadolinium-enhanced MRI and CT scan of the temporal bone, and underwent surgery via either transcanal transpromontorial endoscopic approach (TTEA) or enlarged transcanal transpromontorial endoscopic approach (ETTA). Main outcome measures: Hearing function was evaluated with the Hearing Classification System according to the Committee on Hearing and Equilibrium Guidelines. Facial nerve function was evaluated using the House–Brackmann grading system (HB). Results: In six patients out of eight, a TTEA was performed, whereas, due to the extension of the pathology to the cerebellopontine angle, two patients underwent an ETTA. The mean follow-up period was 15.5 months (range 1–69). No intra-operative and post-operative major complications were observed. Post-operative facial nerve function was normal in seven out of eight patients (grade I HB). One patient presented a grade II HB. Conclusion: The endoscopic approach to cochlear schwannoma represents a good treatment option for patients and should be preferred to other more invasive surgical techniques when indicated, to reduce complications, hospitalization, and offer to patients the chance to eradicate the disease, thus avoiding the stress of a long-life radiological follow-up. Level of evidence: 4.
2018
- Novel Surgical and Radiologic Classification of the Subtympanic Sinus: Implications for Endoscopic Ear Surgery
[Articolo su rivista]
Anschuetz, Lukas; Alicandri-Ciufelli, Matteo; Bonali, Marco; Fermi, Matteo; Caversaccio, Marco; Presutti, Livio; Marchioni, Daniele
abstract
Objective: The aim of this study is to describe the endoscopic anatomy of the subtympanic sinus (STS), establish a classification according to its extension regarding the level of the facial nerve (FN), and assess the feasibility of the transcanal endoscopic approach to the STS. Study Design: Experimental anatomic research. Setting: Temporal bone laboratory. Methods: We performed endoscopic dissection of 34 human whole head and ear block specimens. Of those, 29 underwent high-resolution computed tomography. The STS was classified according to its extension regarding the level of the FN: type A, no extension medial to the FN; type B, extension to the medial limit of the FN; type C, extension of the sinus medially and posteriorly from the FN into the mastoid cavity. Results: The majority of cases (n = 21, 72%) showed a shallow type A STS. We observed a deep type B configuration in 6 cases (21%) and a type C in 2 cases (7%). The STS was completely exposable with a 0° endoscope in 44% of the specimens. Using a 45° endoscope, we gained complete insight in 79%. However, in 21% of the cases, the posteromedial extension of the STS was too deep to be completely explored by an endoscopic transcanal approach. Conclusion: The majority of the STS is shallow and does not extend medially from the FN. This morphologic variant allows complete transcanal endoscopic visualization. In more excavated STS, a complete endoscopic exploration is not achievable, and a retrofacial approach may be adopted to completely access the STS.
2018
- Response to letter to the editor "transcanal Transpromontorial Approach to Vestibular Schwannoma: Are We There Yet?"
[Articolo su rivista]
Marchioni, D.; Soloperto, D.; Masotto, B.; Fabbris, C.; De Rossi, S.; Villari, D.; Presutti, L.
abstract
2018
- The Impact of the Transcanal Endoscopic Approach and Mastoid Preservation on Recurrence of Primary Acquired Attic Cholesteatoma
[Articolo su rivista]
Presutti, Livio; Anschuetz, Lukas; Rubini, Alessia; Ruberto, Marco; Alicandri-Ciufelli, Matteo; Dematte, Marco; Caversaccio, Marco; Marchioni, Daniele
abstract
We aim to investigate the factors associated with recurrent disease following surgery for primary acquired attic cholesteatoma. We hypothesize that minimal invasive, mucosal sparing operation techniques have beneficial effects on the outcome in terms of recurrence.
2018
- The protympanum, protiniculum and subtensor recess: An endoscopic morphological anatomy study
[Articolo su rivista]
Jufas, N.; Rubini, A.; Soloperto, D.; Alnoury, M.; Tarabichi, M.; Marchioni, D.; Patel, N.
abstract
Objectives: An anatomical study was performed to describe the endoscopic anatomy and variations of the protympanum, including classification of the protiniculum and subtensor recess. Methods: A retrospective review was conducted of video recordings of cadaveric dissections and surgical procedures, which included visualisation of the protympanum, across 4 tertiary university referral centres over a 16-month period. A total of 97 ears were used in the analysis. Results: A quadrangular conformation of the protympanum was seen in 60 per cent of ears and a triangular conformation in 40 per cent. The protiniculum was type A (ridge) in 58 per cent, type B (bridge) in 23 per cent and type C (absent) in 19 per cent. The subtensor recess was type A (absent) in 30 per cent, type B (shallow) in 48 per cent and type C (deep) in 22 per cent. Conclusion: The protympanum is an area that has been ignored for many years because of difficulties in visualising it with an operating microscope. However, modern endoscopic equipment has changed this, providing detailed anatomical knowledge fundamental to ensuring the safety of endoscopic surgical procedures in the region.
2018
- Trans-nasal endoscopic and intra-oral combined approach for odontogenic cysts
[Articolo su rivista]
Procacci, P.; Lanaro, L.; Molteni, G.; Marchioni, D.; Lonardi, F.; Fusetti, S.; Nocini, P. F.; Albanese, M.
abstract
Maxillary cysts are a common finding in maxillofacial surgery, dentistry and otolaryngology. Treatment is surgical; a traditional approach includes Caldwell-Luc and other intra-oral approaches. In this article, we analyse the outcomes of 9 patients operated on using a combined intra-oral and trans-nasal approach to the aforementioned disease. Although the number of patients is small, the good results of this study suggest that the combined approach might be a reliable treatment option.
2018
- Transcanal Transpromontorial Acoustic Neuroma Surgery: Results and Facial Nerve Outcomes
[Articolo su rivista]
Marchioni, Daniele; Soloperto, Davide; Masotto, Barbara; Fabbris, Cristoforo; De Rossi, Stefano; Villari, Domenico; Presutti, Livio
abstract
Background: Recently, the transcanal approach for the removal of acoustic neuromas has been introduced. Facial nerve (FN) preservation is one of the main challenges of this kind of surgery. Objective: To describe our experience in the surgical treatment of acoustic neuromas, focusing on the functional results of FN preservation after a transcanal approach. Methods: A retrospective chart review was carried out on clinical data and videos from operations on 49 patients who underwent surgery with a totally transcanal exclusive endoscopic approach for Koos stage I-II lesions, or an enlarged transcanal transpromontorial approach for Koos stage II-III tumors, between March 2012 and February 2017. Patients and tumor characteristics, clinical manifestations, radiologic features, audiological results, FN outcomes (according to the House-Brackmann [HB] grading system) and complications were evaluated. Tumors were classified according to the Koos grading system. Results: The age of the patients (34 females and 15 males) ranged from 27 to 77 years (mean age: 54.9 yr). Preoperative diagnosis was "vestibular schwannoma" in all patients. At the last follow-up (range 1-60 mo, mean 13.9 mo), 42 of 49 showed grade I HB FN function, 5 of 49 grade II HB, and 2 of 49 grade III HB. Overall, in 95.9%, FN function was preserved (grade I-II HB) with stable results at follow-up; in 4.1% of cases, FN function was reduced, but not worse than grade III. Conclusion: The transcanal approach represents a feasible, minimally invasive, and conservative technique for the management of acoustic neuromas of the internal auditory canal.
2018
- Transcanal endoscopic approach to lesions of the suprageniculate ganglion fossa
[Articolo su rivista]
Marchioni, Daniele; Rubini, Alessia; Nogueira, João Flávio; Isaacson, Brandon; Presutti, Livio
abstract
Objective: The aim of this paper would be to describe the first case series of exclusive transcanal endoscopic approach to treat lesions with limited extension at the suprageniculate fossa. This endoscopic approach allowed a complete removal of suprageniculate disesases with low complication rates using a minimally invasive surgical route. Methods: This is a retrospective chart analysis and a surgery video recording review of these patients were performed in August 2015. From November 2011 to November 2015, 29 patients were submitted to an endoscopic transcanal lateral skull base surgery. From those 29 subjects, in 6 patients an exclusive endoscopic transcanal suprageniculate approach was performed to remove lesions located into the geniculate fossa. Surgical indications, pre-operative assessment, results were collected and the surgical technique were described. Results: The final study group was composed of 6 patients. 3 male and 3 female; median age is 25.3 years old. In all 6 subjects it was possible to remove the lesions using an exclusive endoscopic transcanal suprageniculate approach. No intraoperaoperative complications were observed in any patients. The mean follow up period was 15.16 months. Conclusion: Exclusive endoscopic transcanal suprageniculate approach is definitely a minimally invasive technique and should be consider an optimal solution to treat lesions located in the suprageniculate fossa in some patients. We introduce a minimally invasive approach to the geniculate ganglion region in order to allow complete removal of suprageniculate disesases with low complication rates using a minimally invasive surgical route.
2017
- A Multicenter Clinical Evaluation of Data Logging in Cochlear Implant Recipients Using Automated Scene Classification Technologies
[Articolo su rivista]
Cristofari, Eliana; Cuda, Domenico; Martini, Alessandro; Forli, Francesca; Zanetti, Diego; Di Lisi, Diego; Marsella, Pasquale; Marchioni, Daniele; Vincenti, Vincenzo; Aimoni, Claudia; Paludetti, Gaetano; Barezzani, Maria Grazia; Leone, Carlo Antonio; Quaranta, Nicola; Bianchedi, Marco; Presutti, Livio; Della Volpe, Antonio; Redaelli de Zinis, Luca Oscar; Cantore, Italo; Frau, Giuseppe Nicolò; Orzan, Eva; Galletti, Francesco; Vitale, Silvano; Raso, Ferdinando; Negri, Maurizio; Trabalzini, Franco; Livi, Walter; Piccioni, Lucia Oriella; Ricci, Giampietro; Malerba, Paolo
abstract
Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by recipients by means of objective tools. The Nucleus 6 sound processor features a data logging system capable of real-time recording of CI use in different acoustic environments and under various categories of loudness levels. In this study, we report data logged for the different scenes and different loudness levels of 1,366 CI patients, as recorded by SCAN. Monitoring device use in cochlear implant recipients of all ages provides important information about the listening conditions encountered in recipients' daily lives that may support counseling and assist in the further management of their device settings. The findings for this large cohort of active CI users confirm differences between age groups concerning device use and exposure to various noise environments, especially between the youngest and oldest age groups, while similar levels of loudness were observed.
2017
- Bilateral congenital cholesteatoma: Surgical treatment and considerations
[Articolo su rivista]
Marchioni, Daniele; Rubini, Alessia; Gonzalez-Navarro, Mauricio; Alicandri-Ciufelli, Matteo; James, Adrian; Presutti, Livio
abstract
Objectives To describe a multicenter study regarding surgical management of bilateral congenital cholesteatoma (BCC) and underline the importance of endoscopes in the management of this condition. In BCC, hearing preservation is more crucial than in unilateral cases. The endoscopic approach allows complete removal of cholesteatoma via a minimally invasive technique offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain. Study design Retrospective chart and surgical video review of patients with BCC who underwent surgery at Otolaryngology Department of Modena and Verona University Hospitals and the Hospital for Sick Children, Toronto. Methods From 2002 to November 2016, six patients were identified with bilateral congenital cholesteatoma and included in this study. Pre-operative assessments, surgical treatments and outcomes were collected and described. Results The median age at presentation was 4 years (range 2â7 years). A microscopic post auricular tympanoplasty was performed in two ears, four underwent a canal wall up mastoidectomy procedure and in the other six a transcanal endoscopic approach (TEA) was used. No intra- or post-operative complications were observed in any patients. The mean follow up period was 54.5 months. Conclusions When both ears are involved with congenital cholesteatoma, it is particularly important to use a minimally invasive technique that preserves normal ossicular and mastoid structure and function whenever possible. In many cases this can be achieved with TEA, even in young children. In addition the endoscope allows good surgical control of cholesteatoma removal from hidden recesses.
2017
- Diagnosis of human prion disease using real-time quaking-induced conversion testing of olfactory mucosa and cerebrospinal fluid samples
[Articolo su rivista]
Bongianni, M.; Orru, C.; Groveman, B. R.; Sacchetto, L.; Fiorini, M.; Tonoli, G.; Triva, G.; Capaldi, S.; Testi, S.; Ferrari, S.; Cagnin, A.; Ladogana, A.; Poleggi, A.; Colaizzo, E.; Tiple, D.; Vaianella, L.; Castriciano, S.; Marchioni, D.; Hughson, A. G.; Imperiale, D.; Cattaruzza, T.; Fabrizi, G. M.; Pocchiari, M.; Monaco, S.; Caughey, B.; Zanusso, G.
abstract
IMPORTANCE Early and accurate in vivo diagnosis of Creutzfeldt-Jakob disease (CJD) is necessary for quickly distinguishing treatable from untreatable rapidly progressive dementias and for future therapeutic trials. This early diagnosis is becoming possible using the real-time quaking-induced conversion (RT-QuIC) seeding assay, which detects minute amounts of the disease-specific pathologic prion protein in cerebrospinal fluid (CSF) or olfactory mucosa (OM) samples. OBJECTIVE To develop an algorithm for accurate and early diagnosis of CJD by using the RT-QuIC assay on CSF samples, OM samples, or both. DESIGN, SETTING, AND PARTICIPANTS In this case-control study, samples of CSF andOMwere collected from 86 patients with a clinical diagnosis of probable (n = 51), possible (n = 24), or suspected (n = 11) CJD and 104 negative control samples (54 CSF and 50 OM). The CSF and OM samples were analyzed using conventional RT-QuIC. The CSF samples underwent further testing using improved RT-QuIC conditions. In addition, the diagnostic performance of a novel, easy-to-use, gentle flocked swab for sampling of OMwas evaluated. Data were collected from January 1 to June 30, 2015. MAIN OUTCOME AND MEASURES Correlations between RT-QuIC results and the final diagnosis of recruited patients. RESULTS Among the 86 patients (37 men [43%] and 49 women [57%]; mean [SD] age, 65.7 [11.5] years) included for analysis, all 61 patients with sporadic CJD had positive RT-QuIC findings using OMor CSF samples or both for an overall RT-QuIC diagnostic sensitivity of 100% (95%CI, 93%-100%). All patients with a final diagnosis of non-prion disease (71 CSF and 67 OM samples) had negative RT-QuIC findings for 100% specificity (95%CI, 94%-100%). Of 8 symptomatic patients with various mutations causing CJD or Gerstmann-Sträussler-Scheinker syndrome, 6 had positive and 2 had negative RT-QuIC findings for a sensitivity of 75%(95%CI, 36%-96%). CONCLUSIONS AND RELEVANCE A proposed diagnostic algorithm for sporadic CJD combines CSF and OM RT-QuIC testing to provide virtually 100% diagnostic sensitivity and specificity in the clinical phase of the disease.
2017
- Endoscopic-assisted cochlear implant procedure in CHARGE syndrome: Preliminary report
[Articolo su rivista]
Marchioni, Daniele; Carner, Marco; Soloperto, Davide; Sacchetto, Andrea; Genovese, Elisabetta; Presutti, Livio
abstract
The endoscopic approach demonstrated to be useful for cochlear implantations of children with CHARGE syndrome. It allows the surgeon to perform a direct 'safe' cochleostomy in difficult anatomical conditions. Three children with CHARGE syndrome underwent endoscopic-assisted cochlear implant surgery at the Tertiary University Referral Center of Modena and Verona between January 2014 and September 2015. A review of clinical data and videos from the operations was made. All procedures were re-analyzed and codified. Three children, all females (mean age 4.6 years; range: 3-7 years) underwent surgery. Two primary surgical procedures and one revision surgery, for secondary cholesteatoma, were performed. CT scans demonstrated complex malformations of middle and inner ear with anomalous course of the facial nerve. In all subjects, a transcanal endoscopic cochleostomy was performed; no immediate or late postoperative complications were observed. Discharge from hospital was the day post-surgery. The current mean follow-up is 12.5 months (range: 8-19 months).
2017
- Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment
[Articolo su rivista]
Feborl-hns, ; Pavesi, G; Marchioni, D; Alicandri-Ciufelli, M; Rubini, A; Masotto, B; Presutti, L.
abstract
2017
- Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study
[Articolo su rivista]
Presutti, Livio; Bonali, Marco; Marchioni, Daniele; Pavesi, G; Feletti, A; Anschuetz, L; Alicandri Ciufelli, M.
abstract
The aim of this paper is to describe and evaluate the feasibility of an expanded endoscopic transcanal transpromotorial approach (ExpTTA) to the internal auditory canal and the cerebellopontine angle. To this end, we performed a cadaveric dissection study in September 2015. In total, 2 heads (4 sides) were dissected focusing on anatomical landmarks and surgical feasibility. Data from dissections were reviewed and analysed for further consideration. In all 4 sides of the cadavers the procedure was feasible. In all cadavers, it was necessary to extensively drill the temporo-mandibular joint and to calibrate the external ear canal to allow adequate room to manoeuver the instruments and optics and to comfortably access the cerebellopontine angle. In addition, thorough skeletonisation of the carotid artery and the jugular bulb were necessary for the same purpose. In conclusion, ExpTTA appeared to be successful to access the internal auditory canal and cerebellopontine angle region. Potential extensive and routine application of this type of approach in lateral skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among otolaryngologists and neurosurgical community.
2017
- Expanded transcanal transpromontorial approach to the internal auditory canal: Pilot clinical experience
[Articolo su rivista]
Presutti, Livio; Alicandri Ciufelli, Matteo; Bonali, Marco; Rubini, Alessia; Pavesi, Giacomo; Feletti, Alberto; Masotto, Barbara; Anschuetz, Lukas; Marchioni, Daniele
abstract
The aim of this study was to describe and evaluate the feasibility of an expanded transcanal transpromontorial approach, developed from the exclusive endoscopic transcanal transpromontorial approach.
2017
- Transcanal Endoscopic Lateral Skull Base Surgery
[Articolo su rivista]
Marchioni, D.; Bonali, M.; Presutti, L.
abstract
Presutti and Marchioni's transcanal exclusive endoscopic transpromontorial approach represents a new surgical technique to remove diseases that involve cochlea and fundus of internal auditory canal in selected cases, thus avoiding extensive bone drilling, brain, meningeal, and neurovascular manipulation. The advantage of this endoscopic technique is that direct access to internal auditory canal allows the creation of a minimally invasive route through the cochlea with a consequent improved safety during intraoperative and postoperative management. Surgeons who start with this surgical procedure must possess some fundamental prerequisites, like confidence with other inner ear techniques and previous experience with endoscopic middle ear surgery and endoscopic cadaveric dissections. Owing to the reduced invasiveness of the transpromontorial transcanal approach, there is no need for an intensive care unit stay after the operation and patient hospitalization is shorter.
2017
- Transcanal surgery for vestibular schwannomas: a pictorial review of radiological findings, surgical anatomy and comparison to the traditional translabyrinthine approach
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Federici, Gaia; Anschuetz, Lukas; Pavesi, Giacomo; Todeschini, Alessandra; Presutti, Livio; Marchioni, Daniele
abstract
The most popular approaches for vestibular schwannoma (VS) removal are retrosigmoid, middle cranial fossa and translabyrinthine (TL). All require a certain degree of invasivity, bone removal, or brain manipulation. Recently, the authors described the transcanal transpromontorial approaches (TTA), which allow the inner ear to be accessed directly through the external auditory canal (EAC), either with a microscopic (Expanded TTA, or ExpTTA) or even an exclusive endoscopic technique (Endoscopic TTA, or EndoTTA). The advantages compared to traditional approaches are a direct view of the internal auditory canal (IAC) from lateral to medial, very little or no superficial tissue dissection and very little petrous bone drilling. In summary, from an anatomical point of view, they could be considered to be minimally invasive approaches. The radiologic outcome and the anatomical correspondence of these new approaches are described so as to share with the readers the possible radiologic findings and to compare and differentiate them from classic transpetrous approaches such as the TL approach.
2016
- Endoscopic Anatomy of the Protympanum
[Articolo su rivista]
Jufas, N.; Marchioni, D.; Tarabichi, M.; Patel, N.
abstract
The protympanum, a final common pathway between the tympanic cavity and external environment, is gaining relevance due to the ease and completeness of visualization with angled endoscopes. Two primary conformations are described, quadrangular and triangular, and new anatomic structures such as the protiniculum, subtensor recess, and protympanic spine are defined. Surgical relevance of the protympanum is described with respect to ventilation, cholesteatoma, cerebrospinal fluid leak, otic neuralgia, and surgical access to the eustachian tube.
2016
- Endoscopic Facial Nerve Surgery
[Articolo su rivista]
Marchioni, D.; Soloperto, D.; Rubini, A.; Nogueira, J. F.; Badr-El-Dine, M.; Presutti, L.
abstract
Tympanic facial nerve segment surgery has been traditionally performed using microscopic approaches, but currently, exclusive endoscopic approaches have been performed for traumatic, neoplastic, or inflammatory diseases, specially located at the geniculate ganglion, greater petrosal nerve, and second tract of the facial nerve, until the second genu. The tympanic segment of the facial nerve can be reached and visualized using an exclusive transcanal endoscopic approach, even in poorly accessible regions such as the second genu and geniculate ganglion, avoiding mastoidectomy, bony demolition, and meningeal or cerebral lobe tractions, with low complication rates using a minimally invasive surgical route.
2016
- Endoscopic Management of Attic Cholesteatoma: Long-Term Results
[Articolo su rivista]
Alicandri Ciufelli, Matteo; Marchioni, Daniele; Kakehata, Seiji; Presutti, Livio; Villari, Domenico
abstract
The main application of endoscopic surgery relies on the middle ear cholesteatoma surgical treatment, although for a definitive validation and acceptance by scientific community, long-term results are needed about recurrent and residual rates of the pathology. The aim of the present paper was to analyze the single institution experience with the long-term results of surgical treatment of attic cholesteatoma.
2016
- Endoscopic approach for cochlear implantation in advanced otosclerosis: A case report
[Articolo su rivista]
Marchioni, D.; Soloperto, D.; Bianconi, L.; Guarnaccia, M. C.; Genovese, E.; Presutti, L.
abstract
Hypothesis: Ossification of the cochlea was once considered to be a contraindication for cochlear implantation. Advances in cochlear implant technology and coding strategies have led to developments in different surgical procedures to manage cochlear ossification. The endoscopic technique allows a direct approach to the round window and the cochlea, especially in remodeled labyrinth, allowing a better vision of scala tympani. Background: Tertiary referral ENT center. Methods: Between January 2011 and February 2015 three patients with far advanced otosclerosis with partial obliteration of the cochlea were selected and underwent endoscopic-assisted cochlear implantation. Results: In far advanced otosclerosis, endoscopy allowed a magnification of the anatomy of the round window, permitting the surrounding anatomical structures forming the anatomy of the niche to be identified, and avoiding a blind dissection. No postoperative complications were noted, in particular, no surgical site infection, no vertigo, and no facial nerve injuries. Implant activation was routinely performed 1 month after surgery. All monitoring till date has indicated that the external auditory ducts are well ventilated and there are no signs of extrusion. Conclusions: Ossification may occur as a consequence of the pathology of meningitis, chronic otitis media, severe otosclerosis, autoimmune inner ear diseases, temporal bone traumas, and other diseases. Advances in cochlear implant technology and coding strategies have led to developments in different surgical procedures to manage cochlear ossification. Supported by a number of years of experience in the field of otoendoscopic surgery, we propose a technique for cochlear implantation under unfavorable conditions using endoscopic-assisted surgery, especially in advanced otosclerosis. This technique permits us to extend the indication for cochlear implantation, and in our opinion will reduce the morbidity associated with this surgical procedure.
2016
- In reference to A New Theory on the Pathogenesis of Acquired Cholesteatoma: Mucosal Traction
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Presutti, Livio
abstract
N/D
2016
- Is Ménière’s disease the ‘inner ear migraine’? A neurovascular region-based hypothesis supported by epidemiological appraisal and pathophysiological considerations
[Articolo su rivista]
Alicandri Ciufelli, M.; Aggazzotti-Cavazza, E.; Cunsolo, E.; Marchioni, D.; Monzani, D.; Genovese, E.; Presutti, L.
abstract
Migraine (MG) and Ménière’s disease (MD) are idiopathic pathologies, but share several clinical, epidemiological, and genetic characteristics. Based on some considerations with regard to the pathophysiology and epidemiology of both MG and MD, the authors hypothesize that MG and MD could be interpreted as different neurovascular regional manifestations of the same pathology. An interpretation of MG and MD as the same phenomenon involving different brain regions could inspire and stimulate researchers studying aspects linking what has already been discovered in both fields, e.g. pathogenetic mechanisms or therapeutic development.
2016
- Letter to the Editor "Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?" by Prasad et al
[Articolo su rivista]
Alicandri Ciufelli, Matteo; Anschuetz, Lukas; Presutti, Livio; Villari, Domenico; Marchioni, Daniele
abstract
no disponibile
2016
- Round window chamber and fustis: endoscopic anatomy and surgical implications
[Articolo su rivista]
Marchioni, D.; Soloperto, D.; Colleselli, E.; Tatti, M. F.; Patel, N.; Jufas, N.
abstract
The round window region is of critical importance in the anatomy of the middle ear. The aim of this paper is to describe its anatomy from an endoscopic point of view, emphasizing structures that have important surgical implications, in particular the fustis and the subcochlear canaliculus. The fustis, a smooth bony structure that forms the floor of the round window region, is a constant and important structure. It seems to indicate the round window membrane and the correct position of scala tympani. A structure connecting the round window region to the petrous apex, named the subcochlear canaliculus, is also described. A retrospective review of video recordings of endoscopic dissection and surgical procedures, carried out between June 2014 and February 2015, was conducted across two Tertiary university referral centers. A total of 42 dissections were analyzed in the study. We observed the fustis in all the cases and we identify two different anatomical conformations. The subcochlear canaliculus was found in 81.0 %, with a pneumatization direct to the petrous apex in 47.7 %. Conformation and limits of the round window niche may influence the surgical view of the round window membrane. Endoscopic approaches allow a very detailed view, which enables a comprehensive exploration of the round window region. Accurate knowledge of the anatomical relationships of this region has important advantages during middle ear surgery.
2016
- Stapes malformations: the contribute of the endoscopy for diagnosis and surgery
[Articolo su rivista]
Marchioni, Daniele; Soloperto, Davide; Villari, Domenico; Tatti, Maria Fatima; Colleselli, Elena; Genovese, Elisabetta; Presutti, Livio
abstract
The aim of this study is to investigate the contribute of the endoscopic exclusive transcanalar approach for the management of stapes malformations. A retrospective chart review was made at our tertiary referral centers. 17 patients with stapes malformations underwent surgery with endoscopic exclusive transcanal approach. A complete audiological and radiological assessment before and after surgery was performed. 12/17 (70 %) underwent a surgical endoscopic correction, In case of fixed platina underwent five endoscopic stapedotomy and one endoscopic stapedectomy were performed. In case of mobile platina five endoscopic ossiculoplasties with partial ossiculoplasty replacement prosthesis were performed, 3 with autologous remodeling incus and 2 with malleus head remodeling. In 1 case, only an endoscopic stapes mobilization was made. In 5/17 (30 %), due to difficult anatomical findings an endoscopic explorative tympanotomy was finally performed. The mean preoperative air conduction (AC), bone conduction (BC) and air-bone gap (ABG) were, respectively, 60.7, 26.3 and 34.4 dB. The mean postoperative AC, BC and ABG were, respectively, 33.8, 26.5 and 7.3 dB, with a mean improvement of the ABG of 27.1 dB. Discharge from hospital was on the first post-surgery day. No relevant postoperative complications were noted. The median follow-up was 3.6 years (range 1-6). The endoscopic approach results very adequate for the diagnosis and treatment of stapes malformations, checking variations of the ossicles conformation and functioning and performing safe surgery, under direct control of middle ear structures.
2016
- The Epitympanum Revisited: Endoscopic Anatomy
[Articolo su rivista]
Tarabichi, M.; Marchioni, D.; Kapadia, M.
abstract
In contrast to other means of studying the epitymapnum, the endoscope allows unparallel access without disruption of anatomy. The aim of this study is to delineate the anatomy of the epitympanum through transcanal endoscopy. Systematic dissection of anatomic specimens. We performed systematic endoscopic dissection of 20 ears in 10 fresh frozen anatomical specimens. A detailed flow sheet was filled up documenting the status of the lateral attic folds, the tensor fold, the cog and the tensor folds, the supratubal recess, and the patency of the anterior and posterior isthmus. None of the ears showed indication of previous chronic otitis media. The lateral incudomallear fold was intact in all but one ear. The lateral mallear fold was intact in all specimens. The tensor fold was complete in 16 ears and partial in four. Two of these ears belonged to the same specimen. The epitympanic diaphragm was complete in 15 out of 20 ears in 10 anatomic specimens. The endoscope allows for assessment of the attic anatomy and integrity of the diaphragm without undue disruption of anatomy. The epitympanic diaphragm is present in the majority of healthy ears and can in theory serve as the anatomic basis for the isolated attic retraction.
2016
- The Eustachian Tube Redefined
[Articolo su rivista]
Tarabichi, Muaaz; Poe, Dennis S; Nogueira, João Flávio; Alicandri Ciufelli, Matteo; Badr El Dine, Mohamed; Cohen, Michael S; Dean, Marc; Isaacson, Brandon; Jufas, Nicholas; Lee, Daniel J; Leuwer, Rudolf; Marchioni, Daniele; Patel, Nirmal; Presutti, Livio; Rivas, Alejandro
abstract
cdscdscsd
2016
- The Fully Endoscopic Acoustic Neuroma Surgery
[Articolo su rivista]
Marchioni, Daniele; Carner, Marco; Rubini, Alessia; Nogueira, João Flávio; Masotto, Barbara; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract
Surgical approaches to vestibular schwannomas (VS) are widely known and extensively recorded. For the first time, an exclusive endoscopic approach to the internal acoustic canal (IAC) was described and used to safely remove a cochlear schwannoma involving IAC in March 2012. The aim of this article was to summarize indications and technique to treat intracanalicular VS by transcanal/transpromontorial endoscopic approach. Because management of intracanalicular VSs is complex and strongly debated, this kind of therapeutic option in the appropriate and selected cases could modify classic concepts of the management of this pathology.
2016
- To hear or not to hear: Sound Availability Modulates Sensory-Motor Integration
[Articolo su rivista]
Camponogara, I.; Turchet, L.; Carner, M.; Marchioni, D.; Cesari, P.
abstract
When we walk in place with our eyes closed after a few minutes of walking on a treadmill, we experience an unintentional forward body displacement (drift), called the sensory-motor aftereffect. Initially, this effect was thought to be due to the mismatch experienced during treadmill walking between the visual (absence of optic flow signaling body steadiness) and proprioceptive (muscle spindles firing signaling body displacement) information. Recently, the persistence of this effect has been shown even in the absence of vision, suggesting that other information, such as the sound of steps, could play a role. To test this hypothesis, six cochlear-implanted individuals were recruited and their forward drift was measured before (Control phase) and after (Post Exercise phase) walking on a treadmill while having their cochlear system turned on and turned off. The relevance in testing cochlear-implanted individuals was that when their system is turned off, they perceive total silence, even eliminating the sounds normally obtained from bone conduction. Results showed the absence of the aftereffect when the system was turned off, underlining the fundamental role played by sounds in the control of action and breaking new ground in the use of interactive sound feedback in motor learning and motor development.
2016
- Traumatic intraconal foreign body: Report of an injury corrected with combined surgical and endoscopic treatment
[Articolo su rivista]
Marchioni, D.; Bertossi, D.; Soloperto, D.; Bianconi, L.; Procacci, P.; Nocini, P. F.; Aarabi, B.; Rodgers, R. B.; Dalyai, R.; Jallo, J.
abstract
BACKGROUND: Management of penetrating ocular splinter injuries is very controversial. Penetrating wounds of the orbit represent a complex therapeutic problem that requires a multidisciplinary approach. Endoscopic approaches to the orbit are currently performed through the lamina papyracea to access the medial part, or through large orbitotomies to access the lateral part. OBJECTIVE: To describe a novel combined approach to the lateral part of the orbit. METHODS: Clinical and surgical findings of intraorbital foreign body removal are presented. A minimal supraorbital osteotomy was performed, combined with endoscopic intraorbital dissection. RESULTS: The foreign body was removed, no postoperative complications were reported, and visual acuity increased from 2/10 preoperatively, to 8/10 one month after surgery. CONCLUSION: The present technique can be considered a safe and novel surgical approach to access the retrobulbar space and to treat the pathology of this anatomic region.
2015
- Endoscopic Middle Ear Anatomy
[Articolo su rivista]
Marchioni, D.; Bonali, M.; Presutti, L.
abstract
The anatomy of the middle ear is very complex. The otologist must have a good knowledge of the structures comprising the tympanic cavity; a clear view of all the subsites of this region is essential to ensure the complete removal of all pathology. The development of endoscopic techniques to access the middle ear has offered the possibility to “look around corners” and explore hidden recesses the microscope cannot reach. Moreover, by leading to a better understanding of the different ventilation pathways of the tympanic cavity, alterations of which may cause pathologies such as cholesteatoma, endoscopy represents a surgical approach aimed toward restoring normal physiology as well as eradicating disease. In this article, we discuss the state of the art of middle ear endoscopic anatomy, describing the different subsites of this small but challenging region.
2015
- Endoscopic assisted cochlear implants in ear malformations
[Articolo su rivista]
Marchioni, Daniele; Soloperto, Davide; Guarnaccia, MARIA CONSOLAZIONE; Genovese, Elisabetta; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract
The aim of present study is to describe the use of the endoscopic assisted cochlear implant approach in cases with severely malformed temporal bones and with anomalous anatomy of the inner ear and tympanic cavity. Eight patients with malformed middle and inner ear and bilateral profound hearing loss were operated using an endoscopic assisted cochlear implant procedure at our tertiary university referral center between January and September 2013. Five patients received a cochlear implant using a suprameatal endoscopic assisted approach. A chart review of clinical data and videos from the operations was performed. All procedures were re-analyzed and codified. In all patients, discharge from hospital was on the third day post-surgery. No immediate or late postoperative complications were noted. The current mean follow-up is 6 months, with range between 4 and 12 months. This approach proved to be successful in cochlear implant placement. It guaranteed a very good control on the facial nerve, even in cases with difficult anatomical conditions, mainly thanks to the endoscopic procedure. It also permitted an appropriate anatomical orientation of the abnormal middle ear with a direct safe cochleostomy, when the round window position would have been difficult to treat using a traditional approach.
2015
- Endoscopic ear surgery. Principles, indications, and techniques
[Monografia/Trattato scientifico]
Presutti, Livio; Marchioni, Daniele
abstract
endosocpic ear surgery
2015
- Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: Our experience
[Articolo su rivista]
Marchioni, Daniele; Soloperto, Davide; Rubini, Alessia; Villari, Domenico; Genovese, Elisabetta; Artioli, Franca; Presutti, Livio
abstract
The aim of the present study is to describe our experience in the management of tympanic cavity cholesteatoma in pediatric patients, treated with endoscopic exclusive transcanal approach.
2015
- Endoscopic transcanal corridors to the lateral skull base: Initial experiences
[Articolo su rivista]
Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo; Rubini, Alessia; Presutti, Livio
abstract
Surgical approaches to the lateral skull base, internal auditory canal (IAC), and petrous bone are widely known and have been extensively recorded. Despite the benign nature and limited dimensions of lesions located in this anatomical region, extirpative surgical approaches are often required to reach and remove the disease. The aim of present report was to describe our initial experiences with minimally invasive endoscopic approaches to the lateral skull base.
2015
- Radiological assessment of the sinus tympani: temporal bone HRCT analyses and surgically related findings
[Articolo su rivista]
Marchioni, Daniele; Valerini, Sara; Mattioli, Francesco; Alicandri Ciufelli, Matteo; Presutti, Livio
abstract
To evaluate the morphology of the sinus tympani (ST) based on computed tomography (CT) scans (axial view), describing the findings in a cohort of 148 patients (296 ears), and classifying the prevalence according to our ST classification. To evaluate the surgical prevalence based on the type of ST. To calculate the sensibility and positive predictive value (PPV) of high-resolution computed tomography (HRCT) scans for ST involvement by cholesteatoma.
2015
- Response to Letter to the Editor Regarding "The Role of Endoscope in Lateral Skull Base Surgery: Fact Versus Fiction"
[Articolo su rivista]
Presutti, Livio; Alicandri Ciufelli, Matteo; Rubini, Alessia; Gioacchini, Federico Maria; Marchioni, Daniele
abstract
N/D
2015
- The round window region and contiguous areas: endoscopic anatomy and surgical implications
[Articolo su rivista]
Marchioni, Daniele; Alicandri Ciufelli, Matteo; Pothier, David D; Rubini, Alessia; Presutti, Livio
abstract
The round window region is a critical area of the middle ear; the aim of this paper is to describe its anatomy from an endoscopic perspective, emphasizing some structures, the knowledge of which could have important implications during surgery, as well as to evaluate what involvement cholesteatoma may have with these structures. Retrospective review of video recordings of endoscopic ear surgeries and retrospective database review were conducted in Tertiary university referral center. Videos from endoscopic middle ear procedures carried out between June 2010 and September 2012 and stored in a shared database were reviewed retrospectively. Surgeries in which an endoscopic magnification of the round window region and the inferior retrotympanum area was performed intraoperatively were included in the study. Involvement by cholesteatoma of those regions was also documented based on information obtained from the surgical database. Conformation of the tegmen of the round window niche may influence the surgical view of round window membrane. A structure connecting the round window area to the petrous apex, named the subcochlear canaliculus, is described. Cholesteatoma can invade the round window areas in some patients. Endoscopic approaches can guarantee a very detailed view and allow the exploration of the round window region. Exact anatomical knowledge of this region can have important advantages during surgery, since some pathology can invade inside cavities or tunnels otherwise not seen by instrumentation that produces a straight-line view (e.g. microscope).
2015
- The transcanal transpromontorial corridor to treat cochlear schwannomas
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Presutti, Livio
abstract
N/D
2014
- Aesthetic comparison between synthetic glue and subcuticular sutures in thyroid and parathyroid surgery: a single-blinded randomised clinical trial
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Grammatica, Alberto; Molteni, G; Spaggiari, Alan; DI Matteo, S; Tassi, S; Ghidini, Angelo; Izzo, L; Gioacchini, F. M; Marchioni, D; DI Saverio, S; Presutti, Livio
abstract
The aim of our study was to compare, in terms of aesthetic results, the use of synthetic glue to intradermal absorbable sutures in postthyroidectomy and parathyroidectomy wound closure in a single blinded, randomised, per protocol equivalence study. From September 2008 to May 2010, patients undergoing thyroid or parathyroid surgery (with an external approach) at the Otolaryngology Department of the University Hospital of Modena were assessed for eligibility. In total, 42 patients who had had synthetic glue application on surgical incisions (A) and 47 patients who had subcuticular sutures on their surgical incisions (B) were enrolled. The mean of the endpoint (based on the Wound Registry Scale) of group A at 10 days was 1.4, while that in group B (based on the Stony Brook Scar Evaluation Scale) was 2.9. Statistically significant (p = 0.002) and clinically significant (difference of the means = 1.5) differences in the aesthetic results were found between groups A and B at 10 days, with better results in group B. On the other hand, at 3 months, the mean of the endpoint in group A was 3.1 while that in group B was 2.8; no statistically significant (p = 0.62) or clinically significant (difference in means = 0.3) differences were found between groups A and B. In conclusion, synthetic glue differs from subcuticular suture in post-thyroidectomy or post-parathyroidectomy incision for early aesthetic results, with better outcomes for subcuticular sutures. At 3 months, there were no differences in aesthetic outcomes between groups. Moreover, sex, incision length, age, cold/hot blade and correspondence of the incision with a wrinkle in the skin did not seem to influence aesthetic outcomes with this type of incision.
2014
- Combined approach for tegmen defects repair in patients with cerebrospinal fluid otorrhea or herniations: our experience
[Articolo su rivista]
Marchioni, Daniele; Bonali, Marco; ALICANDRI CIUFELLI, Matteo; Rubini, Alessia; Pavesi, Giacomo; Presutti, Livio; Bonali, Marco
abstract
Objectives To describe our departmental experience in the surgical repair of tegmen tympani defects using a combined transmastoid/minicraniotomic approach. Design Retrospective review of videos from surgery and patients' charts. Setting Tertiary university referral center. Participants Twenty-two patients who underwent surgical repair of tegmen defects associated with cerebrospinal fluid (CSF) leakage and/or meningocele/meningoencephalocele by a combined transmastoid/minicraniotomic approach. Main Outcome Measures A retrospective review of videos of surgery and charts of patients with tegmen tympani or tegmen antri defects and CSF leakage, temporal lobe encephalocele, and/or meningoencephalocele. Results All patients underwent the combined approach and had their defects closed, without significant intraoperative or postoperative complications. Conclusions Mastoidectomy with temporal minicraniotomy represents an effective approach in patients with tegmen tympani dehiscence; the advantages of this technique are the control of the floor of the middle cranial fossa and the possibility to reach bony defects located anteriorly without manipulation of the ossicular chain and temporal lobe.
2014
- Combined endoscopic-microscopic approach for vestibular schwannoma removal: outcomes in a cohort of 81 patients
[Articolo su rivista]
Presutti, L.; Magnaguagno, F.; Pavesi, G.; Cunsolo, E.; Pinna, G.; Alicandri Ciufelli, M.; Marchioni, D.; Prontera, A.; Gioacchini, F. M.
abstract
Patients affected by vestibular schwannomas typically report a number of symptoms and minor disabilities after surgery. Therefore, surgeons dealing with this pathology should also try to achieve a good QoL for patients who have undergone tumour removal. The aim of this study was to analyse QoL in subjects undergoing surgery for vestibular schwannomas and to try to establish a relationship with both the tumour size and post-surgical alterations (e.g. facial motor dysfunctions, difficulties in balance, persistence of headache and tinnitus). A retrospective analysis was performed on a consecutive series of 81 patients affected by vestibular schwannomas and treated by a combined microscopic-endoscopic approach. Three groups of patients were identified on the basis of tumour size. Group 1 (lesions < 25 mm) with 31 patients (38%); Group 2 (lesions > 26 mm and < 40 mm) with 39 patients (48%); Group 3 (lesions > 41 mm) with 11 patients (14%). Data obtained with the Short Form Questionnaire showed a statistically significant difference in QoL in those undergoing intervention compared with a control group of healthy subjects. The Glasgow Benefit Inventory Questionnaire showed that 25 (31%) patients felt better, 11 (14%) felt similarly, and 45 (55%) felt poorer health conditions in comparison to the pre-surgical period. Concerning the relationship between preservation of facial nerve function and QoL, using the Glasgow Health Status Inventory, it appeared that only 34% of subjects with good facial nerve function (RGS grade I-II) complained of worsening of QoL, while 45% of those with serious facial nerve injury (RGS grade IV-V) referred poorer QoL. Moreover, the possibility of recovery of facial nerve function during the months following surgery was clearly highlighted by our analysis. Our study confirmed the close relation between tumour size and post-surgical QoL, which is worse for patients affected by larger lesions.
2014
- Combined lateral microscopic/endoscopic approaches to petrous apex lesions: pilot clinical experiences
[Articolo su rivista]
Presutti, Livio; ALICANDRI CIUFELLI, Matteo; Rubini, Alessia; Gioacchini, FEDERICO MARIA; Marchioni, Daniele
abstract
Surgical treatment of lesions involving the temporal bone, petrous apex, or internal auditory canal is usually performed using the classical microscopic approach that necessitates wide external incisions and soft tissue dissection. At present, the main application of endoscopic surgery is in the surgical treatment of middle ear cholesteatoma, but with the natural evolution of the technique, there will be an increasing number of applications in lateral skull base surgery.
2014
- Endoscopic cochlear implant procedure
[Articolo su rivista]
Marchioni, Daniele; Grammatica, Alberto; ALICANDRI CIUFELLI, Matteo; Genovese, Elisabetta; Presutti, Livio
abstract
The objective was to asses the feasibility of the endoscopic technique for cochlear implant (CI) positioning avoiding mastoidectomy and to discuss the benefits and drawbacks of the technique. The study design is a surgical procedure description and prospective case series report. From December 2011 to October 2012, six patients underwent endoscopic CI. All cases were selected based on CT and MRI studies. All surgical steps were analyzed; intra-and post-operative complications were noted. The length of time for each surgical procedure was recorded. The surgical procedure was described step by step focusing on the anatomy of the round window (RW) niche, analyzing the critical point during the dissection. The timing of the surgical procedures was 120 ± 21 (mean ± SD) min. In 1/6 patients, intra-operative injury of the chorda tympani occurred. In all cases, an endoscopic identification was performed and the anatomical details of the RW niche were noted. In 6/6 cases, a RW niche magnification was performed endoscopically. 5/6 cases showed a normal conformation of the RW. In 1/6 patients, obliteration of the RW niche was found. In 4/6 patients, an endoscopic cochleostomy through the RW was performed. In 1/6 patients, a difficult insertion of the array was observed. The current follow-up is 7.3 months (SD ± 3.7). No post-operative short- or long-term complications were noted in this series. Endoscopic CI is a safe and viable technique with a low rate of complications and with good outcomes.
2014
- Facial nerve hemangioma of the geniculate ganglion: an endoscopic surgical approach
[Articolo su rivista]
Marchioni, Daniele; Soloperto, Davide; Genovese, Elisabetta; Rubini, Alessia; Presutti, Livio
abstract
Facial nerve hemangiomas are rare benign tumors arising from the venous plexus surrounding the facial nerve. Surgical management of these tumors is controversial. The goal of surgery is complete tumor removal with restoration of facial nerve function and preservation of hearing, wherever possible. The approaches most used are the translabyrinthine and middle cranial fossa approaches. In this report, we describe the first facial hemangioma treated with an endoscopic transcanal approach, combined with a retroauricular transmastoid minicraniotomy for closure of the dural defect. A great auricular nerve graft was used to reconnect interrupted nerve segments. Histopathological examination confirmed the diagnosis of a hemangioma of the first genu of the facial nerve. With magnification of the structures, the transcanal endoscopic approach allowed a radical excision of the neoplasm permitting hearing function preservation, with the possibility to work with a minimally invasive approach with respect to the labyrinthine block and cochlea. Compared to a middle cranial fossa approach, the transcanal endoscopic approach avoided labyrinthine block removal and brain retraction.
2014
- Partial laryngectomies: when the problem is the pexy
[Articolo su rivista]
Ruberto, Marco; ALICANDRI CIUFELLI, Matteo; Grammatica, Alberto; Marchioni, Daniele; Bergamini, Giuseppe; Presutti, Livio
abstract
To analyse the complications related to pexy, the main clinical manifestations that may raise suspicions of a pexy line rupture/detachment, the most suitable diagnostic technique and the optimum treatment to resolve this complication. This is a retrospective chart review in tertiary university referral centre. Medical charts of patients with oncological laryngeal pathologies admitted to the Otolaryngology Department of the University Hospital of Modena between May 2003 and March 2012 were analysed. Ten patients with rupture of the pexy were identified and included in the present study. The clinical manifestations were dysphagia, alteration of sensitivity of hypopharyngeallaryngeal structures, fever, infection and diastasis of surgical wounds, bleeding, dysphonia and aspiration pneumonia. Rupture of the pexy was diagnosed through endoscopic evaluations, radiological techniques or directly in the operating room during revision surgery of the earlier operation. Surgical treatments, coupled with effective swallowing rehabilitation, allowed progressive functional recovery. Patients were hospitalised until recovery of laryngeal functions was complete. In conclusion, pexy line rupture is one of the complications in the post-operative period of partial laryngectomies. Certain clinical manifestations may indicate this complication, helping the surgeon to establish an early diagnosis and administer prompt treatment.
2013
- A step backward: the “Rough” facial nerve grading system
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Grammatica, Alberto; Salafia, Francesca; Ciancimino, Cristel; Cunsolo, Eliomaria; Pingani, Luca; Rigatelli, Marco; Genovese, Elisabetta; Monzani, Daniele; Gioacchini, FEDERICO MARIA; Marchioni, Daniele; Presutti, Livio
abstract
Several modalities currently exist to rate the degree of facial function clinically but even though it has significant limitations, the most widely used scale is the House-Brackmann grading system (HBGS). A simplified scale is introduced here, the 'Rough' Grading System (RGS - Grade I: normal movement; Grade II: slight paralysis; Grade III: frank paralysis with eye closure; Grade IV: frank paralysis without eye closure; Grade V: almost complete paralysis with only slight movements; Grade VI: total paralysis). The aim of the present study was to verify the interrater reliability and the interscale validity of this simplified grading system.
STUDY DESIGN:
Scale validation study based on a prospective cohort.
METHODS:
Fifty patients with facial palsy, consecutively referred to our department were filmed while performing some codified facial movements. Then two independent groups (one rating using the HBGS, the other rating using the RGS) assigned a grade after reviewing the videos. The time required for the rating was also noted.
RESULTS:
The HBGS showed a mean value of interrater agreement of 0.46 while the RGS showed a mean value of 0.59. The concurrent validity between HBGS and RGS ranged from 0.86 to 0.90 (p < 0.001 for every comparison). There was no statistically significant difference between HBGS and RGS in the mean time taken for rating (p = 0.15).
CONCLUSIONS:
The RGS reached an adequate level of interrater reliability, higher than the HBGS. The correlation between the two scales is high and the times required for rating are similar. The present results may justify the use of the RGS in routine clinical practice.
LEVEL OF EVIDENCE:
N/A
2013
- Beyond the middle ear: endoscopic surgical anatomy and approaches to inner ear and lateral skull base
[Articolo su rivista]
Presutti, Livio; Nogueira, João Flávio; ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele
abstract
Currently, the main application of endoscopic surgery relies on the middle ear cholesteatoma surgical treatment. However, in the natural evolution of the technique there are the steps toward of lateral skull base surgery and treatment of pathologic conditions of pertous bone. The endoscopic approaches to lateral skull base are (1) a transcanal exclusively endoscopic approach or (2) combined approaches (microscopic endoscope-assisted), including transotic, infralabyrinthine, and suprameatal translabyrinthine.
2013
- Cochlear schwannoma removed through the external auditory canal by a transcanal exclusive endoscopic technique
[Articolo su rivista]
Presutti, Livio; ALICANDRI CIUFELLI, Matteo; Cigarini, Elisa; Marchioni, Daniele
abstract
Surgical approaches to the inner ear and internal auditory canal (IAC) are widely known and extensively recorded. The most popular can be classified as retrosigmoid, transmastoid-translabyrinthine, and middle cranial fossa approaches. For the first time, an exclusive endoscopic approach to the IAC is described here, used to remove a cochlear schwannoma involving both the IAC and labyrinth. The operation provided a direct transcochlear intradural approach from lateral to medial and from external to internal auditory canal, without any external incision. The pathology was totally removed, and the postoperative outcome of the facial nerve was grade II (House-Brackmann grading system) at 3-month follow-up.
2013
- Endoscopic anatomy and ventilation of the epitympanum
[Articolo su rivista]
Marchioni, Daniele; Piccinini, Alessia; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract
The use of an endoscope with varied angulations has allowed the surgeon to explore areas that were often not visualized using standard microscopic procedures. The endoscope has improved knowledge of the complex anatomy of mucosal fold and improved functional interventions in middle ear inflammatory disorders during middle ear surgery; intraoperative evaluation of middle ear anatomy during endoscopic surgery for inflammatory disorders helps surgeon visualize anatomic blockages of the middle ear ventilation trajectories. This article discusses the anatomy of the epitympanum and the ventilation patterns and pathophysiology of epitympanic retraction.
2013
- Endoscopic anatomy of the retrotympanum
[Articolo su rivista]
Nogueira, João Flávio; Mattioli, Francesco; Presutti, Livio; Marchioni, Daniele
abstract
This article presents the endoscopic anatomy of the retrotympanum and its relationship to other important anatomic landmarks in the middle ear to provide understanding of its importance and relevance during surgeries. A well-detailed tour of the retrotympanum, its associated structures, variability of anatomic structures, and surgical relevance is presented.
2013
- Endoscopic management of attic cholesteatoma: a single-institution experience
[Articolo su rivista]
Marchioni, Daniele; Villari, Domenico; Mattioli, Francesco; ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Presutti, Livio
abstract
At present, the main application of endoscopic surgery is in the surgical treatment of middle ear cholesteatoma; however, for definitive validation and acceptance by scientific community, results are needed regarding recurrent and residual rates of the condition. This article analyzes the single-institution experience from results of surgical treatment of attic cholesteatoma.
2013
- Endoscopic transcanal ear anatomy and dissection
[Articolo su rivista]
Tarabichi, Muaaz; Marchioni, Daniele; Presutti, Livio; Nogueira, João Flávio; Pothier, Dave
abstract
The authors present a manual of transcanal ear dissection, a completely clinically focused discussion of the goals, steps, and outcomes of endoscopic dissection of the middle ear. From operating station setup through instrumentation and tasks, the reader is presented with detailed technique steps interspersed with observe notes that provide anatomic and technique pearls, such as "by removing the skin of the canal and the epithelial layer of the tympanic membrane (TM), you have largely eliminated the bleeding elements of the external ear and TM".
2013
- From external to internal auditory canal: Surgical anatomy by an exclusive endoscopic approach
[Articolo su rivista]
Marchioni, D.; Alicandri-Ciufelli, M.; Mattioli, F.; Nogeira, J. F.; Tarabichi, M.; Villari, D.; Presutti, L.
abstract
Surgical approaches to the inner ear and internal auditory canal (IAC) are well known and well documented. The objective of this study is to analyze the morphology, and surgical and anatomic findings of an exclusive endoscopic transcanal approach (EETA) to the IAC. Cadaveric dissections were performed on 11 temporal bones, approaching the internal auditory meatus directly through the external ear canal and avoiding mastoidectomy. In all cases, it was possible to dissect the internal carotid artery and jugular bulb with a 0° endoscope, and with good control of these two structures. The medial wall of the bony labyrinth guaranteed good landmarks for IAC dissection, such as the spherical recess, and the labyrinthine tract of the facial nerve. The IAC can be thoroughly visualized in the cadaver using EETA, avoiding mastoidectomy, extensive temporal bone tissue removal and external incisions. Clinically based reports will be required in future to strengthen our preliminary results. © 2012 Springer-Verlag.
2013
- Instrumentation and technologies in endoscopic ear surgery
[Articolo su rivista]
Badr El Dine, Mohamed; James, Adrian L; Panetti, Giuseppe; Marchioni, Daniele; Presutti, Livio; Nogueira, João Flávio
abstract
This article covers state-of-the-art instruments and devices specially designated for endoscopic ear surgery. New technologies stimulate the creation of special endoscopic equipment and microinstruments specially designed to satisfy the exclusive requirements of endoscopic ear surgery, which contribute to the progress of the procedure. The article presents the advantages and disadvantages of working with ear endoscopes and details the advances in equipment used in ear endoscopies. New instruments specially modified for working with angled-vision endoscopes and considerations of the surgeon's use of them are discussed.
2013
- Prevalence of ventilation blockages in patients affected by attic pathology: a case-control study
[Articolo su rivista]
Marchioni, Daniele; Mattioli, Francesco; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract
Using a retrospective video evaluation of exclusive endoscopic middle ear procedures, we analyzed the different anatomical and pathological findings between patients with attic disease or cholesteatoma and patients without attic disease.
2013
- Transcanal endoscopic management of cholesteatoma
[Articolo su rivista]
Tarabichi, Muaaz; Nogueira, João Flávio; Marchioni, Daniele; Presutti, Livio; Pothier, David D; Ayache, Stéphane
abstract
A detailed and comprehensive discussion of transcanal endoscopic management of cholesteatoma is presented. After a presentation of the anatomy of the area, the rationale, advantages and limitations, technique, and long-term results of each technique are presented. A case presentation follows each technique. Techniques presented are: endoscopic transcanal management of limited cholesteatoma, endoscopic open cavity management of cholesteatoma, and expanded transcanal access to middle ear and petrous apex.
2013
- Transcanal endoscopic treatment of benign middle ear neoplasms
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; PRESUTTI, Livio; MARCHIONI, Daniele; GIOACCHINI, FEDERICO MARIA; BONALI, MARCO
abstract
The application of endoscopic surgery for middle ear pathologies is rapidly increasing. At present, its main application is in the treatment of middle ear cholesteatoma. This report describes the application of this technique as treatment for some benign lesions that may involve the middle ear cleft. A retrospective chart review of six patients who underwent exclusive endoscopic tympanic cavity surgery for benign neoplasms was performed between November 2011 and January 2012. Based on charts, images, and surgical reports, data from the patients were summarized for further consideration. All of the six lesions were in the tympanic cavity without involvement of the mastoid region. An exclusive endoscopic transcanal approach was used in all cases. No patient showed signs or symptoms of pathology recurrence. Endoscopic transcanal excision of benign tympanic cavity neoplasms represents a safe procedure, with minimal morbidity and without external incisions or mastoidectomies.
2012
- Bronchial selective ventilation in a wide tracheocutaneous fistula
[Articolo su rivista]
Marchioni, A.; Mattioli, F.; Piccinini, A.; Marchioni, D.; Alicandri-Ciufelli, M.; Monelli, M.; Presutti, L.
abstract
We present the treatment and management of a wide tracheocutaneous fistula after tracheotomy correlated with excessive cuff pressure in a 36-year-old woman with cerebral palsy since infancy in which persistent type II respiratory failure required continuous ventilatory support. We discuss the surgical treatment adopted for the management of this particularly wide lesion. At the end of surgery, mechanical ventilation through a tracheal cannula was hindered by the reduced length of the residual trachea below the tracheotomy. The need to guarantee mechanical ventilation to the patient led to the implementation of a cuff securing system in the two main bronchi. We describe the approach that may be attempted under extreme conditions, when traditional ventilation methods cannot be applied for anatomical reasons. © 2012.
2012
- Mastoid: a vestigial function in humans?
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Gioacchini, FEDERICO MARIA; Marchioni, Daniele; Genovese, Elisabetta; Monzani, Daniele; Presutti, Livio
abstract
At the present time, the function of the mastoid remains unknown. One of the main hypotheses accredited in the literature interprets the mastoid as a pressure buffer. Other theories underline the role of the mastoid mucosa in pressure regulation by transmucosal gas exchanges. The question is what advantage does air reabsorption and the creation of a certain degree of negative pressure that mastoid seems to produce, bring to the middle ear and hearing? In the authors' opinion, it is possible that the mastoid, or, in general, every kind of mucosa contained in the middle ear of mammals, would act to create a quite constant, although slight, negative pressure to obtain favorable compliance and impedance conditions in the middle ear to hear and transmit high frequency sounds and ultrasounds. The Eustachian tube, in this perspective, would compensate excessive values of negative pressure. Clearly, that function of mastoid pneumatization in humans would have lost its role, due to the absence of a sensorineural system to analyse ultrasounds.
2012
- Response to "ossicular chain preservation in epitympanic cholesteatoma surgery: The modified bondy technique"
[Articolo su rivista]
Marchioni, D.; Alicandri Ciufelli, M.; Molteni, G.; Villari, D.; Monzani, D.; Presutti, L.
abstract
2012
- Tympanoplasty: an up-to-date pictorial review
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Grammatica, Alberto; Soloperto, Davide; Carpeggiani, Paolo; Monzani, Daniele; Presutti, Livio
abstract
The indications for tympanoplasty are mainly chronic ear pathologies, such as
cholesteatoma, atelectasis and chronic tympanosclerotic otitis. Usually, modification of the
mastoid and temporal tissues in general mostly involves bone work, which means bone removal
by burs or appropriate bone curettes. It is for this reason that, in both the pre- and postoperative
periods, the computed tomography (CT) scan is the primary radiological tool for studying
the middle-ear, and temporal bone structures and pathologies. The aim of this review is to
illustrate the most up-to-date postoperative results for tympanoplasty, including the emerging
endoscopic techniques. The present work focuses on the five types of tympanoplasty that
are likely to be encountered by the radiologist: radical surgery; open tympanoplasty; closed
tympanoplasty; closed endoscopic tympanoplasty; and open endoscopic tympanoplasty. Understanding
and interpreting temporal bone images in relation to the different types of surgery
are important, especially at the postoperative stage, because of the high risk of recurrence of
middle-ear pathologies, and a good working knowledge of surgical changes is fundamental for
distinguishing iatrogenic bone demolition from complications and new pathological foci.
2011
- Atypical neoglottis after supracricoid laryngectomy: a morphological and functional analysis
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Bergamini, Giuseppe; Ruberto, Marco; Ghidini, Angelo; Marchioni, Daniele; Presutti, Livio
abstract
The objective of this study was to analyze atypical neoglottis after supracricoid subtotal laryngectomy (SSL) from a morphological and functional point-of-view using retrospective case series reviewin a Tertiary university referral center setting. From May 2003 until January 2010, 106 patients underwent SSL (CHEP, CHP, THEP, THP) for laryngeal cancer, in the Otolaryngology Department of the University Hospital of Modena. We performed a retrospective analysis of recorded videos in our database of patients who underwent SSL. Patients with atypical neoglottis were included in the study. Six patients with atypical neoglottis were identified and morphologically evaluated. The functional outcomes were collected and analyzed. Atypical neoglottis may form after SSL, in particular in the case of CHEP. In most cases, these atypical conformations are due to anomalous positioning of the epiglottis, or involvement of the lateral pharyngeal wall in the sphincteric and vibratory function of the neoglottis. Atypical neoglottis formation seems to guarantee adequate functional outcomes in terms of vocal and swallowing performance.
2011
- Endoscopic Anatomy of the Middle Ear
[Articolo su rivista]
Marchioni, D.; Molteni, G.; Presutti, L.
abstract
Good knowledge of anatomy is fundamental for every surgeon. Middle ear anatomy is really complex and sometimes is challenging for otologists, who need to explore every single compartment for a radical removal of pathology. With introduction of the endoscope in middle ear surgery, anatomy of middle ear spaces has become wider and clearer due to a better magnification and to the possibility to look "behind the corner". This article is a review of the state-of-art of endoscopic middle ear anatomy with description of every compartment, with particular attention to ventilation pathways and middle ear folds. © 2011 Association of Otolaryngologists of India.
2011
- Endoscopic open technique in patients with middle ear cholesteatoma
[Articolo su rivista]
Marchioni, Daniele; Villari, Domenico; ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Presutti, Livio
abstract
The objective of this study was to describe an endoscopic open "centrifugal" technique used to treat middle ear cholesteatoma with antral and periantral extension, using a retrospective chart and video review of a case series performed in a university tertiary referral center. Charts and videos of patients who underwent middle ear endoscopic surgery from January 2007 to September 2009 were reviewed. Patients who were treated with endoscopic "centrifuge" open techniques were included in the study. Surgical indications were collected and the surgical technique described. The final study group consisted of 12/150 subjects (9 males and 3 females with a mean age of 40 years). All 12 patients who underwent endoscopic open tympanoplasty had antral, periantral or mastoid involvement of cholesteatoma with or without posterior canal wall erosion. They had sclerotic mastoids with the presence of the antrum and, in some cases, small periantral mastoid cells. In 9/12 patients, external auditory canal reconstruction was performed with a cartilage graft. In 3/12 patients, canal reconstruction was not performed. No subjects required a meatoplasty of the external auditory canal. Endoscopic "centrifugal" open techniques can be an option in the surgical management of middle ear cholesteatoma involving antral and periantral mastoid cells, in the case of sclerotic mastoids. Further study will be necessary to examine the long-term consequences of the endoscopic "centrifugal" open technique. Level of evidence: 2C. © 2011 Springer-Verlag.
2011
- MR evaluation of PDMS injections in head and neck tissues: a pilot study
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Ligabue, Guido; Grammatica, Alberto; Bergamini, Giuseppe; Marchioni, Daniele; Ghidini, Angelo; Genovese, Elisabetta; Presutti, Livio
abstract
To describe the magnetic resonance (MR) appearance of polydimethylsiloxane (PDMS) injections in the head and neck region.Retrospective review of MR images from a case series.MR images of 10 patients, who underwent PDMS injections at our department, were reviewed. Data from imaging were collected and analyzed.After injection, PDMS can be identified in MR images, particularly in T2-weighted images in the early stages. Its MR characteristics are similar to silicone in other regions, but with time, its appearance can change.The integration of PDMS with tissues may also be reflected in changes in MR appearance, as a result of an increased amount of fibrous tissue in the region injected. Radiologists and ENT specialists may benefit from knowledge of the MR characteristics and variability in appearance of PDMS in human tissues for improving image interpretation.
2011
- Ossicular Chain Preservation After Exclusive Endoscopic Transcanal Tympanoplasty: Preliminary Experience
[Articolo su rivista]
Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo; Molteni, Gabriele; Villari, Domenico; Monzani, Daniele; Presutti, Livio
abstract
Objectives: The aim of the present study is to document and analyze the ossicular chain preservation rate in patients affected by acquired primary cholesteatoma with epitympanic involvement and with preoperative intact ossicular chain. Study Design: A retrospective case series in a tertiary university referral center. Methods: From January 2006 to February 2010, at the Otolaryngology Department of the University Hospital of Modena, 68 patients affected by acquired primary cholesteatoma with attic involvement underwent exclusive endoscopic transcanal tympanoplasty. In April 2010, we performed a retrospective chart and video review of these patients. Patients in whom the ossicular chain was found to be intact and not involved by the pathology at the beginning of the operation were included in the study. A cholesteatoma staging was introduced based on tympanic subsite involvement by pathology. Results: Out of 68 patients affected by acquired primary cholesteatoma and who underwent exclusive endoscopic transcanal tympanoplasty, 23 had intraoperative integrity of the ossicular chain (17 male and 6 female subjects; mean age, 40 yr) and were included in the study. An inverse correlation was found between number of subsites involved and chain preservation (Spearman rank correlation coefficient, r = -1; p = 0.017). Medial attic involvement was the factor that most negatively influenced the likelihood of chain preservation. Conclusion: Middle ear endoscopic techniques may increase the likelihood of ossicular chain preservation during cholesteatoma surgery. Medial attic involvement and a high number of subsites involved represent the most significant negative factors for chain preservation. The rate of residual disease requires more thorough evaluation in the future to validate the results.
2011
- Parapharyngeal space tumors without mandibulotomy: our experience
[Articolo su rivista]
Presutti, Livio; Molteni, Gabriele; Chiarini, Luigi; ALICANDRI CIUFELLI, Matteo; Malve', Laura; Marchioni, Daniele; Ghidini, Angelo; Tassi, Sauro
abstract
Parapharyngeal space (PPS) tumors are rare and benign in 80% of cases. Since surgeons first resected this anatomical region, the surgical approach to PPS bulks has been a hot topic due to their shape and the important structures involved. We present a series of patients treated with a transcervical or transcervical-transparotid approach to benign PPS tumors without mandibulotomy. Between May 2003 and March 2009, 18 patients (11 male and 7 female) with benign PPS tumors underwent a surgical resection, avoiding mandibulotomy. Average age of the patients was 49 years (range 3-76), average tumor size was 5.5 × 4 × 3 cm and histological examination of the resected tumors showed: seven pleomorphic adenomas of the deep parotid lobe, four schwannomas, two mycobacteriosis, two paragangliomas of the vagus nerve, one lipoma, one neurofibroma and one cavernous hemangioma. Seven patients underwent a transcervical approach, while 11 patients underwent a transcervical-transparotid approach. Excision of benign PPS tumors is possible without mandibulotomy even in the case of a large tumor mass, but exposure with the mandible in situ is certainly poor. Avoiding mandibulotomy reduces patient morbidity and hospital stay. In our experience, mandibulotomy can be avoided in most cases of benign PPS tumors leaving this procedure for malignant tumors or in patients with very poor exposure.
2011
- Surgical Anatomy of Transcanal Endoscopic Approach to the Tympanic Facial Nerve
[Articolo su rivista]
Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Genovese, Elisabetta; Monzani, Daniele; Tarabichi, Muaaz; Presutti, Livio
abstract
Objectives/Hypothesis: Until recently, tympanic facial nerve surgery had been performed using microscopic approaches, but in recent years, exclusive endoscopic approaches to the middle ear have increasingly been used, particularly in cholesteatoma surgery. The aim of this report was to illustrate the surgical anatomy of the facial nerve during an exclusive endoscopic transcanal approach. Study Design: Retrospective video review of cadaveric dissections and operations on living patients in a tertiary university referral center. Methods: Between November 2008 and July 2010, a total of 12 endoscopic cadaveric dissections were performed by an exclusive endoscopic transcanal approach. All dissections were recorded and stored in a database. In July 2010, video recordings from those dissections were reviewed, and the anatomic variations and accessibility of the tympanic facial nerve were studied and noted. Two further video recordings from living patients affected by middle ear chronic disease were also included in our study. Results: In all 14 subjects, the transcanal endoscopic approach guaranteed direct access to the entire tympanic segment of the facial nerve after ossicular chain removal, allowing decompression of the nerve from the geniculate ganglion and the greater petrosal nerve to the second genu of the facial nerve. As in microscopic techniques, the cochleariform process and transverse crest (cog) may represent useful landmarks. Conclusions: The tympanic facial nerve can be thoroughly visualized by an exclusive endoscopic transcanal approach, even in poorly accessible regions such as the second genu and geniculate ganglion. Further clinically based reports may strengthen our preliminary results.
2011
- The contribution of selective dysventilation to attical middle ear pathology
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Genovese, Elisabetta; Presutti, Livio; Marchioni, Daniele; Grammatica, Alberto; Aggazzotti Cavazza, Elisa
abstract
Epitympanic primary cholesteatoma represents a challenge for ENT surgeons. Its exact pathogenesis is
still unknown because of the very complex anatomy of this region. Until now, only a few authors have
described this region and tried to hypothesize the causes that could lead to cholesteatoma genesis. We
hypothesize the existence of a selective dysventilation of the epitympanic region based on the presence
of various mucosal folds occluding air ventilation from the middle ear to the epitympanum, through the
epitympanic isthmus, causing a negative epitympanic pressure and consequently cholesteatoma formation.
All the anatomic findings were obtained with the aid of 0 and 45 angled surgical endoscopes. From
our findings, patients affected by an epitympanic cholesteatoma often have a total isthmus blockage that
completely isolates the whole epitympanum from the middle ear, causing a deficit of oxygenation of the
mucosa that normally should be guaranteed by the Eustachian tube and which always works physiologically
in these patients. This is confirmed by the tympanogram test where we observed how the pressure
at the level of the tympanic cavity was normal, whereas the epitympanic pressure was selectively negative.
In conclusion, selective epitympanic dysventilation syndrome consists of the concomitant presence
of a series of complete or incomplete epitympanic diaphragms and ME isthmus blockage causing negative
epitympanic pressure, and leading to the formation of a retraction pocket or cholesteatoma associated
with normal Eustachian tube function
2011
- Transnasal endoscopic removal of malformation of the odontoid process in a patient with type I Arnold-Chiari malformation: a case report
[Articolo su rivista]
Grammatica, Alberto; Bonali, M; Ruscitti, F; Marchioni, Daniele; Pinna, G; Cunsolo, E. M; Presutti, Livio
abstract
The endoscopic endonasal approach is emerging as a feasible alternative to the trans-oral route for the resection of the odontoid process, when the latter produces a compression of the brainstem and cervicomedullary junction. This type of approach has some advantages, such as excellent pre-vertebral exposure of the cranio-vertebral junction in patients with small oral cavities and the possibility to avoid the use of mouth retractors. A typical case of a 24-year-old male patient with a previous diagnosis of type I Arnold-Chiari Malformation, suffering from a posterior dislocation of the odontoid process causing severe anterior compression of the brainstem, is presented to stress the potential of this technique. Trans-nasal endoscopic removal of the odontoid process was performed and resolution of the ventral compression of the brainstem was achieved. This report demonstrates that in selected cases, an endoscopic endonasal approach should now be considered an excellent alternative to the traditional trans-oral approach.
2010
- Endoscopic evaluation of middle ear ventilation route blockage
[Articolo su rivista]
Marchioni, D.; Mattioli, F.; Alicandri-Ciufelli, M.; Molteni, G.; Masoni, F.; Presutti, L.
abstract
Objectives: To describe middle ear ventilation route blockage, relieved during middle ear endoscopic surgery, and to analyze its association with mastoid hypopneumatization/sclerotization. Study design: Prospective case series with intraoperative analyses, and with a case-control computed tomographic scan comparison. Methods: Intraoperative findings during endoscopic middle ear surgery are described. Patients with middle ear ventilation route blockage were included in the study group (22 patients), while patients without middle ear ventilation route blockage were included in the control group (16 patients). An intra-patient and inter-group comparison of evaluated mastoid pneumatization was performed from the preoperative computed tomographic scans. Results: Middle ear ventilation route blockage was classified into three types (A, B, C) according to intraoperative findings. Intrapatient and intergroup comparisons showed that the presence of blockages of middle ear ventilation trajectories is associated with a statistically significantly higher prevalence of hypopneumatization/ sclerotization of the mastoid in the study group, a typical sign of middle ear dysventilation pathologies. Conclusions: Intraoperative evaluation of the middle ear anatomy during endoscopic surgery for inflammatory pathology allows us to clearly visualize the presence of anatomic blockages of the middle ear ventilation trajectories. These blockages might provoke a sectorial dysventilation of the middle ear, with consequent reduction of pneumatization of the mastoid. Further studies will be able to clarify to what extent selective dysventilation phenomena could be a principal factor in influencing middle ear pressure homeostasis. © 2010 Elsevier Inc. All rights reserved.
2010
- Endoscopic tympanoplasty in patients with attic retraction pockets
[Articolo su rivista]
Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo; Molteni, Gabriele; Genovese, Elisabetta; Presutti, Livio
abstract
OBJECTIVES:Patients undergoing endoscopic middle ear surgery require reconstruction procedures that are able to give adequate functional results, with particular attention to ventilation of middle ear routes and mastoid tissue preservation.STUDY DESIGN:Outcome research on a prospective case series in a tertiary university referral center.METHODS:A case series of 27 patients with attic retraction pockets underwent endoscopic middle ear surgical procedures. Three kinds of tympanoplasty were selected and performed.RESULTS:In all 27 subjects, it was possible to preserve the mastoid bone and the epitympanic-mastoid mucosa by performing a transcanal endoscopic approach. In total, 21 of 27 (77.7%) subjects presented no recurrence of the disease at 20.1 months mean follow-up.CONCLUSIONS:Three main types of endoscopic tympanoplasty can be performed for surgical treatment of attic retraction pockets, preserving as much as possible the ventilation routes, physiology, and anatomy of the middle ear
2010
- Forestier disease: Single-center surgical experience and brief literature review
[Articolo su rivista]
Presutti, L.; Alicandri-Ciufelli, M.; Piccinini, A.; Trebbi, M.; Marchioni, D.; Ghidini, A.; Ruberto, M.
abstract
Objectives: We describe the experience of our otolaryngology department in the treatment of Forestier disease, particularly regarding the diagnostic process, surgical treatment, and postoperative outcomes. Methods: The charts of 12 patients who underwent surgical treatment of Forestier disease between January 1, 2003, and January 1, 2009, were analyzed. All patients were subjected to clinical, radiologic, and endoscopic evaluation that confirmed the presence of cervical osteophytes. All patients were treated by a right-sided prevascular transcervical approach to remove cervical osteophytes. A literature review on Forestier disease was also carried out. Results: One case of immediate postoperative hemorrhage was reported. During the postoperative follow-up, ranging from 1 to 5 years, all patients underwent cervical radiography and fiberoptic laryngoscopy that confirmed no evidence of recurrence, and all patients remained asymptomatic. Conclusions: A prevascular transcervical right-sided approach seems to be an effective treatment for surgical removal of hyperostosis in Forestier disease, with an acceptable rate of complications and recurrence. © 2010 Annals Publishing Company. All rights reserved.
2010
- Functional anatomy of the Eustachian tube
[Articolo su rivista]
Cunsolo, E; Marchioni, D; Leo, G; Incorvaia, C; Presutti, L
abstract
The Eustachian tube (ET) is divided in 3 portions: a bony portion, a cartilaginous portion, and a junctional portion. From an anatomical-functional point of view, the bony portion of ET is the region of ventilation and clearance of secretions, and is lined by pseudostratified, ciliated, columnar epithelium, with an anti-gravitational direction of the drainage. The ET in the bony portion is in a state of forced opening. The cartilaginous portion is instead the heart of this dynamic system tube, because the mechanism of opening and closing of the tube is at this level. ET is normally closed, and it opens only during swallowing, being essential for good functioning of the middle ear, because it provides ventilation from the nasopharynx to the middle ear, and, at the same time, clearance of secretions from the middle ear-mastoid unit to the nasopharynx. Moreover, the ET protects the middle ear against nasopharyngeal pressure variations, ascending secretions, and microorganisms. The ability to develop all these functions makes the tube a complex organ.
2010
- Inferior retrotympanum revisited: an endoscopic anatomic study
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Genovese, Elisabetta; Presutti, Livio; Marchioni, Daniele; Piccinini, Alessia
abstract
AbstractObjectives/Hypothesis:To describe the inferior retrotympanic anatomy from an endoscopic perspective.Study Design:This was an anatomic study on a retrospective case series.Methods:During November 2009 and December 2009, videos from endoscopic middle ear procedures carried out between June 2007 and November 2009 and stored in our database were retrospectively reviewed. Surgeries in which the inferior retrotympanic region was visualized were included in the study. Accurate descriptions of the anatomic findings were made for each ear included in the study group.Results:The final study group consisted of 25 videos from 25 ear procedures. In 14/25 subjects, a bony ridge connecting the inferior portion of the styloid prominence to the anterior and inferior lip of the round window niche (Proctor's sustentaculum promontory) was identified and renamed the finiculus (from the Latin finis, -is: borderline), representing the ideal limit between the inferior retrotympanum and hypotympanum. In 14/25 patients, a complete sinus subtympanicus could be identified, lying between the subiculum and finiculus.Conclusions:Endoscopic exploration of the middle ear might guarantee a very good exposure of the inferior retrotympanum, allowing detailed anatomic descriptions of this hidden area. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery.
2010
- Lateral endoscopic approach to epitympanic diaphragm and Prussak's space: a dissection study
[Articolo su rivista]
Marchioni, D.; ALICANDRI CIUFELLI, Matteo; Grammatica, A.; Mattioli, F.; Genovese, Elisabetta; Presutti, Livio
abstract
Introduction Until now, anatomic descriptions of the
epitympanic diaphragm and Prussak’s space have been
performed using a microscope. The aim of this study is to
thoroughly describe and review the epitympanic diaphragm
and the anatomy of Prussak’s space from an endoscopic
point of view.
Study design Cadaver dissection study.
Setting Tertiary referral university center.
Materials and methods The anatomy of four temporal
bones dissected using an endoscope was studied. The most
important findings were noted and described.
Results Endoscopic cadaveric dissection of the middle
ear allows a very good visualization of the epitympanic
diaphragm, Prussak’s space and middle ear anatomy in
general.
Conclusion Endoscopic exploration and thorough
knowledge of the complex fold anatomy may improve
‘functional’ interventions in middle ear inflammatory
pathology during middle ear surgery, particularly in the
case of selective dysventilation
2010
- Pyramidal eminence and subpyramidal space: An endoscopic anatomical study
[Articolo su rivista]
Marchioni, D.; Alicandri-Ciufelli, M.; Grammatica, A.; Mattioli, F.; Presutti, L.
abstract
Objectives/Hypothesis: To describe retrotympanic endoscopic anatomy, especially the pyramidal eminence and contiguous spaces. Study Design: This was an anatomical study on a prospective case series. Methods: The anatomy of the retrotympanum was studied by endoscopy in nine patients affected by cholesteatoma who underwent tympanomastoid surgery and in six temporal bone dissections. Results: Pneumatization of the sinus tympani and posterior tympanic sinus or both, noted in 12 ears out of 15, may give rise to a recess beneath the pyramidal eminence, which we have called the subpyramidal space. This space can manifest with a variable degree of depth, shape, or extent depending on the shape and dimensions of the pyramidal eminence. Conclusions: Endoscopic exploration of the middle ear may guarantee a very good exposure of retrotympanic structures, allowing detailed anatomical descriptions of hidden areas. Improvement in our knowledge of the anatomy may decrease the possibility of residual disease during cholesteatoma surgery. © 2009 The American Laryngological, Rhinological and Otological Society, Inc.
2010
- Selective epitympanic dysventilation syndrome
[Articolo su rivista]
Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo; Molteni, Gabriele; Artioli, FRANCA LAURA; Genovese, Elisabetta; Presutti, Livio
abstract
OBJECTIVES/HYPOTHESIS:Although middle ear aeration is certainly related to eustachian tube (ET) function, other anatomic factors may play an important role in ventilation of these spaces, particularly the epitympanum.STUDY DESIGN:A prospective case series study group with retrospective case series comparison.METHODS:Eight patients affected by non-self-cleaning attic retraction pockets or attic cholesteatoma of the middle ear and normal tubal function (verified by type A tympanogram or Williams' test) underwent endoscopic surgery. Anatomic findings were noted and collected, with particular attention paid to middle ear folds. A control group was used for comparison. The prevalence of an isthmus blockage with a complete tensor fold in pathologic ears was compared between the study group and control group.RESULTS:The higher prevalence of an isthmus blockage associated with a complete tensor fold in the study group was found to be statistically significant (P = .001).CONCLUSIONS:A selective epitympanic dysventilation syndrome is hypothesized; normal ET function seems to be insufficient for complete ventilation of the middle ear, and an open tympanic isthmus or an incomplete tensor fold may be necessary for epitympanic recess ventilation. The selective epitympanic dysventilation syndrome would consist of the contemporary presence of the following four conditions: attic retraction pocket or cholesteatoma, normal tubal function tests, complete epitympanic diaphragm, and isthmus blockage.
2010
- Subarcuate canal and artery: A case report
[Articolo su rivista]
Grammatica, A.; Alicandri-Ciufelli, M.; Molteni, G.; Marchioni, D.; Presutti, L.
abstract
Variations in the course of the subarcuate artery (SAA) and of its related funnel are infrequent and asymptomatic. We present a case of a 15-year-old girl with a preverbal severe bilateral hearing loss and a subarcuate canal with an unusual course and atypical correlation with the adjacent anatomical structures, particularly with the lateral semicircular canal and the facial nerve. The variation proposed in this case, not previously reported in the literature consulted, can have important implications during middle ear surgical procedures, particularly for the retro-facial tympanoplasty approach: in fact otologic surgeons should consider any kind of variation of the SAA in surgical planning to avoid unexpected hemorrhages. The CT-scan, particularly HRCT, is a very useful tool for the study of intrapetrous vessels and their funnels, and should be considered mandatory in the case of a posterior approach to the tympanic cavity.
2009
- CT morphological evaluation of anterior epitympanic recess in patients with attic cholesteatoma
[Articolo su rivista]
Marchioni, Daniele; Mattioli, Francesco; Cobelli, Milena; Todeschini, Alessandra; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract
The objective of this study is to analyze the possible variations in size and shape of the AER in the ear affected by acquired cholesteatoma versus the healthy ear in the same patient. A total of 22 patients affected by acquired cholesteatoma were included in our study. A CT morphological evaluation of both ears (pathologic and non-pathologic) was made. Measures of the AER were done, on axial plane, parallel to incudomalleal axis for the deepest anterior-to-posterior (AP) diameter and perpendicular to this line for the maximum transverse (T) diameter, selecting the most inferior cut that showed the Cog in its entirety. A third superior-inferior (SI) measure was done, on coronal plane from the tegmen tympani to the cochleariform process. Comparisons between the mean of AP, T and SI in affected ears versus non-affected have been carried out using a paired t test. The AER measurement was considerably smaller in affected ears than in the non-affected ones. Mean AP +/- DS was 5.1 (1.46) versus 3.1 (0.90), P values <0.0001. Mean T +/- DS was 4.1 (0.74) versus 3.2 (0.74), P values <0.0014. Mean SI +/- DS was 4.0 (1.01) versus 2.0 (0.82), P values <0.0001. In conclusion, based on our results, the AER in an affected ear seems smaller than in a non-affected one. Whether a hypovolumetric AER could be a congenital morphological condition predisposing cholesteatoma despite adequate aeration of the epitympanic compartment, on the contrary the presence of membranous and/or ligamentous folds could exclude the AER from the posterior epitympanic space and from the protympanum, predisposing it for attical dysventilation, should be clarified in further studies.
2009
- Critical literature review on the management of intraparotid facial nerve schwannoma and proposed decision-making algorithm
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Mattioli, Francesco; Trani, Margherita; Presutti, Livio
abstract
Management of intraparotid facial nerve schwannomas (IFNS) is very challenging because the diagnosis is often made intra-operatively and in most cases, resection could lead to severe facial nerve (FN) paralysis, with important aesthetic consequences. Articles in the English language focused on the management of FN schwannoma have been selected and critically reviewed. A decision-making algorithm is proposed. In the case of type A or B neoplasms, or in case of a pre-operative FN House-Brackmann (HB) grade IV or worse, the authors would favor a resection of the IFNS and (where necessary) a reconstruction of the nerve. In the case of pre-operative HB grade III or better and type C or D neoplasms, patients would undergo an intra-operative biopsy to rule out malignancy, and a possible conservative management could be adopted. Localization and adherences of IFNS, as well as pre-operative FN function are important factors that must be considered in the decision-making process for IFNS to optimize the functional outcomes.
2009
- Endoscopic approach to tensor fold in patients with attic cholesteatoma
[Articolo su rivista]
Marchioni, D.; Mattioli, F.; Alicandri-Ciufelli, M.; Presutti, L.
abstract
Conclusion. The endoscopic approach to attic cholesteatoma allows clear observation of the tensor fold area and consequently, excision of the tensor fold, modifying the epitympanic diaphragm. This permits good removal of cholesteatoma and direct ventilation of the upper unit, preventing the development of a retraction pocket or attic cholesteatoma recurrence, with good functional results. Objectives. An isthmus block associated with a complete tensor fold is a necessary condition for creation and development of an attic cholesteatoma. During surgical treatment of attic cholesteatoma, tensor fold removal is required to restore ventilation of the attic region. Use of a microscope does not allow exposure of the tensor fold area and so removal of the tensor fold can be very difficult. In contrast, the endoscope permits better visualization of the tensor fold area, and this aids understanding of the anatomy of the tensor fold and its removal, restoring attic ventilation. Patients and methods. In all, 21 patients with limited attic cholesteatoma underwent an endoscopic approach with complete removal of the disease. Patients with a wide external ear canal were operated through an exclusively endoscopic transcanal approach; patients with a narrow external ear canal or who were affected by external canal exostosis were operated through a traditional retroauricular incision and meatoplasty followed by the endoscopic transcanal approach. Results. In 18/21 patients, the endoscope permitted the discovery of different anatomical morphologies of the tensor fold. Sixteen patients presented a complete tensor fold (one with an anomalous transversal orientation), one patient presented an incomplete tensor fold and one patient presented a bony ridge in the cochleariform region. In all 16 cases of complete tensor tympani fold, the fold was removed and anterior epitympanic ventilation was restored. The ridge bone over the cochleariform process was also removed with a microdrill. © 2009 Informa UK Ltd.
2009
- Facial nerve schwannoma
[Articolo su rivista]
Presutti, Livio; Grammatica, Alberto; ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Cunsolo, Elio Maria
abstract
non disponibile
2009
- Rehabilitation of swallowing with polydimethylsiloxane injections in patients who underwent partial laryngectomy
[Articolo su rivista]
Bergamini, G.; Alicandri-Ciufelli, M.; Molteni, G.; De Siati, D. R.; Luppi, M. P.; Marchioni, D.; Presutti, L.
abstract
Background. We conducted this longitudinal prospective study to illustrate a surgical technique for swallowing rehabilitation of patients after partial laryngectomy. Methods. Nine patients with persistent swallowing impairment after partial laryngectomy were included in the study. Evaluation of swallowing was performed by fiberoptic endoscopic evaluation of swallowing (FEES), and was quantified using 2 scales: a dysphagia score and a modified penetrationaspiration scale. The site of bolus inhalation was identified. Polydimethylsiloxane (PDMS) was injected into the neoglottis to fill these passages, and to obtain a certain continence of the organ. Results. Mean follow-up was 25 months (range, 5-39). All patients showed an improvement both in the dysphagia score and in the modified penetration-aspiration scale. Average improvement was 2.6 points in the dysphagia score (p = .0042) and 2.1 points in the modified penetration-aspiration scale (p = .0043). Conclusion. PDMS injection can be considered as an option in surgical rehabilitation of swallowing in patients who underwent partial laryngectomy. © 2009 Wiley Periodicals, Inc.
2009
- Transcanal endoscopic approach to the sinus tympani: A clinical report
[Articolo su rivista]
Marchioni, D.; Mattioli, F.; Alicandri-Ciufelli, M.; Presutti, L.
abstract
OBJECTIVES: To investigate the anatomic limitations of the endoscopic transcanal approach to sinus tympani (ST), in particular, how this approach might allow a complete visualization of the ST recesses and to propose a morphologic classification of the ST using computed tomography and to examine if this could be useful for the surgeon in preoperative planning to decide the type of approach to the ST. STUDY DESIGN: Case series. PATIENTS AND METHODS: Forty patients affected by middle ear disease with ST involvement were included in our study. All patients underwent a preoperative computed tomographic scan of the temporal bone. All patients underwent tympanomastoid surgery with intraoperative use of the endoscope. We assessed the variation in depth of the ST area, analyzing the posterior and medial extension of the medial boundary of the ST, and performing a radiomorphologic classification of the ST. RESULTS: Of the 40 patients, it has been possible to describe the detailed morphology of the shape of the ST in 38. We classified the depth of the ST into 3 types based on radiologic findings: Type A (a limited ST), Type B (a deep ST), and Type C (a deep ST with a posterior extension). Of 35 ST of Types A and B, there was good exposure of the medial boundary of the sinus using a transcanal endoscopic approach in 33 (94.2%), whereas in 3 (60%) of 5 patients of Type C, it was not possible to explore the complete depth of the sinus, especially the ST portion under and posterior to the facial nerve. CONCLUSION: The transcanal endoscopic approach to the ST is indicated in ST of Types A and B. In ST of Type C, it is not always possible to have good control of the ST; in these cases, a posterior retrofacial approach is suggested. © 2009 Otology & Neurotology, Inc.
2009
- Transnasal endoscopic treatment of cerebrospinal fluid leak: 17 years' experience
[Articolo su rivista]
Presutti, Livio; Mattioli, Francesco; Villari, Domenico; Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo
abstract
Aim of this report is to describe the long-term results of endoscopic endonasal repair of cerebrospinal fluid leak using a septal mucoperichondrial graft. A case series of 52 patients operated for cerebrospinal fluid rhinorrhea between 1990 and 2006 is presented. All patients underwent surgical treatment for endoscopic endonasal closure of a cerebrospinal fluid leak using a septal mucoperichondrial graft. No lumbar drain and fluorescein tests were used. The intra-operative localization of the fistula was aided by Valsalva's manoeuvre by the anaesthetist. The success rate, after the first attempt, was 88.5% (46/52 patients); for the remaining 11.5% (6/52 patients), a second attempt was necessary which proved successful in 5 cases, raising the overall success rate to 98.1% (51/52 patients). Relapse occurred in only one case (1.9%), after the second attempt. In conclusion, a free mucoperichondrial graft offered good results for cerebrospinal fluid leak repair. In the Authors' experience, a high success rate can be achieved without the use of intrathecal fluorescein and lumbar drain.
2008
- A case of syryngocystadenoma papilliferum (SCAP) involving middle ear, presenting with otomastoiditis and cerebral abscess
[Articolo su rivista]
Presutti, L.; Alicandri-Ciufelli, M.; Mattioli, F.; Marchioni, D.; Costantini, M.
abstract
Syryngocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal neoplasm of apocrine gland origin. Until now, fewer than 200 cases have been reported in international literature, of which 12 cases involved the external ear. No cases of SCAP involving the middle ear have been reported. We describe a case of SCAP of external and middle ear, presenting with otomastoiditis and cerebral abscess; this aggressive behavior, never reported for a benign adenoma of the external or middle ear, could lead to a differential diagnosis with cholesteatoma or malignancies. © 2007 Elsevier Ireland Ltd. All rights reserved.
2008
- Endoscopic management of acquired cholesteatoma: our experience
[Articolo su rivista]
Presutti, Livio; Marchioni, Daniele; Mattioli, Francesco; Villari, Domenico; Alicandri-Ciufelli, Matteo
abstract
The purpose of this study was to examine the utility of using an endoscope in cholesteatoma surgery and to demonstrate how it allows a reduction in the incidence of residual disease.
2008
- Exclusive endoscopic removal of a planum sphenoidale meningioma: A case report
[Articolo su rivista]
Presutti, L.; Trani, M.; Alicandri-Ciufelli, M.; Marchioni, D.
abstract
Midline suprasellar meningiomas have traditionally been removed through transcranial approaches. Endoscopic endonasal approaches have already been described for the removal of tuberculum sellae meningiomas (Cook), but their exclusive use for planum sphenoidale meningiomas has never been reported. A case report of a planum sphenoidale meningioma removed through a transnasal endoscopic approach is presented: the goal of this technique is tumor control with minimal morbidity. The anterior skull base defect has been reconstructed with a pedicled mucosa flap from nasal septum (Hadad-Bassagasteguy flap). The postoperative course was uneventful, and no sign of recurrence was noticed at the MRI control performed after 3 months. © Georg Thieme Verlag KG Stuttgart.
2008
- Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis
[Articolo su rivista]
Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo; Mattioli, Francesco; Marchetti, Alessio; Jovic, Gordana; Massone, Federica; Presutti, Livio
abstract
Relapse in patients affected by nasal polyposis and subjected to endoscopic surgery appears to be a relevant feature. Surgical treatment shows a significant increase in quality of life in all the patients aside from surgical technique used. Our results show a better control of relapse of nasal pathology in patients subjected to more radical surgery (group B) vs patients subjected to conservative surgery on middle turbinate (group A). Allergic patients in group B had a smaller number of relapses during the follow-up period compared with allergic patients in group A and this was statistically significant.
2008
- Surgery of septal perforations
[Articolo su rivista]
Presutti, Livio; ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Ghidini, Angelo; Villari, Domenico
abstract
abstract septal
2007
- Intraparotid facial nerve schwannoma: Literature review and classification proposal
[Articolo su rivista]
Marchioni, D.; Alicandri Ciufelli, M.; Presutti, L.
abstract
Objective: The aim of this review was to assess and describe the pathological characteristics of intraparotid facial nerve schwannoma, in order to facilitate correct prognostic evaluation and appropriate therapeutic decision making. Study design and setting: The literature was reviewed regarding involvement of the various portions of the facial nerve. A classification is proposed, based on anatomical and pathological evaluations, which can supply important information on facial functional outcomes. Results: From this study, two important characteristics of facial nerve schwannoma emerged: the schwannoma may be capable of surgical dissection from the facial nerve, leaving the latter anatomically preserved; or it may be tightly bound to the nerve, in which case it must be removed along with a variable section of nerve tract, followed by reconstruction. Conclusions: The extent of the neoplasm and the involvement of different branches of the facial nerve are very important elements to consider when evaluating prognosis and therapy. Significance: To emphasise the usefulness of a classification, based on anatomical and pathological evaluation, which can supply information about post-operative facial function. © 2007 JLO (1984) Limited.
2007
- Nasal septal perforations: Our surgical technique
[Articolo su rivista]
Presutti, L.; Alicandri Ciufelli, M.; Marchioni, D.; Villari, D.; Marchetti, A.; Mattioli, F.
abstract
Objective: The aim of this paper was to describe our surgical technique for the treatment of nasal septal perforations. Study and design: We studied 31 patients with nasal septal perforation treated with an endoscope-assisted technique, based on a bilateral dissection of monopedicled mucosal flaps from the nasal fossa floor, sutured at the edge of the perforation previously unstuck, without any graft interposed between the two mucosal layers. Results: In our experience with 31 patients, the use of this technique led to the persistent closing (with follow-up for at least one year) of 96.3% of the perforations smaller than 3 cm. Conclusions: Our technique has the advantage of an endonasal approach, without any external incision, and the use of monopedicled flaps from the nasal fossa floor without any graft interposition, avoiding any other surgical procedure and morbidity in the donor site of the graft. The use of nasal endoscopy permits superior precision in all surgical steps. Significance: The high success rate in perforations smaller than 3 cm seems to confirm the effectiveness of this technique. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation.
2006
- Endoscopic removal of ethmoido-sphenoidal foreign body with intracranial extension
[Articolo su rivista]
Presutti, L.; Marchioni, D.; Trani, M.; Ghidini, A.
abstract
We describe the case of a foreign body lodged into ethmoidal labyrinth and sphenoidal sinus with fracture of the clivus and consequent rhinoliquorrhea removed by an endoscopic technique. We performed a skull base plasty to close the rhino-liquoral fistula with resolution of the rhinoliquorrhea. There were no postoperative complications and there was a good therapeutic result at long-term follow-up. © Georg Thieme Verlag KG.
2006
- Obstructive sleep apnea syndrome in patients with normal body weight: Pathophysiologic, clinical and therapeutic aspects
[Articolo su rivista]
Marchioni, D.; Trebbi, M.; Alicandri Ciufelli, M.; Presutti, L.
abstract
The prevalence of obstructive sleep apnea syndrome (OSAS) in the general population is considerably high. The epidemiologically most important factor is obesity, since increased adipose tissue leads to alterations in upper airway anatomy and function that can trigger the mechanisms underlying the syndrome. While the bulk of published studies focus on OSAS in patients with an elevated body mass index (BMI), few have investigated the anatomical and pathophysiologic implications of OSAS in patients with normal body weight. In a previous study, the authors found that among these patients the primary anatomic anomaly contributing to the onset of OSAS was hypertrophy of the base of tongue, while septal deviation was a concurrent cause of the syndrome. Morphometric and physiologic studies have highlighted several other differences between OSAS sufferers with normal and those with elevated BMI. With this review the authors describe the anatomic, functional, clinical and therapeutic aspects of OSAS in patients with normal body weight.
2006
- Petrous apex cholesterol granuloma: transsphenoid endoscopic approach
[Articolo su rivista]
Presutti, Livio; Villari, Domenico; Marchioni, Daniele
abstract
The transsphenoid approach to the petrous apex, a surgical procedure described for the first time by Montgomery in 1977, is a rarely performed approach for the drainage and ventilation of cholesterol granuloma. We consider this approach to be the technique of choice when the cholesterol granuloma is located in the medial section of the petrous apex abutting and/or prolapsing into the posterior wall of the sphenoid sinus. The transsphenoid approach, unlike other lateral approaches to the petrous apex, is highly conservative and spares cochlear and vestibular function; moreover, it allows simple and adequate post-operative endoscopic follow up as an out-patient, with easier treatment in the case of recurrence.
2005
- Repeated visually-guided saccades improves postural control in patients with vestibular disorders
[Articolo su rivista]
Monzani, Daniele; Setti, G; Marchioni, D; Genovese, Elisabetta; Gherpelli, Chiara; Presutti, Livio
abstract
One of the most recent and promising theoreticalhypotheses for compensation of persistent asymmetry ofdynamic vestibulo-ocular gain is sensory substitution. Asa switch between oculomotor and vestibulo-ocular systems,saccadic eye movements are engaged in humans to compensatethe angular displacement of the head towards thelabyrinthine defective side thus preserving the foveal fixationof the target. This study focused on the possibility thatsaccadic eye movements might also compensate for theimpaired vestibulo-spinal reflexes and force the posturalsystem to a more effective control on upright stance andverified whether this sway-stabilizing effect could beapplied to patients with vestibular disorders and balancedysfunction. In the first experiment, 27 patients with unilaterallabyrinthine hypofunction, 24 patients with centralvestibular disorders and 24 healthy volunteers were evaluatedby static posturography in 3 different visual conditions:a) eye open with fixation of a steady target, b) eyeclosed, and c) while performing horizontal visually-guidedsaccades. The percentage of individuals with a decreasedbody sway area during the oculomotor task was found tobe higher in labyrinthine-defective patients as compared tothose with central vestibular disorders and controls. In thesecond experiment, 46 patients with vestibular disordersboth of central and peripheral origin, whose postural controlimproved by eye-tracking, as assessed by posturography,were later submitted to 12 consecutive training sessionsbased on repeated visually-guided saccades. Both thesaccadic performances and postural control improved in allpatients but a more pronounced effect was observed in thosewith peripheral vestibular disorders. Outcome of this rehabilitationtechnique was also corroborated by a generalreduction of the perceived overall impairment from balancedisorders as tested by a specific questionnaire.
2005
- The normal-weight snorer: Polysomnographic study and correlation with upper airway morphological alterations
[Articolo su rivista]
Marchioni, D.; Menabue, S.; Ghidini, A.; Trani, M.; Dallari, S.; Presutti, L.
abstract
Obesity is recognized as playing an important role in causing snoring and in turning simple snoring into obstructive sleep apnea syndrome (OSAS). From our series of patients with sleep disturbances, we studied a group of 43 normal-weight snorersin whom we detected a significant number of OSAS episodes. An articulated diagnostic protocol was adopted, and Müller's maneuver was extensively applied. The resulting data were compared to data from a group of 43 obese patients from the same series. The major risk factor for developing OSAS in normal-weight snorers appears to be anatomic abnormalities, in particular, septal deviation and base of tongue hypertrophy. Soft palate hypertrophy alone is not enough, although in obese snorers it can produce a sleep disorder. The normal-weight snorer needs to be thoroughly investigated because of the significant risk of developing OSAS and for the detection of multiple concomitant sites of obstruction.
2004
- Anxiety affects vestibulospinal function of labyrinthine-defective patients during horizontal optokinetic stimulation
[Articolo su rivista]
Monzani, Daniele; Marchioni, D.; Bonetti, S.; Pellacani, P.; Casolari, L.; Rigatelli, Marco; Presutti, Livio
abstract
Comorbidity of vestibular and anxiety disorders wassuggested by epidemiological studies and, recently, newinsights into potential neural circuits which subserve bothbalance control and emotions, appear to support thishypothesis. In particular, disorienting visual surroundings,such as those generated by full-field moving scenes, equallydisrupt postural control of patients with vestibular or panicdisorders. In the present study, behaviour of body sway wasassessed in response to an optokinetic stimulation by meansof static posturography in 20 patients with vestibularneuritis (10 patients with normal affect and 10 with generalizedanxiety disorders, as diagnosed according to theAmerican Psychiatric Association criteria), and 20 normalsubjects who served as controls. Optokinetic responses andvestibulo-spinal function during a full-field, bi-directionalhorizontal optokinetic stimulation, were recorded simultaneously.Labyrinthine-defective patients with low and highlevel of anxiety showed a common pattern of asymmetricoptokinetic reflexes. On the contrary, body sway was foundto be increased more by eye closure and optokinetic stimulationtowards the defective labyrinth in patients affectedby high level of anxiety as compared to those with normalaffect and controls. These data confirm the combined effectof anxiety and labyrinthine dysfunction on vestibulo-spinalfunction which is disclosed by both visual suppression anddisorienting visual contexts.
2004
- Breast carcinoma metastases in paranasal sinuses, a rare occurrence mimicking a primary nasal malignancy. case report.
[Articolo su rivista]
Marchioni, D; Monzani, Daniele; Rossi, G; Rivasi, Francesco; Presutti, Livio
abstract
Metastatic tumours to the paranasal sinuses are an exceedingly rare event, the large majority being of renal origin. Herein, a case of metastatic breast carcinoma to the right maxilla is described which occurred 4 years after radical mastectomy, clinically and radiologically presenting as a primary sinonasal mass. Only the histopathologic examination together with a broad spectrum of immunohistochemical antibodies were useful in confirming the origin of the neoplasm.
2002
- Congenital postauricular swelling in a child
[Articolo su rivista]
Marchioni, D.; Cuzzola, E.; Massone, F.; Ghidini, A.
abstract
First branchial cleft cysts develop as a result of incomplete fusion of the cleft between the first and second branchial arches. In 1972, Work introduced a modified classification of these anomalies that recognized the existence of two types. Type I lesions, which are extremely rare, present as a cystic mass posterior to the pinna and concha. Type II lesions represent a duplication of both the membranous and cartilaginous portions of the external ear canal. They are associated with fistulas in the concha or in the external ear canal. Clinical and surgical management is often difficult because these anomalies have a variable relationship to the facial nerves. We describe a rare localization of a type I first branchial cleft cyst in a child and the clinical management with successive surgical treatment.
2002
- Surgery of the nasal columella in external valve collapse
[Articolo su rivista]
Ghidini, A.; Dallari, S.; Marchioni, D.
abstract
The authors describe and discuss their experience with the collapse of the external nasal valve, focusing on the role that surgery of the columella plays in solving this problem. Thirty-seven cases were treated. In all but 1 there had been a previous septorhinoplasty. Seven patients had concomitant internal valve collapse. A modified alarplasty associated with columelloplasty was adopted in the cases with severe collapse. When the reduction of the nostril opening was mild to moderate, the surgical strategy varied depending on the width of the columella base: alarplasty in cases with a narrow to normal columella, and columelloplasty in the presence of a wide columella base. The authors' philosophy tends to minimize intervention on the nasal valve areas. Their results demonstrate that when the collapse and its functional effect are not too severe, a good result can be achieved by working only on the columella, especially if its base is significantly wide.