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Epistaxis01:30

Epistaxis

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Epistaxis, or nosebleeds, occurs when small, swollen blood vessels in the nasal mucous membrane rupture. Typically, the anterior septum is the primary site of occurrence.
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
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Hemostasis in Endoscopic Endonasal Skull Base Surgery.

Francisco Vaz-Guimaraes1, Shirley Y Su2, Juan C Fernandez-Miranda1

  • 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.

Journal of Neurological Surgery. Part B, Skull Base
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Summary

Meticulous hemostasis is crucial for safe endoscopic endonasal surgery (EES) of the skull base. Preoperative assessment and tailored techniques are vital for managing bleeding during sinonasal and sellar-cranial base procedures.

Keywords:
endoscopic endonasal surgeryhemorrhagic complicationshemostatic techniquessurgical technique

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Surgical Oncology

Background:

  • Meticulous hemostasis and tissue handling, principles established by William Halsted, remain critical in modern surgery.
  • These principles are even more vital for endoscopic endonasal surgery (EES) due to enhanced visualization.
  • Hemostasis is a cornerstone for the safe practice of EES, particularly in skull base surgery.

Purpose of the Study:

  • To highlight the importance of hemostasis in endoscopic endonasal surgery (EES) of the skull base.
  • To discuss preoperative recognition of patients at high risk for hemorrhagic complications.
  • To describe techniques for managing hemorrhagic events during EES, emphasizing technical nuances.

Main Methods:

  • Anatomical division of EES into sinonasal and sellar-cranial base surgery.
  • Selection of hemostatic techniques based on hemorrhage source, tissue, and proximity to neurovascular structures.
  • Utilization of specialized instruments (pistol-grip/single-shaft) and tools like electrocoagulation and hemostatic materials.

Main Results:

  • Recognition of patients at higher risk for hemorrhagic complications is essential.
  • Hemostasis management strategies differ between sinonasal and sellar-cranial base EES.
  • Appropriate instrument and tool selection is key for effective bleeding control.

Conclusions:

  • Hemostasis is a fundamental principle for safe endoscopic endonasal skull base surgery.
  • Preoperative assessment and tailored surgical techniques are crucial for managing bleeding.
  • Effective management of hemorrhagic events relies on understanding anatomy, instrument choice, and hemostatic modalities.