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Biomedical subjects

David W Kennedy

Publications and source records attributed to David W Kennedy.

At least 37 records · Page 2Linked to original sources
PubMed2005

Historical perspective on image-guided sinus surgery.

Image-guided surgery has undergone rapid evolution, to the point where it is now a technology that is surgeon-friendly, relatively easy to set up, and reliable, making it a realistic and worthwhile option for endoscopic sinus surgery. Technologies will continue to advance as the market forces push companies to produce systems that are more accurate, faster, and more convenient. Head-tracking methodologies will likely progress away from headsets toward more reliable and safer modalities. Further integrations of surgical instrumentation, the ability to update images intraoperatively, and advancements in real-time imaging and robotics are likely to continue ata rapid rate.

History, 20th Century↗
PubMed2005

Endoscopic sinus surgery: where we are-and where we're going.

PURPOSE OF REVIEW: Improved understanding of sinonasal mucociliary function as well as technological advancements have led to a renaissance in the management of sinonasal disease. The current techniques, and adjunctive intraoperative technologies, have allowed for a more precise and safer surgical dissection, extending this surgical application to include the routine endoscopic management of skull base lesions and sinonasal malignancies. The anatomic boundaries of the nasal endoscope continue to be redefined. This paper will review the recent advances in the field of surgical rhinology as well as discuss directions for the future. RECENT FINDINGS: Advancements in imaging technology including image acquisition, three-dimensional reconstruction, stereotactic navigation, and CT-MRI fusion have aided in more thorough preoperative planning, enabling safer and more precise endoscopic surgical dissection. Refinement of endonasal powered instrumentation including microdebriders and high-speed suction irrigation drills have minimized trauma to normal tissues and accelerated postoperative healing. Increased experience with the endoscope has broadened the endoscopic ventral skull base exposure from the odontoid process to foramen ovale to the olfactory bulb. SUMMARY: Endoscopic sinus surgery is no longer exclusively for the management of chronic rhinosinusitis and nasal polyposis. Sinonasal malignancies, as well as anterior skull base lesions have become part of the rhinologist's responsibility. Furthermore, selective lesions managed through traditional craniotomies may now be accessed via trans-sinonasal transcranial endoscopic routes.

Debridement↗
PubMed2005

Endoscopic resection of a venous hemangioma of the optic nerve sheath.

We describe a case of a venous hemangioma that arose in the optic nerve sheath of the orbital apex in a 28-year-old man who presented with progressive vision loss. To the best of our knowledge, this is the first reported case of a venous hemangioma occurring at this location. A definitive diagnosis and partial excision was achieved via an endoscopic transsphenoethmoid approach with interactive, computer-assisted, frameless stereotactic surgical navigation. The intervention resulted in minimal morbidity, demonstrating yet again that this surgical approach is a safe and effective way to treat lesions of the orbital apex.

Adult↗
PubMed2004

Surgical management of chronic rhinosinusitis and nasal polyposis: a review of the evidence.

Functional endoscopic sinus surgery is a common adjunct to medical therapy in the management of chronic rhinosinusitis and nasal polyposis. As with most surgical procedures, there is a paucity of randomized, controlled clinical trials examining the use of functional endoscopic sinus surgery in the management of chronic rhinosinusitis and nasal polyposis. This is primarily a result of the physical and ethical conundrums faced in performing a study that involves comparing a surgical procedure with a placebo. However, there is documentation of the marked impact that chronic rhinosinusitis can have on the overall quality of life and evidence that this improves following combined surgical and medical intervention. There are many case series with large patient populations that have shown significant improvement in short- and long-term patient symptoms following surgery. These outcomes are expected to improve with even greater refinement of technology, experience, and instrumentation, and the quality of future studies may be improved by determining and using objective measures of success and, possibly, by the use of control groups.

Chronic Disease↗
PubMed2004

Cerebrospinal fluid pressure monitoring after repair of cerebrospinal fluid leaks.

OBJECTIVE: To measure intracranial pressures (ICPs) via lumbar drains after surgical repair of cerebrospinal fluid (CSF) leaks. METHODS: We conducted a retrospective review of ICP measurements through lumbar drains during the immediate postoperative period after CSF leak repair. RESULTS: Eight patients with spontaneous CSF leaks underwent surgery and postoperative CSF pressures were measured via lumbar drains. ICP was elevated in 7/8 patients (mean, 32.5 cm H(2)O). Diuretics reduced ICP (mean, 10 cm H(2)O). Three traumatic CSF leaks patients served as controls (mean, ICP 14 cm H(2)O). CONCLUSION: Measurement of ICP through lumbar drains provides important information regarding the pathophysiology of CSF leaks that has an impact on subsequent medical and surgical treatment. Although the precise cause and mechanism of spontaneous CSF leaks are not fully understood, this study indicates that elevated ICP plays a role and that further medical or surgical treatment to correct the intracranial hypertension may be warranted.

Adult↗
PubMed2004

Factors associated with failure of frontal sinusotomy in the early follow-up period.

OBJECTIVES: To understand factors associated with failure of endoscopic frontal sinusotomy. METHODS: Retrospective review of 130 consecutive frontal sinusotomies. The preoperative extent of disease was graded radiologically in each frontal sinus as total opacification, partial opacification, or mucosal thickening. Records were also reviewed to determine the incidence of comorbid conditions. RESULTS: Patency at most recent follow-up was observed in 117/130 (90%). Patency was achieved after our first procedure in 107 sinusotomies. These were considered successes. Ten required revision surgery, and an additional 13 were not patent at last follow-up. These 23 sinusotomies were considered failures. Among those failing our initial surgery, 19/23 (83%) were partially or totally opacified preoperatively. In contrast, only 47/107 (44%) in the success group contained partial or total opacification preoperatively (P = 0.003), with the majority exhibiting mucosal thickening only. Mean follow-up was 8.3 months for the successes and 10.7 months for the failures (P = NS). No significant differences were observed between the success and failure groups with respect to the prevalence of asthma, aspirin sensitivity, or allergic fungal disease. Patients in the failure group, however, had a higher mean number of prior surgeries before undergoing frontal sinusotomy at our institution (1.8 vs 0.9, P = 0.033). CONCLUSIONS: During the early follow-up period, failure of endoscopic frontal sinusotomy is associated with advanced degrees of preoperative disease within the sinus and is also more likely in patients who have failed prior surgical management.

Endoscopy↗
PubMed2004

Endoscopic and endoscope-assisted resections of inverted sinonasal papillomas.

OBJECTIVE: To evaluate the success of endoscopic and endoscope-assisted resection of inverted sinonasal papillomas and to assess the indications for adjunctive external procedures. STUDY DESIGN: Retrospective chart review. RESULTS: Fifty patients were treated surgically during the 10-year study period and had greater than 1 year of follow-up care. These patients had a recurrence rate of 14% (7/50) with a mean follow-up of 31.1 months. Of these 7 patients with recurrences, 3 were treated primarily at this institution, and 4 had been treated prior to referral. Recurrence was 11% (3/27) for primary resections and 17% (4/23) for secondary resections. Average time to recurrence was 11.7 months. Of the patients, 38% (19/50) had adjunctive external procedures either during the initial resection or for the management of recurrent disease. CONCLUSIONS: Endoscopic and endoscope-assisted resections of inverted papilloma are effective techniques for managing inverted papilloma. The intraoperative findings, most importantly the site(s) of tumor attachment, dictate whether an endoscopic procedure is sufficient to complete resect the inverted papilloma or whether an adjunctive external procedure is required. Appropriate patient selection and an aggressive surgical approach are necessary for the management of these neoplasms.

Adolescent↗
PubMed2004

Use of the 70-degree diamond burr in the management of complicated frontal sinus disease.

OBJECTIVES/HYPOTHESIS: Management of frontal sinus disease may require drill-out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches. STUDY DESIGN: Retrospective review. METHODS: The authors describe the use of a 70-degree diamond burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance. RESULTS: The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill-out procedure, despite a pre-existing frontoethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow-up (mean period, 9.3 mo). CONCLUSION: Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70-degree diamond burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches.

Adult↗
PubMed2004

Disadvantages of minimal techniques for surgical management of chronic rhinosinusitis.

PURPOSE OF REVIEW: Controversy exists over the best surgical treatment for chronic rhinosinusitis. Minimally invasive sinus technique is a conservative approach in which simple ventilation of the lower sinuses is thought to cure even severe pathologic disease. Recent articles have suggested short-term subjective efficacy. Before this procedure is validated, we must compare it with the current gold standard: functional endoscopic sinus surgery. RECENT FINDINGS: Functional endoscopic sinus surgery has been the standard surgical technique for many years and has demonstrated true short- and long-term subjective and objective efficacy. With improved understanding of the pathogenesis of chronic rhinosinusitis, it appears that much of its success lies in its ability to fully remove diseased bony partitions and to remove areas of chronic inflammation and assist in the medical management of chronic rhinosinusitis. SUMMARY: Given our current knowledge of chronic rhinosinusitis, functional endoscopic sinus surgery is the approach that has shown great success and makes the most sense when surgery is truly required in the management of this disease process.

Chronic Disease↗
PubMed2004

Pathogenesis of chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a multifactorial disease. Predisposing factors can be divided into environmental and non-host factors, such as pollution, viral infections, smoking, fungus, and bacteria; general host factors, including genetic factors and immune deficiency; and local host factors, including persistent focal inflammation within the ostiomeatal complex. Evidence suggests that the underlying bone in the ostiomeatal complex is actively involved in the disease process of CRS. The evidence concerning a broad range of predisposing factors for CRS is reviewed.

Animals↗