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Utility of a nasal access guide in endoscopic endonasal skull base surgery: assessment of use during a cadaveric dissection course
EANS Academy. Gardner P. 09/26/19; 275924; EP04118
Dr. Paul Gardner
Dr. Paul Gardner

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Abstract
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Background: The objective of this study was to assess the utility of a nasal access guide during endoscopic endonasal approaches (EEA) to the skull base during a cadaveric dissection course.
Methods: Dissection stations consisting of a two-surgeon team and one cadaver head were observed for 5 minutes with and 5 minutes without the nasal access guide in place during the same dissection (transclival or transsellar). For both conditions (with/without the nasal access guide), reviewers tabulated the number of instances the endoscope was withdrawn for lens cleaning and when there was inadequate visualization on the monitor due to soiling of the endoscope lens.
Following the procedure, participants completed a Likert-scale survey examining nine dimensions of the nasal access guide's utility and also provided an overall grading of the device's utility. Additionally, anatomic aberrancies identified on pre-dissection CT were correlated with survey and observation findings.
Results: 35 dissection stations were observed. Of survey respondents (n=61), 42.6% were otolaryngologists and 57.4% neurosurgeons. The mean instances of soiling of the endoscope lens was significantly reduced by 39.9% with the nasal access guide (3.43 vs. 2.06; p< 0.001). The mean instances of manual endoscope lens cleaning was reduced by 61.0% (1.46 vs. 0.57; p=0.001) with the nasal access guide. These findings were not significantly affected by anatomic abnormalities identified on pre-dissection CT scan.
The mean survey score was 23.33 (out of 27 possible points; SD ± of 2.64). Scores were not significantly affected by specialty or experience level. The mean overall grading of the nasal access device on scale of 3 (1= 'suboptimal', 3='excellent') was 2.75.
Conclusion; Nasal access guides can significantly reduce instances of inadequate visualization during EEA to the skull base. Participants who trialed the device rated different facets of its utility favorably and most often, assessed its overall utility as being 'excellent.'
Background: The objective of this study was to assess the utility of a nasal access guide during endoscopic endonasal approaches (EEA) to the skull base during a cadaveric dissection course.
Methods: Dissection stations consisting of a two-surgeon team and one cadaver head were observed for 5 minutes with and 5 minutes without the nasal access guide in place during the same dissection (transclival or transsellar). For both conditions (with/without the nasal access guide), reviewers tabulated the number of instances the endoscope was withdrawn for lens cleaning and when there was inadequate visualization on the monitor due to soiling of the endoscope lens.
Following the procedure, participants completed a Likert-scale survey examining nine dimensions of the nasal access guide's utility and also provided an overall grading of the device's utility. Additionally, anatomic aberrancies identified on pre-dissection CT were correlated with survey and observation findings.
Results: 35 dissection stations were observed. Of survey respondents (n=61), 42.6% were otolaryngologists and 57.4% neurosurgeons. The mean instances of soiling of the endoscope lens was significantly reduced by 39.9% with the nasal access guide (3.43 vs. 2.06; p< 0.001). The mean instances of manual endoscope lens cleaning was reduced by 61.0% (1.46 vs. 0.57; p=0.001) with the nasal access guide. These findings were not significantly affected by anatomic abnormalities identified on pre-dissection CT scan.
The mean survey score was 23.33 (out of 27 possible points; SD ± of 2.64). Scores were not significantly affected by specialty or experience level. The mean overall grading of the nasal access device on scale of 3 (1= 'suboptimal', 3='excellent') was 2.75.
Conclusion; Nasal access guides can significantly reduce instances of inadequate visualization during EEA to the skull base. Participants who trialed the device rated different facets of its utility favorably and most often, assessed its overall utility as being 'excellent.'
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