First described by Berger in 1924, esthesioneuroblastoma (ENB) remains a rare sinonasal tumor believed to originate from specialized sensory olfactory cells. To date, the literature includes 1,000 recorded cases of ENB. Patients with ENB often present with non-specific symptoms, most often chronic nasal obstruction or epistaxis. Careful examination may reveal a pink or brown polyploid mass in the nasal cavity. Overall, ENB may demonstrate various growth patterns ranging from slow, indolent progression to aggressive invasion with widespread metastasis.
Current literature indicates that ENB should be treated with a combination of surgical resection and postoperative radiation therapy with or without chemotherapy. However, significant controversy remains regarding the appropriate surgical approach. This video demonstrates a transnasal endoscopic approach, which has gained significant popularity over the previous two decades compared to classic “open” approaches. Although this approach demonstrates improved perioperative outcomes while still achieving oncologic margins, further work is required to evaluate long-term survival.
With improvement in both preoperative parathyroid tumor identification and the use of intraoperative parathyroid hormone assay, minimally invasive parathyroidectomy (MIP) is now performed more frequently in patients with primary hyperparathyroidism (pHPT). Still, many institutions are not familiar with performing MIP under regional or local anesthesia. Here, Dr. Tobias Carling presents an MIP performed under local cervical block anesthesia on a patient with pHPT and parathryoid adenoma.
Tobias Carling, MD, PhD, FACS
Associate Professor of Surgery
Yale School of Medicine
One of the early adaptors of the approach, Tobias Carling, MD, PhD, FACS, performs a right posterior retroperitoneoscopic adrenalectomy on a patient that presented with subclinical Cushing's syndrome. Specifically, she had elevated urinary cortisol, failed a dexamethasone suppression test, and had a growing adrenal tumor as revealed by serial imaging. Due to the patient’s anatomy, Dr. Carling used a lateral approach to ligating the right adrenal vein; this video includes his usual medial approach as an additional module.
Parotid Dissection (Cadaver) Duke University Medical Center Ramon M Esclamado MD, MS
Professor, Department of Surgery
Chief, Division of Head and Neck Surgery & Communication Sciences
Dr. Esclamado instructs a cadaver lab at Duke University Hospital to assist resident training on a standard parotid dissection. The approach should be adjusted depending on tumor malignancy, as Dr. Esclamado explains.
Watch as Dr. Czabanka navigates delicate territory to expose and excise a meningioma from the sphenoid wing of a symptomatic patient. Use of the microscope becomes crucial to prevent damage to healthy tissue while devascularizing the tumor.