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Home Conference TSA 2016  [TSA2016] Basic Principle and Preparation of Endoscopic TSA

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[TSA2016] Basic Principle and Preparation of Endoscopic TSA
Dr. Doosik Kong Samsung Medical Center | Republic of Korea Speciality : Neurosurgery

Advantages of microscopic TSA
 - Comfort & Familiarity to neurosurgeon
 - Tree-dimensional view : Pseudo-depth perception in Endoscope
 - Easily manipulated zoom and focus features
 - Nasal speculum protects the nasal mucosa from injury
 - Microscope is out of the surgical field and does not obstruct the entry or maneuvering of
   instruments into or out of field
 - Don’t need to hold microscope

Traditional Endoscopic TSA
Traditional endoscopic TSA concentrated on safe and wide access
 - Cauterization of anterior sphenoid, posterior septum
 - Transection of posterior septum
 - Removal of rostrum of sphenoid
 - Resection of posterior edge of septum
 - Enlargement of sphenoidotomy
 - Cauterization of Posterior nasal artery

Current Concept of Endoscopic TSA
 - You can remove the bone as wide as possible.
 - You can preserve the mucosa as much as possible.

Key principle of Endoscopic TSA
 - Wide Exposure and Good Visualization.
 - Preservation of Anatomy and Function
 - Dedicated biopolar coagulator
 - Irrigation System

1) Nasal stage
 - Warm/hot saline(over 40℃) irrigation : prevent mucosal swelling
 - 2hr operation time-rule : assoc with mucosal swelling
 - Strict I/O balance for long-time surgery

2) Sphenoid Stage
 - Anticipation of intrasphenoid septa / Onodi air cell
 - Sphenoid mucosa : stripped by gentle maneuver
 - Sphenoid opening

Not applicable
Not applicable
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