The authors will present a case report of a woman that presented a giant sphenoidal tumor with endocranially extension and compression of the cerebral trunk. The patient was already presented in a neurosurgical service where due to the tumor volume, the high-risk surgical elements involved was sent to our ENT department to try to perform an endoscopic biopsy. Using the endoscopic optical and mechanical ensemble the authors performed trans nasally a biopsy. The histopathologic result was a surprise and was confirmed with three different immune- histochemistry exams.
Epidermoid squamous-cell carcinoma is by far the most common malignant tumor of larynx (95-96%), representing 1.6-2% of cancers in men and 0.2-0.4% of malignancies in females, with a world growing incidence and a slight dominance in urban areas. By exposing cells and tissues to UV in part by non-radiative light, the excitation of naturally occurring chromophores occurs deactivations, in part via fluorescence emission. Using laser induced autofluorescence (LIAF) in natural tissues not impregnated with photosensitizers as a noninvasive autofluorescence technique for both diagnosis and intraoperative assessments of laryngeal cancer we can improve the tumor malign identification in vivo. A total of three laryngeal biopsies (i.e. three pairs of tissues, each pair containing a healthy and a tumor tissue sample extracted from the same patient) were considered in this study. The samples were collected from patients previously diagnosed with stage T3 laryngeal carcinoma. Immediately after the surgery fragments of normal tissue and neoplastic tissue were collected, fragments of which later, after freezing, were sectioned in 25-30 μm thickness slices and stretched to quartz slides. All samples were subjected to controlled laser irradiation using a pulsed diode laser (λ=375nm, pulse width=87ps, frequency 31MHz) and the autofluorescence and its lifetime were collected using two optical fibers (inner diameter 400µm and 1500µm, respectively) positioned in a 45o geometry. The signals were recorded using a spectrograph and a photo-sensor module, the output of which was fed to a digital oscilloscope. lifetime We assessed the measurements in order to identify the differences between healthy and tumoral laryngeal tissue and outlining them, in terms of differences between the laser autoinduced fluorescence averaged intensity. The results determined the usefulness of laser induced spectroscopy in the diagnosis of laryngeal squamous cell carcinoma, discriminating between the malignant and normal tissue by analyzing the differences in spectral autofluorescence intensity and autofluorescence lifetime. Acknowledgements: This work has been financed by the National Authority for Research and Innovation in the frame of Nucleus programme - contract 4N/2016 and the project number PN-II-ID- PCE-2011-3-0922. The authors thank Prof. M. L. Pascu for permanent support in performing this research. induced autofluorescence and autofluorescence impact of laser
The evolution of the endoscopic skull base surgery in the last ten years had led to the development of new surgical reconstructive techniques. In the endoscopic reconstructive surgery of the CSF leaks both synthesis and natural materials. The advancement of the endoscopic reconstructive surgery was closely linked with the production of new synthesis materials. The aim of the paper is to compare the efficacy of synthesis versus natural materials in the closure of CSF leaks and to point out certain rules of when and where to use a synthesis or natural material. INTRODUCTION In the reconstructive surgery of the skull base, the surgeon can use both natural and synthesis materials. The developments of the endoscopic surgery of the skull base had led to removing bigger tumors from high-risk areas that were not suitable for endoscopic surgical approach up to now. The endoscopic surgical approaches tend to replace the external approaches even in malignant tumors of the skull base in selected cases. Because of that, the surgeon started to encounter more defects at the level of the skull base with or without CSF leaks. New surgical reconstructive techniques started to be developed in close connection with the production of new surgical reconstructive materials and adhesives. [1] The materials used in the reconstruction of the skull Corresponding author: Silviu Pițuru piturus@yahoo.com base defect can be divided in autologous tissue and synthesis reconstructive materials. Autologous tissues that are used in the reconstructive skull base surgery are: fascia, cartilage, bone, fat, free mucosal grafts, vascularize flaps and free flaps with micro anastomosis. Fat can be used to obliterate dead space or to plug a CSF leak.[1] Fascia lata or fascia temporalis can be placed in an underlay technique between the dura and the skull base or overlay technique in the sinus cavities. Multilayered fascia lata was the effective especially management of open cisterns or in cases of another type of high-pressure CSF leak.[2] in Bone or septal cartilage are placed in the underlying tech- 1 The “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania 2 “Prof. Dr. Dorin Hociotă” Institute of Phonoaudiology and Functional ENT surgery, Bucharest, Romania 29
