Cirugía endoscópica nasosinusal y base de cráneo anterior. Rotación externa

Abstract

Introduction and objective: The prevalence of chronic rhinosinusal pathology can reach up to 10% in general population (United States and Europe). Rhinosinusal diseases (acute and chronic inflammatory diseases, tumors and systemic diseases that affect the respiratory tract) generate a great impact on the quality of life, causing direct and indirect socio-economic costs of great magnitude. The objective was watch and learn complex surgical techniques in the area of rhinology and anterior skull base, which are not usually performed in Castilla y León, even in Spain, due to the complexity of cases that are common in the chosen reference center. Method: The rotation took place at the Circolo Hospital and the Macchi Foundation, located in Varese (Lombardy area), Italy. It is directed by Professor Paolo Castelnuovo. It lasted 4 weeks (from Monday, November 15th to Friday, December 10th, 2021). The rotation consisted of clinical sessions and a patient-by-patient floor visit every morning and then operating room sessions (morning and afternoon), either major outpatient surgery (secondary operating rooms) or main operating room. Results: I attended multiple surgeries with different expert surgeons, the most complex are mentioned below: 1) Revision of recurrence of aggressive inverted papilloma with double approach: FESS and craniectomy. 2) Resection of juvenile angiofibroma. 3) Endoscopic surgery for exeresis/biopsy of fronto-orbital lesion. 4) Left total parotidectomy (lower portion) for tumor removal. 5) Resection of the left ethmoid-frontal-orbital tumor by FESS + left orbital resection + reconstruction of the defect with the left latissimus dorsi. 6) Bilateral orbital decompression through FESS in thyroid pathology. 7) Resection of left nasal melanoma by FESS + bilateral neck dissection + tracheotomy. Discussion: The Circolo Hospital and the Macchi Foundation is a reference center for Italy and diferent parts of Europe, so they have an impressive number of patients that allows them to be world pioneers in nasosinusal and anterior skull base surgery. They discuss the cases together and decide which is the best therapy for the patient. My training center has several ways of working similar to that hospital, because some associates have done observerships in that center and learn and develop these techniques. Conclusions: The observership was an optimal experience, with a lot of learning and enrichment of different and advanced surgical techniques. Opportunities outside our training center make us expand our range of solutions to problems that may arise on a day-to-day basis.