Advanced sinus and skull-base surgery

Our expert surgeons at the Harley Street Nose Clinic are on hand to perform advanced sinus and skull-base surgery. This often involves an endoscopic procedure for conditions such as Graves’ disease, frontal sinusitis and mucocoeles.

Which procedure are you interested in?

What is endoscopic orbital decompression?

Orbital decompression surgery, typically performed to relieve exophthalmos – a condition associated with Graves’ disease that causes the eyes to bulge – increases the available space for the orbital contents of the eye. This will allow the eye to return to a more normal position and improve any loss of vision.

The aims of orbital decompression surgery are:

  • To increase the available space for the orbital contents
  • To reduce the degree of proptosis (entrapment of the eye from behind by the eyelids)

Patients may choose to undergo this procedure when they show symptoms of exophthalmos such as eye pain, headaches, neuropathy, and loss of vision.

The operation is achieved either by removing part of the wall of the orbit and, in some patients, by the additional excision of some of the orbital fatty tissue.

Performed under general anaesthesia, the operation works endoscopically through the nose, where surgeons will remove the bones of the medial and inferior orbit. As the operation is performed entirely through the nostrils, most people can go home the same day.

What is endoscopic pitutary surgery?

Performed to remove tumours from the pituitary gland – which is responsible for regulating most of the body’s hormones – endoscopic pituitary surgery (also called transsphenoidal endoscopic surgery) is executed through the nose with an instrument called an endoscope. The aim of endoscopic pituitary surgery is to remove certain types of tumours that start to grow in the pituitary gland, including hormone-secreting tumours, non-hormone-secreting tumours and cancerous tumours.

A thin tube – which has a microscope, light, and camera built into it – is inserted through the nose to enable the surgeon to watch the operation on a television screen while inserting other special instruments through the scope to remove the tumour.
Endoscopic pituitary surgery is usually done under general anaesthesia.

What is endoscopic repair of cerebrospinal fluid (CSF) leaks?

A nasal cerebrospinal fluid (CSF) leak is an escape of the fluid that surrounds the brain and spinal cord. This can occur when there are breaks in the skull base and microscopic tears in the tissue surrounding the brain, called the dura. This is a very serious condition, and these tears must be repaired.

The symptoms of CSF leak can include: severe headaches, a constant dripping of clear fluid from the nose, meningitis, light sensitivity, nausea and neck stiffness.
The aim of endoscopic repair surgery is:

  • To repair the CSF leak.
  • To improve headaches and reduce the chance of meningitis.

CSF leak closure surgery does not involve cutting through the skin, and is usually performed under general anaesthesia, working endoscopically through the nose. Surgeons will identify the leak and repair it using cartilage and other tissue from the ear and nose.

What is acute frontal sinusitis?

Acute frontal sinusitis is the inflammation of the sinus cavities behind the forehead, often caused by mucus build-up. This can occur due to infections, bacteria, viruses or a deviated nasal septum. In many cases, acute sinusitis can be treated using antibiotics, nasal sprays and pain medication.

Typically, endoscopic sinus surgery is reserved for patients with documented rhinosinusitis, based on a thorough history and a complete physical examination by our consultant rhinologists, including CT scans if appropriate.

Complex endoscopic sinus surgery (ESS) is a procedure that uses nasal endoscopes that are inserted into the nostrils to avoid cutting the skin and establish drainage and ventilation pathways to treat pain and blocked nose symptoms.

ESS can be used to treat the following conditions:

  • Chronic or recurrent sinusitis
  • Nasal polyposis
  • Antrochoanal polyps
  • Sinus mucocoeles
  • Excision of selected tumours
  • Cerebrospinal fluid (CSF) leak closure
  • Orbital decompression (e.g. Graves ophthalmopathy)
  • Optic nerve decompression
  • Dacryocystorhinostomy (DCR)
  • Choanal atresia repair
  • Foreign body removal
  • Epistaxis control

What is a sinus mucocoele?

A frontal paranasal sinus mucocoele is a cystic lesion full of thick mucus in the paranasal sinuses. A mucocoele can develop when the opening of a paranasal sinus becomes obstructed because of trauma, infection, chronic sinusitis, polyps, malignancy, bony tumours, or congenital anomalies. The majority of paranasal sinus mucocoeles are benign, however, if they increase or expand, the pressure they exert on the surrounding areas may cause problems.

Symptoms of a sinus mucocoele include:

  • Diminished visual acuity
  • Visual field abnormalities
  • Drooping of the eyelid(s)
  • Swelling of the tissues surrounding or lining the orbit of the eye
  • Restricted ocular movements
  • Forehead pain

Medical management and decongestants can often treat sinus mucocoeles. However, in extreme cases, endoscopic sinus surgery is required to re-establish the drainage pathways of the sinuses.