William E Bolger

Maxillary sinus hypoplasia is an anomaly of the paranasal sinuses occasionally encountered by otolaryngologists. Although this entity has been previously reported, an association between maxillary sinus hypoplasia and anomalies of other paranasal sinus structures, such as the uncinate process, has not yet been described. Additionally, the literature lacks a system by which the various types of maxillary sinus hypoplasia can be classified using computerized tomographic (CT) imaging. Two ...

OBJECTIVE: To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes.

STUDY DESIGN: Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical ...

Endoscopic surgery of the posterior ethmoid and sphenoid sinuses can present the operator with a considerable challenge. Although endoscopic training and physician experience have increased significantly in the past decade, surgical complications such as optic nerve trauma and cerebrospinal fluid leak still occur. Surgeons reporting such complications cite a lack of orientation within the dissection field as a primary cause. Because endoscopic sinus surgery is now being performed more ...

OBJECTIVES: Encephaloceles usually involve herniation of frontal lobe tissue through an anterior cranial fossa defect into the ethmoid sinus or nasal cavity. Encephaloceles can also result from temporal lobe herniation through a middle fossa defect into the sphenoid sinus. Within the sphenoid, encephaloceles are thought to occur most commonly in the central or midline aspect of the sinus. Lateral sphenoid encephaloceles, especially within the lateral aspect of the sphenoid sinus when the ...

Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the "background" prevalence of these findings are needed to determine their clinical relevance. A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was ...

OBJECTIVES: Previous reports indicate that elevated intracranial pressure (ICP) may cause spontaneous cerebrospinal fluid (CSF) leaks. In this study we examined the clinical diagnosis of benign intracranial hypertension (BIH) in this population using the modified Dandy criteria.

METHODS: We performed a retrospective review of clinical data and measurements of ICPs after surgical repair.

RESULTS: Sixteen patients with spontaneous CSF leaks were surgically treated from 1996 to 2002. In 11 ...

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management ...

BACKGROUND: Traditionally, idiopathic cerebrospinal fluid (CSF) leaks have been associated with normal intracranial pressure (ICP). We speculate that at least one subset of these leaks may be associated with elevated ICP, more specifically, idiopathic intracranial hypertension (IIH). We sought to identify radiographic manifestations suggestive of elevated ICP in 14 patients with idiopathic CSF leaks who clinically and epidemiologically resembled patients with IIH.

METHODS: We ...

Recently, the role of various cytokines in the pathogenesis of chronic rhinosinusitis has come under investigation. Various studies have reported increased levels of interleukin-3, interleukin-4, interleukin-5, interleukin-13, and granulocyte macrophage-colony stimulating factor in the sinonasal mucosa of patients with chronic rhinosinusitis. The present study investigated the levels of pro-inflammatory cytokines, including interleukin-1 beta (IL-1 beta), interleukin-5 (IL-5), ...

OBJECTIVES: Preliminary data suggest efficacy for the endoscopic approach for sinonasal malignancy. The purpose of this study is to evaluate the effectiveness of the endoscopic approach for the resection of sinonasal squamous cell carcinoma (SCC).

STUDY DESIGN: Retrospective analysis of patients undergoing endoscopic resection of sinonasal SCC from August 1996 to May 2004.

METHODS: Eleven patients were treated with curative intent. Demographic data, histopathology, extent of tumor ...

BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leak is a condition that previously has been considered idiopathic and classified as having "normal" intracranial pressure (ICP). We present clinical and radiographic evidence that indicates elevated ICP in this group. In addition, we review the pathophysiology and unique management issues in caring for patients with spontaneous CSF leak.

METHODS: We present a retrospective review of medical records, imaging studies, ICP measurements, and ...

BACKGROUND: Congenital skull base defects have traditionally been treated via an intracranial approach. Recent advances in endoscopic management have made minimally invasive extracranial approaches feasible, with less morbidity.

OBJECTIVE: To determine the success of endoscopic treatment of congenital cerebrospinal fluid leaks and encephaloceles.

MAIN OUTCOME MEASURES: Retrospective review of congenital cerebrospinal fluid leaks and encephaloceles treated from January 1, 1992, to ...

Posterior epistaxis is a significant medical problem that can be challenging to treat. Endoscopic surgery could potentially reduced operative time and patient risk; however, surgeons report difficulty in endoscopically isolating the major offending artery, the sphenopalatine. These difficulties could be reduced if a recognizable anatomic structure marked the region of the artery. The study objective is to characterize the relationship of a relatively unknown anatomic structure, the ...

BACKGROUND: Over the past 20 years, many patients have benefited from endoscopic sinus surgery and its ability to relieve sinus obstruction. However, problems still occur with surgery, thereby leaving room for innovation. Recently, catheter-based technology has provided new options for treating cardiac, vascular, and urologic diseases. We speculated that catheter technology also might offer new treatment options for sinusitis patients. The purpose of this investigation was to explore the ...

OBJECTIVE: To determine the effect of functional endoscopic sinus surgery (FESS) on facial skeletal growth in children.

DESIGN: Prospective randomized controlled animal study; retrospective histopathologic study of pediatric FESS specimens.

SETTING: Academic tertiary referral medical center.

PARTICIPANTS: Eight newly weaned piglets; uncinate and ethmoid bone of FESS specimens from 84 children.

INTERVENTIONS: The piglets underwent unilateral FESS. When they had developed to nearly adult ...