title: Fluorescein-guided intraoperative endoscopy in patients with hereditary hemorrhagic telangiectasia: first impressions.
abstract: Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disease that results in mucocutaneous telangiectasias and arteriovenous visceral malformations. Nasal telangiectasias lead to recurrent epistaxis, which affects up to 96% of patients. Different morphologic classifications and methods of visualization of nasal lesions have been described in the literature. We developed a new method of intraoperative endoscopy based on the intravenous administration of fluorescein. Preliminary data of this technique are reported.
  
  
  
  After the intravenous administration of sodium fluorescein, an intraoperative fluorescein-guided endoscopy was carried out using photographic customized yellow filters on top of a 0-degree, 4-mm endoscope.
  
  
  
  In 2015, 65 HHT patients underwent surgery for their epistaxis in our institution, and in 7 patients (3 males, 4 females; mean age, 54 years) an intraoperative fluorescein-guided intraoperative nasal endoscopy was performed. No adverse events or complications were observed.
  
  
  
  First impressions regarding the usage of this technique in HHT patients seem to be promising and positive in terms of efficacy and safety. However, further studies with larger cohorts of patients should be performed in order to better investigate the use of this method for diagnostic and surgical purposes in HHT.
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pagella
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pusateri
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Zaccari
authors.affiliation: Department of Neurosurgery, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bongetta
authors.affiliation: Department of Neurosurgery, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Zoia
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinozzi
authors.affiliation: General Biology and Medical Genetics, Department of Molecular Medicine, University of Pavia, Pavia, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Olivieri
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Italy.
authors.forename: Elina
authors.initials: E
authors.lastname: Matti
mesh_terms: D004724:Endoscopy / Q000379:methods*; D005260:Female; D019793:Fluorescein / Q000627:therapeutic use*; D005456:Fluorescent Dyes / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000601:surgery*
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein
keywords: HHT; Rendu-Osler-Weber disease; endoscopy; epistaxis; hemorrhagic disorders; hereditary; hereditary hemorrhagic telangiectasia