Mr Sunkaraneni is a Fellowship-trained Specialist Endoscopic Sinus Surgeon, performing FESS/CASS (see below).
Functional endoscopic sinus surgery (FESS) is a type of keyhole surgery whereby diseases of the sinuses can be treated through your nostrils, without the need for making any cuts on the skin or inside the mouth. Taken further, this technique is also used for treating problems of the base of the skull, and also certain tumours of the brain.
Mr Sunkaraneni completed a year’s intensive fellowship training specifically in this type of surgery in Vancouver, Canada, including endoscopic skull base surgery. Most of the procedures he carried out during this time were with the use of special computerised ‘image guidance systems’, hence the term computer assisted sinus surgery (CASS).
Mr Sunkaraneni also specialises in the surgical management of the frontal sinus. This is one of the most difficult aspects of FESS and must be treated with the utmost care to avoid making problems in this area much worse.
A large number of Mr Sunkaraneni’s patients will have previously had sinus surgery elsewhere, and then come to see him with ongoing problems because of his expertise in revision FESS. The initial surgery will have often been incompletely or inadequately performed, leading to ongoing chronic sinus problems, or even worsening of the original problems. Surgery in these cases is more difficult because of scarring, loss of anatomical landmarks, and new bone formation, and must be undertaken with care and thoroughness.
The types of conditions that can be treated using FESS/CASS are some of those listed in the Rhinology section of these pages.
The Procedure
Surgery for chronic rhinosinusitis is performed under a general anaesthetic and lasts roughly 2hrs (for tumours it may be longer than this). Risks associated with it are mainly related to bleeding and infection. If these do occur, they are usually managed in a straightforward manner.
More serious risks can occur but fortunately are extremely uncommon (<0.5% of cases). They relate to the areas that are very close to the sinuses:
EYE:
-some bruising around the eye.
-very rarely, loss of vision or permanent double vision.
CRANIAL CAVITY/BRAIN:
-a leak of the fluid that bathes the brain (cerebrospinal fluid, or CSF)
Read more about FESS/CASS on the following links:
See here for surgical videos created by Mr Sunkaraneni.
See here for video interviews by Amin Javer discussing sinus surgery.
Balloon Sinuplasty
This is a recently introduced technique, designed to open up individual sinus drainage pathways. It works along the same principle as that used to open blocked heart (coronary) arteries.
The aim of this procedure is to widen the natural sinus openings without injuring the lining of the sinuses, thereby reducing the likelihood of scarring (and further narrowing) of these openings.
More information here.
Page last updated on 18th January 2013.
