Defining the caudal limits of the endoscopic endonasal approach to the craniovertebral junction: anatomic study correlating radiographic measures.

Objective: The endoscopic endonasal approach (EEA), has become the preferred alternative to traditional open and transoral approaches to the ventral craniovertebral junction (CVJ) region. However, preoperative prediction of the limitations of caudal reach remains challenging. This cadaveric study aimed to quantify the CVJ area of exposure and access afforded by the EEA, evaluate the accuracy of previously described radiographic anthropometric lines, and identify the lowest limit of the EEA corridor.

Impact of Tobacco, Marijuana, and Alcohol Use on Overall Survival in Recurrent Metastatic Head and Neck Cancer Patients Treated With Immune Checkpoint Inhibitors.

Aim: The response rates to immune checkpoint inhibitors (ICI) remain low (13%-20%) in metastatic head and neck cancer patients, indicating an urgent need to better understand factors predictive of response to these agents. This study explored the impact of smoking status, marijuana use, and alcohol consumption on treatment outcomes in recurrent-metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients treated with ICI.

Methods: A retrospective analysis was performed on 201 R/M HNSCC patients treated with ICI between January 15th 2016 and April 9th 2020 at a single institution.

Development and validation of a predictive scoring model for complications following endoscopic endonasal skull base surgery.

Objective: The endoscopic endonasal approach (EEA) has evolved into an established technique in skull base surgery. The authors previously examined 1002 EEA procedures and reported factors associated with postoperative complications. Here they report the development and validation of a scoring model based on risk factors to better predict complications following EEA.

Meningioma En Plaque Associated with Cerebrospinal Fluid Rhinorrhea: A Systematic Review of the Literature with Case Presentation.

Background: Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpetlike proliferation along the dura, typically arising in the spheno-orbital region, and, therefore, causes proptosis, decreased visual acuity, and orbital pain.

The Nasopharyngo-Septal Butterfly Flap: A Novel Adjunct for Reconstructing Large Skull Base Defects.

Objective: Skull base defects can be challenging to reconstruct. The nasoseptal flap (NSF) remains the first-line option for reconstruction. However, it can be inadequate to cover wide defects or compromised by tumor invasion or prior surgery requiring additional reconstructive options.

Modified salpingopharyngeus myomucosal flap: a novel technique for skull base reconstruction.

Purpose: Advancements in endoscopic skull base surgery have enabled complex tumor resections, necessitating a variety of reliable reconstructive techniques to repair resultant defects. Vascularized flaps represent optimal options, but frequently used local pedicled intranasal flaps may be unavailable due to tumor invasion or prior surgery. This study applies a modification to the previously described salpingopharyngeus myomucosal flap (Dicle flap) with potential for its use in extensive endoscopic skull base surgery defect's repair.

Growth dynamics of Rathke's Cleft cyst: a risk score system for surgical decision making.

Objective: Rathke's cleft cysts (RCCs) exhibit variable growth patterns, thus posing a challenge in predicting progression. While some RCCs may not cause symptoms, others can insidiously cause pituitary dysfunction, which is often irreversible, even following surgery. Hence, it is crucial to identify asymptomatic RCCs that grow rapidly and pose a higher risk of causing endocrinologic dysfunction.

Leadership Development and Its Association With Retention of Surgical Versus Nonsurgical Faculty at a Large Academic Health Center.

Introduction: Leadership development programs are the key for engaging physicians as partners in health-care administration. These programs have become common; however, one potential consequence of leadership training is attrition.

Methods: Using a prospectively collected database, Kaplan-Meier curves were used to analyze attrition of physician faculty following an intramural leadership program at an academic health center.

An Uncommon Case of Sinonasal Adenoid Cystic Carcinoma Metastatic to the Kidney Treated with Metastasectomy.

Adenoid cystic carcinoma (ACC) is a rare tumor, accounting for 1% of all head and neck cancers, with an aggressive nature characterized by local recurrence, delayed metastasis, and survival of less than 50% at 10 years. This is a case of biopsy-proven ACC to the kidney, 1 of 29 known occurrences, managed by metastasectomy by robotic-assisted nephrectomy, with plans for resection of lung metastasis. Thirteen years after diagnosis of sinonasal ACC treated with resection, the patient presented with shortness of breath.

"Intrasellar tumor-to-tumor metastasis: A single center experience with a systematic review".

Purpose: This study investigates the rare occurrence of tumor-to-tumor metastasis in Pituitary Neuroendocrine Tumors (PitNETs), also known as pituitary adenomas, aiming to enhance understanding of its diagnostic and therapeutic challenges. We report two cases from our institution of tumor-to-tumor metastasis involving PitNETs, followed by a systematic literature review.

Methods: We conducted a comprehensive literature review using PubMed and Google Scholar databases.

Factors Precipitating Overnight Admission After Sialolithectomy.

Objective: To determine factors predicting overnight admission after sialolithectomy.

Study Design: Quality outcome database research.

Setting: The National Surgical Quality Improvement Program American College of Surgeons Participant User Files.

Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques.

Objective: Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital, endoscopic transoral, and endoscopic sublabial transmaxillary approaches to address extensive lesions not amenable to a single approach. The study provides anatomical metrics including area of exposure and degree of surgical freedom.

Methods: Five human cadaveric specimens (10 sides) were dissected to expose and methodically analyze the anatomical intricacies of the ITF using the following minimal access approaches: endoscopic transnasal transpterygoid (EETA), endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques.

Modified Function-Preserving Endoscopic Endonasal Extracapsular Resection of a Large Orbital Apex Cavernous Hemangioma.

Background And Importance: Various invasive oculoplastic procedures are commonly utilized to control the rectus muscles and widen the surgical corridor through the endoscopic endonasal removal of large orbital apex cavernous hemangiomas (OACHs). They require additional transconjunctival incision, rectus muscle insertional retraction, or muscle deinsertion at the globe that might not be safe and lead to prolonged postoperative extraocular muscle dysfunction. In this article, the authors described a modified 3-handed extracapsular technique for the resection of a large OACH without an additional procedure for rectus muscle control.

Effectiveness of Nasolacrimal SCC Treatments and Promising Role of Chemo-Induction: A Case Report and Systematic Review.

Objective: To comprehensively analyze reported cases of nasolacrimal squamous cell carcinoma (NLSCC), focusing on risk factors, treatment modalities, and outcomes. Additionally, investigate the impact of human Papillomavirus (HPV) status and histopathological subtypes' impact on prognosis.

Data Sources: Pubmed, Embase.

Endoscopic-Guided Suture Lateralization for Bilateral Vocal Fold Paralysis: Surgical Tips for Better Outcome.

Objective: This study aims to describe a precise description of suture lateralization (SL) technique and evaluate its effectiveness and safety in management of bilateral vocal fold paralysis (BVFP).

Method: A preclinical cadaveric study followed by application on a case series of BVFP patients. After the preliminary study executed to precisely localize the optimal sites for needle insertion, a prospective interventional study was conducted on 19 subjects presenting with respiratory distress due to BVFP.

Endoscopic precaruncular medial transorbital and endonasal multiport approaches to the contralateral skull base: a clinicoanatomical study.

Objective: Minimally invasive endoscopic endonasal multiport approaches create additional visualization angles to treat skull base pathologies. The sublabial contralateral transmaxillary (CTM) approach and superior eyelid lateral transorbital approach, frequently used nowadays, have been referred to as the "third port" when used alongside the endoscopic endonasal approach (EEA). The endoscopic precaruncular contralateral medial transorbital (cMTO) corridor, on the other hand, is an underrecognized but unique port that has been used to repair CSF rhinorrhea originating from the lateral sphenoid sinus recess.

Customized ventral bony and dural opening in the transplanum/transtuberculum and transclival variants of extended endoscopic endonasal approach to suprasellar craniopharyngiomas: an approach-based stepwise cadaveric dissection and clinical applicability.

Background: Optimal initial exposure through an extended endoscopic endonasal approach (EEA) for suprasellar craniopharyngiomas ensures safe and unrestricted surgical access while avoiding overexposure, which may prolong the procedure and increase neurovascular adverse events.

Method: Here, the authors outline the surgical nuances of a customized bony and dural opening through the transplanum/transtuberculum and transclival variants of the extended EEA to suprasellar craniopharyngiomas based on the tumor-pituitary stalk relationship. A stepwise cadaveric dissection and intraoperative photographs relevant to the approaches are also provided.

Anatomical Variations of the Ascending Pharyngeal Artery: Implications for Endoscopic Surgery in the Parapharyngeal Space.

The ascending pharyngeal artery (APA) travels with the parapharyngeal internal carotid artery (pICA) in the parapharyngeal space (PPS). This study aimed to investigate the anatomical variations of the APA, and to explore their implications for endoscopic surgery in the PPS. Dissection of the APA in the PPS was performed on 10 cadaveric specimens (20 sides).

Successful treatment of medically and surgically refractory lymphocytic hypophysitis with fractionated stereotactic radiotherapy: a single-center experience and systematic literature review.

Purpose: To explore the potential role of focused radiotherapy in managing the lymphocytic hypophysitis (LH) refractory to medical therapy and surgery.

Method: A systematic literature review was conducted following PRISMA guidelines to identify the studies on radiation treatment for hypophysitis, along with the experience in our institution.

Results: The study included eight patients, three from our institution and five from existing literature.

Real-time ultrasound guidance in the endoscopic endonasal resection of a retro-odontoid pannus: Technical note and case illustration.

Background And Objectives: Odontoidectomy is a surgical procedure indicated in the setting of various pathologies, with the main goal of decompressing the ventral brain stem and spinal cord as a result of irreducible compression at the craniovertebral junction. The endoscopic endonasal approach has been increasingly used as an alternative to the transoral approach as it provides a straightforward, panoramic, and direct approach to the odontoid process. In addition, intraoperative ultrasound (US) guidance is a technique that can optimize safety and surgical outcomes in this context.