Endoscopic endonasal approaches to infratemporal fossa tumors: a classification system and case series.

Objectives/hypothesis: To propose a clinically applicable anatomic classification system describing three progressive endoscopic endonasal approaches (EEAs) to the infratemporal fossa (ITF) and their potential sequelae. Overall feasibility and outcomes of these approaches are presented through a consecutive case series.

Study Design: Description of classification system for EEAs to the ITF and case series.

Reducing nasal morbidity after skull base reconstruction with the nasoseptal flap: free middle turbinate mucosal grafts.

Objectives/hypothesis: The nasoseptal flap provides hearty vascularized tissue for reconstruction of expanded endonasal approaches (EEA); however, it produces donor site morbidity due to exposed cartilage. Mucosalization of the septum requires 12 weeks, multiple debridements, and frequent saline rinses. This study addresses the reduction of nasal morbidity by grafting middle turbinate mucosa onto the exposed septum.

A controlled laboratory and clinical evaluation of a three-dimensional endoscope for endonasal sinus and skull base surgery.

Background: One criticism of current video systems for endoscopic surgery is that two-dimensional (2D) images lack depth perception and may impair surgical dissection. To objectively measure the efficacy of 3D endoscopy, we designed a training model with specific tasks to show potential differences between 2D and 3D endoscopy. Its clinical value was then evaluated during endoscopic sinus and skull base surgical cases.

Nasoseptal "rescue" flap: a novel modification of the nasoseptal flap technique for pituitary surgery.

Objectives: The introduction of the pedicled nasoseptal flap (NSF) has decreased postoperative cerebrospinal fluid (CSF) leak rates from >20% to <5% during expanded endoscopic skull base surgery. The NSF must be raised at the beginning of the operation to protect the posterior pedicle during the expanded sphenoidotomy. However, in most pituitary tumor cases, an intraoperative CSF leak is not expected but at times encountered.

Transpalatal greater palatine canal injection: Radioanatomic analysis of where to bend the needle for pediatric sinus surgery.

Background: The greater palatine canal (GPC) local injection is used to limit posterior bleeding during sinus surgery in adults. Given the potential for causing iatrogenic damage to the intraorbital contents, this procedure is not commonly used in the pediatric population. No studies have described the anatomic development of the GPC during facial growth.

Nasoseptal flap takedown and reuse in revision endoscopic skull base reconstruction.

Objectives/hypothesis: To provide a description of the techniques and limitations of nasoseptal flap takedown and reuse during second-stage and revision endoscopic skull base surgery and review the institutional experience with the use of this reconstructive technique.

Study Design: : Case series.

Methods: A retrospective analysis of cerebrospinal fluid (CSF) leak outcomes was performed for a consecutive series of patients who underwent the nasoseptal flap takedown technique during endoscopic skull base surgery at two tertiary care skull base centers.

A prospective study of the clinical impact of a multidisciplinary head and neck tumor board.

Objective: There have been no studies undertaken on the effect of the multidisciplinary head and neck tumor board on treatment planning. The objective of this study was to determine the efficacy of the multidisciplinary tumor board in altering diagnosis, stage, and treatment plan in patients with head and neck tumors.

Study Design: Case series with planned data collection.

Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients.

Objectives/hypothesis: Pediatric skull base surgery is limited by several boney sinonasal landmarks that must be overcome prior to tumor dissection. When approaching a sellar or parasellar tumor, the piriform aperture, sphenoid sinus pneumatization, and intercarotid distances are areas of potential limitation. Quantitative pediatric anatomical measurements relevant to skull base approaches are lacking.

Post-transplantation lymphoproliferative disease: Epstein-Barr virus DNA levels, HLA-A3, and survival.

Rationale: Elevation in Epstein-Barr virus (EBV) circulating DNA has been proposed as a marker for development of post-transplant lymphoproliferative disease (PTLD), but few published data exist in the study of lung-transplant recipients.

Objectives: To determine if elevated EBV DNA levels, in combination with other risk factors, were predictive of PTLD.

Methods: We conducted a retrospective, single-center study examining all lung transplant recipients (n = 296) and EBV DNA levels (n = 612) using real-time TaqMan polymerase chain reaction.