Postoperative rhinosinusitis and microbiological outcomes following endoscopic endonasal approaches: A retrospective analysis of 300 patients.

Background: Endoscopic endonasal approaches (EEAs) are an efficient way to manage skull base lesions; however, studies regarding postoperative rhinosinusitis are limited. This study analyzed the incidence of postoperative rhinosinusitis, the associated risk factors, microbial species, and antibiotic usage in patients who underwent EEA.

Methods: Patients who underwent EEAs at a tertiary referral hospital between July 2015 and May 2019 were retrospectively evaluated.

The learning curve for cavernous sinus surgery illustrated by symptomatic intracavernous aneurysm clipping through a pretemporal transcavernous approach.

Objective: The anatomy of the cavernous sinus (CS) has been well studied in the laboratory for decades; however, performing surgery in and around the CS is still a challenge. To reveal the learning curve for CS surgery via the pretemporal transcavernous approach (PTTC), surgical procedures were examined. The authors proposed 4 levels of surgical difficulty in opening the walls of the CS through this approach.

Analysing sinonasal microbiota of fungal rhinosinusitis by next-generation sequencing.

Objectives: Fungal rhinosinusitis is an inflammatory disease of the nose that may lead to life-threatening complications. This study compared the bacterial and fungal microbiomes between patients with invasive fungal rhinosinusitis (IFRS) and non-IFRS (NIFRS).

Design: This was a prospective study including 18 IFRS and NIFRS patients.

Predicting the Need for Desmopressin Treatment During Inpatient and After Discharge Following Endoscopic Sellar Surgery.

Introduction: Postoperative diabetes insipidus (DI) is a common complication following endoscopic sellar surgery. However, the requirement of desmopressin treatment for patients with DI are heterogenous. Although the predictors of postoperative DI have been reported, whether these patients required desmopressin treatment remained uninvestigated.

The role of nasopharyngectomy in the management of nasopharyngeal carcinoma.

Purpose Of Review: Recently, endoscopic nasopharyngectomy (ENPG) has become an effective treatment for locally recurrent nasopharyngeal carcinoma (NPC). This article reviews recent publications on ENPG and specifically addresses the surgical anatomy of the nasopharynx and discusses several important issues regarding ENPG.

Recent Findings: The surgical techniques for ENPG have been previously described in several studies.

Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences.

Background: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease.

Thymosin β4 increases cardiac cell proliferation, cell engraftment, and the reparative potency of human induced-pluripotent stem cell-derived cardiomyocytes in a porcine model of acute myocardial infarction.

Previous studies have shown that human embryonic stem cell-derived cardiomyocytes improved myocardial recovery when administered to infarcted pig and non-human primate hearts. However, the engraftment of intramyocardially delivered cells is poor and the effectiveness of clinically relevant doses of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) in large animal models of myocardial injury remains unknown. Here, we determined whether thymosin β4 (Tb4) could improve the engraftment and reparative potency of transplanted hiPSC-CMs in a porcine model of myocardial infarction (MI).

Combined Endoscopic Endonasal and Contralateral Transmaxillary Approach for Petrous Cholesteatoma: 2-Dimensional Operative Video.

This 59-yr-old man presented with headache, dizziness, diplopia, and right-side hearing impairment for years. The objective degree of hearing impairment was not available. Magnetic resonance imaging (MRI) showed a right petrous apex lesion centered behind the right petrous internal carotid artery and extending lateral to the medial aspect of the right internal auditory canal.

Endoscopic endonasal transcavernous approach for invasive corticotroph pituitary adenoma.

This is a 37-year-old woman who presented with weight gain, a moon-shaped face, and muscle weakness for 4 months. Cushing's disease was confirmed after a series of diagnostic tests. MRI demonstrated a pituitary macroadenoma with right cavernous sinus invasion and encasement of the right ICA.

Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study.

Objective: For symptomatic nonsecreting pituitary adenomas (PAs), resection remains a critical option for treatment. In this study, the authors used a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for the surgical management of PA.

Methods: The National Cancer Database was queried for all patients diagnosed with histologically confirmed PA who underwent resection between 2010 and 2016 in which the surgical approach was specified.

The pretemporal trans-cavernous trans-Meckel's trans-tentorial trans-petrosal approach: a combo skill in treating skull base meningiomas.

Purpose: Surgical treatments for skull base meningiomas are challenging. We found that most of these lesions (75%), despite locating at the anterior, middle or posterior fossa, could be dealt with a combo skill-the pretemporal trans-cavernous trans-Meckel's trans-tentorial trans-petrosal approach (PCMTP), which adopted the same curvilinear skin incision as for the classic pterional approach. Our aim of this study is to validate the application of this technique in treating skull base meningiomas.

Gamma Knife radiosurgery for cerebral cavernous malformation.

This is a retrospective study examining the efficacy and safety of Gamma Knife radiosurgery (GKS) in treating patients with cerebral cavernous malformations (CCMs). Between 1993 and 2018, 261 patients with 331 symptomatic CCMs were treated by GKS. The median age was 39.

A porcine model of heart failure with preserved ejection fraction: magnetic resonance imaging and metabolic energetics.

Aims: A significant proportion of heart failure (HF) patients have HF preserved ejection fraction (HFpEF). The lack of effective treatments for HFpEF remains a critical unmet need. A key obstacle to therapeutic innovation in HFpEF is the paucity of pre-clinical models.

Bilateral Smell Preservation is Routinely Possible following Endoscopic Endonasal Approach for Sellar/Suprasellar Lesions.

 The endoscopic endonasal approach (EEA) has been shown to be an effective means to access sellar lesions. However, there are limited studies centered on evaluating olfactory function after surgery. In this study, we assessed the pre- and postoperative olfactory function of patients who underwent EEA for sellar and suprasellar lesions.

Excessive Expression of Microglia/Macrophage and Proinflammatory Mediators in Olfactory Bulb and Olfactory Dysfunction After Stroke.

Background/aim: Olfactory dysfunction can be caused by stroke but the pathogenesis is still unclear. Previous studies have proved that olfactory dysfunction could be caused by microglia activation in the olfactory bulb and that middle cerebral artery occlusion (MCAO) may induce ipsilateral olfactory bulb microglia activation. This study aimed to explore the possible pathogenesis of ischemic stroke-induced olfactory dysfunction.

Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery.

Objective: Injury to the internal carotid artery (ICA) is the most critical complication of endoscopic endonasal skull base surgery. Packing with a crushed muscle graft at the injury site has been an effective management technique to control bleeding without ICA sacrifice. Obtaining the muscle graft has typically required access to another surgical site, however.

Pretemporal transcavernous transtentorial approach for left pontine glioma.

A 39-year-old man, who had a history of spinal myxopapillary ependymoma with cerebrospinal seeding status post twice operations and radiation therapy, presented with aggravating headaches, diplopia, dysphagia, and unsteady gait for 2 weeks. The brain MRI revealed a parenchymal lesion at the left aspect of the pons, about 2.8 × 2.

The foramen lacerum: surgical anatomy and relevance for endoscopic endonasal approaches.

Objective: The foramen lacerum is a relevant skull base structure that has been neglected for many years. From the endoscopic endonasal perspective, the foramen lacerum is a key structure due to its location at the crossroad between the sagittal and coronal planes. The objective of this study was to provide a detailed investigation of the surgical anatomy of the foramen lacerum and its adjacent structures based on anatomical dissections and imaging studies, propose several relevant key surgical landmarks, and demonstrate the surgical technique for its full exposure with several illustrative cases.

Endoscopic Endonasal Interdural Middle Fossa Approach to the Maxillary Nerve: Anatomic Considerations and Surgical Relevance.

Background: The maxillary nerve (V2) can be approached via the open middle fossa approach.

Objective: To delineate the anatomy of V2 and its specific segments with respect to the endonasal landmarks. We present the endoscopic endonasal interdural middle fossa approach to V2 and its potential application for the treatment of perineural spread in sinonasal/skull base tumors.

Endoscopic transnasal skull base surgery: pushing the boundaries.

The endoscopic endonasal approach (EEA) has significantly evolved since its initial uses in pituitary and sinonasal surgery. The literature is filled with reports and case series demonstrating efficacy and advantages for the entire ventral skull base. With competence in 'minimally invasive' parasellar approaches, larger and more complex approaches were developed to utilize the endonasal corridor to create maximally invasive endoscopic skull base procedures.

Endoscopic Endonasal Transclival Transcondylar Approach for Foramen Magnum Meningiomas: Surgical Anatomy and Technical Note.

Background: The endoscopic endonasal approach provides a direct route to ventral foramen magnum (FM) lesions like meningiomas, which are difficult to access. Endonasal access at the FM is limited laterally by the occipital condyles and inferiorly by the C1 anterior arch and the odontoid process, which may need partial resection.

Objective: We investigated the surgical anatomy and technical nuances for endonasally increasing the surgical corridor at the FM region both laterally and inferiorly.

Skull Base Anatomy.

The anatomy of the skull base is complex with multiple neurovascular structures in a small space. Understanding all of the intricate relationships begins with understanding the anatomy of the sphenoid bone. The cavernous sinus contains the carotid artery and some of its branches; cranial nerves III, IV, VI, and V1; and transmits venous blood from multiple sources.

Gamma Knife Radiosurgery for Atypical and Anaplastic Meningiomas.

Background: Atypical and anaplastic meningiomas have much higher recurrence rates after surgical resection compared with benign meningiomas, but the role of adjuvant radiosurgery remains unclear. This study was undertaken to evaluate the outcomes of gamma knife radiosurgery for patients with atypical and anaplastic meningiomas.

Methods: In this retrospective analysis of a prospectively maintained database, 46 patients with histologically proven atypical or anaplastic meningiomas by current World Health Organization (WHO) criteria underwent postoperative Gamma Knife radiosurgery between 1993 and 2013.

Endoscopic Endonasal Approach to the Optic Canal: Anatomic Considerations and Surgical Relevance.

Background: Increasing use of endoscopic endonasal surgery for suprasellar lesions with extension into the optic canal (OC) has necessitated a better endonasal description of the OC.

Objective: To identify the osseous OC transcranially and then investigate its anatomic relationship to the key endonasal intrasphenoidal landmarks. We also aimed to determine and describe the technical nuances for safely opening the falciform ligament and intracanalicular dura (surrounding the optic nerve [ON]) endonasally.