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The predictive value of intraoperative visual evoked potential for visual outcome after extended endoscopic endonasal surgery for adult craniopharyngioma.

J Neurosurg 2021 May 7:1-11. Epub 2021 May 7.

1Department of Neurosurgery, Beijing Tiantan Hospital, and.

Objective: Due to the proximity of craniopharyngioma to the optic apparatus, one of the most common complications after surgery is visual deterioration. Intraoperative visual evoked potential (VEP), as a means of real-time visual function monitoring, has been integrated into transsphenoidal surgery for pituitary adenoma to predict postoperative visual outcome. Compared with pituitary tumor, craniopharyngioma often adheres to optic nerves, with increased risk of postoperative visual impairment. Read More

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Endoscopic Endonasal Surgery of a Large Vidian Nerve Schwannoma With Preparation for Avoiding Major Vascular Injury.

Cureus 2021 Mar 31;13(3):e14230. Epub 2021 Mar 31.

Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JPN.

Vidian nerve schwannomas are extremely rare, and their surgical management requires an awareness of the surrounding vascular and nervous systems, including the internal carotid artery. Herein, we report a case of a vidian nerve schwannoma that was successfully removed using an endoscopic endonasal approach in a 21-year-old patient who presented with lacrimal hyposecretion. Imaging revealed a large mass extending to the middle cranial fossa posteriorly, to the pterygopalatine fossa laterally, and to the sphenoid sinus medially. Read More

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Commentary: The Infratemporal Retro-Eustachian Transposition of the Temporoparietal Fascial Flap for Clival Reconstruction After Endoscopic Endonasal Approach: An Anatomic Conceptual Technique.

Authors:
Patrik Pipkorn

Oper Neurosurg (Hagerstown) 2021 May 6. Epub 2021 May 6.

Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, USA.

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Impact of Routine Endoscopic Skull Base Surgery on Subjective Olfaction and Gustation Outcomes.

Oper Neurosurg (Hagerstown) 2021 May 6. Epub 2021 May 6.

Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Background: As endoscopic endonasal skull base surgery (EESBS) for sellar pathology has become routine, there is increasing awareness of quality-of-life (QOL) outcomes related to this approach. Similarly, there is a growing interest in postoperative chemosensory function, with notable emphasis on olfaction and the corresponding psychosocial implications of olfactory dysfunction. Meanwhile, there has been minimal direct investigation into gustatory outcomes, and the association between these 2 chemosensory functions remains poorly understood. Read More

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The Infratemporal Retro-Eustachian Transposition of the Temporoparietal Fascial Flap for Clival Reconstruction After Endoscopic Endonasal Approach: An Anatomic Conceptual Technique.

Oper Neurosurg (Hagerstown) 2021 May 6. Epub 2021 May 6.

Department of Neurosurgery, Stanford Medical Center, Stanford, California, USA.

Background: Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important. Read More

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Endonasal CNS Delivery System for Blood-Brain Barrier Impermeant Therapeutic Oligonucleotides Using Heterotopic Mucosal Engrafting.

Front Pharmacol 2021 19;12:660841. Epub 2021 Apr 19.

Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, United States.

The most significant obstacle in the treatment of neurological disorders is the blood-brain barrier (BBB), which prevents 98% of all potential neuropharmaceuticals from reaching the central nervous system (CNS). Brain derived neurotrophic factor (BDNF) is one of the most intensely studied targets in Parkinson's disease (PD) as it can reverse disease progression. BDNF AntagoNAT's (ATs) are synthetic oligonucleotide-like compounds capable of upregulating endogenous BDNF expression. Read More

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Transcavernous Resection of an Upper Clival Chondrosarcoma: "Cavernous Sinus as a Route": 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 May 3. Epub 2021 May 3.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Complete resection of skull base chondrosarcomas offers the potential for a durable, or even lifelong, cure and is best achieved at the first surgery.1,2 When a skull base chondrosarcoma is located at the upper clivus and in the interpeduncular cistern and invading laterally toward the petrous apex and cavernous sinus, the traditional approaches, ie, endonasal endoscopic or middle fossa approaches, are not adequate for the exposure and resection. The transcavernous sinus approach has been utilized to remove tumor from the cavernous sinus and as a corridor to the interpeduncular cistern and upper clivus, originally described for the clipping of basilar apex aneurysms. Read More

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Petrosal Approach for Giant Retrochiasmatic Craniopharyngioma: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 May 3. Epub 2021 May 3.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Microsurgical resection of craniopharyngiomas poses significant challenges, which are amplified with tumors in the retrochiasmatic location and larger size. Traditional pterional trans-sylvian, subfrontal translamia terminalis, or interhemispheric approaches provide narrow surgical corridors with obstructed visualization of the tumor by the prefixed chiasm and slit optic carotid window.1-5 The superior extension of the tumor compressing the hypothalamus and third ventricle are likewise inaccessible. Read More

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Staged Repositioning in Endoscopic Endonasal Odontoidectomy Maximizes Decompression while Allowing Preservation of the C1 Anterior Arch: A Technical Note.

World Neurosurg 2021 Apr 30. Epub 2021 Apr 30.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213. Electronic address:

Background: Preservation of the anterior arch of C1 in endoscopic endonasal odontoidectomy has been proposed as an alternative to complete C1 arch resections, potentially affording less destabilization of the craniocervical junction. Nonetheless, this approach may limit the decompression achieved. In this case, intra-operative repositioning allowed maximal decompression while preserving the anterior arch of C1. Read More

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Long-Term Quality of Life after Endoscopic Pituitary Adenoma Surgery with Nasoseptal Flap Reconstruction.

Rambam Maimonides Med J 2021 Apr 29;12(2). Epub 2021 Apr 29.

Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel.

Introduction: Endoscopic endonasal transsphenoidal surgery (EETS) on the pituitary gland is considered safe and efficacious. The nasoseptal flap (NSF) is sometimes used to prevent or repair postoperative cerebrospinal fluid (CSF) leaks. Few investigators have quantified long-term quality-of-life (QOL) outcomes regarding sinonasal measures after EETS, with or without involvement of the NSF. Read More

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Optic Canal Decompression: Concepts and Techniques: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Apr 30. Epub 2021 Apr 30.

Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA.

The optic canal (OC) is a bony channel that transmits the optic nerve (ON) and ophthalmic artery (OphA) as they course through the lesser wing of the sphenoid bone to the orbital apex. The OC is involved in a variety of intracranial and extracranial pathologies,1 and opening of the canal may be necessary in order to achieve adequate exposure, better disease control, and vision preservation.2 Depending on the location of the pathology and its relationship with the optic nerve, the OC may be decompressed through an open transcranial approach or an endoscopic endonasal approach. Read More

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Commentary: Endoscopic Endonasal Excision of an Optic Pathway Cavernous Malformation: Technical Case Report.

Oper Neurosurg (Hagerstown) 2021 Apr 30. Epub 2021 Apr 30.

Department of Neurosurgery, NSCB Medical College, Jabalpur, India.

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Pterygovaginal artery as a target of embolization before endoscopic skull base surgery.

Neuroradiol J 2021 Apr 30:19714009211013490. Epub 2021 Apr 30.

Department of Neurosurgery, Keio University School of Medicine, Japan.

Background: The pterygovaginal artery (PtVA), a recurrent branch of the internal maxillary artery (IMA), can be a feeder of skull base tumors. Preoperative embolization can help endoscopic resection of hypervascular lesions, which is performed under a narrow surgical space with restricted instrumental maneuverability.

Methods: We performed preoperative embolization in five cases with hypervascular skull base lesions supplied by the PtVA, four of which were resected via endoscopic endonasal approach. Read More

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Extradural anterior temporal fossa approach to the paranasal sinuses, nasal cavities through the anterolateral and anteromedial triangles: Combined microscopic and endoscopic strategy.

Acta Neurochir (Wien) 2021 Apr 29. Epub 2021 Apr 29.

Department of Neurosurgery, Lariboisière Hospital, University of Paris, 2 rue Ambroise Paré, 75010, Paris, France.

Objective: To demonstrate the utility and limitations of the extradural endoscopic-assisted anterior temporal fossa approach to the pterygopalatine fossa (PPF), infratemporal fossa (ITF), paranasal sinuses (PS), parapharyngeal region (PPR), nasal cavities (NC), epipharynx (EP), and clivus.

Methods: A frontotemporal orbitozygomatic craniotomy is performed. The dura is elevated from the cavernous sinus (CS). Read More

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Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey.

Eur Arch Otorhinolaryngol 2021 Apr 29. Epub 2021 Apr 29.

Department of Otorhinolaryngology, Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark.

Purpose: The aim of this study was to investigate and compare the use of simulation-based technical skills training (SBTST) in the otolaryngology curriculum in different countries, and to explore the needs and opinions about the use of simulation among young otolaryngologists.

Methods: An e-survey conducted among Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) members.

Results: 139 Yo-IFOS members from 51 countries completed the survey. Read More

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Incidence and Management of Delayed Epistaxis Following Endoscopic Skull Base Surgery.

Turk Arch Otorhinolaryngol 2021 Mar 26;59(1):49-53. Epub 2021 Mar 26.

Department of Otorhinolaryngology, University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.

Objective: Among other complications of endoscopic skull base surgery, delayed epistaxis has not been given much importance. This report presents postoperative delayed nosebleed cases in a large number of patients who underwent an endoscopic endonasal transsphenoidal approach to the sellar region for resection of lesions.

Methods: Three hundred and sixty three patients who were reached to the sellar region by endoscopic endonasal transsphenoidal route and operated was included in the study. Read More

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Symptomatic ecchordosis physaliphora of the upper clivus: an exceedingly rare entity.

Acta Neurochir (Wien) 2021 Apr 26. Epub 2021 Apr 26.

Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.

Objective: This paper highlights the management of 5 patients affected by symptomatic ecchordosis physaliphora (EP), treated via endoscopic endonasal transsphenoidal-transclival approach and contextual multilayer skull base reconstruction. A detailed analysis of each case is provided, along with the review of the current body of literature.

Methods: A retrospective review of patients treated by means of endoscopic endonasal approach for EP from 2010 to 2020 in the Otolaryngology and Neurosurgery Departments of a tertiary-care referral center for endoscopic skull base surgery was analyzed. Read More

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Endonasal endoscopic management of different cases of dentigerous cysts and ectopic teeth.

J Surg Case Rep 2021 Apr 19;2021(4):rjab099. Epub 2021 Apr 19.

ENT Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Dentigerous cyst is a type of developmental odontogenic cysts that arises from the crown impacted, embedded or unerupted teeth that standardly managed by Caldwell-luc procedure, which is found to be associated with morbidities and complications. Endonasal endoscopic removal is a minimally invasive approach aiming to prevent morbidities and complications. The aim of this article is to study the advantages of the endonasal endoscopic approach in managing different cases of dentigerous cyst and ectopic teeth. Read More

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[Excisional surgery of orbital tumors].

Ophthalmologe 2021 Apr 23. Epub 2021 Apr 23.

Klinik für Augenheilkunde, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland.

The indications for orbital tumor surgery are an incisional biopsy to confirm the diagnosis or in malignant operable tumors a complete excision or a debulking to avoid complications in large invasively infiltrating tumors. In the case of benign tumors, the indications for surgery depend mostly on the clinical symptoms and cosmetic esthetic disfigurement. In the present article the preoperative examinations as well as surgical access approaches to different orbital regions, endoscopic procedures and methods of intraoperative navigation are presented. Read More

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Suction mask device: a simple, inexpensive, and effective method of reducing spread of aerosolized particles during endoscopic endonasal surgery in the era of COVID-19.

J Neurosurg 2021 Apr 23:1-7. Epub 2021 Apr 23.

Departments of1Neurosurgery and.

Objective: Aerosol-generating procedures, including endoscopic endonasal surgery (EES), are a major risk for physicians during the COVID-19 pandemic. Techniques for reducing aerosolization and risk of transmission of COVID-19 during these procedures would be valuable to the neurosurgical community. The authors aimed to simulate the generation of small-particle aerosols during EES and craniectomy in order to develop methods to reduce the spread of aerosolized particles, and to test the effectiveness of these methods. Read More

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Endoscopic endonasal approach for craniopharyngiomas.

J Neurosurg Sci 2021 Apr;65(2):133-139

Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.

The operative management of craniopharyngiomas has evolved over the last two decades. Traditional transcranial microsurgical approaches were the only option until the advent of the endoscopic endonasal approach. It has given surgeons the ability to tackle a challenging entity from a new perspective with comparable if not superior results. Read More

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The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy.

Braz J Otorhinolaryngol 2021 Apr 10. Epub 2021 Apr 10.

Bandırma State Hospital, Ophthalmology Department.

Introduction: Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors.

Objective: To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Read More

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Intracavernous branches of the internal carotid artery through an endoscopic endonasal approach: anatomical study and review of the literature.

World Neurosurg 2021 Apr 19. Epub 2021 Apr 19.

Human Anatomy Unit of the Universitat Autònoma de Barcelona (UAB), Barcelona Spain.

Objective: The endoscopic endonasal transcavernous (EET) approach is an increasingly popular approach for cavernous sinus (CS) and surrounding structure lesions as well as a surgical corridor to pre-mesencephalic cisterns. This endoscopic study describes the main intracavernous branches of the internal carotid artery (ICA), providing nuances to improve the safety of this approach.

Material And Methods: Forty-six fresh CS (23 heads) were injected with colored silicon and studied via an EET approach; six were excluded due to insufficient injection. Read More

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Closure of skull base defects after endoscopic endonasal transsphenoidal surgery: the role of the local sphenoid mucosal flap for low flow leaks.

Neurosurg Rev 2021 Apr 22. Epub 2021 Apr 22.

Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.

A local sphenoid mucosal flap (SMF) is naturally raised during endonasal exposure of the sella. Typically, these flaps are repositioned; however, they could be used in place of a nasoseptal flap (NSF) for closure of low-grade CSF leaks. In this study, we aim to establish the safety and efficacy of SMF closure for low-grade CSF leaks and to assess the impact on sinonasal quality of life (QoL) compared to NSF closure. Read More

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Long Term Outcomes of Nasoseptal Perforation Repair With an Anterior Ethmoidal Artery Flap.

Am J Rhinol Allergy 2021 Apr 20:19458924211012120. Epub 2021 Apr 20.

Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.

Background: Nasoseptal perforation repair is a challenging condition with no standard technique for repair recognized.

Methods: A case series of consecutive patients who underwent nasoseptal perforation repair with an anterior ethmoidal artery flap was conducted. Demographic data, preoperative features of the perforation and postoperative outcomes were analyzed. Read More

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Novel Bendable Ring Curette for Endoscopic Transsphenoidal Surgery for Pituitary Tumors.

World Neurosurg 2021 Apr 16. Epub 2021 Apr 16.

Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.

Objective: In transsphenoidal resection of pituitary tumors, even dedicated instruments sometimes cannot readily reach the surgical fields and they interfere with the endoscope and other instruments, making instrumental manipulations difficult and often ineffective. To solve these problems, we invented a bendable ring curette to further improve maneuverability and accessibility.

Methods: The newly developed ring curette has a tip (14-mm long) that can bend spanning a range of 90°. Read More

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Combined Endonasal-Transorbital Approach to Manage the Far Lateral Frontal Sinus: Surgical Technique.

World Neurosurg 2021 Apr 17;151. Epub 2021 Apr 17.

Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Varese, Italy.

In recent decades, the ever-expanding use of endoscopes and development of dedicated instrumentation have reshaped the panorama of surgical approaches to the frontal sinus. Nonetheless, the far lateral portion of the sinus might still represent a concern, especially in cases with unfavorable or distorted anatomy. We report the case of a 52-year-old man, referred to our department for recurrent episodes of left orbital swelling and supraorbital headache, 3 months after Draf III frontal sinusotomy for marsupialization of multiple frontal mucoceles. Read More

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Results of Endoscopic Surgery in Patients with Pituitary Adenomas : Association of Tumor Classification Grades with Resection, Remission, and Complication Rates.

J Korean Neurosurg Soc 2021 Apr 16. Epub 2021 Apr 16.

Department of Neurosurgery, Bakirkoy Research & Training Hospital for Psychiatry, Neurology, and Neurosurgery, Health Sciences University, Istanbul, Turkey.

Objective: The endoscopic endonasal transsphenoidal approach is a widely-used method for the surgical treatment of pituitary adenomas. We aimed to evaluate the results of endoscopic surgery by comparing preoperative classification methods and investigating their relationship with postoperative resection and remission rates and complications.

Methods: We retrospectively reviewed the medical records of 236 patients (118 males) who underwent surgery for pituitary adenomas. Read More

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