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Introduction Radiation-induced hypopituitarism (RIH) has long been recognized as one of the deleterious side effects of skull base radiation. This study aims to assess the quality of life (QoL) among patients with RIH compared with radiated patients who did not develop hypopituitarism using the validated Anterior Skull Base Questionnaire (ASBQ). Methods This was a single-institution retrospective cohort study. Included patients had a history of anterior skull base tumor, underwent at least one round of radiation to the skull base, and had filled out at least one ASBQ survey after their radiation treatment. Three statistical models were used to determine the effect of hypopituitarism and treatment on QoL scores. Results A total of 145 patients met inclusion criteria, and 330 ASBQ surveys were analyzed. Thirty-five percent (51/145) had evidence of RIH at some point after their radiation treatment. Those with hypopituitarism had significantly lower overall ASBQ scores across all three models even after adjusting for potential confounders and intraperson correlation (average decrease of 0.24–0.45 on a 5-point Likert scale; p -values ranging from 0.0004 to 0.018). The increase in QoL with hormonal replacement was modulated by time out from radiation, with long-term survivors (5+ years out from radiation) gaining the most benefit from treatment (increase of 0.89 on a 5-point Likert scale, p 0.0412), especially in the vitality domain. Conclusion This data demonstrates that hypopituitarism is an independent predictor of lower QoL. Early detection and appropriate treatment are essential to avoid the negative impact of hypopituitarism on QoL. [ABSTRACT FROM AUTHOR]

Introduction  Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. Methods  We conducted a multicenter retrospective analysis of shared quality data points for the endoscopic endonasal approach (EEA) for pituitary adenomas, along with other sellar and parasellar region masses that were included by participating institutions. Patient and operative characteristics, perioperative and postoperative antibiotic regimens and their durations, intraoperative and postoperative cerebrospinal fluid leak, and onset of postoperative meningitis and sinusitis were compared. Results  Fifteen institutions participated and provided 6 consecutive months' worth of case data. Five hundred ninety-three cases were included in the study, of which 564 were pituitary adenomectomies. The incidences of postoperative meningitis and sinusitis were low (0.67 and 2.87% for all pathologies, respectively; 0.35% meningitis for pituitary adenomas) and did not correlate with any specific antibiotic regimen. Immunocompromised status posed an increased odds of meningitis in pituitary adenomectomies (28.6, 95% confidence interval [1.72–474.4]). Conclusions  The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed. [ABSTRACT FROM AUTHOR]

Objectives  The role of surgery in management of sinonasal rhabdomyosarcoma (SNRMS) has traditionally been limited, owing to anatomic and technological challenges and the established role of systemic therapy. Herein, we report our institutional experience with surgical management of SNRMS, with a particular focus on operative approaches, extent and outcomes. Design  This study is a retrospective cohort study. Setting  This study was conducted at a single-institution, academic center. Participants  Patients of any age with histologically confirmed RMS of the nasal cavity, maxillary, ethmoid, frontal, or sphenoid sinus, nasolacrimal duct, or nasopharynx presenting between 1994 and 2020 were included in this study. Main Outcome Measures  Demographics, tumor characteristics, operative settings, complications and recurrence, and survival outcomes were the primary outcomes of this study. Results  Our study cohort comprised of 29 patients (mean [range] age: 27.0 [3.1–65.7], n  = 12 [41%] female). Tumors of the nasal cavity (n  = 10, 35%) and ethmoid sinuses (n  = 10, 35%) and those with alveolar histology (n  = 21, 72%) predominated. Patients who had surgery as part of their treatment (n  = 13, 45%) had improved distant metastasis-free survival (DMFS) overall (hazard ratio [HR]: 0.32, 95% CI: 0.11, 0.98, p  = 0.05) as compared with those who did not have surgery. Surgical approaches included open (n  = 7), endoscopic (n  = 4), and combined (n  = 2). Eight of these 13 patients (62%) had an R0 resection. Additionally, surgical salvage of recurrent disease was employed in five patients (17%). Conclusion  SNRMS is an aggressive malignancy with a high rate of recurrence and spread requiring a multidisciplinary approach for optimal outcomes. Our data supports an expanding role for surgery for SNRMS given its feasibility, tolerability, and potential to improve outcomes. [ABSTRACT FROM AUTHOR]

Objectives  Antibiotic use in lateral skull base surgery (LSBS) has not been thoroughly investigated in the literature. There is wide variability in antibiotic use and insufficient data to guide management. This study aims to describe the factors and patterns influencing antibiotic use in LSBS among the membership of the North American Skull Base Society (NASBS). Design  An online-based survey was designed and distributed to the membership of the NASBS. Data was analyzed using bivariate analysis and logistic regression modeling. Setting  Online-based questionnaire. Participants  NASBS membership. Main Outcome Measures  Use of intraoperative antibiotics and use of postoperative antibiotics. Results  The survey response rate was 26% (208 respondents). Of the 208 total respondents, 143 (69%) respondents performed LSBS. Most respondents are neurosurgeons (69%) with the remaining being otolaryngologists (31%). The majority of respondents (79%) are fellowship-trained in skull base surgery. Academic or government physicians make up 69% of respondents and 31% are in private practice with or without academic affiliations. Bivariate analysis showed that practice setting significantly influenced intraoperative antibiotic use (p  = 0.01). Geographic location significantly affected postoperative antibiotic use (p  = 0.01). Postoperative antibiotic duration was significantly affected by presence of chronic otitis media, cerebrospinal fluid leak, and surgeon training (p  = 0.02, p  = 0.01, and p  = 0.006, respectively). Logistic regression modeling showed that the motivation to reduce infection significantly impacted postoperative antibiotic use (p  = 0.03). Conclusion  This study demonstrates significant variations in intraoperative and postoperative antibiotic use in LSBS among the NASBS membership. Appropriate guidelines for optimal perioperative antibiotic use patterns should be determined with randomized studies in the future. [ABSTRACT FROM AUTHOR]

Background  Sinonasal melanoma is a rare disease with a high mortality rate. The surgical management paradigm has significantly changed over the past decade with the introduction of expanded endonasal techniques. There have also been advances in management of metastatic and locally advanced disease with the advent of immunotherapy. Methods  Single-institution retrospective review of adult patients with sinonasal melanoma, surgically managed at the University of Michigan over a 9-year period. Thirty-one patients met inclusion criteria. All patients were retrospectively staged according to the 7th Edition AJCC staging system for mucosal melanoma. Parameters that may affect survival were analyzed using Cox's proportional hazard models and survival outcomes were analyzed with the Kaplan–Meier method. Additionally, a review of three patients with distant metastatic disease receiving immunotherapy is presented. Results  Most patients were managed endoscopically (67%), and had stage III disease (71%). However, 57% of stage IVB tumors were successfully managed endoscopically. Stage statistically impacted overall survival whereas distant control was impacted by stage, site of origin, mitotic rate, and necrosis. The 2-year overall survival for all stages was 77% which declined with advanced disease. Two-year locoregional control and distant control showed similar trends. Conclusion  Treatment of sinonasal melanoma has drastically changed over the past decade with increased use of expanded endonasal techniques. Our review revealed excellent 2-year overall survival in stage III disease with an appreciable decline in survival in more advanced disease. Immunotherapy may play a large role is future management given the high-risk of distant metastasis. [ABSTRACT FROM AUTHOR]