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Abstract Background Chordoma is a rare slow-growing malignant bone tumor that arises from embryonic notochordal remnants in the axial skeleton. Clival chordomas have a high propensity for extension through the skull base and a high proclivity for recurrence. Recently, resection of skull base chordomas through the endoscopic transnasal approach has become the standard way of managing these lesions with the new advancements in neuronavigation and reconstructive techniques in skull base surgery. Methods It is a retrospective study of all patients with clival chordoma that were operated upon using endoscopic endonasal resection at the Main Alexandria University Hospital during the period from March 2008 to April 2013. The extent of surgical resection was assessed intraoperatively and confirmed by the postoperative MRI study performed 8–12 weeks, 6 months, and yearly after the surgery. Results Twelve patients with clival chordoma were managed by endoscopic transnasal resection. Gross total resection confirmed by postoperative MRI was achieved in four cases, subtotal resection in six cases, and partial resection in two cases of clival chordoma. In cases where gross total resection was not achieved, residual tumors were adherent to vital neurovascular structures as confirmed with the utilization of an intraoperative imaging navigation device. A study of postoperative complications and possible recurrence was done for all cases. Conclusions The findings of this study highlight the significance of gross total resection as a major determinant for preventing the recurrence of chordoma. Our findings also support the validity of the endoscopic approach for the management of clival chordoma especially when the approach is tailored based on the site and extent of the tumor.

Objective:Transection or ablation of the posterior nasal nerve (TRPN) has been described as an adjunctive tool to reduce the symptoms of intractable allergic rhinitis (AR). The procedure, however, requires surgical skill and carries the risk of bleeding from the sphenopalatine artery. The aim of the present study is to describe radiofrequency ablation of the peripheral branches of the posterior nasal nerves within the inferior turbinates (RAPN) as an effective easier alternative to TRPN.Methods:The procedure was performed on 24 patients with intractable AR. Nasal reactivity was tested by cold dry air (CDA) provocation before and 12 months after the radiofrequency procedure. Visual analog scale and acoustic rhinometry were used to measure the changes in nasal reactivity subjectively and objectively.Results:Worsening of nasal symptoms following CDA provocation had significantly decreased after the RAPN procedure. Likewise, postoperative decrease in nasal volumes and minimal cross-sectional areas after CDA provocation were significantly less than the corresponding preoperative values.Conclusion:RAPN effectively reduces nasal reactivity in patients with AR. The procedure is simple, minimally invasive, and can be performed under local or general anesthesia.

Abstract Background The physiological functions of the paranasal sinuses are as yet unclear, and it is often assumed that these empty air-filled spaces have no vital function in our body. Recently, nitric oxide has been reported to be synthetized in high concentration by the paranasal sinuses which seems to be the main function of these air-filled empty spaces. Body of abstract The functional role of the paranasal sinuses is still ambiguous despite the several hypotheses that have been put forward to justify their existence. Although it has been recently demonstrated that the paranasal sinuses produce large amounts of nitric oxide (NO), otolaryngologists overwhelmed by attempting to unravel the enigmatic etiology underlying chronic rhinosinusitis have interpreted the high NO output in this context. Nevertheless, NO prime function is vasodilation and has long been recognized to be produced by the endothelial cells. In this review, evidence in the literature is piled and pieces of the puzzle are put together to show that NO synthesized in the paranasal sinuses functions as an airborne messenger that induces pulmonary vasodilation and thereby decreases the workload on the heart. Recognition that the paranasal sinuses are in fact an organ with known function is likely to foster further research and has an impact on our current surgical philosophy. Conclusion The paranasal sinuses seem to play a vital physiological role in our body rather than being evolutionary remnants as initially thought. They are likely responsible for regulating the pulmonary blood pressure thereby preventing pulmonary hypertension.

Abstract Objective The objective of the study was to translate the Sino-Nasal Outcome Test 22 (SNOT-22) into Arabic and to check its reliability and validity in Arabic-speaking patients. Patients and methods The study included 178 patients with confirmed chronic rhinosinusitis (CRS) and 95 asymptomatic individuals as a control group. All participants completed the Arabic SNOT-22 (A-SNOT-22) questionnaire. The scores of the two groups were compared for validity analysis. Eighty-two patients completed the questionnaire twice, 1 week apart, for test-to-test reliability analysis. The A-SNOT-22 scores of 60 CRS patients were correlated with Lund–Mackay scores for criterion validity analysis. The preoperative and postoperative scores of 73 patients were compared for responsiveness analysis. Results All participants completed the questionnaire with no or minimal assistance. Internal consistency (α=0.90) and test-to-test reliability (intraclass correlation=0.78) were good. The differences between the scores of CRS patients and asymptomatic individuals were significant (P