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This article discusses the surgical outcomes of patients who underwent endoscopic radical resection of skull base lesions that required sacrificing the internal carotid artery (ICA). The study included 14 cases with various pathologies, including osteoradionecrosis, skull base malignancy, and rhinocerebral mucormycosis. The management of the ICAs varied, with some cases experiencing spontaneous occlusion, while others required intentional occlusion or bypass surgery. The study found that there were no treatment-related deaths, but there were some morbidities associated with the resection and bypass procedures. The prevalence of severe headaches decreased after the resection, but the incidence of cranial nerve palsy increased. The overall survival rates were 62.9% for progression-free survival and 70.0% for overall survival. The study concludes that radical resection of skull base lesions invading the ICA can be performed with no perioperative mortality, and good surgical outcomes can be expected depending on the pathology. [Extracted from the article]

This article discusses the treatment results of craniofacial resection (CFR) for sinonasal tumors involving the anterior skull base. The study compares the outcomes, complications, and morbidity of different surgical approaches and pathologies. The findings show that endoscopic CFR has become the main surgical approach in recent years, with comparable or better results and decreased complication rates and morbidity compared to the open approach. However, the selection of surgical approach and extent of excision should consider the pathology and staging of the tumor. [Extracted from the article]

This article explores the relationship between age and olfactory recovery after endoscopic endonasal anterior skull base surgery. The study conducted a retrospective analysis on 46 patients who underwent the surgery and found that age had a negative correlation with olfactory function at both 3-month and 6-month postoperative time points. Additionally, histological analysis of the olfactory epithelium showed that a higher number of mature olfactory sensory neurons and basal cells were associated with more favorable olfactory outcomes in younger patients. The findings suggest that age and histological characteristics play a role in postoperative olfactory recovery. [Extracted from the article]

Objective  Skull base osteoradionecrosis (SB-ORN) is a serious, potentially lethal complication of radiation therapy. We aimed to review the clinical characteristics and outcomes of SB-ORN according to the extent of treatment. Design  Retrospective analysis design was used for this study. Setting  The study was conducted in two tertiary care hospitals. Participants  Patients included who had been clinically diagnosed with SB-ORN from January 2006 to 2017. Main Outcome Measures  Clinical characteristics, including demographics, predisposing factors, presenting symptoms, radiological findings, treatment modalities, and treatment outcomes, were reviewed. Treatment was classified into conservative and aggressive types. Aggressive treatment included radical surgical removal of soft tissue and bony sequestrum with the placement of vascularized tissue. Treatment outcome was analyzed in terms of clinical control, survival, and carotid artery blow out. Results  Fifteen patients (11 males and 4 females) were identified during the study period. Eight patients were managed conservatively, whereas seven patients were managed with aggressive treatment. The 2-year survival was 75% in the aggressive treatment group and 15% in the conservative group (log-rank, p  = 0.049). The estimated 2-year blow out free rate was 46.7% for the conservative group and 100% for the aggressive group (log-rank, p  = 0.100). Conclusion  In patients with SB-ORN, aggressive management, including surgical removal of sequestrum and coverage with a pedicled flap, is associated with increased survival. [ABSTRACT FROM AUTHOR]

Background: We recently introduced a patient‐specific rhinologic virtual surgical environment (VSE) that has shown potential for surgical rehearsal of various skull base lesions. Our aim in this study was to validate the usefulness of the rhinology VSE in performing the Draf 3 procedure. Methods: An outside‐in Draf 3 procedure was performed on 4 cadaver heads. Computed tomography (CT) scans were obtained before and after cadaver dissection (CD). Pre‐dissection CT scans were used to construct a cadaver‐specific VSE. A virtual Draf 3 dissection (VD) was performed using the same technique. Validation was conducted by comparing the final common frontal outflow tract. A subjective comparison of the post‐dissection endoscopic findings (CD vs VD) and an objective measurement using the post‐dissection CT scan for the CD and the reconstructed CT scan obtained from the data after the VD was performed. Results: Subjective overall resemblance of the 2 dissections (CD vs VD) assessed by the 4‐point Likert scale (0‐3) was 2.5 (median interquartile range [IQR], 0.25) for the 4 cadavers. The median difference for the anteroposterior dimension of the frontal neo‐ostium (CD vs VD) assessed in the midsagittal view was 0.11 mm, whereas the median difference for the lateral dimension assessed in the coronal view was 2.71 mm. Thus, no statistical difference was observed. Conclusion: VD showed nearly matching results with the actual cadaver dissection. With further validation, our rhinologic VSE may be used for presurgical planning and rehearsal before the actual Draf 3 procedure is performed in the operating room. [ABSTRACT FROM AUTHOR]

Background The objective of this work was to assess the feasibility of using the nasoseptal flap (NSF) for covering the anterior skull-base defect in Asians, and to compare the results in whites. Methods A retrospective radioanatomic analysis was conducted in 100 Korean adult patients. Septal and skull-base dimensions were measured and the feasibility of the NSF in reconstructing a full anterior skull-base defect was evaluated. Scans of 49 white patients were analyzed for a comparative study. Results Among various septal dimensions, the length of the septum was significantly different in Koreans when compared to whites. Skull-base dimensions such as anterior skull-base length and width at the level of the anterior ethmoidal artery were different between the 2 ethnic groups. Individual differences between the anterior width of the hypothetical NSF and the anterior margin of the skull-base defect (2.8 ± 3.1 vs 6.4 ± 4.8) and the difference between the hypothetical NSF length and the length of the flap needed for full coverage of the defect were significantly smaller in Korean patients (7.2 ± 3.8 vs 13.1 ± 5.6), leading to a statistically higher chance of flap insufficiency. The insufficiency was more often found in female patients. Conclusion The risk of NSF insufficiency for covering the anterior skull-base defect in Koreans is higher relative to whites, and is accentuated in female patients. Efforts to increase the size of the NSF as well as efforts to avoid intraoperative shrinkage of the NSF should be considered to compensate for the relatively small NSF in Asians. [ABSTRACT FROM AUTHOR]

Background The extended endoscopic endonasal approach (EEA) to the anterior cranial base is used for the resection of craniopharyngiomas. Objective We present clinical experience and outcomes of using EEA for craniopharyngiomas. Methods A total of 116 patients in 2 remote institutions were enrolled in this retrospective study. Surgical, endocrinologic, and ophthalmologic outcomes were assessed. Results The mean follow-up was 35 months (range, 1–115). Gross total resection (GTR), near total resection (NTR, >95%), and subtotal resection (STR) were achieved in 46%, 39%, and 15% of the patients, respectively. Surgery performed after 2010 was the only variable significantly associated with greater extent of resection, which might be explained by the learning curve. Overall tumor recurrence rate was 15.5%, with a median interval until recurrence of 14.5 months (range, 3–58). Extent of resection was significantly associated with recurrence-free survival ( P = 0.0116). Those who underwent NTR/STR followed by adjuvant radiotherapy had a similar median recurrence-free survival rate compared with those who underwent GTR (26.5 vs. 20 months, P = 0.167). Endocrinologic examination revealed that 47.4% of patients experienced worsening of anterior pituitary function following surgery while 25.5% developed new-onset diabetes insipidus. Of the 89 patients with preoperative visual deficits, 68 (76.4%) experienced improvement in visual field assessment. Conclusion EEA is effective for the surgical resection of craniopharyngiomas, resulting in high rates of visual improvement and low complication rates. Adjuvant radiotherapy is a useful method for tumor control after incomplete resection. [ABSTRACT FROM AUTHOR]