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Objective To study the etiological and anatomical factors in pathophysiology of invasive fungal rhinosinusitis affecting the skull base. Design Retrospective clinical study over 5 years. Setting Single-center tertiary referral hospital. Materials and Methods All cases of invasive fungal rhinosinusitis with clinicoradiological and/or operative evidence of anterior and central skull base, orbit, and orbital apex involvement with or without intracranial disease were included in the study. Patients with a sinonasal-palatal disease without the involvement of the skull base or orbit were excluded from the study. In addition, we assessed the risk factors such as coronavirus disease 2019 (COVID-19) infection, diabetes mellitus (DM), and other immunocompromised conditions. Results There were 79 patients, of which 65.8% had skull base rhino-oribitocerebral mucormycosis (ROCM), and 34.2% had Aspergillus infection. The mean duration from onset of the symptom to presentation of ROCM was 36.75 ± 20.97 days, while for the Aspergillus group was 21 weeks. The majority of patients (66%) with ROCM presented after 30 days of symptom onset. Among ROCM patients, 88.7% had a history of COVID-19 infection, and 96% had DM. In 40.8% of patients with Aspergillus infection, the tissue diagnosis was unavailable, and galactomannan assay and clinicoradiological assessment were used for diagnosis. The most common area of the skull base involved was the pterygopalatine fossa (88.5%), followed by the infratemporal fossa (73.1%). The most common neurovascular structure (75%) involved was the pterygopalatine ganglion and the infraorbital nerve. Conclusion With the increasing incidence of invasive fungal infections worldwide, particularly after the COVID-19 pandemic, it is crucial to understand the evolving nature of this disease. ROCM, documented in the literature to cause fulminant disease, became a chronic illness, possibly due to the improvement of the patient's immunity during the disease course. [ABSTRACT FROM AUTHOR]

Byline: Nazrin. Hameed, Ravi. Manogaran, Abhishek. Dubey, Govind. Bhuskute, Kanika. Arora, Amit. Keshri, Anant. Mehrotra, Awadhesh. Jaiswal, Kuntal. Das, Kamlesh. Bhaisora, Arun. Srivastava, Raj. Kumar, Ramandeep. Virk The lateral recess [...]

Byline: Jayesh. Sardhara, Arun. Srivastava, Satya. Pandey, Amit. Keshri, Anant. Mehrotra, Kuntal. Das, Kamleshsingh. Bhaishora, Awadesh. Jaiswal, Sanjay. Behari Background: This prospective study analyzes the factors responsible for pre and [...]

Objectives  The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design  Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting  The study was conducted in a tertiary care referral center. Main Outcome Measures  The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results  A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n  = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n  = 2), cosmetic deformity (24%, n  = 4), petrous internal carotid artery injury (7%, n  = 1), and hypoglossal nerve palsy (7%, n  = 1). The cosmetic deformity included flap necrosis (n  = 2) and postoperative bony defects leading to contour defects of the scalp (n  = 2). Conclusion  Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes. [ABSTRACT FROM AUTHOR]

Byline: Amit. Keshri, Saurin. Shah, Simple. Patadia, Rabi. Sahu, Sanjay. Behari Introduction: Encephaloceles in relation to the nose are rare lesions affecting the skull base. In the pediatric population, majority [...]

Objective  This study was aimed to understand the usefulness of transarterial angiography and embolization in management of juvenile nasopharyngeal angiofibroma (JNA) and to apply the information obtained to stage the disease, select appropriate surgical approach, predict intraoperative bleeding, and prognosticate the disease. Study Design  This study represents a retrospective review of the patients of JNA with major focus on transarterial angiography and embolization findings and its clinical and surgical implications. Setting  The study conducted at a tertiary-care super-specialty referral center. Participants  Forty-two patients who had undergone transarterial angiography and embolization followed by surgery over the period of 5 years from July 2015 till February 2019 were participated in this study. Main Outcome Measures  Tumor vascular pattern based on transarterial angiography, staging of the disease based on extent and vascular supply, surgical approach selected, and prognosticating the disease were determined from this study. Conclusion  Transarterial angiography with embolization becomes a prudent preoperative investigation for management of JNA. It provides a complete three-dimensional map of the tumor with stage-specific vascular pattern, reduces vascularity of the tumor, and predicts the sites from where bleeding can occur intra operatively. Thus, it helps in choosing the appropriate surgical approach aiding in complete tumor removal with minimal bleeding. [ABSTRACT FROM AUTHOR]