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This meeting abstract was removed due to the OA licensing requirements of this journal. The full abstract is listed here : https://www.svin.org/files/SVIN_2021_Abstracts_for_Web.pdf

Background: The efficacy and safety of radiosurgery led to paradigm shift in the management of cavernous sinus meningiomas. Nevertheless, patients are still significantly affected by cranial nerve deficits related to the mass effect of these tumors. Our management strategy involves the combination of a functional surgical decompression followed by radiation therapy. Methods: We reviewed a single institution's cohort of patients who underwent endoscopic endonasal decompression (EED) for symptomatic meningiomas primarily involving the cavernous sinus (CS) from 2010 to 2016. The preoperative neuro-ophthalmological exam was compared to the 1- and 6-month postoperative exams. The patient's length of hospital stay, complications, and radiological and clinical follow-up were noted. Results: A total of 17 patients underwent EED for CS meningiomas that fit our radiological criteria. The final outcome at the 6-month visit showed five patients (62.5%) with normalization of deficit and three patients (37.5%) with partial improvement of the CNII deficit. Out of the 12 patients who had cavernous sinus cranial nerves (CSCN) deficits, the final outcome at the 6-month visit showed four patients (33.33%) with normalization of deficit, seven patients (58.3%) with partial improvement, and one patient (8.33%) with no improvement. There were no intraoperative complications. Conclusion: The EED for CS meningiomas is a valuable technique when addressing acute/subacute CNII and CSCN deficits. This conservative surgical approach showed good functional outcomes, low morbidity, and low complication rates. However, it does not exempt the need for radiosurgery/radiation therapy for control of tumor growth.

Objectives/Hypothesis Endonasal approaches to the pterygopalatine fossa for epistaxis or as part of a transpterygoid approach have been popularized somewhat by the ability to control the terminal branches of the maxillary artery (MA). Surgical landmarks are useful to identify these arteries. Therefore, identification of surface features on the posterior wall of the antrum that reflect the position of deeper structures within the pterygopalatine fossa would help predict anatomical position and orientation. Study Design Describe the incidence of identifiable markings on the posterior wall of the maxillary sinus and ascertain their nature. Methods An anatomical study of 18 cadaveric specimens noting and recording the presence, location, and number of prominences on the posterior wall of the antrum. After removing the bony wall, structure in the pterygopalatine fossa corresponding to the surface markings was noted. Results Two prominences were identified. Prominence (P)1 extended from the upper part of the posterior wall of the maxillary sinus to the inferior orbit and corresponded to the infraorbital nerve. P2 was located at the middle part of the posterior wall, below P1, and corresponded to the MA. P2 was located medial to a vertical “drop line” where P1 connected to the posterior wall. P1 and P2 were found in 41.7% and 22.2%, respectively, of the specimens. Conclusions This study defines features on the maxillary sinus posterior wall from an endoscopic perspective. These landmarks may be useful to identify the MA and its branches during surgery within the pterygopalatine fossa. Level of Evidence N/A. Laryngoscope, 124:2451–2455, 2014

Background The purpose of this study was to describe the incidence of the middle ethmoidal artery and its anatomical nuances via an endoscopic endonasal approach. Methods A cadaveric study was performed on 22 adult specimens. First, a frontal sinusotomy and ethmoidectomy were performed via an endoscopic endonasal approach in order to fully expose the anterior skull base. Subsequently, the lamina papyracea and the bone of the canals covering the ethmoidal neurovascular bundles were removed to identify the anterior, middle, and posterior ethmoidal arteries. Presence, laterality, and location of the middle ethmoidal artery were recorded. Results A total of 14 middle ethmoidal arteries were identified (10 right and 4 left), among 44 sides (22 specimens), accounting for an incidence of 31.8%. Bilateral middle ethmoidal arteries were found in 3 of 22 specimens (14%). Endonasal endoscopy features of the middle ethmoidal artery were noted. Conclusion This is the first study assessing the anatomical features of the middle ethmoidal arteries from an endonasal endoscopic perspective. The findings of this research have clinical significance in guiding surgeries that involve the medial orbital wall, intractable epistaxis, and anterior skull base pathologies, as well as endoscopic endonasal surgeries.

Resection of a neoplasm is the most common indication for an anterior skull base approach. This surgery aims to obtain a complete extirpation (with negative histologic margins) yielding the best oncologic outcome, while producing the least degree of functional and cosmetic morbidity. Open or endoscopic endonasal routes, or both, may be used for the resection based on the tumor stage, histology, and patient's specific needs and characteristics, as well as the surgeon's training and preference. Traditional open craniofacial approaches require a craniotomy and maxillofacial osteotomies that include those necessary for a subfrontal approach. This technique remains one of the primary strategies to manage anterior cranial base lesions, especially those with significant extension or involving critical neurovascular structures. A significant recent development in cranial base surgery is the adoption of endonasal endoscopic approaches, which have been applied to resect the anterior cranial base. Its benefits include the minimal manipulation of the brain (no retraction), avoidance of maxillofacial osteotomies, and lack of cosmetic deficits. Endoscopic, endoscopic-assisted, and open approaches afford advantages and disadvantages and have different indications and limitations; therefore, the skull base surgeon (or the skull base surgery team) must be versed in all techniques.

The purpose of this study is to demonstrate the potential contribution of positron emission tomography (PET)/computed tomography (CT) to help differentiate olfactory neuroblastoma (ONB) from sinonasal undifferentiated carcinoma (SNUC).Following approval by the institutional review board at the Wexner Medical Center at the Ohio State University, Columbus, Ohio, a pilot study with retrospective review of patients with biopsy-proven diagnosis of ONB s and SNUC s was conducted. Staging PET/CT scans were reviewed to document the maximum standardized uptake value (SUVmax). A statistical comparison of SUVmax was performed.We identified 13 patients (7 with ONBs and 6 with SNUCs) with mean age 60.2 years who had undergone staging F-18 fluorodeoxyglucose (Maximum standardized uptake value of4. Laryngoscope, 2016 127:321-324, 2017.

Background and Methods:Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction.Results:Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad–Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap. Extranasal flaps include the transfrontal pericranial and transpterygoid temporoparietal flaps.Conclusion:The Hadad–Bassagaisteguy nasoseptal flap is overwhelmingly favoured for reconstructing extensive defects of anterior, middle and posterior cranial base. Its pertinent technical features are described. However, it is essential to master the skills required for the various extranasal or regional vascularised flaps because each can offer a reconstructive alternative for specific patients, especially when open approaches are needed and/or intranasal vascularised flaps are not feasible.

The purpose of this study was to describe the incidence of the middle ethmoidal artery and its anatomical nuances via an endoscopic endonasal approach.A cadaveric study was performed on 22 adult specimens. First, a frontal sinusotomy and ethmoidectomy were performed via an endoscopic endonasal approach in order to fully expose the anterior skull base. Subsequently, the lamina papyracea and the bone of the canals covering the ethmoidal neurovascular bundles were removed to identify the anterior, middle, and posterior ethmoidal arteries. Presence, laterality, and location of the middle ethmoidal artery were recorded.A total of 14 middle ethmoidal arteries were identified (10 right and 4 left), among 44 sides (22 specimens), accounting for an incidence of 31.8%. Bilateral middle ethmoidal arteries were found in 3 of 22 specimens (14%). Endonasal endoscopy features of the middle ethmoidal artery were noted.This is the first study assessing the anatomical features of the middle ethmoidal arteries from an endonasal endoscopic perspective. The findings of this research have clinical significance in guiding surgeries that involve the medial orbital wall, intractable epistaxis, and anterior skull base pathologies, as well as endoscopic endonasal surgeries.

BACKGROUND Olfactory groove meningiomas grow insidiously and compress adjacent cerebral structures. Achieving complete removal without further damage to frontal lobes can be difficult. Microsurgical removal of large lesions is a challenging procedure and usually involves some brain retraction. The endoscopic endonasal approaches (EEAs) for tumors arising from the anterior fossa have been well described; however, their effect on the adjacent brain tissue has not. Herein, the authors utilized the magnetic resonance imaging fluid attenuated inversion recovery (FLAIR) sequence signal as a marker for edema and gliosis on pre- and post-operative images of olfactory groove meningiomas, thus presenting an objective parameter for brain injury after surgical manipulation. METHODS Imaging of 18 olfactory groove meningiomas removed through EEAs was reviewed. Tumor and pre/postoperative FLAIR signal volumes were assessed utilizing the DICOM image viewer OsiriX(®). Inclusion criteria were: (1) No previous treatment; (2) EEA gross total removal; (3) no further treatment. RESULTS There were 14 females and 4 males; the average age was 53.8 years (±8.85 years). Average tumor volume was 24.75 cm(3) (±23.26 cm(3), range 2.8-75.7 cm(3)), average preoperative FLAIR volume 31.17 cm(3) (±39.38 cm(3), range 0-127.5 cm(3)) and average postoperative change volume, 4.16 cm(3) (±6.18 cm(3), range 0-22.2 cm(3)). Average time of postoperative scanning was 6 months (range 0.14-20 months). In all cases (100%) gross total tumor removal was achieved. Nine patients (50%) had no postoperative FLAIR changes. In 2 patients (9%) there was minimal increase of changes postoperatively (2.2 cm(3) and 6 cm(3) respectively); all others demonstrated image improvement. The most common complication was postoperative cerebrospinal fluid leakage (27.8%); 1 patient (5.5%) died due to systemic complications and pulmonary sepsis. CONCLUSIONS FLAIR signal changes tend to resolve after endonasal tumor resection and do not seem to worsen with this operative technique.