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Key points: Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post‐operative period has not been studied in live subjects and controversy exists in when to restart this post‐operatively.This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post‐surgical sphenoid sinus and the mid‐nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect. [ABSTRACT FROM AUTHOR]

Introduction: Although surgical navigation is commonly used in rhinologic surgery, data on real world performance are sparse because of difficulties in collecting measurements for target registration error (TRE). Despite publications showing submillimeter TRE, surgeons do report TRE of >3 mm. We describe a novel method for assessing TRE during surgery and report findings with this technique. Methods: The TruDi navigation system (Acclarent, Irving, CA) was registered using a contour-based protocol. The surgeon estimated target registration error (e-TRE) at up to 8 points (anatomic regions of interest [ROI]) during endoscopic sinus surgery (ESS). System logs were used to simulate the localization for quantitative assessment of TRE (q-TRE). Results: We performed 98 localizations in 20 patients. The ROI in the sinuses were ethmoid (33 sites), maxillary (28 sites), frontal (17 sites), and sphenoid (22 sites). For localizations, mean qTRE and eTRE were 0.93 and 0.84 mm (P =.56). Notably, 80% of qTRE and 81% of eTRE were 1 mm or less. Mean qTRE and eTRE were less for attending-performed registrations at the maxillary, frontal and sphenoid. Conclusion: Surgical navigation accuracy, as measured by qTRE and eTRE, approaches 1 mm or better at all sinus sites in a real-world setting for 80% of localizations. The qTRE method provides a unique approach for assessing TRE. Surgeons underestimate TRE (overstate navigation accuracy), but this difference does not seem to be statistically significant. Registration performed by trainees yields higher TRE than registration performed by attendings. These data may be used to guide navigation optimization. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aims to investigate the three-dimensional morphological differences of the sphenoid sinus according to sex in the Korean adult population and conduct an exploratory study based on the findings. The sphenoid sinus, located deep within the skull, plays a crucial role in forensic identification due to its relative protection from external damage and its unique anatomical characteristics. Methods: Using cone-beam computed tomography (CBCT) data from 120 patients (60 males and 60 females) aged 20–29, the sphenoid sinus was visualized and measured in three dimensions using Mimics software (version 22.0). Measurements included the volume of the sphenoid sinus, as well as its dimensions in the X, Y, and Z axes. The measured data were analyzed using SPSS (version 23.0) with a t-test and linear regression analysis. Results: The results showed that the sphenoid sinus volume was significantly larger in males compared to females (p < 0.05), with an average male sinus volume of 16,957.9 mm3 and a female volume of 13,517.7 mm3. Additionally, the X-width, Y-width, and Z-width were all larger in males, with significant differences (p < 0.001) across all dimensions. Further regression analysis revealed that the volume of the sphenoid sinus was primarily influenced by the Z-axis height (measured from the coronal view) and the Y-axis width (measured from the sagittal view), while the X-axis width had a negligible effect on the overall volume. Conclusions: These findings suggest that sex-specific differences in the sphenoid sinus may provide important insights for clinical diagnoses and forensic personal identification. This study highlights the need for further research on different age groups and ethnic populations to enhance the understanding of anatomical variations in the sphenoid sinus and their potential applications in both medical and forensic fields. [ABSTRACT FROM AUTHOR]

This study aims to summarize the clinical characteristics of skull base osteoradionecrosis (ORN) with the internal carotid artery (ICA) involvement and to distill the key surgical techniques that can enhance the protective measures for ICA. Methods: We conducted a retrospective, observational study over a six-year period from February 2017 to May 2023. We included patients who were diagnosed with osteoradionecrosis with invasion of the internal carotid artery and collected their demographic information, pathology results, complication rates, ect. The goal was the alleviated rate after the surgery and the anatomic consideration during the surgery. We compared the verbal rating score (VRS) of headache pre- and post-operation by the Wilcoxon rank-sum test. Results: A retrospective analysis was conducted on 19 patients diagnosed with ORN, with a mean age of 53.73 yr (range, 32– 68 yr). Among them, 17 patients (89.47%) were nasopharyngeal carcinoma (NPC), 1 patient (5.23%) was squamous cell carcinoma of the sphenoid sinus, and 1 patient (5.23%) had adenoid cystic carcinoma. After the surgery, 1 fatality occurred within 2 months, which was attributed to a severe parapharyngeal space infection.1 patient succumbed to ICA rupture two days post-operation. Additionally, 1 patient experienced ORN recurrence 2 years after the initial surgery. The mean follow-up period for the study was 37.47 mo (range 2 − 77 mo). The alleviation rate was 89.4%. The results revealed a significant decrease in VRS after the surgery (Z=− 3.921, P=0.000). Finally, we summarized clinical evidences of ICA involvement, such as the formation of pseudoaneurysm. Conclusion: A four-quadrant division of SBORN as a standardized and systematic approach is meaningful to guide surgical intervention for osteoradionecrosis. There are relevant clinical and imaging evidences that can predict the rupture of ICA. [ABSTRACT FROM AUTHOR]

Background: The overwhelming majority of pituitary tumors consist of pituitary adenomas (PAs), which have recently also been termed pituitary neuroendocrine tumors (PitNETs). Clinically significant PAs occur in approximately one in every 1000 individuals, while other types of pituitary tumors, such as craniopharyngiomas and pituicytomas, are significantly less common. Although PAs are generally benign, a subset of them exhibits malignant‐like biological traits. They tend to infiltrate and grow aggressively into adjacent tissues and organs, including the dura mater, cavernous sinus, and sphenoid sinus. This invasive behavior often results in the destruction of the normal anatomical architecture of the sella turcica and skull base. Clinically, such tumors are classified as invasive PAs (IPAs), emphasizing their aggressive and destructive nature. Objective and Significance: Currently, the diagnostic indicators for IPAs frequently suffer from suboptimal sensitivity and specificity. The invasiveness assessment of PAs lacks a definitive gold standard and instead serves as a predictive tool, with a greater number of indicators met suggesting a higher likelihood of invasiveness. Consequently, a comprehensive approach that integrates imaging, pathological, molecular biological, and other disciplinary metrics is crucial for accurate evaluation. Despite surgery being the primary treatment modality for IPAs, their malignant‐like behavior complicates complete resection, resulting in lower resection rates and heightened postoperative recurrence, necessitating multiple surgeries. Therefore, adjunctive drug therapy is often necessary for IPA patients. Preoperative drug therapy can shrink tumor size, facilitating resection and postoperative recovery, mitigating hormone imbalances, delaying recurrence, and enhancing patients' quality of life. Conclusions: This article comprehensively reviews the diagnostic criteria for assessing the invasiveness of PAs in the domains of imaging, pathology, and molecular biology, provides an overview of the current research status of drug therapy for these conditions, and deepens our insight into the biological and therapeutic aspects of the tumor microenvironment in PAs. [ABSTRACT FROM AUTHOR]

Objective: This study analyzed the causes of sphenoid sinus (SS) infection (SSI) following endoscopic transsphenoidal skull base surgery and determined appropriate treatment methods. Methods: This study included 31 cases of secondary SSI following the endoscopic transsphenoidal approach (ETSA; SSI group) and 246 cases without SSI (non‐SSI group). Data collected included post‐ETSA pathological results, types of artificial skull base reconstruction materials, and SS patency. For the SSI group, data included time from ETSA to symptom onset, endoscopic and imaging findings, intraoperative conditions during the second surgery, and changes in visual analog scale (VAS) scores. Results: The incidence of secondary SSI was 11.19%. In the SSI group, 26 patients (83.87%) reported headaches, and 24 (77.42%) had stenosis or closure of the SS ostium (SSO). The non‐SSI group reported no symptoms, and 236 patients (95.93%) had well‐opened SSOs. Centripetal hyperosteogeny (CHO) in the SS walls was observed in 20 patients (64.5%) in the SSI group. Absorbable materials were used in five cases (16.13%) and 215 cases (87.40%) in the SSI and non‐SSI groups, respectively, while non‐absorbable materials were used in 24 cases (77.42%) and 20 cases (8.13%), respectively. SSI risk was 9.42 times higher with non‐absorbable synthetic materials. VAS scores for SSI symptoms and Lund–Kennedy scores significantly decreased at 3 and 12 months post‐second surgery. Conclusion: Secondary SSI after ETSA can cause persistent symptoms. Non‐absorbable synthetic repair materials should be avoided to prevent secondary SSI. Extended sphenoidectomy and removal of artificial materials can lead to rapid resolution of SSI symptoms. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: Somatotroph adenomas account for approximately 5%-15% of pediatric pituitary adenomas and are more common in males. The aim of this study was to discuss the early and late outcomes of endoscopic pediatric growth hormone (GH)-secreting pituitary adenoma surgery performed at a high-volume tertiary hospital. Methods: A total of 4875 consecutive patients underwent endoscopic transsphenoidal surgery between August 1997 and December 2022 in Kocaeli University Medical Faculty Neurosurgery Department and Pituitary Research Center. We reviewed the medical data, radiological images, and surgical videos of these patients and included 19 (0.39%) pediatric patients aged 18 years with pathologically identified GH-secreting pituitary adenoma. Results: The data of 19 pediatric patients with GH-secreting pituitary adenoma were pathologically identified at our institution and retrospectively analyzed. 8 (42.1%) participants were male and 11 (57.9%) were female. Gross total resection (GTR) was performed in 10 (52.6%) patients, and subtotal resection was performed in 9 (47.4%) patients. 9 (47.4%) patients met the criteria for remission. Statistically significant results for adenoma size on GTR were obtained (p-value: 0.021). Sphenoid sinus pneumatization was not associated with resection rate (p-value 0.264). The absence of cavernous sinus invasion was significant as a positive predictive value for GTR, but it was not significant for remission (p-value:0.027-0.102, respectively). Conclusion: Somatotroph adenomas in pediatric patients are rare and challenging lesions. Adenoma size and cavernous sinus invasion are effective for resection. Sphenoid sinus pneumatization does not affect the resection rate in experienced centers. [ABSTRACT FROM AUTHOR]

To investigate the accurate volume changes in the paranasal sinus and nasal cavity with age development, using three-dimensional (3D) imaging software Paranasal sinus and nasal cavity volumes from computed tomography (CT) images in patients aged 0–24 years were measured using a 3D model to examine age-related changes. Paranasal sinus and nasal cavity growth were compared between age groups. Additionally, the correlation between body height and paranasal sinus growth was examined. A total of 139 CT scans from 137 patients were analyzed. Volume growth of maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavity was observed until 18, 16, 20, 20, and 22 years, respectively. Maxillary sinus rapidly grew at 2–8 and 9–12 years, ethmoid sinus 2–8 and 13–16 years, sphenoid sinus 5–8 years, frontal sinus 2–10 years, and nasal cavity 7–12 years. The median volume after growth completion for maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavities was 21,937 mm³, 4868 mm³, 5870 mm³, 3172 mm³, and 15,555 mm³, respectively. The left-right difference in the nasal cavity volume increased with age. Sinus and nasal cavity growth completion was delayed by 2–4 years compared to general height growth. Growth of the ethmoid, maxillary, sphenoid, frontal sinus, and nasal cavity was completed in approximately 20 years. Compared to the results shown in reports based primarily on 2D measurements, the ethmoid and sphenoid sinuses and nasal cavity were found to continue to grow until older age than previously thought. [ABSTRACT FROM AUTHOR]

To evaluate the quality of life in the post maxillectomy patients due to Coronavirus disease 2019 (COVID-19) associated Mucormycosis (CAM) following rehabilitation with obturators. The study also described the management and treatment outcomes of CAM patients. The study included 80 confirmed patients of CAM. The demographic profile, clinical presentations, predisposing and risk factors, and treatment outcomes were studied. Surgical and medical outcomes were expressed as percentages. After surgical debridement, 27 out of 80 patients were rehabilitated with obturators. The quality of life (QOL) of post debridement at 1 month (T1) vs. post 3 months (T2) of obturator use was measured using the oral health impact profile 14 (OHIP-14) scale. Maxillary sinus was involved in 98.75%, Ethmoid sinus in 51.25% and Sphenoid sinus in 26.25%. Surgical management involved Infrastructure maxillectomy in 56.25%, subtotal maxillectomy in 23.75%, and total maxillectomy with zygoma debridement in 20% of cases. Maxillary sinus debridement was done in 100%, Ethmoid sinus in 51.25%, and Sphenoid sinus in 26.25%. Medical management involved administration of intravenous Amphotericin B (total 3–5 g), and Posaconazole 300 mg OD for 3 months. The measured QOL using mean scores of each domain and the total score of OHIP-14 were lower at T2 (25.5 ± 6.809) compared to T1 (49.55 ± 9.822), (indicating better treatment outcomes) and were found to be statistically significant (P < 0.001). Early diagnosis, controlling risk factors, combined aggressive surgical and medical management reduces the morbidity and mortality of the patients. Early rehabilitation of the maxillectomy defects in CAM patients with temporary obturators mitigates deficient mastication and speech, thereby leading to improved function, aesthetics, and social well-being, and improving the overall QOL of these patients. [ABSTRACT FROM AUTHOR]

BACKGROUND. Foreign bodies of paranasal sinuses are very rare in ENT clinical practice. CASE REPORT. We will discuss the case of a 38-year-old gentleman who showed up at our Emergency Room with loss of vision in his left eye following a blast injury. The initial physical examination identified a ruptured globe in the left eye, which caused left-eye blindness. An immediate plain X-ray revealed a metallic object lodged in the left maxillary sinus, reaching up to the left sphenoid sinus. The external approach was used to manage the patient surgically, with no intra- or postoperative complications. CONCLUSION. Inadequate managing of foreign bodies in the paranasal sinuses might result in significant morbidity. They must be removed surgically, either endoscopically or via an external method. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to determine the clinical characteristics and cephalometric risk factors associated with decreased postoperative olfaction in patients in whom the transplanum and transtuberculum expanded endonasal approach (EEA) was performed. Methods A retrospective cohort of 41 patients treated with the transplanum and transtuberculum EEA was divided into two groups based on the maximum change in the postoperative 22-item Sino-Nasal Outcome Test (SNOT22) olfaction score: prolonged olfactory loss group (n = 5) with a ΔSNOT22 olfaction score of ≥ 4 without a return to baseline and a preserved olfaction group (n = 36) with a ΔSNOT22 olfaction score ≤ 3 with return to baseline on follow-up of at least 3 months. Demographics, operative details, and cephalometric measurements were compared between the two groups. Results There were no differences in terms of the type of surgical approach (transplanum and transtuberculum), resection of turbinates (middle and superior), use of reconstructive flap (nasoseptal flap and reverse flap), or tumor pathology between the two groups. In the prolonged olfactory loss group, there was a smaller angle between the planum and the face of the sella (89.75 ± 9.18 vs. 107.17 ± 16.57 degrees, p = 0.05) and a smaller angle between the anterior nasal spine and the sphenoid sinus face (21.20 ± 2.49 vs. 25.89 ± 4.90 degrees, p = 0.047) compared with the preserved olfaction group. Conclusion Patients with a narrow angle between the planum and the face of the sella or that between the anterior nasal spine and the sphenoid sinus face are at a higher risk of prolonged olfactory dysfunction with the transplanum and transtuberculum approaches. Level of Evidence IV. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to assess the developmental attributes of sphenoid sinuses affected by fungal balls and describe a surgical approach which reestablishes gravity‐dependent drainage to compensate for any mucociliary dysfunction. Methods: A within‐patient case–control analysis was performed on sphenoid sinus dimensions from patients with sphenoid sinus fungal ball (SSFB). Radiological dimensions were assessed to determine the dominant or larger sinus by volume and width. Pneumatization in the sagittal and lateral extent was assessed. The influence of sinus size and pneumatization variants within a patient was analyzed. Patency and the presence of mucostasis from radical reshaping of the sinus cavity were documented at least 3 months after surgery. Complications (bleeding, cerebrospinal fluid leak, and cranial nerve palsy) were recorded. Results: Twenty‐three patients (59 ± 19 years, 86% female, 46 sphenoid sinuses) were assessed. Fungal ball was more common in the smaller (non‐dominant) sinus, by width (78% vs. 22%, p < 0.01) and by proportion of total sphenoid volume (0.39 ± 0.16 vs. 0.61 ± 0.16, p < 0.01). Pneumatization variants did not influence the development of SSFB within a patient. All patients had patency and the absence of mucostasis or persistent inflammation at last follow‐up. No complications were reported. Conclusion: The smaller or nondominant sphenoid sinus is more affected by SSFB. Surgical reshaping of the sphenoid to prevent mucostasis is favorable in managing the smaller affected sinus cavity. Level of Evidence: 4 Laryngoscope, 134:4888–4892, 2024 [ABSTRACT FROM AUTHOR]

Objective: There is only one study in the literature in which 3D evaluation of sphenoid sinus volume in patients with cleft lip and palate was used. This shows that this issue has not been adequately evaluated. The present study aimed to compare the volume of the sphenoid sinuses in patients with cleft lip and palate on cone-beam computed tomography images, and to compare them with healthy controls. The high variability of sphenoid sinus volumes poses a risk for iatrogenic lesions during surgical procedures. Because the degree of pneumatization due to increased volume increases the likelihood of exposure of vital neurovascular structures such as the internal carotid artery, maxillary nerves, and optic nerves. Design: Retrospective cohort study. Setting: University Hospital. Patients: A total of 64 patients (32 cleft palate, 32 controls) over 18 years of age who had sphenoid sinuses in the image area were included in our study. Outcomes: Sphenoid Sinus Volume. Results: When the groups were compared in terms of total sinus volume, there was a statistically significant difference between them. Total sinus volume was significantly mean 2.806,87 mm lower in patients with cleft lip and palate compared to the healthy group (P =.015). Conclusion: To be aware this lower volume of the sphenoid sinus in cleft lip and palate patients will be useful for the surgical approach to sphenoid sinus. However, the literature on the subject is insufficient, more comprehensive clinical and radiological studies are needed on a larger sample. [ABSTRACT FROM AUTHOR]

Background: Endoscopic Endonasal Decompression for Traumatic Optic Nerve Injury has become an established endoscopic technique. However, Poor sphenoid sinus pneumatization often obscures landmarks, elevating the risk to vital neurovascular structures. Method: By decompressing the orbital apex region and determining the contour of the optic nerve, sequential decompression of the medial wall, superomedial wall, and inferomedial wall of the optic canal. Conclusion: This surgical technique can gradually reveal the contour of the optic canal when the anatomical landmarks on the lateral wall of the sphenoid sinus are unclear, ensuring the surgery can be completed safely and effectively. [ABSTRACT FROM AUTHOR]

Nonfunctional pituitary neuroendocrine tumors (PitNETs) exhibit wide variability in growth pattern based on subtype. Silent corticotroph adenomas (SCAs) demonstrate aggressive growth compared with other nonfunctional pituitary adenomas (NFPAs), especially into the cavernous sinus. In this study, we sought to characterize other growth patterns of SCAs compared with NFPAs. We performed a retrospective analysis of all patients with nonfunctional PitNETs treated with surgical resection via endoscopic endonasal approach at a single institution from August 1, 2018, to May 11, 2024. Preoperative computed tomography and magnetic resonance imaging were reviewed to determine extension into the suprasellar space, sphenoid sinus, cavernous sinus, and clivus. The study comprised 91 patients, including 20 SCAs and 71 NFPAs. SCAs demonstrated significantly greater rates of growth into the sphenoid sinus (55.0% vs. 23.94%, P = 0.013), clivus (65.0% vs. 16.9%, P < 0.0001), and cavernous sinus (defined as Knosp grade 3 or 4; 55.0% vs. 23.35%, P = 0.016). Other NFPAs were more likely to grow into the suprasellar space (92.96% vs. 75.0%, P = 0.038). Tumor volume was similar between groups (11.93 cm3 vs. 9.06 cm3, P = 0.2). Silent corticotroph PitNETs demonstrate predilection for invasion of bony structures, with higher rates of growing through the sellar floor into the sphenoid sinus, growing posteroinferiorly into the clivus and laterally into the cavernous sinuses. Other nonfunctional PitNETs tended to follow the path of least resistance, growing superiorly into the suprasellar space. These differences in growth patterns may account for some of the clinical challenges of treating silent corticotroph PitNETs. [ABSTRACT FROM AUTHOR]

Objective: The objective is to describe the clinical features, treatments, and outcomes of a case series of patients with Onodi cell mucocele, with or without cholesterol granuloma (CG). Material and methods: We retrospectively reviewed the medical records of eight patients diagnosed with Onodi cell mucocele at a single tertiary care university hospital in Beijing, China, between January 2017 and September 2020. Data regarding nasal symptoms, ocular symptoms, sinus computed tomography findings, treatments, histopathological results, and clinical outcomes were extracted. Results: We identified eight patients (six men and two women) of an average age of 48.1 (range, 26–70) years. Four patients presented nasal symptoms. Three patients presented ocular symptoms. Among them, one patient experienced concurrent nasal and ocular symptoms. Two patients were diagnosed based on a physical examination in the absence of nasal or ocular symptoms. All patients underwent endoscopic sinus surgery. The pathological specimens showed mucocele in four cases and mucocele with CG in the other four cases. Among the four cases with CG, three cases presented with decreased vision. After endoscopic sinus surgery, one patient recovered completely, and two patients showed significant improvement. Conclusion: If Onodi cell opacity is observed, especially with optic neuropathy, mucocele and CG are important differential diagnoses. The combination of mucocele and CG is more likely to promote bone destruction and cause serious optic neuropathy than simple mucocele. Endoscopic sinus surgery is appropriate. Diagnoses, treatments, and follow-up should be performed by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: Nasal irrigation is among the most widely used treatment modalities for sinonasal diseases. The extent of irrigation is well studied in operated sinuses but not for non-operated sinuses. Moreover, the preferred head positioning during irrigation is not known. Herein, we studied the extent of nasal irrigation in cadaveric heads with non-operated sinuses. Methods: Nine cadaveric heads were used. Normal saline solution mixed with radiological contrast material was used to irrigate the nasal cavities with the heads in 2 different positions: standing-leaning-forward (SLF) and Head-down forward (HDF). After each irrigation, computed tomography images of the head were acquired. The extent of irrigation was assessed for each subunit of the sinonasal cavity. Results: Irrigation was performed twice on a total of 18 sides, each time in 1 position. Nine subunits were evaluated: inferior, middle, and superior meati; the olfactory cleft; and the frontal, maxillary, anterior, and posterior ethmoid and sphenoid sinuses. The extent of irrigation was significantly better in the HDF position for the olfactory cleft (100% vs 33%), P -value=.001, frontal sinus (33% vs 11%), P -value=.002, maxillary sinus (78% vs 17%), P -value=.001, and anterior ethmoid sinus (89% vs 17%), P -value=.001. There was no significant difference in the extent of irrigation between the 2 positions for the other evaluated subunits. The overall extent of irrigation was 70.37% of the subunits in HDF position and 45.06% of the subunits for SLF position, P -value=.001 Conclusions: Nasal irrigation reached the cavities of non-operated paranasal sinuses. However, while the extent of irrigation was limited in the SLF, it was well achieved in the HDF position. Studies on the clinical efficacy of irrigation in this position are recommended. [ABSTRACT FROM AUTHOR]

The study examines the safety of performing simultaneous surgery for pituitary neoplasms and rhinosinusitis. Results show that there is no significant increase in nasal or intracranial complications when combining transsphenoidal surgery with endoscopic sinus surgery. The study suggests that simultaneous surgery for these conditions can be considered safe and feasible. Additionally, the research highlights the importance of preoperative antibiotic treatment and the lack of significant association between sinusitis severity and complication rates. [Extracted from the article]

Background: Surgical approaches to the cavernous sinus (CS) and middle cranial fossa (MCF) can be challenging, particularly for young neurosurgeons. The anteromedial (Mullan's) triangle is a triangle by the side of the CS and constitutes part of the floor of the MCF. The contents include the sphenoid sinus, superior ophthalmic vein, and sixth cranial nerve. The literature contains very little research that has precisely defined and measured the anteromedial triangle while considering anatomical variances minimally. Methodology: The present study was conducted on the skulls of 25 adult human cadavers which were dissected to expose the anteromedial (Mullan's) triangle on both sides. After precisely defining the triangle on each side, measurements of the three borders were taken, and using Heron's formula, the area of each triangle was calculated. Results: On average, the length of the medial border was 12.5 (+ 3.1 mm); the length of the lateral border was 9.9 (+ 3.1 mm); the length of the base was 10.75 (+ 2.4 mm) and the area of the anteromedial triangle was 43.9 (+ 15.06 mm2). Conclusion: Precise anatomical knowledge of the Mullan's triangle enables the treatment of disorders in often deformed anatomy or difficult-to-access structures. That is the reason it is important to gain a thorough understanding of the surgical anatomy and to adopt a safe procedure. [ABSTRACT FROM AUTHOR]

This study aims to investigate the anatomical features relating to nasofrontal and septum osteotomy during Le Fort Ⅲ osteotomy among patients with syndromic craniosynostosis, and to compare them with normal controls using computed tomographic cephalometry. A total of 63 subjects were included (syndromic craniosynostosis, n = 21; controls, n = 42). The craniosynostosis subjects were subdivided into group A (craniosynostosis patients without history of previous surgery, n = 8) and group B (craniosynostosis patients with history of previous surgery, n = 13). Cephalometric measurements based on computed tomographic images were analyzed. The angle between the refencing plane (HP) of the anterior cranial base and the most inferior point of the sphenoid sinus via Nasion (∠HP-N-ISS) was 23.85 ± 3.10°, 21.15 ± 4.64° and 28.32 ± 2.92° for group A, group B and the control group, respectively. The angle between HP and the posterior nasal spine (PNS) via nasion (∠HP- N- PNS) was 42.63 ± 2.02°, 38.50 ± 4.84° and 47.68 ± 2.62° for group A, group B and the control group, respectively. This study characterized the surgically relevant anatomical features in nasofrontal osteotomy during Le Fort Ⅲ osteotomy. The safe range for osteotomy angle is significantly different between normal and syndromic craniosynostosis subjects. Awareness of this difference may prevent further complications. [ABSTRACT FROM AUTHOR]

Background Intracavernous carotid aneurysms (ICCAs) are rare, frequently asymptomatic, with a low rupture risk, which, however, can lead to life-threatening epistaxis. The aim of this study was to assess the effect of the treatment of asymptomatic ICCAs with flow diverters (FD) on sphenoid bone erosion or dehiscence in a selected cohort of patients. Methods We retrospectively reviewed all asymptomatic ICCAs with sphenoid bone erosion or dehiscence detected on cone beam CT (CBCT) and treated with FD between December 2018 and December 2022. Patients were followed-up with CBCT and bone reconstruction was blindly evaluated by two interventional neuroradiologists and classified as unchanged, partial, or complete. Results A total of 10 patients (women: 90%, mean age 58 years) treated with an FD for an asymptomatic ICCA with associated sphenoid bone erosion or dehiscence were included in this cohort. Sphenoid bone erosion was present in seven patients and dehiscence was observed in the remaining three. After treatment with FD, complete reconstruction of the sphenoid sinus wall occurred in seven cases, and partial reconstruction in two cases. Sphenoid bone erosion remained unchanged after treatment in only one patient. Conclusions The decision to treat asymptomatic and unruptured ICCAs remains challenging due to their benign natural history and low hemorrhagic risk. The presence of sphenoid sinus erosion or dehiscence should not be overlooked since it could be considered as an indication for prophylactic treatment of life-threatening epistaxis. The mechanisms of bone erosion by the aneurysm and of reconstruction after treatment are still to be fully elucidated. [ABSTRACT FROM AUTHOR]

Background: There are various bones around the nasal cavity that pneumatize to form the paranasal sinuses; namely, maxilla, ethmoid bone, frontal bone, and sphenoid bone. The CT scan of nose and paranasal sinus is the gold standard investigation for the patients of chronic rhino-sinusitis (CRS). Objective: This study was conducted with aim to determine the prevalence anatomical variation of Nose and Paranasal Sinuses on CT-scan and their relation with symptoms. Methods: A retrospective study was conducted among 200 patients over a period of one year (2022-2023). Patients with various symptoms of chronic rhinosinusitis were subjected to non-contrast enhanced Computed Tomography of nose and paranasal sinuses. Results: In our study 56% patients had septal deviation with most common C shaped deviation followed by S shaped deviation. 99.5% patients have agger nasi cells. The attachment of uncinate process was to the lamina papyracea in 83.0%, followed by the base of skull in 13.0%. The least common types were free uncinate process in 1.5%. The prevalence of concha bullosa was found 16.5%. However, paradoxical turbinate was present in 2.0% subjects. The incidence of Haller cells was found to be 5.0% and Onodi cells were found in 4.5%. The type of frontal cell was Agger Nasi followed by a Supra-bullar. In Sphenoid sinus, commonest type was pre-sellar type of pneumatisation. Conclusion: Our study concluded these various anatomical variations and its prevalence. The relation of variations with disease symptomatology is inconclusive.

Background: The nasal cavity and paranasal sinuses play a crucial role in respiration, filtration, and humidification, influencing various clinical conditions. This study aims to analyze the morphometric dimensions of the human nasal cavity and paranasal sinuses in a sample of 50 individuals, focusing on anatomical variations, symmetry, and gender-based differences. Understanding these measurements is critical for clinical practices such as surgery, diagnostic imaging, and the treatment of sinus disorders. Materials and Methods: A cross-sectional study was conducted over six months, where computed tomography (CT) scans were used to measure the dimensions of the nasal cavity and paranasal sinuses. Parameters such as length, width, and height of the nasal cavity, as well as the volumes of the frontal, maxillary, ethmoid, and sphenoid sinuses, were assessed. Statistical analysis was performed to compare differences between left and right nasal cavities and between genders. Results: The average length of the nasal cavity was 5.6 cm (± 0.4), while the width and height were 2.5 cm (± 0.3) and 3.1 cm (± 0.2), respectively. Significant gender differences were observed in frontal and maxillary sinus volumes, with males having larger volumes (p < 0.05). Anatomical variations, such as deviated nasal septum (20%) and concha bullosa (16%), were prevalent. No significant asymmetry was found between the left and right nasal cavities. Conclusion: This study provides essential morphometric data on the nasal cavity and paranasal sinuses, contributing to better clinical management of sinus-related conditions. The findings highlight the importance of considering gender-based differences in anatomical assessments. [ABSTRACT FROM AUTHOR]

Introduction Endoscopic transsphenoidal surgery (ETS) is the standard practice in pituitary surgeries. The sellar exposure becomes the main factor which determines the residual disease in ETS. Not many studies can be found in the literature on the influence of anatomical variations of the sphenoid on intraoperative sella exposure. Objective The aim of the current study is to ascertain whether sphenoid sinus variations play a role in sellar exposure and residual tumor volume. Methods This is a prospective study conducted in a south Indian tertiary care center between June 2020 to June 2022, with 21 study participants who were scheduled to have ETS. The relation of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) parameters with the intraoperative area of sellar exposure and residual tumor volume was evaluated. Results Sphenoid sinus dimensions, like presellar width (mean = 1.89 ± 0.51 cm), maximum width (mean = 2.94 ± 1.09 cm), presellar depth (mean = 1.14 ± 0.55 cm), suprasellar depth (mean = 1.08 ± 0.24 cm), infrasellar depth (mean = 2.36 ± 0.92 cm), presellar height (mean = 2.22 ± 0.47 cm), or the 9 internal carotid artery (ICA)-related measures, did not have any correlation with the mean intraoperative area of sellar exposure (0.57 ± 0.28 cm 2). Also, the adequacy of sellar exposure did not relate to the residual tumor. Preoperative tumor volume was found to be higher (20.2 [55.3–13.2] cm 3) in patients with residual tumor compared with those with no residual tumor (5.9 [6.8–5.2] cm 3). Tumor extension had a significant association with the residual tumor volume. Conclusion According to the present study, anatomical variations of the sphenoid sinus do not influence the adequacy of sellar exposure. Further studies need to be undertaken concerning residual tumor volume as well as preoperative tumor volume and extension. [ABSTRACT FROM AUTHOR]

Objectives: Sphenomaxillary plate (SMP) is an inconstant bony septum separating the maxillary and sphenoid sinuses. Neglecting the SMP during endoscopic sinus surgery may lead to mistaking the sphenoid sinus for the posterior ethmoid cell with potentially dangerous consequences. However, its proper identification may allow planned sphenoidotomy through the posterior wall of the maxillary sinus or to enlarge transnasal or transethmoidal sphenoidotomy. The aim of this study was to evaluate (1) the incidence and morphology of the SMP and (2) possibility and safety of trans-SMP sphenoidotomy. Methods: In the radioanatomical part of the study multiplanar reconstruction analysis of 117 consecutive paranasal sinus CT scans was conducted. In the clinical part of the research, trans-SMP sphenoidotomy was performed in consecutive patients operated on for chronic rhinosinusitis. Results: The SMP was found in 25% of sides (34% of patients). It was constantly located superolateral to the posterior insertion of the middle turbinate. The SMP formed the prominence on the posterior wall of the maxillary sinus that could be identified using volume rendering in 11% of sides (19% of patients). 30 trans-SMP sphenoidotomies were performed in 18 patients. The SMP prominence was identified in 15 sides. In absence of SMP prominence, identification of the SMP was still possible using other anatomical landmarks. Conclusions: The SMP is present in over 30% Caucasian subjects at least on one side. Sphenoidotomy through the SMP is feasible and safe. [ABSTRACT FROM AUTHOR]

In surgical practice during endoscopic endonasal approach, growth hormone-secreting pituitary neuroendocrine tumor (GH-secreting PitNET) patients show morphologic differences in the nasal cavities and sinuses, leading to a narrower surgical field and a carotid prominence and potentially increasing the complexity of the surgical and the risk of complications. The aim of the study is to evaluate the anatomical differences of the sphenoid sinus between patients with GH-secreting PitNETs and patients with nonfunctioning pituitary neuroendocrine tumor (NF-PitNET) who underwent endoscopic endonasal approach. This is a monocentric retrospective study conducted at the author's institution. The minimum intercarotid distance, the largest diameter of the sphenoid sinus (DSS), and the distance between vomer and clivus (VCD) were collected and compared. Presence, localization, and course of intersphenoid sinus septum were also evaluated. One hundred consecutive patients were identified: 57 males (57%) and 43 females (43%), with a mean age of 55 years. Sixty patients had NF-PitNET (60%) and 40 had GH-secreting PitNET (40%). GH-secreting PitNET group presented inferior values of intercarotid distance (16.8 ± 3.94 mm vs. 20.4 ± 3.94 mm, P < 0.001), DSS (32.5 ± 9.81 mm vs. 38.6 ± 11.03 mm, P = 0.006), and VCD (25.5 ± 6.96 mm vs. 29.6 ± 8.47 mm, P = 0.012) compared to NF-PitNET group. Intersphenoid sinus septum showed no differences between the 2 groups. Intercarotid distance, DSS, and VCD resulted smaller in acromegalic patients, confirming that patients with GH-secreting PitNETs have a narrower surgical field. A meticulous anatomical preoperative planning and neuronavigation are important to recognize the sphenoid anatomical landmarks in order to reduce the risk of complications, especially in acromegalic patients. [ABSTRACT FROM AUTHOR]

Internal carotid artery injury is one of the most feared intraoperative complications of endoscopic sinus surgery and endoscopic skull base surgery. Vidian canal is used as a landmark to identify laceral genu of ICA. But, this structure leads to the lateral aspect of the genu and so, there is still a possibility of injuring the genu, if we blindly follow this landmark. So, to find out a more reliable landmark to locate ICA, we conducted a computed tomography-based study in our institution. The aim was to evaluate the anatomical variations in position of palatovaginal canal in relation to laceral genu of ICA. The primary objective was to know the anatomical relation of medial opening of PVC to laceral genu of ICA, and the secondary objective was to measure the distance between these two structures. CT paranasal sinus images of 105 patients were collected and axial cuts evaluated to find out the anatomical relation between PVC and ICA. In 97.1% of the scans, laceral genu of ICA was found lateral to medial opening of PVC, and in the rest 2.9%, both structures were found to lie in the same line. In 62.9% of the patients, the distance between the two structures was found to be between 3.1 and 6 mm. The inter-palatovaginal canal corridor can possibly be considered as a safe corridor to clival region of sphenoid sinus. This corridor can be easily identified intraoperatively during endoscopic skull base surgeries So, if the surgeon limits the instrumentation to the inter-palatovaginal canal corridor, iatrogenic injury to ICA, one of the most dreaded complications, can be avoided, while working in the clival region of sphenoid sinus. [ABSTRACT FROM AUTHOR]

We report a challenging and uncommon case involving a 53-year-old Japanese man with cerebrospinal fluid (CSF) leakage caused by a meningocele in the lateral recess of the sphenoid sinus. Our innovative treatment approach involved a combination of transpterygoid and endoscopic modified medial maxillectomy techniques, with special emphasis on the preservation of the sphenopalatine artery. This strategic preservation was pivotal to the successful use of the ipsilateral nasoseptal flap for reconstruction, which played a crucial role in the prevention of postoperative CSF leakage. Otolaryngologists and neurosurgeons collaborated to perform the bath-plugging technique; effective collaboration was instrumental to the success of the procedure. This report highlights significant advancement from conventional frontal craniotomy to a more sophisticated endoscopic technique, shows the importance of meticulous surgical planning and execution, emphasizes careful preservation of critical anatomical structures during complex neurosurgical and otolaryngological procedures, and underscores the evolving landscape of surgical approaches for managing complex medical conditions. [ABSTRACT FROM AUTHOR]

To elucidate the effectiveness of a 30-degree anteriorly tilted coronal CT in visualizing the anterior wall of the sphenoid sinus. Medical records and CTs of patients who underwent septoplasty, inferior turbinectomy, or endoscopic sinus surgery were reviewed. We evaluated the visibility of the anterior wall of the sphenoid sinus on conventional coronal CT scans and categorized its orientation. We then created anteriorly tilted coronal CT images to evaluate its improved visibility. A total of 129 patients were evaluated. While conventional coronal CT scans fully visualized the anterior wall of the sphenoid sinus in cases with an Onodi cell, 17.7% remained unidentified when the Onodi cell was absent. However, anteriorly tilted coronal CT scans consistently identified the anterior wall regardless of the presence of an Onodi cell. Our study highlights the effectiveness of anteriorly tilted coronal CT scans in consistently visualizing the anterior wall of the sphenoid sinus, regardless of the presence of an Onodi cell. It is possible that some other structures may become less identifiable on anteriorly tilted coronal CT. [ABSTRACT FROM AUTHOR]

The anteromedial temporal region and the lateral wall of the sphenoid can be the site of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol granuloma of the petrous apex, malignancy, infection, and sellar pathology extending to the lateral cavernous sinus. Approaches to this region are technically challenging and the existing approach requires sacrifice of all of the turbinates including the nasolacrimal duct, which can cause postoperative complications. We describe a novel anatomical landmark between the periorbita and the periosteum of the pterygopalatine fossa (which is located at the inferolateral periorbital periosteal line [ILPPL]). The posterior one-third of the incision line lies between the foramen rotundum and the superior orbital fissure, which is proximal to the maxillary strut. A 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the posterior inferolateral orbital region, anteromedial temporal region, lateral wall of the sphenoid sinus, and lateral wall of the cavernous sinus. A combined multiangled approach to the ILPPL will enable us to preserve all of the turbinates and the septum, and the nasolacrimal duct, allowing for the preservation of the physiological function and pedicled flaps, such as the middle turbinate, inferior turbinate, and septal membrane flap. The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach to the anteromedial temporal fossa. [ABSTRACT FROM AUTHOR]

Background and Objectives: Brain imaging studies in pediatric patients with headaches often reveal inflammation of the sphenoid sinus. When we encounter patients presenting with headaches without respiratory symptoms, determining the causal relationship between isolated sphenoid sinusitis observed in brain imaging studies and headache is challenging. This study aims to evaluate the clinical characteristics of pediatric patients with headaches and isolated sphenoid sinusitis identified by brain imaging studies and to determine the effects of antibiotics on headache relief. Materials and Methods: Among patients aged <18 years with headaches, those in whom isolated sphenoid sinusitis was observed on brain imaging were included. Their medical records were retrospectively reviewed to evaluate their clinical characteristics and outcomes. Based on antibiotic and analgesic effects, the included patients were categorized into acute bacterial sinusitis (BS) and non-BS groups, and clinical data were compared between the two groups. Results: Brain imaging studies were performed for 1751 patients, and 205 (11.7%) and 41 (2.3%) patients demonstrated sinusitis and isolated sphenoid sinusitis, respectively. For the 41 patients with isolated sphenoid sinusitis, migraine with or without aura (58.5%) was the most frequent type of headache. Throbbing pain (34.1%) occurred most frequently, and the temporal area (51.2%) was the most common location of headache. Nausea/vomiting (56.1%) was the most common accompanying symptom, followed by ocular symptoms (34.1%). Only one (2.4%) patient complained of neurologic symptoms. Headache improved in 26 (63.4%) patients, with improvement without antibiotic therapy in 19 (46.3%) patients. The acute BS and non-BS groups demonstrated comparable characteristics, except for a higher frequency of ocular symptoms in the acute BS group than in the non-BS group (p = 0.044). Conclusions: Isolated sphenoid sinusitis was rarely identified in pediatric patients with headache examined using brain imaging studies. Considering the clinical characteristics and antibiotic effects, early intensive antibiotic therapy cannot be prioritized. [ABSTRACT FROM AUTHOR]

Background: The posterior ethmoid sinuses have a complex anatomy and a highly variable normal structure. The posterior ethmoid Onodi cell needs careful assessment because of its proximity to the optic nerve and the internal carotid artery canal. Recognising the distinctions is essential for optimal pre-op preparation. Sphenoid sinus surgery can now be performed without worrying about compromising vital structures like the internal carotid artery or optic nerve. Preoperative radiological assessment is a quick and easy way to check for ethmoid cell pneumatisation differences. Aim and objectives: To determine the pneumatisation patterns of Onodi cells among the North-East Indian population using 16-slice multidetector computed tomography (MDCT). Results: Nine-hundred MDCT paranasal sinuses were analysed over a period of 0–2 years, out of which 220 cases showed the presence of Onodi cell. Type I were 89 cases (40.45%, CI 32.00–48.90), Type II were 128 cases (58.18%, CI 49.72–66.63), and 3 cases with Type III cell (1.36%, CI 0.18–2.54). Conclusion: The most prevalent pneumatisation pattern is Type II. The pneumatisation patterns of Onodi cells can be best detected and evaluated by multiplanar MDCT imaging. Sinus surgeons need a firm grasp of pneumatisation patterns to avoid damaging the optic nerve and internal carotid artery canal during operations. [ABSTRACT FROM AUTHOR]

Background. Transsphenoidal surgery is the treatment of choice for Cushing's disease. Successful surgery is associated with subnormal postoperative serum cortisol concentrations and cortisoluria levels, which may guide decisions regarding immediate reoperation. Remission is defined as the biochemical reversal of hypercortisolism with the re-emergence of diurnal circadian rhythm. Methods. A single-center prospective cohort study was conducted among thirty-three patients who underwent transsphenoidal pituitary surgery for Cushing's disease. Postoperative surgical outcomes, daily morning cortisolemia, and 24 h urinary-free cortisol from the first to the fifth morning were evaluated. Results. All patients underwent surgery, with a remission rate of 81.2%. Of the 26 patients who achieved early remission, 92% remained in remission. Two patients (7.7%) showed recurrence of Cushing's disease during a mean follow-up of 81.7 months. Early postoperative hypocortisolism suggests complete removal of the tumor, correlating with high rates of remission (p < 0.001). Also, in 12.5% of patients with early cortisol values >138 nmol/L, there was a gradual late remission. Conclusions. In our cohort of patients, the endoscopic transsphenoidal approach was safe and effective in the treatment of Cushing's disease. We demonstrated that serum and urinary cortisol concentrations did not experience significant fluctuations from the first to the fifth day. This constitutes an accurate predictor of durable remission, comprising a distinctive finding in the intermediate term by our team. [ABSTRACT FROM AUTHOR]

We report a case of a 73-year-old woman presenting with intracranial and extracranial meningioma with perineural spread crossing the foramen rotundum and pterygopalatine fossa, primarily along the maxillary nerve. She visited our hospital with the chief complaint of the left cheek swelling. Subsequent magnetic resonance imaging revealed a well-demarcated mass containing intracranial (cavernous sinus, Meckel's cave, and middle cranial fossa) and extracranial components (pterygopalatine fossa, orbit, nasal cavity, ethmoid and sphenoid sinuses, infratemporal fossa, and buccal space) through the foramen rotundum. A biopsy specimen was obtained from the cheek mass, and the histopathological diagnosis was meningothelial meningioma. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF) leakage is a common complication associated with endoscopic endonasal skull-base surgery (EESBS). Postoperative mobilization-associated postural changes are considered to cause CSF leakage. However, no study has demonstrated a robust relationship between postural changes and CSF leakage. We used upright computed tomography (CT) to clarify the effects of postural changes on the reconstructed skull base (RSB) after EESBS. Thirty patients who underwent EESBS at our institution were prospectively included, and their upright and supine CTs were compared to measure morphological changes in the RSB. Patient clinical data were also collected from medical charts and surgical videos, and their relationships with morphological changes were assessed. In upright CTs, the RSB shifted intracranially by 0.94 (0.0–2.9) mm on average. This shift was larger in cases with lesions extending to the sphenoid sinus, dural defects, intraoperative pulsation of the RSB, and large bone windows. The direction of the change was opposite to intuitive movement driven by gravity because of reduced intracranial pressure in the sitting position. Thus, these shifts can be directly associated with postoperative CSF leakage caused by reconstruction material displacement. Skull-base reconstruction and postoperative postural management accounting for these morphological changes may be necessary for preventing CSF leakage. [ABSTRACT FROM AUTHOR]

Pituitary adenomas are a type of of the most frequent intracranial tumors. These tumors can extend outside the sella, but very rarely originate ectopically to the sellar region. A 71-year-old patient presented to our institution, with prior clinical history of noncontrolled arterial hypertension and new-onset high-intensity pulsatile headache. Upon suspicion of a hypertensive emergency with probable brain compromise, a nonenhanced computed tomography of the head was performed. A mass within the sphenoid sinus was found. Endocrinological workup demonstrated a significant elevation of the growth hormone. As an incidental finding, a brain aneurysm was evidenced, which was treated endovascularly prior to the mass treatment. Subsequently, the patient successfully underwent a gross total resection through an endonasal transsphenoidal approach. Histopathological results were consistent with a pituitary ectopic adenoma. A postoperative improvement in levels of somatomedin C was documented postoperatively. [ABSTRACT FROM AUTHOR]

To summarize the clinical manifestations of craniofacial fibrous dysplasia (CFD) patients with ocular complications, and find effective methods to diagnose early. Nine CFD patients with ocular complications, and their parents were recruited in this study. All patients underwent ocular and systemic examinations. Bone lesions from all patients and peripheral blood from patients and their parents were collected for whole exome sequencing (WES). According to the screening for low-frequency deleterious variants, and bioinformatics variants prediction software, possible disease-causing variants were found in multiple CFD patients. The variants were validated by Sanger sequencing. Trio analysis was performed to verify the genetic patterns of CFD. All patients were diagnosed with CFD, according to the clinical manifestations, classic radiographic appearance, and pathological biopsy. The main symptoms of the 9 CFD patients, included visual decline (9/9), craniofacial deformity (3/9) and strabismus (2/9), with few extraocular manifestations. The family backgrounds of all the CFD patients indicated that only the patient was affected, and their immediate family members were normal. GNAS variants were identified in all bone lesions from CFD patients, including two variant types: c.601C > T:p.R201C(6/9) and c.602G > A:p.R201H (3/9) in exon 8. The detection rate reached 100% by WES, but only 77.8% by Sanger sequencing. Interestingly, we found GNAS variants could not be detected in peripheral blood samples from CFD patients or their parents, and other potentially disease-causing gene variants related to CFD were not found. For CFD patients with bone lesions involving the optic canal or sphenoid sinus regions, ocular symptoms should also be considered. Furthermore, we confirmed that CFD is not inherited, somatic variants in the GNAS gene are the main pathogenic gene causing CFD. Compared to the traditional methods in molecular genetic diagnosis of CFD, WES is more feasible and effective but limited in the type of samples. [ABSTRACT FROM AUTHOR]

Context: Head and neck paragangliomas (HNPGLs) are rare, usually benign, slow‐growing tumours arising from neural crest‐derived tissue. Definitive management pathways for HNPGLs have yet to be clearly defined. Objective: To review our experience of the clinical features and management of these tumours and to analyse outcomes of different treatment modalities. Methods: Demographic and clinical data were obtained from The Northern Ireland Electronic Care Record (NIECR) as well from a prospectively maintained HNPGL database between January 2011 through December 2023. Results: There were 87 patients; 50 females: 37 males with a mean age of 52.3 ± 14.2 years old (range 17–91 years old). 58.6% (n = 51) of patients had carotid body tumours, 25.2% (n = 22) glomus vagal tumours, 6.8% (n = 6) tumours in the middle ear, 2.2% (n = 2) in the parapharyngeal space and 1.1% (n = 1) in the sphenoid sinus. 5.7% (n = 5) of patients had multifocal disease. The mean tumour size at presentation was 3.2 ± 1.4 cm (range 0.5–6.9 cm). Pathogenic SDHD mutations were identified in 41.3% (n = 36), SDHB in 12.6% (n = 11), SDHC in 2.2% (n = 2) and SDHA in 1.1% (n = 1) of the patients. Overall treatment modalities included surgery alone in 51.7% (n = 45) of patients, radiotherapy in 14.9% (n = 13), observation in 28.7% (n = 25), and somatostatin analogue therapy with octreotide in 4.5% (n = 4) of patients. Factors associated with a significantly higher risk of recurrence included age over 60 years (p =.04), tumour size exceeding 2 cm (p =.03), positive SDHx variants (p =.01), and vagal and jugular tumours (p =.04). Conclusion: The majority of our patients underwent initial surgical intervention and achieved disease stability. Our results suggest that carefully selected asymptomatic or medically unfit patients can be safely observed provided lifelong surveillance is maintained. We advocate for the establishment of a UK and Ireland national HNPGL registry, to delineate optimal management strategies for these rare tumours and improve long term outcomes. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, among which around 18–64% metastasize, most frequently to lungs, regional lymph nodes and adrenal glands. Metastasis of HCC to the central nervous system represents a rare yet clinically significant phenomenon, often presenting diagnostic and therapeutic challenges. In this case report, we document a 35-year-old male who presented with a secondary headache and right ophthalmoplegia attributable to metastatic deposits secondary to HCC infiltrating the cavernous sinus and superior orbital fissure. Despite therapeutic interventions including local palliative radiotherapy and sorafenib, the patient succumbed to acute liver failure after 9 months. This case highlights the aggressive potential of HCC to involve the central nervous system and the importance of heightened clinical suspicion for early diagnosis and intervention in such rare but clinically impactful scenarios. [ABSTRACT FROM AUTHOR]

A 66-year-old female with a history of sinusitis presented with persistent diplopia and worsening eyelid swelling. Examination revealed bilateral vision loss, cranial nerve palsies, left-sided chemosis, proptosis, and edema. Initial imaging showed sphenoid sinus opacification, bilateral ethmoid disease, lack of filling of bilateral cavernous sinuses, and partial thrombosis of the left superior ophthalmic vein. The sinus findings were evaluated with endoscopic sinus surgery, which was unremarkable. Subsequent orbital imaging suggested the lesions were in keeping with tumor thrombus as opposed to bland thrombus. CT scans revealed a large mass in the right axilla, which was biopsied and confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was treated with anticoagulation, steroids, and chemotherapy resulting in marked improvement. Our report highlights a rare case of tumor thrombus from DLBCL causing bilateral cavernous sinus thrombosis and, to the best of our knowledge, the first documented case of superior ophthalmic vein thrombosis from tumor thrombus. [ABSTRACT FROM AUTHOR]

Adenoid cystic carcinoma (AdCC) is a salivary gland neoplasm that infrequently appears in the sinonasal region. The aim of this study was to evaluate the outcome and clinicopathological parameters of sinonasal AdCC. A retrospective analysis was conducted on all cases of AdCC affecting the nasal cavity or paranasal sinuses between 2000 and 2018 at the University Hospital Zurich. Tumor material was examined for morphological features and analyzed for molecular alterations. A total of 14 patients were included. Mean age at presentation was 57.7 years. Sequencing revealed MYB::NFIB gene fusion in 11/12 analyzable cases. Poor prognostic factors were solid variant (p < 0.001), histopathological high-grade transformation (p < 0.001), and tumor involvement of the sphenoid sinus (p = 0.02). The median recurrence-free survival (RFS) and OS were 5.2 years and 11.3 years. The RFS rates at 1-, 5-, and 10-year were 100%, 53.8%, and 23.1%. The OS rates at 1-, 5-, and 10- years were 100%, 91.7%, and 62.9%, respectively. In Conclusion, the solid variant (solid portion > 30%), high-grade transformation, and sphenoid sinus involvement are negative prognostic factors for sinonasal AdCC. A high prevalence of MYB::NFIB gene fusion may help to correctly classify diagnostically challenging (e.g. metatypical) cases. [ABSTRACT FROM AUTHOR]

Background: The sphenoid wing dural arteriovenous fistula (AVF) is rare, and can manifest with severe symptoms, particularly in cases classified as greater sphenoid wing type. Endovascular therapy is generally employed, however, open surgical intervention could be warranted in cases with complex fistula. Method: We present a case with ruptured greater sphenoid wing dural AVF (Cognard type IV), in which endovascular embolization using liquid material was performed, followed by open surgery to concurrently disconnect the fistula and evacuate the hematoma. Conclusion: The sphenoid wing dural AVFs may be effectively cured by open surgery for fistula disconnection in conjunction with endovascular embolization. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusions\nHighlightsPituitary neuroendocrine tumours (PitNETs) are the second most common type of intracranial tumour. Several studies have explored the prognostic factors for PitNETs. However, prognostic factors for postoperative PitNET recurrence remain not fully understood. This study aimed to explore potential prognostic factors for PitNET recurrence, such as surrounding tissue invasion and the extent of surgical resection in patients with postoperative PitNETs.We included 106 patients who underwent PitNET surgery between 2013 and 2018, dividing them into two groups: those with recurrence and those without recurrence. Tumours were classified based on demographics, neuroradiological, and immunohistological characteristics. Univariate and multivariate analyses were used to determine factors predicting recurrence. Kaplan–Meier plots and log-rank tests were used to analyse each independent factor based on the cumulative 5-year recurrence rate.During the 5-year follow-up period, 29.2% of the patients (n = 31) had disease recurrence. Univariate analysis showed that predictors of recurrence included cavernous and sphenoid sinus invasions, optic chiasm compression, larger tumour volume, giant adenoma >4 cm, and gross total resection (GTR). Multivariate analysis showed that lactotroph tumour type, sphenoid sinus invasion, and GTR were independent predictors. Kaplan–Meier analysis revealed significant differences in the 5-year recurrence rate among the three independent predictors, with significantly lower recurrence rate in patients with lactotroph tumours and GTR, and a significantly higher recurrence risk in patients with sphenoid sinus invasion.Lactotroph tumour type, sphenoid sinus invasion, and GTR are independent predictors of postoperative PitNET recurrence. This study provides insights into the factors affecting postoperative PitNET recurrence.PitNETs are the second most common intracranial tumour typePrognostic factors for postoperative PitNET recurrence remain not fully understoodWe explored potential prognostic factors in patients with postoperative PitNETsProlactin secretion and GTR failure were independent recurrence predictorsProliferative factors did not correlate with recurrence [ABSTRACT FROM AUTHOR]

This article discusses a rare type of mesenchymal malignancy called EWSR1:POU2AF3(COLCA2) spindle/round cell sarcoma, which primarily affects the sinonasal tract but can also occur in other locations. The article presents a case study of a 32-year-old male patient with this type of sarcoma, describing the clinical presentation, imaging findings, histopathological characteristics, and immunohistochemical analyses. The authors emphasize the importance of molecular testing in the diagnosis of undifferentiated tumors in the sinonasal tract and highlight the significance of targeted RNA sequencing. They also discuss the prognosis and treatment options for this rare malignancy. [Extracted from the article]

Objective: Granulomatous invasive fungal sinusitis (GIFS) is a rare and life-threatening disease, whereas fungus ball (FB) is the most common form of noninvasive fungal sinusitis. Both GIFS and FB primarily develop in immunocompetent patients, with the former associated with higher mortality and morbidity. Methods: A chart review and review of the literature. Results: We present the case of a 77-year-old woman with mixed fungal sinusitis who was successfully treated with voriconazole. Conclusions: GIFS and FB can coexist in extremely rare cases, known as mixed fungal sinusitis; however, the diagnosis and subsequent treatment of mixed fungal sinusitis can be delayed because of a lack of awareness of the underlying concept. Therefore, it is crucial for clinicians to recognize the concept of mixed fungal sinusitis. [ABSTRACT FROM AUTHOR]

Primary cranial meningioma is extremely rare and only rarely described in clinical practice, as is primary sinus ectopic meningioma. We detailed the surgical management of a female patient, aged 83, who had a primary meningioma of the sphenoid sinus. This uncommon clinical entity was the subject of a study of the literature, and its prognosis was summarized. [ABSTRACT FROM AUTHOR]

Fungal rhinosinusitis accounts for a significant portion of paranasal sinus diseases, with fungus ball being the most frequently observed form, constituting 27% of cases. While commonly affecting the maxillary sinus, sphenoid sinus localization occurred in 24.78% of cases. Managing fungal balls in the sphenoid sinus poses challenges because of their proximity to critical structures, necessitating a careful and effective approach. A retrospective analysis was conducted on patients diagnosed with a paranasal sinus fungal ball, specifically isolated sphenoidal localization. Trans-nasal sphenoidotomy was performed, and the patients were followed up postoperatively for recurrence or residual disease. Among four identified cases, headache was the predominant symptom, and all patients underwent successful endoscopic surgery without complications. The follow-up revealed no recurrence or residual disease. Fungal ball in the sphenoid sinus, although uncommon, present diagnostic challenges with symptoms that often mimic other conditions. CT scans play a crucial role in diagnosis and reveal dense masses with characteristic features. Surgical intervention, particularly endoscopic sphenoidotomy, remains the primary and successful treatment, emphasizing the importance of early detection. This study emphasizes the effectiveness of endoscopic sphenoidotomy for managing isolated sphenoid sinus fungal ball. This also highlights the importance of early detection and treatment to prevent complications. Headache, a primary symptom, was successfully resolved after surgery, reinforcing the role of surgery as the primary treatment. [ABSTRACT FROM AUTHOR]

Purpose: To describe the relation of the sphenoid ridge (SR) with the surrounding anatomical structures in healthy children when approaching the anterior and middle fossae. Methods: Computed tomography of 180 pediatric patients (90 males / 90 females), aged 1–18 years were included the study. The size of the lesser wing (LW) and the distances of the LW to certain landmarks were measured. Results: The LW length was 28.48 ± 8.15 mm. The LW widths at the midline and the midpoint and lateral point of the SR were 7.78 ± 1.74 mm, 2.84 ± 0.81 mm, and 1.91 ± 0.64 mm, respectively. The distance between the midpoint of the SR and the crista galli was 28.22 ± 5.56 mm, and the distance between the crista alaris and internal auditory meatus was 51.73 ± 5.79 mm. The linear function was calculated as y = 18.748 + 1.024 × age for SR length, y = 6.046 + 0.182 × age for the midline width of SR, y = 2.367 + 0.050 × age for the midpoint width of SR, y = 1.249 + 0.069 × age for the crista alaris width, y = 21.727 + 0.683 × age for the distance between the SR midpoint and the crista galli, and y = 43.614 + 0.855 × age for the distance between the crista alaris and internal auditory meatus. Conclusion: All measured parameters increased irregularly with advancing age. Furthermore, our regression equations representing the growth dynamics of SR may be used to estimate these parameters. [ABSTRACT FROM AUTHOR]

Introduction: Volumetric analysis of the paranasal sinuses can help evaluate disease extent, treatment, and sinus surgery outcome. This study aims to determine the baseline volumes of frontal, maxillary, and sphenoid sinuses. Methods: An observational cross-sectional study was conducted in a tertiary care center after obtaining ethical approval (Reference number: 264/2021). Computerized Tomography Scan head or Computerized Tomography Scan nose/Paranasal sinus images of patients across all age groups from January to December 2022 were analyzed. Sinus volumes were calculated using Digital Imaging and Communications in Medicine software. Results: The study included 154 patients, median age was 29 years (IQR: 22.75 - 39.25) and 84 (54.5%) were male. The median volume of the maxillary sinus was 14.30 cm³ (IQR: 10.76 - 18.02), with the right side at 13.82 cm³ (IQR: 10.34 - 17.39) and the left at 14.62 cm³ (IQR:11.11 - 18.75). The median volume of the sphenoid sinus was 4.52 cm³ (IQR:3.02 - 6.03), with the right side at 4.42 cm³ (IQR: 2.61 - 6.84) and the left at 3.95 cm³ (IQR: 2.16 - 6.47). The median volume of the frontal sinus was 2.59 cm³ (IQR:1.42 - 4.59), with the right side at 2.27 cm³ (IQR:0.94 - 4.12) and the left at 3.04 cm³ (IQR:1.22 - 5.04). Conclusions: Male population had larger volumes across all types. The maxillary and frontal sinuses had the largest and smallest volumes respectively.