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The article in the Journal of Neurological Surgery. Part B. Skull Base, published on February 2, 2025, presents a 2-dimensional endoscopic video showcasing the successful resection of a retro-infundibular craniopharyngioma while preserving the pituitary stalk. The surgical approach involved removing the bony sellar face, tuberculum, and planum for enhanced visualization, followed by careful tumor removal behind the right side of the pituitary stalk to maintain normal pituitary gland function. The authors, Alexander F. Kuffer, Danielle Golub, Mark B. Chaskes, Judd H. Fastenberg, and Amir R. Dehdashti, reported on this procedure. [Extracted from the article]

This article discusses the use of endoscopic endonasal surgery (EES) as an alternative treatment for microprolactinomas, which are small pituitary tumors. The study, conducted at multiple medical centers in the United States and the Netherlands, found that EES had a surgical cure rate of nearly 70% for microprolactinomas. The main predictor of surgical success was achieving gross total resection of the tumor, with minimal complications reported. The study highlights the potential of EES as a viable option for patients who are unable to tolerate long-term dopamine agonist therapy for microprolactinomas. [Extracted from the article]

This article compares the use of two different embolic agents, Onyx and n-BCA, for preoperative direct puncture embolization (DPE) of juvenile nasopharyngeal angiofibroma (JNA). The study found that both agents were effective in devascularizing JNA and facilitating safe resection with less intraoperative blood loss. However, there are important considerations for each technique, such as the special material properties, injection technique, cost, timing of injection, and consistency of the tumor post-injection. Surgeons should be aware of these differences to make informed decisions for patients with JNA. [Extracted from the article]

Objective  Patients undergoing endoscopic endonasal surgery have historically been restricted from using straws postoperatively, due to the concern that this activity generates negative pressure. The objective of this study is to evaluate the pressure dynamics in the sinonasal cavity associated with the use of a straw. Methods  Intracranial pressure catheters were placed in the nasal cavity of 20 healthy individuals. Pressure measurements were then recorded while participants drank liquids of different viscosities from a cup and from a straw. Measurements were recorded with and without subjects occluding their nose to simulate postoperative nasal obstruction. Results  The average pressure in the nasal cavity while drinking water from a cup was −0.86 cmH 2 O, from a straw was −1.09 cmH 2 O, and while occluding the nose and using a straw was −0.81 cmH 2 O. The average pressure in the nasal cavity while drinking a milkshake from a cup was −0.98 cmH 2 O, from a straw was −1.88 cmH 2 O, and while occluding the nose and using a straw was −1.37 cmH 2 O. There was no statistically significant difference in pressure measurements when comparing either task or consistency (p  > 0.05). Conclusion  Straw use is not associated with the generation of significant negative pressure in the nasal cavity. The pressure generated when drinking from a straw is not significantly different from that of drinking from a cup. This data suggest that straw use may be safe for patients following endoscopic skull base surgery, but further investigation is warranted. [ABSTRACT FROM AUTHOR]

Objective  A variety of endonasal sellar repair techniques have been described; many of which are complex, expensive, and carry potential morbidity but are felt to be necessary to prevent postoperative cerebrospinal fluid (CSF) leaks. We propose an effective, technically simple repair for select sellar defects utilizing an onlay of regenerated oxidized cellulose. Design  Retrospective review of patients from a single neurosurgeon who underwent endoscopic transsphenoidal surgery for pituitary adenoma and sellar reconstruction with only an onlay of regenerated oxidized cellulose. Patients were selected for this repair technique based on the absence of: (1) intraoperative identification of a CSF leak, (2) patulous diaphragm (expanded diaphragm sella herniating to or through sellar floor defect), and (3) other prohibiting comorbidities. Setting  The present study was conducted at a tertiary care center. Participants  In this study, pituitary adenoma patients were the participants. Outcome Measures  Main outcome measure of the study is postoperative CSF leak. Results  A total of 172 patients were identified. Of these, 153 were initial resections of pituitary adenomas. Gross total resection was achieved in 142 (82.6%) cases. Average tumor size was 2.2 ± 1.1 cm. Average tumor volume was 10.4 ± 19.8 cm 3. No patients had intraoperative CSF leaks. All cases were repaired with only an onlay of regenerated oxidized cellulose. There were two postoperative CSF leaks (1.16%). Pre and postoperative SNOT-22 scores were 12.9 ± 11.9 and 14.3 ± 14.9 (p  = 0.796), respectively. Conclusion  The use of an onlay of regenerated oxidized cellulose alone is an effective repair technique for select sellar defects. This technique does not result in increased postoperative CSF leak rates and avoids the higher relative cost and potential morbidity associated with more complex, multilayered closures. [ABSTRACT FROM AUTHOR]

Background  Due to the diverse histopathologic features and variable survival rates seen in sinonasal undifferentiated carcinoma (SNUC), it is likely that this diagnostic entity is comprised of a heterogonous group of morphologically undifferentiated tumors. As advancements in molecular testing have led to a better understanding of tumor biology, it has become increasingly evident that SNUC may actually encompass several tumor subtypes with different clinical behavior. As a result, it is also likely that all SNUC patients cannot be treated in the same fashion. Recent investigations have identified loss of the tumor suppressor SMARCB1 (INI1) expression in a subset of undifferentiated sinonasal tumors and extrasinonasal tumors and, studies have suggested that this genetic aberration may be a poor prognostic marker. The objective of this study was to identify differential expression of SMARCB1 in SNUC and to analyze and compare the survival outcomes in SNUC patients with and without SMARCB1 expression. Methods  All cases of undifferentiated or poorly differentiated neoplasms of the sinonasal tract treated between 2007 and 2018 at a single tertiary care institution were selected. All cases of SNUC were tested for SMARCB1 status by immunohistochemistry (IHC). Clinical parameters were analyzed using Student's t -test and Fischer's test. Kaplan–Meier methods were used to estimate survival durations, while comparison between both the subgroups was done using the log-rank test. Statistical analysis was performed with the use of SPSS software, Version 25 (IBM, New York, NY, United States). Results  Fourteen cases of SNUC were identified. Approximately two-thirds (64%; n  = 9) of patients were male and the majority (79%; n  = 11) were between fifth to seventh decade. Skull base and orbital invasion were seen in 79% (n  = 11) and 93% (n  = 13) of cases, respectively. Fifty-seven percent of tumors (n  = 8) retained SMARCB1 expression by IHC (SR-SNUC), while the remaining 43% (n  = 6) showed loss of SMARCB1 expression and, thus, were considered as SMARCB1 -deficient (SD-SNUC). Although clinicopathological features and treatment modalities were similar, SD-SNUC showed poorer (OS: p  = 0.07; disease free survival [DFS]: p  = 0.02) overall survival (OS) and DFS on Kaplan–Meier curves. Additionally, SD-SNUC showed higher recurrence (75 vs. 17%) and mortality (67 vs. 14%) (hazard rate = 8.562; p  = 0.05) rates. Both OS (28.82 ± 31.15 vs. 53.24 ± 37.50) and DFS durations (10.62 ± 10.26 vs. 43.79 ± 40.97) were consistently worse for SD-SNUC. Five-year survival probabilities were lower for SD-SNUC (0.33 vs. 0.85). Conclusion  SNUC represents a heterogeneous group of undifferentiated sinonasal malignancies. Based on the status of SMARCB1 expression, the two subgroups SD-SNUC and SR-SNUC appear to represent distinct clinical entities, with loss of SMARCB1 expression conferring an overall worse prognosis. [ABSTRACT FROM AUTHOR]