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Key points: Silent sinus syndrome (SSS) and chronic maxillary atelectasis (CMA) represent an overlapping clinical entity, both likely lying on the spectrum of one disease process.There is widespread inconsistency of diagnosis in the literature of reported cases of SSS and CMA.We propose a novel, comprehensive staging system to simplify diagnosis and inform management. [ABSTRACT FROM AUTHOR]

This article explores the differences in neuroimaging findings between patients with medically refractory idiopathic intracranial hypertension (IIH) and spontaneous cerebrospinal fluid (CSF) leak (IIHwL) and patients with IIH without spontaneous CSF leak (IIHwoL). The study conducted a retrospective review of medical records and compared demographic information, clinical presentations, venous sinus manometry data, lumbar puncture opening pressure, and neuroimaging findings between the two patient groups. The results showed that patients with IIHwL had different neuroimaging findings compared to those with IIHwoL, highlighting the importance of recognizing these differences for the timely identification and management of CSF leak patients with IIH. [Extracted from the article]

This article examines the risk factors for spontaneous cerebrospinal fluid leaks (sCSF leaks) in patients with idiopathic intracranial hypertension (IIH). The study, which is based on a large multinational database, compares the demographic and treatment characteristics of patients with IIH who have sCSF leaks of the anterior or lateral skull base (IIHwL) to those without sCSF leaks (IIHwoL). The results show that IIHwL patients tend to be older, have a higher body mass index (BMI), and have more comorbidities compared to IIHwoL patients. They also experience a higher prevalence of symptoms such as headaches, tinnitus, and visual disturbance. The findings contribute to a better understanding of this unique subpopulation of IIH patients and may aid in their management. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the use of a wearable device called the "Upright Go" (UG) to improve surgical ergonomics and reduce musculoskeletal strain in rhinologic surgery. The study involved rhinologists at a tertiary-care center and consisted of three phases: baseline recording of posture and pain, incorporating biofeedback to correct poor posture, and post-intervention recording of posture without biofeedback. The results showed that the UG device improved posture with real-time feedback and had a sustained effect even after biofeedback was removed. However, there was no correlation between improved posture and reduced pain. The study highlights the potential for conditioning proper surgical posture and promoting ergonomic sustainability. [Extracted from the article]

This article discusses the impact of venous sinus stenting (VSS) on symptoms and quality of life in patients with idiopathic intracranial hypertension (IIH) and a spontaneous cerebrospinal fluid (CSF) leak. The study included nine female patients who underwent VSS for IIH complicated by a CSF leak. The results showed that VSS effectively alleviated symptoms such as tinnitus and headaches, and allowed for discontinuation of medication in some patients. Complications were minimal, and there was no recurrence of CSF leak in the early postoperative period. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the use of magnetic resonance imaging (MRI) and computed tomography (CT) to assess the thickness of the temporalis and masseter muscles as indicators of frailty in patients with sinonasal squamous cell carcinoma (SNSCC). The study found that both MRI and CT measurements correlated with frailty measures, but MRI measurements were better associated with frailty than CT measurements. The authors suggest that MRI should be considered the gold standard imaging for future studies on TMT and MMT in patients with SNSCC. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the presence of pigment incontinence in sinonasal mucosal melanoma (SNMM). The study conducted a retrospective chart review of patients diagnosed with SNMM at Thomas Jefferson University Hospital from 2007 to 2023. The results showed that pigment incontinence was present in 65% of patients, and regression was observed in 15 out of 17 patients. The study suggests that pigment incontinence can be a part of the natural tumor life cycle and may be mistaken for melanoma, especially after neoadjuvant therapy. Understanding these findings is important for diagnosis and clinical management of SNMM. [Extracted from the article]

This article explores the use of temporalis muscle thickness (TMT) and masseter muscle thickness (MMT) as measures of sarcopenia and proxies for frailty in patients with squamous cell carcinoma of the sinonasal tract (SNSCC) and sinonasal adenocarcinoma (SNAC). The study aimed to determine if lower TMT and MMT were associated with worse overall survival, 30-day readmission, and progression-free survival. However, the results showed that TMT and MMT measurements did not correlate with these outcomes in the study population. The authors suggest that further research with larger patient numbers and different types of pathology is needed to investigate the use of TMT and MMT as markers for frailty in sinonasal cancer. [Extracted from the article]

This article discusses the timing of neck dissection in patients with sinonasal malignancy (SNM) who undergo anterior cranial base resection. The study found that the timing of neck dissection did not significantly impact patient outcomes, including overall survival, incidence of emergency room visits, and instances of adjuvant radiotherapy. The majority of patients underwent neck dissection on the same day as primary resection, but those who had neck dissection more than 30 days after primary resection did not have worse outcomes. This study provides valuable insights into the treatment of SNM and the coordination of surgical teams. [Extracted from the article]

This article discusses the safety and timing of restarting continuous positive airway pressure (CPAP) following endoscopic anterior skull-base surgery (ESS). The study measured the pressures delivered to the sinonasal cavity during CPAP use and assessed the safety of restarting CPAP after sinonasal surgery. The results showed that restarting CPAP following ESS was found to be safe, with the pressures delivered to the postoperative sphenoid sinus being less than 65% of the delivered pressures in most patients. This suggests that factors such as mucosal edema and nasal packing may limit the amount of CPAP pressure that can access the sphenoid sinus. [Extracted from the article]

Byline: Shreya. Mandloi, Caio. Matias, Wu. Chengyuan, Ashwini. Sharan There is a considerable number of patients with epilepsy that have drug resistant epilepsy (DRE). An additional option for these patients [...]

Background and Purpose: Spinal cord injury (SCI) results in the loss of motor and sensory function from disconnections between efferent and afferent pathways. Most SCI patients are affected with chronic neuropathic pain, but there is a paucity of data concerning neuroplastic changes following SCI. Chronic pain disrupts default networks and is associated with abnormal insular connectivity. The posterior insula (PI) is associated with the degree of pain and intensity of pain. The anterior insula (AI) is related to signal changes. Comprehension of SCI pain mechanisms is essential to elucidate effective treatment options. Methods: This study examines the insular gyri functional connectivity (FC) of seven (five male, two female) SCI participants with moderate‐severe chronic pain compared to 10 (five male, five female) healthy controls (HC). All subjects had 3‐Tesla MRI performed and resting‐state functional MRI (fMRI) was acquired. FC metrics were obtained from the comparisons of resting‐state fMRI among our various groups. A seed‐to‐voxel analysis was pursued, encompassing six gyri of the insula. For multiple comparisons, a correction was applied with a significance level of p <.05. Results: There were significant differences in FC of the insula between SCI participants with chronic pain compared with HC. In the SCI participants, there was hyperconnectivity of the AI and PI to the frontal pole. In addition, there was increased FC noted between the PI and the anterior cingulate cortex. Hyperconnectivity was also observed between the AI and the occipital cortex. Conclusions: These findings illustrate that there is a complex hyperconnectivity and modulation of pain pathways after traumatic SCI. [ABSTRACT FROM AUTHOR]

Background and Purpose: Spatial registration is crucial in establishing correspondence between anatomic brain regions for research and clinical purposes. The insular cortex (IC) and gyri (IG) are implicated in various functions and pathologies including epilepsy. Optimizing registration of the insula to a common atlas can improve the accuracy of group‐level analyses. Here, we compared six nonlinear, one linear, and one semiautomated registration algorithms (RAs) for registering the IC and IG to the Montreal Neurologic Institute standard space (MNI152). Methods: 3T images acquired from 20 controls and 20 temporal lobe epilepsy patients with mesial temporal sclerosis underwent automated segmentation of the insula. This was followed by manual segmentation of the entire IC and six individual IGs. Consensus segmentations were created at 75% agreement for IC and IG before undergoing registration to MNI152 space with eight RAs. Dice similarity coefficients (DSCs) were calculated between segmentations after registration and the IC and IG in MNI152 space. Statistical analysis involved the Kruskal‐Wallace test with Dunn's test for IC and two‐way analysis of variance with Tukey's honest significant difference test for IG. Results: DSCs were significantly different between RAs. Based on multiple pairwise comparisons, we report that certain RAs performed better than others across population groups. Additionally, registration performance differed according to specific IG. Conclusion: We compared different methods for registering the IC and IG to MNI152 space. We found differences in performance between RAs, which suggests that algorithm choice is important factor in analyses involving the insula. [ABSTRACT FROM AUTHOR]

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. 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]

Key points This follow‐up dual‐institutional and longitudinal study further evaluated for underlying gender biases in LORs for rhinology fellowship. Explicit and implicit linguistic gender bias was found, heavily favoring male applicants [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is an age-related neurodegenerative disorder hallmarked by amyloid-β (Aβ) plaque accumulation, neuronal cell death, and cognitive deficits that worsen during disease progression. Histone acetylation dysregulation, caused by an imbalance between reduced histone acetyltransferases (HAT) Tip60 and increased histone deacetylase 2 (HDAC2) levels, can directly contribute to AD pathology. However, whether such AD-associated neuroepigenetic alterations occur in response to Aβ peptide production and can be protected against by increasing Tip60 levels over the course of neurodegenerative progression remains unknown. Here we profile Tip60 HAT/HDAC2 dynamics and transcriptome-wide changes across early and late stage AD pathology in the Drosophila brain produced solely by human amyloid-β 42. We show that early Aβ 42 induction leads to disruption of Tip60 HAT/HDAC2 balance during early neurodegenerative stages preceding Aβ plaque accumulation that persists into late AD stages. Correlative transcriptome-wide studies reveal alterations in biological processes we classified as transient (early-stage only), late-onset (late-stage only), and constant (both). Increasing Tip60 HAT levels in the Aβ 42 fly brain protects against AD functional pathologies that include Aβ plaque accumulation, neural cell death, cognitive deficits, and shorter life-span. Strikingly, Tip60 protects against Aβ 42 -induced transcriptomic alterations via distinct mechanisms during early and late stages of neurodegeneration. Our findings reveal distinct modes of neuroepigenetic gene changes and Tip60 neuroprotection in early versus late stages in AD that can serve as early biomarkers for AD, and support the therapeutic potential of Tip60 over the course of AD progression. • Aβ causes transient, late-onset and constant changes in biological processes. • Disruption of Tip60HAT/HDAC2 balance precedes Aβ plaque accumulation in AD brain. • Tip60 prevents early and late Aβ transcriptome changes via distinct mechanisms. [ABSTRACT FROM AUTHOR]

Background: Transoral robotic surgery (TORS) lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) are effective surgical interventions for well-selected patients with obstructive sleep apnea (OSA) intolerant to continuous positive airway pressure (CPAP) therapy. Previous publications have demonstrated that HGNS patients have a lower postoperative apnea-hypopnea index (AHI) and length of hospital stay than TORS patients. No prior study has investigated the differences in costs between HGNS and TORS., Objectives: This study aims to compare surgery-related costs in patients undergoing HGNS versus TORS lingual tonsillectomy for OSA intolerant to CPAP., Methods: A retrospective study on OSA patients intolerant to CPAP that underwent HGNS or TORS from 2015 to 2022 at a tertiary care center. Cost was defined as the dollar amount associated with providing a specific service prior to the application of insurance., Results: This study included 395 patients (375 UAS and 20 TORS). Average total cost was significantly higher in the UAS group than the TORS group (UAS: $25,582.60; TORS: $5832.60; p < 0.001). Operating room costs were also significantly higher in the UAS group (UAS: $1978.20; TORS: $1490.90; p = 0.001). The TORS cohort averaged higher costs for pharmacy (UAS: $201.30; TORS: $416.60; p < 0.001) and anesthesia (UAS: $139.00; TORS: $307.60; p < 0.001)., Discussion: The total cost was significantly higher in the UAS group compared to the TORS group. When making management decisions, it is important to consider the cost of care provided as well as patient-centered outcomes to optimize the value of care., Level of Evidence: N/A Laryngoscope, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

The great majority of spinal cord injury (SCI) patients have debilitating chronic pain. Despite decades of research, these pain pathways of neuropathic pain (NP) are unknown. SCI patients have been shown to have abnormal brain pain pathways. We hypothesize that SCI NP patients' pain matrix is altered compared to SCI patients without NP. This study examines the functional connectivity (FC) in SCI patients with moderate-severe chronic NP compared to SCI patients with mild-no NP. These groups were compared to control subjects. The Neuropathic Pain Questionnaire and neurological evaluation based on the International Standard Neurological Classification of SCI were utilized to define the severity and level of injury. Of the 10 SCI patients, 7 (48.6 ± 17.02 years old, 6 male and 1 female) indicated that they had NP and 3 did not have NP (39.33 ± 8.08 years old, 2 male and 1 female). Ten uninjured neurologically intact participants were used as controls (24.8 ± 4.61 years old, 5 male and 5 female). FC metrics were obtained from the comparisons of resting-state functional magnetic resonance imaging among our various groups (controls, SCI with NP, and SCI without NP). For each comparison, a region-of-interest (ROI)-to-ROI connectivity analysis was pursued, encompassing a total of 175 ROIs based on a customized atlas derived from the AAL3 atlas. The analysis accounted for covariates such as age and sex. To correct for multiple comparisons, a strict Bonferroni correction was applied with a significance level of p  < 0.05/NROIs. When comparing SCI patients with moderate-to-severe pain to those with mild-to-no pain, specific thalamic nuclei had altered connections. These nuclei included: medial pulvinar; lateral pulvinar; medial geniculate nucleus; lateral geniculate nucleus; and mediodorsal magnocellular nucleus. There was increased FC between the lateral geniculate nucleus and the anteroventral nucleus in NP post-SCI. Our analysis additionally highlights the relationships between the frontal lobe and temporal lobe with pain. This study successfully identifies thalamic neuroplastic changes that occur in patients with SCI who develop NP. It additionally underscores the pain matrix and involvement of the frontal and temporal lobes as well. Our findings complement that the development of NP post-SCI involves cognitive, emotional, and behavioral influences., Competing Interests: Ashwini Sharan has received support from Cerebral Therapeutics, Mudjala/Defuse, Tigerlabs, Neuspera, and Neurotargeting and as the Chief Medical Officer of the Medtronic Neuromodulation Operating Unit., (© Shreya Mandloi et al., 2024; Published by Mary Ann Liebert, Inc.)