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This article, titled "Artificial Intelligence in Skull Base Surgery: A Scoping Review," examines the use of artificial intelligence (AI) in the field of skull base surgery. The authors conducted a systematic review of relevant articles published between January 2018 and September 2023. They found that AI is being increasingly utilized in skull base surgery, particularly for diagnostic and prognostic purposes. The majority of the studies focused on radiomics, with MRI being the most common imaging modality used. However, there are still many areas within skull base surgery that have not been explored with AI and warrant further investigation. [Extracted from the article]

The article discusses the versatility of the SPIWAY, an endonasal access guide (EAG) used in surgery. The SPIWAY is a stent that can be placed in the nasal cavity to provide access during endoscopic endonasal surgery. The study includes a retrospective review of cases, a cadaveric model, and a literature review to demonstrate the various uses of the SPIWAY. The article highlights the advantages of the SPIWAY, such as reducing aerosol spread, improving efficiency, and preventing tumor spillage. Overall, the SPIWAY is a useful tool in facilitating access in different surgical approaches within the head and neck. [Extracted from the article]

This article presents a case series of patients with Tuberculum Sella Meningiomas (TSMs) who underwent endoscopic endonasal resection. TSMs are challenging to diagnose and treat due to their location near critical neurovascular structures and the optic chiasm. The study included 74 patients, predominantly female, with a median age of 56.7 years. The surgical approach resulted in a high rate of gross total resection and improved visual outcomes. However, CSF leak remains a concern, although it has decreased over time. Overall, the endoscopic endonasal approach is considered a safe and effective treatment for TSMs. [Extracted from the article]

This article discusses the use of endoscopic endonasal approaches (EEA) in the management of foramen magnum meningiomas (FMM). FMM is a rare type of intracranial meningioma, and traditional treatment involves transcranial corridors. The study presents the experience of the authors in using EEA for FMM resection and highlights its role and limitations. The results show that EEA can be an alternative corridor for carefully selected patients with ventral FMM, especially when involvement or encasement of the anterior spinal arteries is suspected. However, CSF leak remains a significant limitation. [Extracted from the article]

This article discusses the use of the vascularized lateral nasal wall flap (LNWF) in endoscopic endonasal surgery (EES) for closure of complex skull base defects. The study presents a 15-year single-institutional experience with the LNWF, focusing on its role in providing durable closure after intradural endoscopic endonasal tumor resection. The LNWF is an axial transposition flap based on the inferior turbinate artery and its branches, and it can be modified to include the nasal floor and nasal septum for reconstruction of large skull base defects. The primary outcomes measured were postoperative flap necrosis and cerebrospinal fluid (CSF) leak. The study found that the LNWF successfully addressed CSF leak in 64% of cases and that postoperative CSF leak occurred in 28.5% of cases with intraoperative leak. The most common adverse outcomes associated with LNWF closures were CSF leak and flap necrosis. Overall, the LNWF is a valuable technique for the treatment of persistent CSF leaks after endonasal surgery. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, compares four transorbital approaches to the skull base: the lateral orbitotomy, the modified orbitozygomatic approach through a palpebral incision, the modified orbitozygomatic approach through an eyebrow incision, and the supraorbital craniotomy through an eyebrow incision. The study used cadaveric dissections to assess the working corridors and map the anatomical points on the cranial base. The article concludes that each approach has its own advantages and limitations, and appropriate case selection is crucial for successful surgical outcomes. [Extracted from the article]

Background: Traditional management of olfactory neuroblastoma (ONB) includes margin‐negative resection with removal of cribriform plate, dura, and olfactory bulb, regardless of intracranial disease. This approach may be overtreating certain patients. Our investigation examines risk factors associated with occult intracranial disease to optimize therapeutic outcomes. Methods: This retrospective, multi‐institutional cohort study examined clinical covariates associated with occult intracranial involvement. Patient demographics, staging, Hyam's grade, and pathologic involvement of dura, olfactory bulb/tract, and brain were collected. Diagnostic imaging was reviewed. Positive and negative predictive value (NPV) were estimated along with effect size estimates. Cox hazard regression examined associations with overall survival (OS) and disease‐free survival (DFS). Results: A total of 224 subjects with new diagnoses of ONB (2005–2021) were identified. Skull base bone involvement on computed tomography (CT) had the highest NPV for pathologic dura (88.0%), olfactory bulb (88%), and brain involvement (97.3%). Hyam's grade category was significantly associated with dural involvement (φC = 0.26; 95% confidence interval [CI]: 0.16, 0.42). Subjects without radiologic skull base involvement (n = 66) had pathologic positivity of 12.1%. Within this subgroup, Hyam's grade was clinically significant for dural positivity (φ = 0.34; 95% CI: −0.12, 0.71) with 28.6% involvement in high grade tumors. Neither clinical nor pathologic positivity of intracranial structures were associated with significantly different OS or DFS. Conclusions: Both CT and magnetic resonance imaging (MRI) had reasonably good NPV for involvement of dura and olfactory bulb. Higher Hyam's grade was associated with dural involvement. Patients with low‐grade tumors not involving the skull base may be suitable for avoiding skull base resection; however, further investigation is warranted. [ABSTRACT FROM AUTHOR]

Background: We seek to inform radiotherapy (RT) delivery for adenoid cystic carcinoma of the head and neck (ACC) by evaluating RT techniques and recurrence patterns. Methods: We identified patients with ACC treated with curative‐intent RT from 2005 to 2021. Imaging was reviewed to determine local recurrence (LR). Results: Ninety‐one patients were included. The 5‐year LR risk was 12.2% (6.6–22.7). One patient each experienced a marginal and out‐of‐field recurrence. Patients receiving >60 Gy postoperatively had a 5‐year LR risk of 0% compared to 10.7% (4.2–27.2) with ≤60 Gy. Those receiving 70 and <70 Gy definitively had a 5‐year LR risk of 15.2% (2.5–91.6) and 33.3% (6.7–100.0), respectively. No patients had regional nodal failure. Conclusions: Modern, conformal RT for ACC results in low rates of LR. Doses >60 and 70 Gy may improve control in the postoperative and definitive settings, respectively. Elective nodal treatment can be omitted in well‐selected patients. [ABSTRACT FROM AUTHOR]

Hospitals, payors, and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed. Skull base lesions interact with surrounding anatomy to produce a complex spectrum of presentations and surgical challenges, requiring a wide variety of surgical approaches. Moreover, many skull base lesions are relatively rare. These factors and others often preclude the use of prospective randomized clinical trials, thus necessitating alternate methods of scientific inquiry. In this paper, we propose a roadmap for implementing a skull base registry, along with expected benefits and challenges. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this article is to provide a state‐of‐the‐art review of the literature and summarize the latest publications on medical and surgical treatment of cystic fibrosis (CF) chronic rhinosinusitis (CRS), with an emphasis on describing recent advancements in cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies. Methods: A comprehensive literature review was conducted utilizing the PubMed database with search phrases detailed within the body of the article. Abstracts were reviewed to include publications detailing medical, surgical, and CFTR modulating therapies for CF CRS. Findings from studies not previously reviewed and publications regarding CFTR modulators were emphasized. Results: No clear guidelines for treatment of CF CRS are available. Nasal saline rinses, topical steroids, topical antibiotics, and topical dornase alfa are reported medical therapies. Ivacaftor has some sinonasal symptomatic benefit. A new triple therapy CFTR modulator, elexacaftor/tezacaftor/ivacaftor, is capable of treating 90% of patients with CF and has shown the greatest FEV1 improvement of any CFTR modulator yet. There is no clear consensus on surgical indications or technique, though aggressive surgery in recalcitrant disease has shown some symptomatic benefit. Endoscopic sinus surgery after lung transplantation may benefit some patients in whom the sinuses serve as a reservoir for recurrent pulmonary infections by decreasing rates of bronchiolitis obliterans syndrome and improving 5 year survival. Conclusion: As lifespan increases for patients with CF, further investigation into medical therapy, CFTR modulator sinonasal outcomes, and surgical technique and outcomes for CF CRS is needed. Level of Evidence: 5. [ABSTRACT FROM AUTHOR]

Background  There is little data regarding postoperative outcomes of patients with obstructive sleep apnea (OSA) undergoing skull base surgery. The purpose of this study is to determine an association between risk factors and proximity of cerebrospinal fluid (CSF) leak to surgery in patients with OSA undergoing endoscopic skull base surgery. Methods  A retrospective review of neurosurgical inpatients, with and without OSA, at a tertiary care institution from 2002 to 2015 that experienced a postoperative CSF leak after undergoing endoscopic skull base surgery. Results  Forty patients met inclusion criteria, 12 (30%) with OSA. OSA patients had significantly higher body mass index (BMI; median 39.4 vs. 31.7, p  < 0.01) and were more likely to have diabetes (41.7 vs. 10.7%, p  = 0.04) than non-OSA patients; otherwise there were no significant differences in clinical comorbidities. No patients restarted positive pressure ventilation (PPV) in the inpatient setting. The type of repair was not a significant predictor of the time from surgery to leak. Patients with OSA experienced postoperative CSF leak 49% sooner than non-OSA patients (Hazard Ratio 1.49, median 2 vs. 6 days, log-rank p  = 0.20). Conclusion  Patients with OSA trended toward leaking earlier than those without OSA, and no OSA patients repaired with a nasoseptal flap (NSF) had a leak after postoperative day 5. Due to a small sample size this trend did not reach significance. Future studies will help to determine the appropriate timing for restarting PPV in this high risk population. This is important given PPV's significant benefit to the patient's overall health and its ability to lower intracranial pressure. [ABSTRACT FROM AUTHOR]

The article presents case studies of a a 59-year-old woman and a 64-year-old woman who underwent the approach of resection vestibular schwannoma. The patients have developed cerebrospinal fluid (CSF) rhinorrhea. Temporalis muscle grafting was performed on both the patients. The surgical technique included various step-by-step methods including raising the nasoseptal flap (NSF), preparation of the recipient bed, and closure of eustachian tube (ET) with NSF.

Objective: Since first described in the 1990s, the endoscopic modified Lothrop procedure (EMLP) has been the subject of a growing body of literature. We performed a review to compare indications and outcomes of EMLP in an early cohort of publications (1990-2008) versus a contemporary cohort (2009-2016) and compare outcomes associated with follow-up ≥2 years versus <2 years.Data Sources: PubMed, SCOPUS and Cochrane databases.Review Methods: An English-language search of the PubMed and Ovid databases was conducted to identify publications from 1990 to 2016 reporting clinical outcomes of EMLP. Meta-analysis was performed using Statistical Analysis System 9.4.Results: A total of 1,205 patients were abstracted from 29 articles with a mean follow-up of 29.1 ± 10.3 months. The overall rate of significant or complete symptom improvement was 86.5% (95% confidence interval [CI]: 84.2%-88.7%). The overall patency rate was 90.7% (95% CI: 89.1%-92.3%), with a revision rate of 12.6% (95% CI: 10.6%-14.3%). Compared to the early cohort, patients in the contemporary cohort underwent EMLP more often for tumors (P < .001), had higher rates of complete or significant symptom improvement (90.0% vs. 82.6 %, P < .001); and trended toward greater patency rates (92.1% vs. 88.6%, P = .052). Compared to the short-term follow-up cohort, the long-term cohort showed no differences in symptom improvement or patency, but the revision rate was higher (14.5% vs. 9.2%, P = .016).Conclusions: In the last decade, EMLP has been performed more frequently for tumors. Recent studies have demonstrated improved symptom outcomes and a trend toward improved patency rates. The revision rate increased significantly when follow-up exceeded 2 years. Laryngoscope, 128:317-326, 2018. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to describe how the up-front transoral robotic surgery (TORS) approach could be used to individually tailor adjuvant therapy based on surgical pathology. Methods Between January 2009 and December 2013, 76 patients received TORS for oropharyngeal squamous cell carcinoma (OPSCC). Clinical predictors of adjuvant therapy were analyzed and comparisons were made between recommended treatment guidelines for up-front surgery versus definitive nonsurgical approaches. Results Advanced N classification, human papillomavirus (HPV)-positive tumor, extracapsular spread (ECS; 26 of 76), perineural invasion (PNI; 14 of 76), and positive margins (7 of 76) were significant predictors of adjuvant chemoradiotherapy (CRT) ( p < .05). Up-front TORS deintensified adjuvant therapy; 76% of stage I/II and 46% of stage III/IV patients avoided CRT. Conversely, pathologic staging resulted in 33% of patients who would have received radiotherapy (RT) alone based on clinical staging, to be intensified to receive adjuvant CRT. Conclusion The TORS approach deintensifies adjuvant therapy and provides valuable pathologic information to intensify treatment in select patients. TORS may be less effective in deintensification of adjuvant therapy in patients with clinically advanced N classification disease. © 2016 Wiley Periodicals, Inc. Head Neck 38:1201-1207, 2016 [ABSTRACT FROM AUTHOR]

Background Asthma is a prevalent disease characterized by chronic inflammatory changes of the airway and marked by airway hyperresponsiveness, edema, and excess mucus production. Management of the disease has focused upon reversing the early airway changes and limiting the late effects of airway remodeling. Several classes of medications are available for the effective treatment and long-term control of asthma and novel therapeutic options are in development that hold promise in improving patient outcome. Methods A review of updated guidelines and current literature was conducted to identify available pharmacologic treatments of asthma and determine future directions in development of novel therapeutic options. Results Inhaled corticosteroids are the most effective medications in long-term asthma control with adjunct medications such as β2-agonists, which can provide symptomatic relief. Other classes of asthma control medications including anticholinergics, cromolyns, and leukotriene receptor modifiers can also be used to develop an effective management strategy based on asthma severity. Conclusion Several classes of medications are available for the effective management of asthma. Inhaled corticosteroids play a central role in control of inflammation and several other adjuncts are available to tailor therapy to the patient's symptoms. New therapeutic options that target downstream inflammatory mediators can provide increased efficacy while limiting side effects. [ABSTRACT FROM AUTHOR]

Papillary thyroid cancer (PTC) is the most common malignancy of the thyroid gland. It typically spreads via lymphatic extension. The rate of regional PTC metastasis to the neck is relatively high, while metastases outside the deep cervical chain are rare. Distant metastases are found in only 1% of patients with PTC at the time of surgery; the two most common sites are the lung and bone. We report 4 cases of PTC metastasis to unusual sites: (1) the occipital skull and internal jugular vein, (2) the parapharyngeal space, (3) the sternocleidomastoid muscle, and (4) the right atrium of the heart. It has been well documented that aggressive distant metastasis is a characteristic of PTC, and it is known to be an indicator of a poor prognosis. Some of our patients' sites ofmetastatic disease have not been previously reported. Patients in this series exhibited aggressive histologic findings, including columnar cell andfollicular variants of papillary disease. In addition, all 4 patients demonstrated "PET-avid" disease with decreased iodine avidity. [ABSTRACT FROM AUTHOR]

Objective: The objective of this systematic review was to evaluate synechiae formation in patients who underwent packing in the middle meatus at the completion of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis. Data Sources: PubMed and Ovid. Review Methods: Prospective randomized controlled studies of ESS with the placement of middle meatal packing were reviewed and included for analysis. Metaanalysis of the pooled data was performed. Results: Eighteen prospective, randomized, controlled trials met inclusion criteria, resulting in a total of 925 subjects. Although there was a trend toward decreased risk of synechiae formation in the patients who underwent placement of middle meatal packing postoperatively (RR = 0.544), this did not achieve statistical significance on metaanalysis (p = 0.052). Conclusions: This systematic review and metaanalysis suggests that use of middle meatal packing does not significantly reduce the risk of synechiae formation after ESS. There was, however, significant heterogeneity of the data analyzed, and the difference between groups was just short of statistical significance in our metaanalysis. Additional prospective randomized studies on this topic will further elucidate the utility of middle meatal packing. [ABSTRACT FROM AUTHOR]

Background: The middle turbinate (MT) is a structure that is often carefully preserved during endoscopic sinus surgery (ESS) in an effort to preserve nasal physiology and serve as an anatomic landmark. However, resection is performed in select cases because of involvement of the MT in the inflammatory process, obstruction, or instability. Therefore, significant controversy exists among surgeons regarding the indications for proceeding with MT resection in ESS. This study evaluates clinical outcomes of MT resection after ESS. Methods: An English language search of the PubMed and Ovid databases was conducted for publications examining clinical outcomes of MT resection after ESS performed for chronic rhinosinusitis. Two authors independently examined the articles to identify those meeting inclusion criteria. Any differences over which studies to include were resolved by discussion and consensus. Bias assessment was conducted using the Cochrane Collaboration bias tool for randomized controlled trials and the Newcastle-Ottawa bias tool for cohort and case-control studies. Results: After initial screening, search results revealed 71 articles that warranted detailed evaluation. After applying inclusion criteria, 9 studies were selected. A total of 2123 patients were included among the studies. All studies were controlled. Within the limited available data, olfaction scores may be improved in the MT resection patients compared with MT preservation patients. No difference between the groups was noted for quality of life outcomes, nasal airway resistance, or rates of postoperative frontal sinusitis. In regard to postoperative endoscopic examinations, some studies note greater improvement in the MT resection group compared with the MT preservation group, while others were equivalent. Conclusion: Although some studies show outcome benefit in MT resection patients compared with MT preservation patients, several others show no difference. When MT resection was appropriately indicated, no studies showed detrimental effects compared with MT preservation in their designated outcomes. Additional more stringent studies are warranted. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To identify factors contributing to local tumor recurrence in oral cavity and laryngeal squamous cell carcinomas treated with surgery alone, to approximate tumor age from time to recurrence data by applying Collins' law, and to identify factors that may affect time to recurrence. Study Design: Retrospective review. Methods: A retrospective review of all patients treated for head and neck cancer from 1997 to 2013 at the University of Pittsburgh Medical Center was performed. Results: A total of 517 patients treated with surgery alone qualified for the study, of which 84 had local recurrence, and 433 had no local recurrences. History of tobacco use (P = .017), pack-year cigarette history (P = .001), and T stage (P = .03) were associated with disease recurrence. Overall, never tobacco users, those with fewer pack-years of smoking history, and those with lower T stage were more likely to recur. Time to recurrence was significantly shorter for laryngeal tumors compared to oral cavity tumors (P = .027). Median time to recurrence for oral cavity tumors was 8.6 months and laryngeal tumors was 7.1 months. Conclusions: In this study, lower pack-year smoking history, lower T stage, and history of never tobacco use were associated with local tumor recurrence. Applying the concept of Collins' law to estimate the age of tumors at diagnosis, the median tumor age at diagnosis was estimated to be 8.6 months for oral cavity tumors and 7.1 months for laryngeal tumors. [ABSTRACT FROM AUTHOR]

Objective When the use of the nasoseptal flap for endoscopic skull base reconstruction has been precluded, the posterior pedicle inferior turbinate flap is a viable option for small midclival defects. Limitations of the inferior turbinate flap include its small surface area and limited arc of rotation. We describe a novel extended inferior turbinate flap that expands the reconstructive applications of this flap. Design Cadaveric anatomical study. Participants Cadaveric specimens. Main Outcome Measures Flap size, arc of rotation, and reconstructive applications were assessed. Results The average width of the flap was 5.46 ± 0.58 cm (7.32 ± 0.59 cm with septal mucosa). The average length of the flap was 5.01 ± 0.58 cm (5.28 ± 0.37 cm with septal mucosa). The average surface area of the flap was ∼ ± 27.26 ± 3.65 cm2 (40.53 ± 6.45 cm2 with septal mucosa). The extended inferior turbinate flap was sufficient to cover clival defects extending between the paraclival internal carotid arteries. The use of the flap in 22 cadavers and 5 clinical patients is described. Conclusion The extended inferior turbinate flap presents an additional option for reconstruction of skull base defects when the nasoseptal flap is unavailable. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Patients with sinonasal malignancy (SNM) present with significant sinonasal quality of life (QOL) impairment. Global sinonasal QOL as measured by the 22‐item Sinonasal Outcomes Test (SNOT‐22) has been shown to improve with treatment. This study aims to characterize SNOT‐22 subdomain outcomes in SNM.Patients diagnosed with SNM were prospectively enrolled in a multi‐center patient registry. SNOT‐22 scores were collected at the time of diagnosis and through the post‐treatment period for up to 5 years. Multivariable regression analysis was used to identify drivers of variation in SNOT‐22 subdomains.Note that 234 patients were reviewed, with a mean follow‐up of 22 months (3 months–64 months). Rhinologic, psychological, and sleep subdomains significantly improved versus baseline (all p < 0.05). Subanalysis of 40 patients with follow‐up at all timepoints showed statistically significant improvement in rhinologic, extra‐nasal, psychological, and sleep subdomains, with minimal clinically important difference met between 2 and 5 years in sleep and psychological subdomains. Adjuvant chemoradiation was associated with worse outcomes in rhinologic (adjusted odds ratio (5.22 [1.69–8.66])), extra‐nasal (2.21 [0.22–4.17]) and ear/facial (5.53 [2.10–8.91]) subdomains. Pterygopalatine fossa involvement was associated with worse outcomes in rhinologic (3.22 [0.54–5.93]) and ear/facial (2.97 [0.32–5.65]) subdomains. Positive margins (5.74 [2.17–9.29]) and surgical approach—combined versus endoscopic (3.41 [0.78–6.05])—were associated with worse psychological outcomes. Adjuvant radiation (2.28 [0.18–4.40]) was associated with worse sleep outcomes.Sinonasal QOL improvements associated with treatment of SNM are driven by rhinologic, extra‐nasal, psychological, and sleep subdomains. [ABSTRACT FROM AUTHOR]

Objectives: (1) Assess secondary nasoseptal flaps (NSF) as a viable reconstructive option. (2) Evaluate postoperative vascularity of secondary NSFs. (3) Compare cerebrospinal fluid (CSF) leaks and complication rates of secondary NSFs to primary NSFs. Methods: This is a retrospective review of patients from 2009 to 2013 undergoing transsellar approaches for skull base tumors at the University of Pittsburgh Medical Center. In cases where the necessity of a vascularized reconstructive flap was made evident only after tumor resection, the NSF was raised after the tumor had been resected and/or CSF leak had developed (secondary NSF). Outcome measures include postoperative magnetic resonance imaging (MRI) findings, CSF leak rates, and complication rates. Results: Transsellar approaches were performed in 436 patients during this timeframe. Primary NSFs were used to reconstruct 178 patients while 32 patients had secondary NSFs. Postoperative MRI scans were available in 29 of 32 secondary NSF patients; all maintained vascularity on examination of T1 post‐contrast images (mean time to MRI 4.9 months). There was no significant difference in CSF leak rate between primary NSFs (3.4%) and secondary NSFs (3.1%) (P =. 95). Primary NSFs had a higher overall complication rate (11.7%) compared to secondary NSFs (3.1%), but this was not statistically significant (P =. 142). Logistic regression analysis demonstrated no significant effect of flap type, age, or sex on CSF leak rates. Conclusions: Secondary NSFs are a viable reconstructive option for sellar skull base defects. They maintain vascularity as evidenced on postoperative MRI imaging and compare favorably to primary NSFs in regard to CSF leak rates and complication rates. [ABSTRACT FROM AUTHOR]

Objective: 1) Develop a novel extended inferior turbinate flap (EITF) for endoscopic skull base reconstruction when the nasoseptal flap is unavailable. 2) Describe the anatomic and reconstructive limits of this flap. 3) Understand what types of skull base defects would benefit from this flap. Method: The EITF was designed for harvest in cadaveric specimens based on the inferior turbinate (IT) artery, a terminal branch of the sphenopalatine artery. The anatomical limits of the EITF were assessed. The arc of rotation and reach for reconstruction of ventral skull base defects were assessed in the cadaver. Results: The average width of the flap was 55.8 ± 4.1 mm. The average length of the flap was 52.5 ± 5.5 mm. The average surface area was 29.3 ± 4.4 cm2. The flap was rotated with the turbinate surface at the inferior aspect of the clival defect, and the extended mucosa of the floor was able to cover the upper portion of the defect. Thus, the angle of rotation was smaller when compared to the 180° angle necessary for the traditional ITF to reach the clivus. The EITF was sufficient to cover defects extending between the paraclival internal carotid arteries. Conclusion: The EITF presents an additional option for reconstruction of skull base defects when the nasoseptal flap is unavailable or fails. In contrast to the traditionally described ITF, the EITF provides a greater surface area and better arc of rotation. [ABSTRACT FROM AUTHOR]

Objective: To present our center's experience with a maintenance treatment algorithm for intravenous bevacizumab that allows for personalized therapy decisions., Patients and Methods: We reviewed all patients treated with intravenous bevacizumab for hereditary hemorrhagic telangiectasia-related bleeding and/or high-output cardiac failure (HOCF) from January 1, 2013, to July 1, 2019, at the Mayo Clinic, Rochester, Minnesota. Data regarding subsequent bevacizumab dosing were abstracted., Results: A total of 57 patients (n=40, 70.2% females) were identified with a median age of 65 (55 to 74; range, 37 to 89) years. High-cardiac output state was present in 21 patients (36.8%) and 10 (17.5%) were treated with intravenous bevacizumab primarily for HOCF. The median duration of follow-up after completion of the initial intravenous bevacizumab treatment was 25 (12.3 to 40.8; range, 0.1 to 65.4) months. A total of 20 (35.1%) patients with a median follow-up of 13.5 (range, 0 to 48.4) months required no maintenance dosing throughout the duration of follow-up. Among those who required subsequent maintenance doses, only a small fraction (8 patients; 14.0%) required regular maintenance doses every 4 to 8 weeks during follow-up whereas the majority of patients required intermittent "as-needed" doses at varying intervals., Conclusion: There is significant inter-individual variability in the need for maintenance intravenous bevacizumab when patients are followed using a predefined bevacizumab maintenance dosing treatment algorithm. The use of "as-needed" maintenance bevacizumab appears to be an effective strategy for management of hereditary hemorrhagic telangiectasia-related bleeding and HOCF., (Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Papillary thyroid cancer (PTC) is the most common malignancy of the thyroid gland. It typically spreads via lymphatic extension. The rate of regional PTC metastasis to the neck is relatively high, while metastases outside the deep cervical chain are rare. Distant metastases are found in only 1% of patients with PTC at the time of surgery; the two most common sites are the lung and bone. We report 4 cases of PTC metastasis to unusual sites: (1) the occipital skull and internal jugular vein, (2) the parapharyngeal space, (3) the sternocleidomastoid muscle, and (4) the right atrium of the heart. It has been well documented that aggressive distant metastasis is a characteristic of PTC, and it is known to be an indicator of a poor prognosis. Some of our patients' sites of metastatic disease have not been previously reported. Patients in this series exhibited aggressive histologic findings, including columnar cell and follicular variants of papillary disease. In addition, all 4 patients demonstrated "PET-avid" disease with decreased iodine avidity.