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Objective: The aim of this work is to comprehensively review and synthesize the literature related to sinonasal mucosal melanoma (SNMM) treatment with immunotherapy, including potentially targetable genetic mutations, survival outcomes, and adverse events. Data Sources: Embase, Cochrane, Scopus, and Web of Science. Review Methods: The study protocol was designed according to Preferred Reporting Items for Systematic Reviews and Meta‐analysis statement. Databases were searched from inception through May 23, 2023. Results: A total of 42 studies met inclusion criteria. Twenty‐four of the included studies reported genetic mutations for a combined 787 patients with SNMM. 8.1% (95% confidence interval, CI: 7.6‐8.6), 18.9% (95% CI: 18.1‐19.8), and 8.5% (95% CI: 8.1‐9.0) of reported patients were positive for BRAF, NRAS, and KIT mutations, respectively. The presence of brisk tumor‐infiltrating lymphocytes was associated with improved recurrence‐free survival and overall survival (OS). Six studies reported a combined 5‐year OS after adjuvant immunotherapy treatment of 42.6% (95% CI: 39.4‐45.8). Thirteen studies encompassing 117 patients reported adjuvant or salvage immune checkpoint inhibitor (ICI) immunotherapy response rates: 40.2% (95% CI: 36.8‐43.6) had a positive response (tumor volume reduction or resolution). Eleven studies reported direct comparisons between SNMM patients treated with or without immunotherapy; the majority (7/11) reported survival benefit for their entire cohort or select subgroups of SNMM patients. With the transition to modern ICIs, there is a stronger trend toward survival improvement with adjuvant ICI. Tumors with Ki67 <40% may respond better to ICI's. Conclusion: ICI therapy can be an effective in select SNMM patients, especially those with advanced/metastatic disease. [ABSTRACT FROM AUTHOR]

A case of a middle-aged man with a dysplastic right P3 aneurysm that was not amenable to endovascular treatment due to inflow stenosis. The aneurysm was treated with a left occipital to right P3 bypass with a radial interposition graft and trapping of the aneurysm.By Bhuvic Patel; Maria Karampouga and Georgios A. ZenonosReported by Author; Author; Author [Extracted from the article]

We present an operative video illustrating the technique for clipping a ventrally located ruptured PICA aneurysm through an endoscopic endonasal transclival approach. After soft tissue dissection, the clivus is drilled and the dura exposed. Important landmarks identified during this approach include the hypoglossal nerve located between the jugular tubercle and occipital condyle. The dura was opened, and the aneurysm identified, dissected, and clipped with no residual on postoperative angiogram.By Bhuvic Patel; David Fernandez-Cabral; Carl H. Snyderman and Georgios A. ZenonosReported by Author; Author; Author; Author [Extracted from the article]

This article, titled "Clipping of Bilateral MCA Aneurysms Necessitating a Contralateral Anterior Clinoidectomy," discusses a surgical procedure for treating bilateral MCA (middle cerebral artery) aneurysms. The authors describe a case in which they performed a unilateral approach with contralateral anterior clinoidectomy. They successfully clipped both aneurysms and confirmed their treatment efficacy through a postoperative angiogram. The article provides valuable insights into the surgical management of bilateral MCA aneurysms. [Extracted from the article]

The case refers to a middle-aged woman with an irregular calcified MCA aneurysm. No good endovascular options were thought to be feasible and she was referred for microsurgical therapy. The aneurysm was treated with multiple fenestrated clips and an M2 to M2 side-to-side bypass. She tolerated the procedure well.By Ali Alattar; Bhuvic Patel and Georgios ZenonosReported by Author; Author; Author [Extracted from the article]

This refers to a case of a patient with an irregular carotid cave aneurysm who presented with new recurrent headaches. She was not eligible for a flow diverting stent as she had chronic menometrorrhagia. An endoscopic endonasal clipping was offered. The patient tolerated the procedure well.By Zachary C. Gersey; Bhuvic Patel; Eric Wang and Georgios A. ZenonosReported by Author; Author; Author; Author [Extracted from the article]

We present an operative video illustrating a minimally invasive lateral orbitotomy via a lateral epicanthal incision for an intracavernous trigeminal schwannoma resection. After mapping of the frontalis branch of the facial nerve, a 2 to 3 cm incision and canthotomy were made. Utilizing this incision and the natural opening of the eye, a lateral orbital rim craniotomy was performed, and the lateral wall of the cavernous sinus was exposed. Intracavernous dissection and complete tumor resection were performed.By Bhuvic Patel; Anna K. Terrarosa; Susan Stefko and Georgios A. ZenonosReported by Author; Author; Author; Author [Extracted from the article]

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]

This article discusses the use of a suction nerve stimulator technique for the resection of pituitary adenomas that invade the cavernous sinus. The cavernous sinus is a complex region with many neurovascular structures, making surgical resection challenging. The study reviewed the cases of 50 patients who underwent the endoscopic endonasal approach for pituitary adenoma resection using the suction nerve stimulator device. The results showed that most patients with preoperative cranial nerve palsy experienced full recovery, and no new postoperative cranial neuropathies were reported. The authors suggest that this technique is safe and valuable in managing pituitary adenomas with cavernous sinus invasion, and further research could establish it as a standard protocol to minimize post-surgical complications. [Extracted from the article]

This article, titled "Immunotherapy in the Management of Sinonasal Mucosal Melanoma: A Systematic Review and Meta-Analysis," provides a comprehensive review of the literature on the use of immunotherapy in the treatment of sinonasal mucosal melanoma (SNMM). The study examines genetic mutations, survival outcomes, and adverse events associated with immunotherapy for SNMM. The review includes 44 studies that met the inclusion criteria, with a total of 876 patients. The findings suggest that adjuvant immune checkpoint inhibitor (ICI) immunotherapy can be effective in select patients with SNMM, particularly those with advanced or metastatic disease. While there is a moderate risk of adverse events, the potential survival benefit outweighs the risks. The study also highlights the need for future research on neoadjuvant immunotherapy in SNMM. [Extracted from the article]

This article examines the relationship between patient age and clinical characteristics and outcomes in endoscopic endonasal surgery (EES) for pediatric skull base neurosurgery. The study analyzes data from a single pediatric center over a 23-year period. The research finds that there are age-dependent differences in pathology, with younger patients more likely to have certain types of tumors and older patients more likely to have others. However, the study concludes that EES can be safely performed in patients of all age ranges, with no significant difference in complication rates. [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, published in the Journal of Neurological Surgery, discusses the use of the endoscopic endonasal approach (EEA) for the resection of diaphragma sellae meningiomas. The study involved a retrospective review of patients who underwent EEA for the removal of these tumors between 2000 and 2023. The results showed that EEA was successful in achieving gross total resection in the majority of cases, with minimal postoperative complications. The study suggests that EEA is a viable and safe option for managing diaphragma sellae meningiomas, with potential advantages in preserving visual and pituitary function. [Extracted from the article]

This article proposes a simplified classification system for the transverse/sigmoid and superior petrosal sinus complex (TSSP) in neurosurgical approaches to the posterior and middle cranial fossa. The study retrospectively reviewed the clinical records of patients who underwent retrosigmoid craniectomy for various pathologies. The classification system analyzed the width of the sigmoid sinus protruding medially and the width of the transverse sinus protruding below the tentorium. The study found three different grades of sinus configuration, but no strong correlation was found between the grade and postoperative complications. The authors suggest that employing this grading scheme widely could facilitate safer surgical management for pathologies in the cerebellopontine angle and beyond. [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, published in the Journal of Neurological Surgery, presents the findings of a multicenter study on sellar reconstruction techniques after endoscopic transsphenoidal resection of pituitary tumors. The study aimed to identify the most efficient and least morbid surgical approach to sellar reconstruction. The retrospective chart review included 507 patients from 5 participating sites, and variables such as patient demographics, tumor characteristics, reconstruction technique, postoperative CSF leak, and Sino-Nasal Outcome Test (SNOT-22) scores were analyzed. The study found that the effectiveness and morbidity of different sellar reconstruction techniques were comparable, with no significant differences in postoperative complications and SNOT-22 outcomes. Nasoseptal flaps were more commonly used in cases of giant pituitary adenomas and high-flow intraoperative CSF leaks, while mucosal grafts had shorter operating times. The study also reported a low postoperative CSF leak rate in the cohort. [Extracted from the article]

This article presents a retrospective review of pediatric patients who underwent endoscopic endonasal surgery (EES) for skull base pathologies at a large tertiary pediatric hospital between 1999 and 2022. The study included 243 patients with a median age of 14.2 years, with a male predominance. Various pathologies were treated, including juvenile nasopharyngeal angiofibroma, craniopharyngioma, chordoma, pituitary adenoma, encephalocele, Rathke cleft cyst, and basilar invagination or odontoid pannus. Most patients were treated with EES alone, and the overall rate of postoperative complications was 14%. CSF leak was the most common complication. The study concludes that EES is an effective approach for pediatric skull base pathologies, with lower neurovascular complication rates compared to traditional open approaches. [Extracted from the article]

This article discusses the learning curve and changes in practice patterns for pediatric endoscopic endonasal surgery (EES) over a 23-year period at a single institution. The authors analyzed data from 243 patients with skull base pathologies treated with EES between 1999 and 2022. They found an increase in the proportion of patients with chordoma and a decrease in the proportion with pituitary adenoma. There were also changes in the anatomical locations of the pathologies treated and an increase in the utilization of advanced reconstruction techniques and adjunctive preoperative treatments. Overall, the authors observed minimal increased morbidity despite treating more complex cases. [Extracted from the article]

This article explores the use of radiomic feature analysis to predict overall survival and progression-free survival after surgery in patients with skull base chordomas. The study extracted radiomic features from preoperative MRI scans and used unsupervised analysis to identify distinct groups based on these features. The results showed that the radiomic features were able to model overall survival and progression-free survival, and were also associated with genetic markers commonly used in clinical decision-making. The authors suggest that radiomics-based imaging biomarkers could be a noninvasive and cost-effective way to personalize care for patients with skull base chordomas. [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 discusses the effect of irrigation on intraoperative neuromonitoring during skull base surgery. The study included five patients who underwent posterior fossa surgery, and the facial nerve was exposed to both normal saline (NS) and lactated D Ringer's solution (LR) irrigation. The results showed that NS irrigation resulted in high-frequency electromyography (EMG) discharge of the facial nerve and interfered with the ability to record brainstem auditory evoked potentials (BAER). However, the application of LR immediately abolished this activity and did not interfere with BAER. The study suggests that using warm LR as an irrigant may be superior to NS in reducing detrimental spontaneous EMG activity during and after irrigation. [Extracted from the article]

This article discusses the outcomes of the endoscopic endonasal approach (EEA) for nonfunctional pituitary adenomas (NFPAs) in elderly patients. The study involved a retrospective review of NFPAs in patients aged 65 and older who underwent EEA between 2007 and 2022 at a single medical center. The results showed that EEA was a safe and effective option for NFPA resection in elderly patients, with high rates of visual recovery postoperatively and acceptable rates of gross total resection (GTR). The study also identified risk factors for progression and subtotal resection, but found no associations between postoperative complications and age or frailty scores. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, introduces a novel outcome metric called the 30-day hospitalization ratio (HR) for patients with pituitary adenomas. The metric combines the length of stay and readmission rates within a 30-day period to provide a comprehensive measure of the economic burden of treatment. The study analyzed the clinical records of 468 patients who underwent endoscopic endonasal surgery for pituitary adenoma. Factors associated with a high HR included high preoperative ASA scores, postoperative lumbar drain placement, intradural extension, and employment status. Understanding these risk factors can lead to personalized monitoring and care, ultimately reducing burden and improving outcomes. [Extracted from the article]