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Background Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second-look procedure may require general anesthesia; however, there is currently little evidence assessing the benefit of this practice. Methods This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second-look debridement under general anesthesia following ESBS. Intraoperative findings, interventions performed, and perioperative complications were reviewed. Multivariate regression analysis was performed to identify associations between intraoperative findings and clinical factors. Results We reviewed 69 cases of second-look debridements (age mean 8.6 ± 4.2 years, range: 2–18 years), occurring a mean of 18.3 ± 10.3 days following ESBS. All abnormal findings were noted in patients age ≤12 years. Synechiae were noted in 8.7% of cases, bacterial rhinosinusitis in 2.9%, and failed reconstruction with cerebrospinal fluid leak in 4.5% (two cases of flap malposition and one case of flap necrosis). All failed reconstructions were noted following expanded endonasal cases for craniopharyngioma, and in each case, a revision reconstruction was performed during the second-look surgery. Synechiae were not significantly associated with younger age, revision cases, or cases with reconstructive flaps. There were no perioperative complications. Conclusion Second-look debridement under general anesthesia may be useful in the identification and intervention of sinonasal pathology following endoscopic skull base surgery, particularly in children ≤12 years old or those with pedicled flap reconstructions. Larger controlled studies are warranted to validate this practice and refine indications and timing of this second procedure. [ABSTRACT FROM AUTHOR]

This article, titled "Risk of Venous Thromboembolism in Endoscopic Skull Base Surgery: A Systematic Review," examines the incidence of venous thromboembolism (VTE) in endoscopic skull base surgery (ESBS) and identifies associated risk factors. The study conducted a systematic literature search and analyzed 39 publications that met the criteria. The pooled VTE rate was found to be 1.9%, with subgroup analyses indicating a pulmonary embolism (PE) rate of 0.9% and a deep vein thrombosis (DVT) rate of 1.4%. Certain factors, such as meningioma, Cushing's syndrome, craniopharyngioma, and chordoma, were associated with an increased risk of VTE. The study also identified potential risk factors, including lumbar drainage placement exceeding a week, prolonged hospital stays, advanced age, malignancies, endocrinopathies, elevated Caprini score, and recent history of stroke. However, there was insufficient data to provide conclusive practice recommendations regarding perioperative anticoagulation. The findings of this study may help inform decision-making and guide future investigations to optimize patient outcomes in ESBS. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the patency of the cavernous sinus (CS) after medial wall resection. The study included 66 patients who underwent endoscopic endonasal approach (EEA) surgeries to resect CS-invading tumors. The results showed that CS patency was achieved in 85% of patients within the first 12 months and 92% by 18 months. Bilateral resection of the CS medial wall and resection for the removal of meningiomas were associated with increased rates of nonpatency. However, the study found that patency versus nonpatency did not have any significant difference in postoperative adverse events or effects. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, examines the use of indocyanine green (ICG) fluorescence angiography to evaluate the impact of surgical and patient factors on the vascular perfusion of nasoseptal flaps (NSFs) in endoscopic skull base surgery (ESBS). The study found that tobacco smokers had lower baseline fluorescence intensity compared to nonsmokers, and patients who underwent a transpterygoid approach had a greater decrease in fluorescence intensity following reconstruction. Other factors, such as revision case, timing of flap harvest, and concurrent septoplasty, did not significantly influence fluorescence intensity. The article concludes that tobacco use and transpterygoid approaches may be associated with decreased vascular perfusion of NSFs. [Extracted from the article]

This article, titled "Outcomes of the Middle Turbinate Swing Technique during the Expanded Endonasal Approach (EEA): A Tertiary Center Experience," explores the use of the middle turbinate (MT) swing technique in skull base surgery. The MT swing technique involves detaching the posterior and lateral attachments of the middle turbinate to allow it to swing laterally into the maxillary sinus, providing better access to the skull base. The study analyzed surgeries performed between January 2021 and August 2023, finding that the MT swing technique did not compromise skull base exposure or tumor resection and had low rates of complications. The authors suggest that further research is needed to investigate the long-term benefits of preserving the middle turbinate during skull base surgery. [Extracted from the article]