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Objective: Chronic rhinosinusitis (CRS) is a proposed risk factor for meningitis and other intracranial complications following the endoscopic endonasal transsphenoidal approach (TSA). Some have recommended staging TSA following surgery for CRS; however, delaying TSA has important ramifications. The objective of this study is to determine whether asymptomatic sinonasal inflammation (RSNI) on preoperative computed tomography scans, without clinical CRS, is associated with postoperative complications following TSA.Methods: All consecutive TSA cases performed at a single tertiary care institution from January 1, 2009, to December 31, 2017, were reviewed for patient demographics, prior surgery, presence of RSNI on preoperative computed tomography scan based on Lund-Mackay (LM) score, intraoperative cerebrospinal fluid (CSF) leak, and postoperative complications (postoperative CSF leak, bleeding, infection). The association between preoperative RSNI and postoperative complications was analyzed via multivariate logistic regression.Results: One hundred seventy-one cases of TSA were included with mean patient age of 52.6 years, 42.7% males, 18.1% revision cases, and mean LM score of 1.9 ± 2.7. Complications were identified in 9.9% of patients at the following rates: 5.3% postoperative CSF leak, 2.9% bleeding, and 1.8% infection (all sinusitis, no episodes of meningitis). Neither total LM score nor LM score > 5 (representative of clinically significant radiographic CRS) were predictors of any postoperative complication (both P > 0.05). Age, sex, revision status, intraoperative CSF leak, and total LM score were not independent predictors of any postoperative complication on multivariate analysis (all P > 0.05).Conclusion: In asymptomatic patients, radiographic evidence of sinonasal inflammation is not associated with increased risk of complications following TSA.Level Of Evidence: 4 Laryngoscope, 129:1545-1548, 2019. [ABSTRACT FROM AUTHOR]

Objective Rhinologists are seeing an increasing number of immunosuppressed patients. Currently, no treatment paradigm exists for treating acute and chronic noninvasive rhinosinusitis (ARS, CRS) in this growing population. This study aims to identify patient and treatment factors that affect rhinosinusitis outcomes in this vulnerable population. Study Design Prognostic retrospective cohort study. Methods Immunocompromised patients treated by rhinologists for ARS or CRS 10/2007 to 10/2012 were identified by rhinosinusitis diagnostic codes, codes for transplant, cancer, HIV, diabetes, and codes indicating immunosuppression in the intensive care setting. Associations between patient factors and outcome were analyzed by logistic regression. Associations between treatment and outcome were analyzed by Firth logistic regression. Results A total of 132 subjects were identified. Of those, 90.9% had CRS and 9.1% had ARS; 12.9% were transplant patients; 47% were diabetic; 37.9% were cancer patients; and 16.7% were in the intensive care unit. Patients with higher American Society of Anesthesiologists (ASA) scores had decreased disease resolution (odds ratio [OR] = 0.5, P = 0.021). Transplant patients (OR = 22.5, P = 0.001), diabetics patients (OR = 6.4, P = 0.017), cancer patients (OR = 5.4, P = 0.046), and patients with prior medical therapy for rhinosinusitis (OR = 5.84, P < 0.001) had increased disease resolution compared to immunosuppressed critical care patients. Patients treated with antibiotics alone had no statistically significant difference in disease resolution compared to those receiving no treatment. In contrast, treatment plans including surgery were associated with greater disease resolution. Conclusion This data indicates that surgical treatment provides improved outcomes for patients presenting with acute exacerbations of rhinosinusitis related to their immunocompromised state. Given the limited study population, these findings may not apply to HIV-positive or ARS patients, and further study should be undertaken in these groups. Level of Evidence 4. Laryngoscope, 125:1767-1771, 2015 [ABSTRACT FROM AUTHOR]

Objectives: (1) Describe 10 cases of posterior fossa encephaloceles. (2) Compare spontaneous posterior fossa encephaloceles to the more common middle fossa encephaloceles. Methods: This is a retrospective review of patients with surgically‐confirmed encephaloceles of the posterior fossa managed at a tertiary care center from 2006 to 2013. Clinical presentation, imaging, and operative findings were reviewed. Patient demographics were summarized with descriptive statistics. Results: Ten cases of surgically confirmed posterior fossa encephaloceles were identified. The median age of diagnosis was 45.5 years; 6 subjects were female, 4 were male. The median length of follow‐up was 18 months, with 2 subjects lost to follow‐up. Seven of 10 cases followed temporal bone surgery, craniotomy, or trauma. The remaining 3 out of 10 were spontaneous. Two of 3 subjects with spontaneous encephaloceles presented with pneumocephalus and 1 with cerebrospinal fluid otorrhea. Computed tomography scans in all cases showed bone loss and soft tissue protrusion from posterior fossa into the mastoid, with a radiologic differential of arachnoid granulation versus encephalocele. At surgical exploration, there was brain tissue protruding from a defect of the posterior fossa in all cases. One subject had a concomitant tegmen defect. Conclusions: Posterior fossa encephaloceles are much less common than middle fossa encephaloceles, only 23 have been reported to date. The difference is presumably due to intracranial pressure differences in the upright position. Given the location of these 3 spontaneous posterior fossa defects, as well as intraoperative findings of cerebral tissue within the mastoid, we suggest that these lesions are true encephaloceles and not just arachnoid granulations. [ABSTRACT FROM AUTHOR]