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A rare case of intraosseous cavernous hemangioma was identified in the nasal root. Using a combination of endoscopic surgery and open rhinoplasty, an osteotomy was performed and resection of the hemangioma was successfully achieved with transcolumellar and infracartilaginous incisions and 2 stab incisions. No adverse side effects were observed after the procedure, no tumor recurrence was observed at the 16-month-postoperative follow-up. The preserved periosteum contributed to the osteogenesis and thus, a need for a reconstructive surgery was indicated. The favorable outcomes associated with this approach justify and authenticate the use of endoscopy-assisted open rhinoplasty in the treatment of intraosseous cavernous hemangiomas without leaving ventral surgical scarring. [ABSTRACT FROM AUTHOR]

Background/aims: This study aimed to examine variations in the location of the infraorbital nerve relative to postoperative maxillary cysts to assess the potential risk of nerve injury during endonasal marsupialization.Methods: Coronal computed tomography images of 130 patients (162 sides) with postoperative maxillary cysts who visited our clinic between 2003 and 2014 were reviewed from the viewpoint of the anatomical relationship between the infraorbital nerves and cysts.Results: The proportions of the six locations were as follows: upside 45.1% (n = 73), separate 13.0% (n = 21), medial 5.6% (n = 9), lateral 14.2% (n = 23), in-between 7.4% (n = 12), and unevaluable 14.8% (n = 24). The proportion of the cases with a potential risk of infraorbital nerve damage during endoscopic marsupialization, including medial, in-between, and unevaluable locations, was 27.8%. Retrospective chart review revealed that 2 patients with a postoperative maxillary cyst that were unevaluable complained of persistent postoperative hypoesthesia of the cheek.Conclusion: The anatomical relationship between the infraorbital nerve and postoperative maxillary cysts varied among patients, with approximately one-fourth of the patients being at risk of infraorbital nerve injury even during endoscopic procedures. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses the fusion of endoscopic surgical field and microsurgical dissection as a method for preserving critical perforators and neural structures during the endoscopic removal of meningiomas. The authors present two illustrative cases, one involving a planum sphenoidale meningioma and the other a posterior clinoid meningioma, both of which required meticulous dissection due to the involvement of critical neuroanatomies. The video provides key steps for successful tumor removal and highlights the potential risk of postoperative neurological deficits. [Extracted from the article]

Non-vascularized multilayer fascial closure technique (NMFCT) can be used instead of nasoseptal flap reconstruction for dural repair in endoscopic transnasal surgery (ETS); however, due to the lack of blood supply, its long-term durability and possible limitations need to be clarified. This was a retrospective study on patients who underwent ETS with intraoperative cerebrospinal fluid (CSF) leakage. We assessed the postoperative and delayed CSF leakage rates and the associated risk factors. Among 200 ETSs with intraoperative CSF leakage, 148 (74.0%) ETSs were performed for skull base pathologies other than pituitary neuroendocrine tumor. The mean follow-up period was 34.4 months. Esposito grade 3 leakage was confirmed in 148 (74.0%) cases. NMFCT was used either with (67 [33.5%]) or without (133 [66.5%]) lumbar drainage. There were 10 cases (5.0%) of postoperative CSF leakage that necessitated reoperation. In 4 other cases (2.0%), CSF leakage was suspected but lumbar drainage alone successfully restored the condition. Multivariate logistic regression analyses revealed that posterior skull base location (P < 0.01, odds ratio 11.5, 95% CI 1.99–2.17 × 102) and craniopharyngioma pathology (P = 0.03, odds ratio 9.4, 95% CI 1.25–1.92 × 102) were significantly associated with postoperative CSF leakage. No delayed leakage occurred during the observation period except for 2 patients who underwent multiple radiotherapies. NMFCT is a reasonable alternative with long-term durability, though vascularized flap may be a better choice for cases in which vascularity of the surrounding tissues is significantly impaired due to interventions including multiple radiotherapies. [ABSTRACT FROM AUTHOR]

Trigeminal schwannoma is a rare skull base tumor that can be managed in a variety of treatments including image observation, surgery, stereotactic radiosurgery, such as gamma knife radiosurgery (GKS), and combination of these. Endoscopic transnasal resection is very effective when the tumor is not invading far laterally, or the risk of cerebrospinal fluid (CSF) leak is estimated to be low. A 74-year-old man with a history of prostate cancer and diabetes presented with left oculomotor nerve palsy over a month. Magnetic resonance images (MRI) demonstrated a 25-mm mass in the left cavernous sinus protruding to the left orbit via the superior orbital fissure (Fig. 1). The patient underwent endoscopic transnasal surgery to decompress the mass. The surgery was uneventful, and postoperative MRI demonstrated satisfactory subtotal resection of the mass (Fig. 2). The final pathology returned as schwannoma. At 1-year follow-up, the tumor slowly enlarged, and the patient underwent GKS with a marginal dose of 14 Gy. At the last follow-up, 4 months after GKS, the tumor was stable. Unfortunately the patient deceased from the known prostate cancer. Endoscopic transnasal surgery was especially useful in this case, considering the preoperative known cancer state that management of this benign tumor did not ruin the quality of life of this patient while minimizing hospitalization, as achieving satisfactory tumor control with aid from postoperative GKS, minimizing complications. The link to the video can be found at: https://youtu.be/Q0Ugc2VFV4w. [ABSTRACT FROM AUTHOR]

Background: The olfactory cleft (OC) comprising the olfactory epithelium (OE) is the most important anatomical location for olfactory function. Endoscopic sinus surgery (ESS) is used to treat diseases related to the OC and improve olfactory dysfunction. However, iatrogenic OE injury occasionally occurs. Comprehensive knowledge of the olfactory region is required to avoid damage to the OE during endoscopic procedures. Methods: Immunohistochemistry was performed on olfactory mucosa obtained from the unaffected side of olfactory neuroblastoma surgical specimens. The OE was defined as the epithelium containing mature olfactory sensory neurons (OSNs). The distribution and cell kinetics of the OE were examined. Results: The OE was selectively localized to the anterior two‐thirds of the superior turbinate (ST) and in the nasal septum (NS) just opposite to the ST; the OE was not detected within the mucosa of the superior meatus. The density of mature OSNs was high at the ethmoid tegmen but gradually decreased with distance from the ethmoid tegmen. The extent of cell death and proliferation was relatively even across the OE. Analysis of airflow profiles revealed that resection of inferior ST does not decrease airflow to the OC. Conclusion: The results indicate that the distribution and degree of differentiation of mature OSNs are heterogenous throughout the OE. Epithelial resection of the anterior or superior ST has the potential to damage olfactory function. Resection of the inferior or posterior ST or widening of the superior meatus is a safer alternative that does not damage mature OSNs or alter airflow to the OC. [ABSTRACT FROM AUTHOR]