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Valore prognostico del Sinonasal Outcome Test 22 (SNOT-22) nella rinosinusite cronica.Studi in letteratura hanno evidenziato che il punteggio basale del Sinonasal Outcome Test 22 (SNOT-22) influenza l’outcome chirurgico nella rinosinusite cronica (CRS) ed hanno suggerito che un approccio SNOT-22-mediato potrebbe migliorare la comprensione delle aspettative dei pazienti dopo il trattamento. Il presente studio mirava a verificare questa ipotesi in una popolazione italiana di CRS. In 457 pazienti con CRS, trattati con chirurgia endoscopica endonasale dopo fallimento della terapia medica massimale, sono stati calcolati la percentuale di raggiungimento della differenza minima clinicamente rilevabile (MCID) e la percentuale di miglioramento relativo dopo l’intervento chirurgico. Inoltre, è stato studiato l’impatto di diversi fattori sul punteggio dello SNOT-22 preoperatorio e postoperatorio. Il miglioramento dei sintomi si è verificato nella maggior parte dei pazienti ed era direttamente proporzionale alla SNOT-22 basale. Il 79,7% dei pazienti ha raggiunto l’MCID e la percentuale di miglioramento relativo è stata del 50,1%. Le implicazioni psicologiche e sociali hanno influenzato significativamente i punteggi dello SNOT-22. Un’analisi di regressione multipla ha mostrato che la storia di precedenti interventi chirurgici, asma, score endoscopico preoperatorio e SNOT-22 basale hanno statisticamente predetto il punteggio dello SNOT-22 postoperatorio (R2 = 0,229). Sottoporre i pazienti con CRS a SNOT-22 prima dei trattamenti chirurgici potrebbe quindi aiutare ad informarli sui probabili esiti, sebbene sia fortemente influenzato dalla percezione individuale. Sono necessari ulteriori studi per identificare un set efficace di parametri soggettivi e oggettivi per la valutazione dei risultati.Previous studies have highlighted that baseline Sinonasal Outcome Test 22 (SNOT-22) score affects surgical outcomes in chronic rhinosinusitis (CRS) and suggested that a SNOT-22-based approach might ameliorate patients’ understanding of expectations after treatment. Our study aimed at verifying this hypothesis in an Italian CRS population. In 457 CRS patients treated with endoscopic sinus surgery after failure of maximal medical therapy, the percentage of achieving a minimal clinically important difference (MCID) and the percentage of relative improvement after surgery were calculated. Moreover, the impact of several factors on preoperative and postoperative SNOT-22 score was investigated. Symptom improvement occurred in the majority of patients and was directly proportional to baseline SNOT-22. 79,7% of patients achieved the MCID and the percentage of relative improvement was 50,1%. Psychological and social-functioning implications significantly affected SNOT-22 scores. Multiple regression analysis showed that history of previous surgery, asthma, preoperative endoscopic and SNOT-22 scores predicted the postoperative SNOT-22 score (R2 = 0,298). Submitting CRS patients to SNOT-22 prior to surgical treatments might help to inform about probable outcomes, although it is strongly influenced by individual perception. Further studies are needed to identify an effective set of subjective and objective parameters for evaluation of outcomes.

ObjectiveThe extent of surgery, the type of device used and head position may influence nasal irrigation. The aim of this study was to determine the effectiveness of topical irrigant delivery to the paranasal sinuses according to these factors.MethodFour cadaveric heads underwent four stepwise endoscopic dissections. Irrigations were evaluated after every stage using different delivery devices (squeeze-bottle, gravity-dependent device and syringe) in two head positions (nose-to-sink and vertex down). Irrigant penetration into each sinus was estimated using a four-point scale.ResultsA significant positive effect of surgery was demonstrated for each sinus as well as for the delivery device. High-volume irrigant devices are more effective, and the head position plays a significant role in irrigant distribution to the frontal sinus.ConclusionThis study further confirms the efficacy of high-volume irrigant devices. A vertex down position during the irrigation could improve delivery to the frontal sinus, and the widening of the ostia increases irrigant access to the sinuses.

Objectives Spontaneous cerebrospinal fluid (CSF) leaks are a rare but insidious clinical entity. In the recent literature, their pathogenesis has been linked with idiopathic intracranial hypertension (IIH). Considering a worse surgical outcome compared to traumatic leaks, a medical treatment of the underlying IIH has been suggested in order to prevent relapses. Nevertheless, some aspects of this rare pathology remain unclear. We report our long experience in the management of spontaneous CSF leaks. Methods A retrospective evaluation of all patients with spontaneous CSF leaks treated from 1998 to 2018 in a tertiary referral center was carried out. All patients received surgery without any adjuvant routine medical treatment. Epidemiological and clinical data were reviewed. A telephone survey was conducted to investigate IIH-related symptoms in this population. Results One hundred sixty-seven patients and 195 procedures were included in the study. The total rate of failure after surgical treatment was 9%. Eight patients suffered a relapse in the same site (4%, 8 of 195), whereas seven patients experienced a relapse in a different site (4%, 7 of 167). Twenty-nine percent of the population interviewed referred at least one IIH-related symptom. Conclusion Spontaneous CSF leaks represent a complex pathology that need a multidisciplinary evaluation. Surgical treatment seems to guarantee favorable results in most of the patients. Despite this, a not negligible percentage of patients experienced a relapse during a long-term follow-up. Further studies are needed to reach a deeper understanding of the presentation and course of this particular condition. Level of evidence 4 Laryngoscope, 131:E401-E407, 2021.

The introduction of monoclonal antibody (mAb) therapies represents a promising treatment for refractory chronic rhinosinusitis (CRS). We assessed the effects of selected mAbs (omalizumab, mepolizumab, benralizumab) on CRS in severe asthmatic patients in a real-life setting.A prospective observational study on severe asthmatic patients, treated with 3 different mAb (omalizumab, mepolizumab, benralizumab), and comorbid CRS was conducted. All patients were followed for 52 weeks. The degree of nasal control, SinoNasal Outcome Test (SNOT) 22, Nasal Polyp Score (NPS), Lund Kennedy Score (LKS) were collected at baseline and at 52-week.40 patients (33 with nasal polyps) were studied. 33 patients (82.5%) had uncontrolled nasal disease at baseline, and 15 (37.5%) were uncontrolled after 52 weeks. Significant improvement was observed for SNOT 22 (P0.001), SNOT 1-12 (P0.001) and degree of nasal control (P0.001). Differences in NPS (P = 0.130) and LKS (P = 0.124) were not significant. Net change in the above-mentioned parameters among the three treatment groups was not significantly different.The study shows an improvement of nasal symptoms after 52 weeks of mAb treatment, which was not associated with significant improvement of endoscopic findings. Larger studies are needed to assess the real-life efficacy of mAbs in CRS.L’efficacia delle terapie biologiche sulla rinosinusite cronica nel paziente asmatico severo.L’introduzione degli anticorpi monoclonali (mAb) rappresenta una promettente risorsa per il trattamento delle rinosinusiti croniche (RSC) refrattarie. Obiettivo dello studio è valutare l’efficacia del trattamento biologico sulla RSC nel paziente asmatico severo in un contesto real-life.È stato condotto uno studio osservazionale di 52 settimane su pazienti asmatici severi, trattati con 3 diversi mAb (omalizumab, mepolizumab, benralizumab), e con RSC come comorbidità. Sono stati raccolti raccolti dati riguardanti il grado di controllo nasale, il SinoNasal Outcome Test (SNOT) 22, il Nasal Polyp Score (NPS), il Lund Kennedy Score (LKS) al baseline e a 52 settimane.Sono stati analizzati 40 pazienti (33 con polipi nasali). 33 pazienti (82.5%) presentavano una RSC non controllata al baseline, 15 (37.5%) soffrivano ancora di RSC non controllata dopo 52 settimane. Un miglioramento significativo è descritto per lo SNOT 22 (P0.001), lo SNOT 1-12 (P0.001) e il grado di controllo nasale (P0.001); differenze nel NPS (P = 0.130) e LKS (P = 0.124) sono risultate non significative. Il cambiamento netto dei sopracitati parametri tra i tre gruppi di trattamento non era significativamente differente.Lo studio evidenzia a 52 settimane di trattamento con mAb un miglioramento dei sintomi, non associato a cambiamenti significativi dei riscontri endoscopici. Sono necessari studi più ampi per determinare l’efficacia nella real-life dei mAb nella RSC.

Characterising the eosinophilic profile represents the main step in chronic rhinosinusitis (CRS) endotyping. The aim of the study is to verify the correlation between different methods for tissue eosinophilia quantification.33 CRS patients undergoing endoscopic sinus surgery and 30 controls undergoing non-CRS surgeries were enrolled. Blood venous sampling, nasal biopsy on uncinate process (UP), nasal cytology on inferior turbinate (IT) and middle meatus (MM) were performed.Differences in eosinophil count in blood (P=0.0001), UP (P#x003C;0.0001), IT (P = 0.01) and MM (P = 0.0006) were significant between CRS cases and controls. A weak correlation was found between UP and blood eosinophil count (r = 0.34, P = 0.006) and between UP and IT eosinophil count (r = 0.30, P = 0.017). Moderate correlation between UP and MM (r = 0.51, P #x003C; 0.0001) was shown. ROC analysis predicted eosinophilic CRS with an overall low sensitivity. Once allergic patients were excluded from the analysis, the sensitivity decreased for sampling on IT and increased for MM sampling.This study suggests that MM cytology gives more accurate information on the degree of tissue eosinophilia. Replication in wide and unbiased cohorts is necessary to verify these results and define accurate thresholds.Il ruolo della citologia nasale nella rinosinusite cronica.L’identificazione del profilo eosinofilico è uno step fondamentale nell’endotipizzazione della rinosinusite cronica (RSC). Lo scopo dello studio è verificare il grado di correlazione tra le diverse metodiche di quantificazione dell’eosinofilia.Sono analizzati, per 33 pazienti RSC candidati a chirurgia endoscopica nasosinusale e 30 controlli sottoposti a chirurgia non RSC-correlata, un campione di sangue venoso periferico, una biopsia del processo uncinato (PU), un citologico sul turbinato inferiore (TI) e un citologico nel meato medio (MM).Differenze tra RSC e controlli negli eosinofili su sangue periferico (P = 0,0001), PU (P #x003C; 0,0001), TI (P = 0,01) e MM (P = 0,0006) sono risultate statisticamente significative. È stata dimostrata una correlazione debole tra sangue periferico e PU (r = 0.34, P = 0,006) e tra PU e IT (r = 0,30, P = 0,017), e una correlazione moderata tra PU e MM (r = 0,51, P #x003C; 0,0001). Le curve ROC hanno predetto forme di RSC eosinofila con una sensibilità globalmente bassa. Escludendo i pazienti allergici la sensibilità si riduce ulteriormente per TI mentre aumenta per MM.Il presente studio suggerisce di eseguire il prelievo citologico nel MM al fine di identificare le RSC eosinofile. Sono necessari studi più ampi per verificare i risultati e definire valori limite adeguati.

Cerebrospinal fluid (CSF) leaks associated with endoscopic sinus surgery (ESS) are a rare complication related to anatomical and technical factors. The anatomical variations at skull base level are imperative to be detected preoperatively by CT scan to avoid this complication. Identifying the factors playing a role in the incidence of the CSF leaks during and after ESS and the common leak sites. A retrospective review of 24 patients presented with incidental CSF leaks, gathered from 1999 to 2016 was performed. Images interpretation of the skull base area was done using four parameters includes Keros classification, skull base slope, fovea plane and maxillary ethmoid height ratio (MER). Each parameter is classified into three types according to the anatomical configuration, then these parameters scores categorized according to the level of the safety into a level I, II and III, all levels were correlated with each other and with the site of leakage. It was found that the major group presented with the level I and the least group with level III safety, with an evidence of the most unsafe anatomical variation was the least relevant. Parameters measurements revealed that the larger group of the anatomical variation type III was in the MER and the commonest leak site was in the posterior ethmoidal roof. CT scan study of the skull base is crucial in delineating the variations and be a roadmap to proceed safely through the dissection remembering that incidental CSF leaks are multifactorial in etiology.

Background The aim of this article is to describe the Riedel-Mosher’s surgical technique and identify its current role in the endoscopic endonasal era based on the experience of a tertiary care medical centre. It also provides a brief excursus on materials available for frontal reconstruction. Methods A retrospective review of patients submitted to Riedel-Mosher’s procedure from 2005 to 2018 at a single tertiary care centre was carried out. Details of the surgical technique along with data on frontal reconstruction timing and materials used were collected. Results A total of 21 patients (16 males and 5 females) underwent the Riedel-Mosher’s procedure. The age of the patients ranged from 15 to 84 years. The underlying pathology was represented mainly by chronic osteitis of the frontal bone (17 cases), followed by benign tumours (3 cases) and malignancy (1 case). Perioperative complications occurred in 3 patients. Cranioplasty was carried out only on 16 cases and delayed by an average time of 10 months. Materials for reconstruction included titanium, ceramic, plastic and free flap . Conclusions Nowadays, Riedel-Mosher’s procedure is still indicated in selected cases of benign and malignant pathologies of the frontal sinus and/or frontal bone. Surgical expertise is key to approach the frontal sinus safely. Its reconstruction requires proper planning and a wide variety of materials to perform it is now available.

Il profilo di espressione genica multipla rivela una disfunzione epiteliale nella rinosinusite cronica polipoide.La rinosinusite cronica (CRS) è un disturbo infiammatorio eterogeneo risultante da una complessa interazione genetico-ambientale. Sebbene l’eziologia rimanga tuttora sfuggente, numerosi studi riportano alterazioni nell’espressione genica di diversi fattori implicati nell’ambito della risposta infiammatoria. Tuttavia, la gran parte di queste sono analisi isolate, non replicate, che prendono in considerazione un singolo gene alla volta. Inoltre, gli studi riguardanti analisi di espressione genica multipla, solitamente su mediatori infiammatori (es. citochine), spesso presentano risultati contrastanti, che in parte possono essere dovuti all’eterogeneità dei campioni o a metodologie analitiche di potenza limitata. In quest’ottica, il nostro obiettivo è stato di verificare simultaneamente l’espressione genica di un pannello di geni (AQP5, MUC5AC, CAV1, LTF, COX2, PGDS, TNFα, TGFβ1, MGB1) potenzialmente coinvolti nei meccanismi infiammatori della CRS. Nonostante la gran parte dei campioni sia stata esclusa dall’analisi a causa del deterioramento dell’RNA tissutale, siamo stati in grado di dimostrare una riduzione statisticamente significativa dell’espressione dei geni AQP5, CAV1, LTF e MGB1, in uno specifico sottogruppo di pazienti affetti da CRS nella variante con polipi nasali senza le tipiche comorbidità frequentemente associate (asma, allergia, intolleranza all’acido acetil-salicilico). Questi dati sembrano suggerire una disfunzione della barriera epitaliale nella CRS polipoide. Ulteriori studi saranno necessari per incrementare ulteriormente la nostra conoscenza sulla patogenesi della CRS. A tal proposito l’applicazione delle nuove e più potenti tecniche di sequenziamento, come la next-generation RNA sequencing, e la disponibilità di analisi bioinformatiche più complete potranno migliorare la caratterizzazione del transcriptoma negli endotipi della CRS.Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disorder resulting from a complex gene-environment interaction. Although its aetiology remains elusive, numerous studies reported gene expression alterations of factors apparently implicated in all aspects of the inflammatory response. However, most investigations are limited, unconfirmed analyses of a single gene. Moreover, studies concerning multiple gene expression analyses, usually on inflammatory mediators (e.g. cytokines), show contrasting outcomes in part due to use of heterogeneous samples or methodologies with limited power. In this scenario, our goal was to simultaneously evaluate the expression of a panel of selected genes (AQP5, MUC5AC, CAV1, LTF, COX2, PGDS, TNFα, TGFβ1, MGB1) potentially involved in CRS inflammatory mechanisms. While most of the samples collected were excluded from the analysis because of poor quality RNA, we were able to demonstrate statistically significant downregulation of the AQP5, CAV1, LTF, MGB1 genes in a specific subset of polypoid CRS (patients without typical comorbidities), which might suggest relevant underlying epithelial dysfunction. Further studies are needed to enrich our knowledge on the pathogenesis of CRS. Forthcoming approaches might utilise next-generation RNA sequencing and comprehensive bioinformatics analyses to better characterise the transcriptome profiles of CRS endotypes.

Background: Several authors highlighted the limitations of the Keros classification system in predicting intracranial entry risk. Recently, our group proposed a new classification system based on the angle formed between the lateral lamella of the cribriform plate (LLCP) and the continuation of an horizontal plane passing through the cribriform plate (Gera classification). The aim of this study was to analyze whether the risk of iatrogenic cerebrospinal fluid leak (CSF-L) was better predicted by Keros or Gera classification. Methodology: The pre-operative CT scans of 24 patients (CSF-L group) who suffered from iatrogenic CSF-L during endoscopic sinus surgery (ESS) were compared to those obtained from a group of 100 patients who underwent uneventful ESS (control group). The skull base measurements as well as the distribution of Keros and Gera classes in the 2 groups were analyzed. Results: No difference in the distribution of Keros classes or in the depth of the cribriform plate between CSF-L and control group were demonstrated. On the contrary, significant differences in the distribution of Gera classes and in the degree of the angle formed by the LLCP and the continuation of the horizontal plane passing through the cribriform plate were found. In particular, according to Gera classification system, 19 out of 24 patients in the CSF-L group were considered at risk for iatrogenic CSF-L. Conclusions: Gera classification system might be more sensitive to anatomical variations associated with CSF-L than the Keros one, further suggesting the application of the former during the preoperative CT scan evaluation.

Chronic rhinosinusitis (CRS) is a debated topic in the international rhinologic literature because of its high prevalence, heterogeneity of clinical manifestations and unpredictability of disease course. Recently, the focus in CRS research has moved to identify biological subtypes that might explain its aetiology and clinical variability. However, these analyses are still expensive and limited to scientific purposes, so that they cannot be used on a large scale in daily practice. For this reason, we wondered if it was possible to define a risk stratification for CRS patients based only on first level investigations. The heterogeneity of the disease has given us a large amount of data compelling to find an additional storage system. Herein, we present the results of our work, the RhinoBank, as we believe that it is an easy-to-use tool for those professionals dealing with CRS and an effective system to exploit in clinical research.Strategie integrative nella raccolta dati del paziente affetto da rinosinusite cronica.La rinosinusite cronica (CRS) rappresenta un argomento dibattuto nella letteratura rinologica internazionale a causa della sua alta prevalenza, dell’eterogeneità delle manifestazioni cliniche e della difficoltà a predire l’andamento della malattia. Recentemente l’attenzione della ricerca nella CRS si è spostata verso l’identificazione di sottotipi biologici che possano giustificare l’eziologia e la variabilità clinica. Tuttavia, queste analisi risultano ancora costose e limitate nell’impiego per scopi di ricerca, per cui non applicabili su larga scala e nella pratica clinica quotidiana. Per questo motivo ci siamo domandati se fosse possibile ottenere una stratificazione del paziente rinosinusitico solo sulla base di indagini di primo livello. L’eterogeneità intrinseca della malattia ci ha messo di fronte ad una vasta quantità di dati obbligandoci a trovare strategie di archiviazione addizionali. Presentiamo quindi il frutto del nostro lavoro, il RhinoBank, principalmente per due motivi. Crediamo che sia uno strumento di facile impiego a disposizione di chiunque tratti questa patologia ed un sistema efficace da sfruttare nella ricerca clinica.

Background The aim of this study is to propose a classification of the angle formed by the lateral lamella of the cribriform plate (LLCP) and the horizontal plane passing through the cribriform plate. In particular, the angle was classified into class I (over 80 degrees), class II (45 to 80 degrees, and class III (under 45 degrees) METHODOLOGY: A total of 190 computed tomography scans were retrospectively reviewed in order to obtain four sets of measurements. 1) depth of the cribriform, 2) angle, 3) length of the LLCP, 4) width of the fovea ethmoidalis. The relationship among these measurements were analyzed. Results The angle was significantly correlated with the depth of the cribriform and the length of the fovea, while it was negatively correlated with the length of the LLCP. Significant negative correlation was also found between the length of the LLCP and the width of the fovea. Conclusions This angle classification is based on the theoretical risk of iatrogenic injuries, but it could be helpful also in clinical practice by providing indirect information on the thickness of the anterior skull base. As the angle decreases, in fact, the portion of the anterior skull base composed by the LLCP, increases.

Background The purpose of this study was to evaluate the clinical behavior of oncocytic Schneiderian papillomas in relation to the rate of malignant transformation and recurrences and to report the long-term results of the endoscopic endonasal treatment. Methods A retrospective analysis was carried out on patients with oncocytic papilloma, endoscopically managed over the past 20 years, at 2 university centers following a uniform policy. Results Thirty-three patients were treated between November 1991 and December 2010. The mean follow-up period was 62 months. We observed 2 cases of persistence (6%) at the maxillary sinus level. Both of these patients underwent endoscopic surgical revision. Squamous cell carcinoma (SCC) was observed in 1 patient (3%). Conclusion The endonasal endoscopic technique proved to be a safe and effective approach for the treatment of oncocytic papillomas. An oncocytic papilloma is not to be considered a negative prognostic factor in terms of malignant transformation or recurrence. © 2013 Wiley Periodicals, Inc. Head Neck 36: 624–630, 2014

Objective The purposes of this study were to report our experience with endoscopic treatment of choanal atresia (CA), to illustrate our surgical technique and analyse the different factors that may affect outcomes. Material and methods A retrospective review was performed of patients affected by congenital CA and treated between June 1996 and November 2013 at three referral centres which follow a uniform policy. Results Eighty-four patients with CA (55 unilateral and 29 bilateral), aged between one day and 76 years (mean, 13 years) were included. Associated malformations were present in 28 patients. The overall success rate was 93%, with 96.3% and 86.2% success rates for unilateral and bilateral CA respectively. Six patients (7%) required revision surgery for early symptomatic restenosis. Statistical analysis revealed that outcomes were not influenced by sex, previous surgeries, unilateral versus bilateral atresia or associated anomalies. However, age seemed to be a prognostic risk factor for patients under one year-old. Conclusion The endoscopic endonasal approach is safe and effective, with a very high success rate and low morbidity. The removal of the vomer and the use of mucoperiosteal flaps are the main keys to avoiding postoperative stenosis. The use of stents or Mitomycin C is therefore not mandatory.

The aim of this study is to evaluate the reliability and validity of the Italian SNOT-22 (I-SNOT-22). The study consisted of five phases: item generation, reliability analysis, normative data generation, validity analysis and responsiveness analysis. The item generation phase followed the five-step, cross-cultural, adaptation process of translation and back-translation. A group of 222 patients with chronic rhinosinusitis (CRS) were enrolled for the internal consistency analysis. Sixty patients completed the I-SNOT-22 twice, 2 weeks apart, for test–retest reliability analysis. A group of 119 asymptomatic subjects completed the I-SNOT-22 for normative data generation. I-SNOT-22 scores obtained by CRS patients and asymptomatic subjects were compared for validity analysis. I-SNOT-22 scores were correlated with Lund-Mackay and visual analogue scale (VAS) scores in 50 CRS patients for criterion validity analysis. Finally, I-SNOT-22 scores obtained in a group of 59 CRS patients before and after surgical treatment for CRS were compared for responsiveness analysis. All the enrolled subjects managed to complete the I-SNOT-22 without needing any assistance. Internal consistency was satisfactory (α = 0.86). Test–retest reliability was also satisfactory (ICC = 0.85). A significant difference in the I-SNOT-22 scores between the CRS patients and the asymptomatic subjects was found (p

Objectives:1) Review the management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS), currently in balance between radiotherapy, surgical decompression of neural structures, and wait-and-see policy. 2) Report our experience in the surgical removal of these lesions through an endoscopic endonasal trans-sphenoidal approach (EETSA).Methods:From 1999 to 2010, 56 cases of NFPA with CS invasion were treated through an EETSA. The Knosp classification was used to describe CS involvement as evidenced by preoperative magnetic resonance imaging (MRI) and intraoperatively. Extent of resection was evaluated on postoperative contrast-enhanced MRI, as well as the surgical and visual outcomes. Endocrinological remission was defined according to the most recent consensus criteria.Results:EETSA was performed using direct para-septal, trans-ethmoidal, or trans-ethmoidal-pterygoidal approach. The surgical procedure was well tolerated by all patients. At discharge, visual disturbance was improved ...

Cholesterol granulomas (CGs) are rare benigncystic lesions containing cholesterol crystals in a glue-like fluid and are frequently found in the petrous apex(PA) and in the nearby anatomical area. The goldstandard treatment of PA CG counts on its surgicaldrainage and ventilation to prevent recurrence. Differ-ent surgical approaches have been described in the pastto achieve drainage of these lesions, either through lat-eral, or more recently through an endoscopic endonasalcorridor.

Objective: The ability to repair skull base defects resulting from the treatment of different skull base diseases has been a major challenge over the past decade. Aims of the study are to define different endoscopic techniques of reconstruction, focusing on their evolution, and evaluate their efficacy and indications, analyzing their failures.Method: All cases submitted to endoscopic skull base reconstruction from 1995 to 2011 were divided into group A: patients treated for traumatic or non-traumatic CSF-leaks and group B: patients treated for skull base tumors. Patients were fully investigated prior to surgery with endoscopic evaluations and neuroimaging, eventually associated to other in-depth examinations.Results: 420 patients underwent endoscopic skull base reconstruction: 263 in group A and 157 in group B. Primary closure was achieved in 251/263 cases of group A (95.4%) and in 143/157 cases of group B (91.1%). In 26/420 failures (6.2%) revision surgery reached an effective secondary closure of the de...