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The article discusses the versatility of the SPIWAY, an endonasal access guide (EAG) used in surgery. The SPIWAY is a stent that can be placed in the nasal cavity to provide access during endoscopic endonasal surgery. The study includes a retrospective review of cases, a cadaveric model, and a literature review to demonstrate the various uses of the SPIWAY. The article highlights the advantages of the SPIWAY, such as reducing aerosol spread, improving efficiency, and preventing tumor spillage. Overall, the SPIWAY is a useful tool in facilitating access in different surgical approaches within the head and neck. [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 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]

Introduction  The application of cranial tissue sealants to assist with postoperative closure is widespread, but data are lacking regarding its utility in endoscopic endonasal surgery (EEA). A prospective study was conducted to assess the effect of sealant usage on postoperative cerebrospinal fluid (CSF) leak rate following standard reconstruction. Methods  A prospective trial of sealant usage after endoscopic endonasal skull base surgery was performed from May 2016 to June 2019 at a tertiary referral cranial base center. This study enrolled 300 consecutive adult and pediatric patients with skull base pathology who underwent EES in which an intraoperative CSF leak occurred. Patients were sequentially stratified into equally sized groups who did or did not receive sealant as part of their reconstruction. Results  Three hundred consecutive adult and pediatric patients were enrolled in the study and had a confirmed intraoperative CSF leak. The intervention cohort with sealant (first 150 patients) had 21 postoperative CSF leaks (14% rate) compared with 9 postoperative CSF leaks (6% rate) in the control group without sealant (p  = 0.02). On multivariate analysis, sealant usage was associated with a higher rate of postoperative CSF leak (odds ratio [OR] = 2.7; p  = 0.025). Male gender (OR = 2.4; p  = 0.04) and high-flow intraoperative CSF leak (OR = 3.1; p  = 0.038) were also found to be associated with postoperative CSF leak. Conclusion  Among all patients undergoing EES with an intraoperative CSF leak, the addition of sealant to standard closure techniques did not reduce the rate of postoperative CSF leaks. [ABSTRACT FROM AUTHOR]

Prealbumin levels correlate with overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative prealbumin levels predict risk of endoscopic endonasal skull base surgery (EESBS) reconstruction failure, as demonstrated by postoperative cerebrospinal fluid (CSF) leak and/or infection. Between October 2018 and February 2020, 98 patients with documented preoperative prealbumin levels were prospectively followed. The incidence of CSF leak and infection in patients with low prealbumin levels (≤20 mg/dL) was compared with those with normal prealbumin levels (>20 mg/dL). Numerous factors previously shown to influence CSF leak rates were assessed. Both univariate and multivariable analyses were performed to identify independent predictive factors. Within this prospectively gathered patient cohort composed of >95% "high-risk" expanded EESBS, 14 of 98 patients (14.3%) experienced a postoperative CSF leak. Factors univariately associated with postoperative complications at the 0.2 level of significance were used in a multivariable model. Low prealbumin levels (≤20 mg/dL) proved to be a strong independent predictive factor associated with a 5-fold increased risk of postoperative CSF leak (odds ratio 5.01, P = 0.01), and postoperative surgical-site infection (P = 0.0009). These associations remained after controlling for multiple other factors, including body mass index, surgical pathology, previous EESBS, risk assessment index, and high- versus low-flow intraoperative CSF leaks. Preoperative prealbumin levels are an independent predictor of EESBS associated CSF leak and infection. Future studies are needed to investigate the utility of screening and correcting prealbumin levels to limit postoperative complications. [ABSTRACT FROM AUTHOR]