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Background: This is the largest study in North America investigating olfactory outcomes after pituitary surgery to date. Objective: Characterize factors associated with subjective olfactory dysfunction (OD) and worsened sinonasal quality-of-life (QOL) after endoscopic TSA. Methods: Patients undergoing primary TSA for secreting and non-secreting pituitary adenomas between 2017 and 2021 with pre- and post-operative SNOT-22 scores were included. Subjective OD was determined by the smell/taste dysfunction question on the SNOT-22 (smell-SNOT). Results: 159 patients with pre- and post-operative SNOT-22 scores were included. Average total SNOT-22 scores worsened from pre-operative (16.91 ± 16.91) to POM1 (25.15 ± 20.83, P <.001), with no difference from pre-operative (16.40 ± 15.88) to POM6 (16.27 ± 17.92, P =.936) or pre-operative (13.63 ± 13.54) to POM12 (12.60 ± 16.45, P =.651). Average smell-SNOT scores worsened from pre-operative (0.40 ± 1.27) to POM1 (2.09 ± 2.01, P <.001), and pre-operative (0.46 ± 1.29) to POM6 (1.13 ± 2.45, P =.002), with no difference from pre-operative (0.40 ± 1.07) to POM12 (0.71 ± 1.32, P =.100). Female gender had a 0.9-point (95% CI 0.1 to 1.6) P =.021, increase in smell-SNOT at POM1, resolving by POM6 (0.1 [−0.9 to 1.1], P =.800) and POM12 (0.0 [−1.0 to 0.9], P =.942). Septoplasty with tunnel approach had a 1.1 [0.2 to 2.0] out of 5-point (P =.023) increase in smell-SNOT at POM1, resolving by POM6 (0.2 [−1.1 to 1.6], P =.764) and POM12 (0.4 [−0.9 to 1.6], P =.567). Female gender had a 9.5 (4.0 to 15.1)-point (P =.001) increase in SNOT-22 scores at POM1, resolving by POM6 (3.4 [−3.0 to 9.8], P =.292) and POM12 (6.4 [−5.4 to 18.2], P =.276). Intra-operative CSF leak had an 8.6 [2.1 to 15.1]-point (P =.009) increase in SNOT-22 scores at POM1, resolving by POM6 (5.4 [−1.7 to 12.5], P =.135), and POM12 (1.1 [−12.9 to 15.1], P =.873). Conclusion: Changes in subjective olfaction and sinonasal QOL after TSA may be associated with gender, operative approach, and intra-operative CSF leak, resolving 6-12 months post-operatively. [ABSTRACT FROM AUTHOR]

Background Understanding the genetic basis for the molecular classification of sinonasal undifferentiated carcinoma (SNUC) based on SMARCB1 may improve our understating regarding the nature of the disease. The objective of the study was to compare the genetic profile of SMARCB1-retained (SR-SNUC) and SMARCB1-deficient SNUC (SD-SNUC). Methods Formalin-fixed, paraffin-embedded tissue from treatment-naive patients with SNUC were selected. Three cases of SR-SNUC, four cases of SD-SNUC, and four samples of nontumor tissue (control samples) were selected. Ribonucleic acid (RNA) sequencing was performed. Results SR-SNUC had a higher number of variants (1 variant for every 15,000 bases) compared with SD-SNUC (1 variant every 29,000 bases). The ratio of missense to silent mutation ratio was higher for SR-SNUC (0.8) as compared with SD-SNUC (0.7). Approximately 1,500 genes were differentially expressed between SR-SNUC and SD-SNUC. The genes that had a higher expression in SR-SNUC included TPD52L1, B3GNT3, GFY, TJP3, ELL3, CYP4F3, ALDH3B2, CKMT1B, VIPR1, SLC7A5, PPP2R2C, UPK3B, MUC1, ELF5, STY7, and H2AC14. The gene that had a higher expression in SD-SNUC was ZFHX4. Most of these genes were related to either protein translation or immune regulation. The most common (n = 3, 75%) mechanisms of loss of SMARCB1 gene in SD-SNUC was loss of heterozygosity. Conclusion RNA sequencing is a viable and informative approach for genomic profiling of archival SNUC samples. Both SR-SNUC and SD-SNUC were noted to have distinct genetic profiles underlying the molecular classification of these diseases. [ABSTRACT FROM AUTHOR]

This is the first study to examine chronic rhinosinusitis (CRS) outcomes after starting immunoglobulin (Ig) replacement therapy for patients with primary (PID) and secondary immunodeficiency (SID). This is a retrospective review of patients diagnosed with CRS from 2018 to 2022 prior to initiating Ig therapy for the treatment of PID or SID. Outcomes included medication use and Sinonasal Outcome Test (SNOT‐22) scores. Ten patients met the inclusion criteria. PID and SID patients had a decrease in antibiotics (PID: 9.40 to 3.20, P =.05, SID: 8.20 to 2.00, P =.04) and steroids (PID: (5.40 to 0.60; P =.06; SID: 2.20 to 0.20, P =.047) prescribed in the year after Ig compared to the year prior. Patients with SID had a decrease in mean SNOT‐22 scores by 12 months after Ig (47.50 to 20.50, P = 0.03). Patients receiving Ig for PID and SID showed decreased medication use and SID patients experienced subjective improvement in CRS symptoms in year‐over‐year comparison. [ABSTRACT FROM AUTHOR]

This article discusses the safety and timing of restarting continuous positive airway pressure (CPAP) following endoscopic anterior skull-base surgery (ESS). The study measured the pressures delivered to the sinonasal cavity during CPAP use and assessed the safety of restarting CPAP after sinonasal surgery. The results showed that restarting CPAP following ESS was found to be safe, with the pressures delivered to the postoperative sphenoid sinus being less than 65% of the delivered pressures in most patients. This suggests that factors such as mucosal edema and nasal packing may limit the amount of CPAP pressure that can access the sphenoid sinus. [Extracted from the article]

This article explores the differences in neuroimaging findings between patients with medically refractory idiopathic intracranial hypertension (IIH) and spontaneous cerebrospinal fluid (CSF) leak (IIHwL) and patients with IIH without spontaneous CSF leak (IIHwoL). The study conducted a retrospective review of medical records and compared demographic information, clinical presentations, venous sinus manometry data, lumbar puncture opening pressure, and neuroimaging findings between the two patient groups. The results showed that patients with IIHwL had different neuroimaging findings compared to those with IIHwoL, highlighting the importance of recognizing these differences for the timely identification and management of CSF leak patients with IIH. [Extracted from the article]

This article examines the risk factors for spontaneous cerebrospinal fluid leaks (sCSF leaks) in patients with idiopathic intracranial hypertension (IIH). The study, which is based on a large multinational database, compares the demographic and treatment characteristics of patients with IIH who have sCSF leaks of the anterior or lateral skull base (IIHwL) to those without sCSF leaks (IIHwoL). The results show that IIHwL patients tend to be older, have a higher body mass index (BMI), and have more comorbidities compared to IIHwoL patients. They also experience a higher prevalence of symptoms such as headaches, tinnitus, and visual disturbance. The findings contribute to a better understanding of this unique subpopulation of IIH patients and may aid in their management. [Extracted from the article]

This article discusses the impact of venous sinus stenting (VSS) on symptoms and quality of life in patients with idiopathic intracranial hypertension (IIH) and a spontaneous cerebrospinal fluid (CSF) leak. The study included nine female patients who underwent VSS for IIH complicated by a CSF leak. The results showed that VSS effectively alleviated symptoms such as tinnitus and headaches, and allowed for discontinuation of medication in some patients. Complications were minimal, and there was no recurrence of CSF leak in the early postoperative period. [Extracted from the article]

Objectives Cerebrospinal fluid (CSF) leaks of the anterior cranial base are frequently repaired with endonasal, multilayered reconstructions. Vascularized tissue flaps are superior to free mucosal grafts and biomaterials in many cases. Limitations of previously described flaps include reach, rotation, pedicle availability, and postoperative sinonasal morbidity. The objective of this study is to describe the superiorly based middle turbinate flap, a novel vascularized mucosal reconstruction option, and to present a case series demonstrating flap utility. Design Cadaveric feasibility study with technical description and illustrative case series. Setting Tertiary medical center. Participants Three silicone-injected cadaveric specimens (6 sides); 7 patients with CSF rhinorrhea from bony dehiscence of the anterior cranial fossa repaired with a superiorly based middle turbinate flap. Outcome Measures Cadaveric feasibility, in vivo repair outcomes, sinonasal symptoms, and postoperative healing. Results Cadaveric dissection demonstrated a consistent vascular plexus arising from the anterior and posterior ethmoid arteries, originating at the superior attachment of the middle turbinate and traveling inferiorly to supply the mucosa of the middle turbinate. Mean surface area of the flap was 776.67 ± 114.60 mm 2. The clinical series of 7 patients involved leaks around the cribriform plate and fovea ethmoidalis. There were no instances of repair failure. All cases showed rapid and complete remucosalization without significant sinonasal morbidity. Conclusion The superiorly based middle turbinate flap is a reliable, versatile, and effective option for a vascularized mucosal flap onlay that can be used in anterior skull base reconstruction. This flap is particularly useful in the repair of defects involving the cribriform plate and fovea ethmoidalis. [ABSTRACT FROM AUTHOR]

Objectives: Among the transsphenoidal (TSS) approaches to pituitary tumors, the microscopic approach (MA) has historically been the predominant technique with the increasing adoption of the endoscopic approach (EA). This study investigates national trends in TSS approaches and postoperative outcomes for MA and EA through 2021. Methods: The TriNetX database was queried for patients undergoing TSS (MA and EA) between 2010 and 2021. Data were collected on demographics, geographic distribution of surgical centers, postoperative complications, stereotactic radiosurgery (SRT), repeat surgery, and postoperative emergency department (ED) visits. Results: 8644 TSS cases were queried between 2010 and 2021. MA rates were highest until 2013 when rates of EA (52%) surpassed MA (48%) and continued to increase through 2021 (81%). From 2010 to 2015 EA had higher odds of a postoperative CSF leak (OR 3.40) and diabetes insipidus (DI (OR 2.30)) versus MA (p < 0.05); from 2016 to 2021 differences were not significant. Although there was no significant difference among approaches from 2010 to 2015 for syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia, or bacterial meningitis, from 2016 to 2021 EA had lower odds of SIADH (OR 0.54) and hyponatremia (OR 0.71), and higher odds of meningitis (OR 1.79) versus MA (p < 0.05). EA had higher odds of additional surgery (either EA or MA) after initial surgery from 2010 to 2021. From 2010 to 2015 EA had lower odds of postoperative SRT compared to MA, whereas in 2016–2021 there was no statistical difference among approaches. Conclusion: This study demonstrates increasing EA adoption for TSS in the United States since 2013. Complication rates have overall improved for EA compared to MA, potentially as a result of improving surgeon familiarity and experience. Level of Evidence: 4 Laryngoscope, 133:2135–2140, 2023 [ABSTRACT FROM AUTHOR]