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Purpose Due to the potential risk of COVID-19 transmission during endonasal surgery, we studied methods to reduce droplet and aerosol generation during these procedures. Methods Droplet spread was assessed using ultraviolet light and a camera that detected fluorescence in the operative field and surgeon's personal protective equipment. Density of aerosols sized <10 µm was measured using a photometric particle counter. We designed a face-mounted negative-pressure mask placed on the patients' face during endoscopic endonasal surgery. Sixteen patients were recruited between October 2020 and March 2021 and randomly assigned to the mask and no-mask groups. We compared droplet spread and aerosols generated in both groups, with copious irrigation and continuous suction during drilling forming the mainstay of surgical technique in all cases. Results Droplet contamination due to direct spillage of fluorescein from the syringe was noted in two patients. Aerosol density rose during sphenoid drilling in both groups, with no significant difference when continuous suction and irrigation were employed (1.27 times vs. 1.07 times the baseline, p = 0.248). Aerosol density rose significantly when suction and irrigation were interrupted in the no-mask group (44.9 times vs. 1.2 times, p = 0.028) , which was not seen when the mask was used. Conclusion Aerosol generation increases during drilling in endonasal procedures and is a concern during this pandemic. The use of a rigid suction close to the drill along with copious irrigation is effective in reducing aerosol spread. The use of a negative pressure mask provides additional safety when inadvertent blockage of suction and inadequate irrigation occur. [ABSTRACT FROM AUTHOR]

Byline: Gandham. Jonathan, Sauradeep. Sarkar, Georgene. Singh, Sunithi. Mani, Regi. Thomas, Ari. Chacko Background: Intraoperative cerebrospinal fluid (CSF) leaks are a frequent cause of morbidity in patients undergoing transsphenoidal surgery. [...]

Byline: Edmond. Gandham, Rajan. Sundaresan, Regi. Thomas, Ari. Chacko Objectives: To describe the technique of harvesting the nasoseptal flap (NSF) in revision-expanded endoscopic approaches (EEA). Study Design: We retrospectively analyzed [...]

Abstract Introduction Myelolipomas are rare, benign tumors comprising mature adipose tissue and hematopoietic elements. The vast majority occur within the adrenal glands, but extra-adrenal myelolipomas have also been reported in the presacral region, retroperitoneum, mesentery, stomach, spleen, liver, mediastinum and lungs. Here, we present a case of primary myelolipoma occurring in an unusual site: the nasal cavity. To the best of our knowledge, we believe that this location for extra-adrenal myelolipoma has not been previously described in the literature. Case presentation We report a case of primary myelolipoma occurring in the nasal cavity of a 48-year-old Asian woman. We describe the etiology, pathology and differential diagnosis of extra-adrenal myelolipomas, and review the literature. Conclusions We chose to present this case because of its unusual location. Although myelolipomas are rare, we conclude that they it should be considered in the differential diagnosis of lesions in this site.

Central skull base osteomyelitis has an infective pathology located in the deep-seated regions of the skull base, close to critical neurovascular structures. The targeted skull base biopsy technique described in this article outlines the principles of wide exposure and early identification of intraoperative landmarks in order to safely take biopsy and cultures from deep-seated regions, located close to the internal carotid artery. [Extracted from the article]