Endoscopic Skull Base Research Articles

Accuracy and Completeness of Bard and Chat-GPT 4 Responses for Questions Derived from the International Consensus Statement on Endoscopic Skull-Base Surgery 2019

AbstractArtificial intelligence large language models (LLMs), such as Chat Generative Pre-Trained Transformer 4 (Chat-GPT) by OpenAI and Bard by Google, emerged in 2022 as tools for answering questions, providing information, and offering suggestions to the layperson. These LLMs impact how information is disseminated and it is essential to compare their answers to experts in the corresponding field. The International Consensus Statement on Endoscopic Skull-Base Surgery 2019 (ICAR:SB) is a multidisciplinary international collaboration that critically evaluated and graded the current literature. Objectives Evaluate the accuracy and completeness of Chat-GPT and Bard responses to questions derived from the ICAR:SB policy statements. Design Thirty-four questions were created based on ICAR:SB policy statements and input into Chat-GPT and Bard. Two rhinologists and two neurosurgeons graded the accuracy and completeness of LLM responses, using a 5-point Likert scale. The Wilcoxon rank-sum and Kruskal–Wallis tests were used for analysis. Setting Online. Participants None. Outcomes Compare the mean accuracy and completeness scores between (1) responses generated by Chat-GPT versus Bard and (2) rhinologists versus neurosurgeons. Results Using the Wilcoxon rank-sum test, there were statistically significant differences in (1) accuracy (p < 0.001) and completeness (p < 0.001) of Chat-GPT compared with Bard; and (2) accuracy (p < 0.001) and completeness (p < 0.001) ratings between rhinologists and neurosurgeons. Conclusion Chat-GPT responses are overall more accurate and complete compared with Bard, but both are very accurate and complete. Overall, rhinologists graded lower than neurosurgeons. Further research is needed to better understand the full potential of LLMs.

Postoperative management following endoscopic skull base surgery.

The purpose of this opinion is to review current evidence regarding postoperative management following endoscopic skull base surgery. Postoperative management encompasses consideration of level of care, laboratory tests, analgetic and antiemetic therapy, antibiotic, antithrombotic and antiepileptic prophylaxis, pharmacological and nonpharmacological cerebrospinal fluid (CSF) pressure reduction measures, including CSF diversion, activity restrictions, nasal packing removal, nasal debridement and toilet, nasal glucocorticoid administration, positive pressure ventilation, imaging, CSF leak diagnosis, and future perspectives. Although significant effort has been put into research of postoperative measures after endoscopic skull-base surgery, there is a heterogeneity of practices and deficit of high-level studies, which would enable highly powered systematic reviews and meta-analyses.

Related factors of delirium after transsphenoidal endoscopic pituitary adenoma resection-A matched retrospective cohort study

ObjectivesThe primary aim of this study is to explore the factors associated with delirium incidence in postoperative patients who have undergone endoscopic transsphenoidal approach surgery for pituitary adenoma. MethodsThe study population included patients admitted to Tianjin Huanhu Hospital's Skull Base Endoscopy Center from January to December 2022, selected through a retrospective cohort study design. The presence of perioperative delirium was evaluated using the 4 'A's Test (4AT) scale, and the final diagnosis of delirium was determined by clinicians. Statistical analysis included Propensity Score Matching (PSM), χ2 Test, and Binary Logistic Regression. ResultsA total of 213 patients were included in this study, and the incidence of delirium was found to be 29.58 % (63/213). Among them, 126 patients were selected using PSM (delirium:non-delirium = 1:1), ensuring age, gender, and pathology were matched. According to the results of univariate analysis conducted on multiple variables, The binary logistic regression indicated that a history of alcoholism (OR = 6.89, [1.60–29.68], P = 0.010), preoperative optic nerve compression symptoms (OR = 4.30, [1.46–12.65], P = 0.008), operation time ≥3 h (OR = 5.50, [2.01–15.06], P = 0.001), benzodiazepines for sedation (OR = 3.94, [1.40–11.13], P = 0.010), sleep disorder (OR = 3.86, [1.40–10.66], P = 0.009), and physical restraint (OR = 4.53, [1.64–12.53], P = 0.004) as independent risk factors for postoperative delirium following pituitary adenoma surgery. ConclusionsFor pituitary adenoma patients with a history of alcoholism and presenting symptoms of optic nerve compression, as well as an operation time ≥3 h, enhancing communication between healthcare providers and patients, improving perioperative sleep quality, and reducing physical restraint may help decrease the incidence of postoperative delirium.

The Future of Neuroendoscopy: Looking Ahead Through a Lens

Neuroendoscopy has progressed remarkably in the past few decades. Ventriculoscopy, skull base endoscopy, and spinal endoscopy are now part of routine practice in the neurosurgical treatment of numerous pathologies. Like other developing fields, however, it faces numerous challenges and obstacles that must be overcome for the field to continue to evolve and expand. This brief review of new and exciting developments in neuroendoscopy describes some of the most interesting directions the field is starting to steer towards.

Reconstruction Strategy After Endoscopic Skull-Base Surgery.

Endoscopic skull-base surgery (ESBS) is a rapidly growing surgical area that involves collaboration of otolaryngology-head and neck surgeons and neurosurgeons. Various tumor pathologies and extents have been successfully treated with ESBS, and diverse reconstruction methods have been adopted since its introduction. The optimal reconstructive strategy should be based on heterogeneous surgical situations and tumor extent. Nevertheless, there are few current guidelines for selecting reconstructive methods. Therefore, we review diverse options for endoscopic skull-base reconstruction.

Anterior Skull Base Analysis from Coronal and Reconstructed Computed Tomography: Radio-Anatomical Study

Endoscopic sinus and skull base Surgery has gained significant improvement widely all over the world. A computerized tomography (CT) scan provides a detailed anatomy of the skull base especially the bone framework. This study aims to analyze the fixed anatomical bony landmarks of the anterior skull base through coronal and reconstructed CT in the context of the Nepalese population and guide the surgeon to perform endoscopic sinus and skull base surgery safely. This Prospective study includes 70 Computerized Tomography scans of Paranasal sinuses. The different measurement from nasal floor to skull base was taken in coronal and reformatted sagittal CT scan. Mean, standard deviation, minimum and maximum values were analyzed using descriptive statistics. Student T-test was applied to compare between right and left side. This study includes 75 patients between 18 to 77 years. The measurement from nasal floor to the cribriform plate and ethmoidal roof in right and left side were, mean± SD (47± 4.1, 45.3±4.3, 47.9±5.1, and 49±8.5 mm) respectively. Mean Take off angle at the cribriform plate was 43.9 ±10.9°on right side and 43 ± 9.4° on the left side. The distance from the nasal spine to the skull base (mean ± SD) at nasofrontal recess, bulla ethmoidalis, and the junction of sphenoethmoid levels at right sides were 51.5 ± 4.7, 52.9 ± 4.1, and 61.2 ±4.7 little higher at left side. This study provides a detailed analysis of the anterior skull base in coronal and sagittal CT scans which helps to reduces complications.

The recent concept in the management of anterior Skull base tumor: A review of the literature

Introduction Tumor of the skull base are classified based on their tissue of origin. Tumor originates from epithelium, mesenchyme, and neuroectoderm. Management of tumors depends on location, histologic characteristics, and their behaviors. A sinus endoscopy, Computerized tomography scan, and Magnetic Resonance Imaging should be performed to know the type and extent of the tumor. Treatment includes surgical excision either endoscopic vs open, chemotherapy and immunotherapy. We are highlighting the management option of each tumor according to their type of tissue origin and its location. Methods: A PubMed search was conducted for relevant publications using the terms “anterior skull base malignancies” and “anterior skull base malignancies treatment and “open vs endoscopic anterior skull base malignancies.” The publication language should be English. Results: Articles published after 2000 that cover the most recent paradigm shift in the treatment of anterior skull base tumors were included. There have been 35 articles found, despite 20 of them are being rejected due to the lack of full text, abstract, and non-english. Three of the fifteen articles have been downloaded twice, thus they have been excluded. Conclusion: Skull base tumors are treated based on findings of diagnostic nasal endoscopy and imaging results. CT scans and MRIs are becoming more significant in the diagnosis of diseases. Endoscopic techniques to the skull base were beneficial in treating the malignancy. Chemotherapy can be used as a gold standard first-line treatment with radiation and surgery for significant types of head and neck tumors. immunotherapy-like checkpoint inhibitors targeting PD1 are the second-line treatments of advanced HNSCC. Prospective research and trials will be required in the future.

Surgical Outcome of Pure Endonasal Transsphenoidal Approach for Pituitary Tumors

Objective: To determine the frequency of complete tumor excision by endoscopic skull base (transsphenoidal) approach in pituitary adenoma patients presenting to a neurosurgical department.
 Materials & Methods: This descriptive case series was conducted at the Department of Neurosurgery Unit II, Lahore General Hospital Lahore from May 2019 to November 2019. The study included60 patients with pituitary adenoma from the outpatient department who qualified for the inclusion criteria. All patients went through the endoscopic binarial transsphenoidal approach for pituitary adenectomy. All patients were treated according to the department protocols and were followed for 6 weeks to determine the outcome i.e. no residual tumor left as determined by Magnetic Resonance Imaging.
 Results: The mean age of pituitary adenoma patients studied was 50.02 ± 8.2 years. 43 patients (71.7%) were male.56 patients (93.3%) showed complete resection on MRI using the endoscopic binarial transsphenoidal approach. The outcome was not affected by patients' gender and age. Tumor size significantly affected the outcome i.e. complete resection.
 Conclusion: It is concluded that the endoscopic skull base (transsphenoidal) approach for excision of pituitary adenomas gives desirable results as depicted by 93.3% success rate in terms of complete resection of the tumor. We did not observe a significant effect of patients' gender and age on the clinical outcome in the studied sample of the population.

Assessment of Biomarker Heterogeneity in Sinus Versus Inferior Turbinate Tissue in Patients Without Chronic Rhinosinusitis.

Currently, no consensus exists on the appropriate control specimen site to utilize in studies evaluating for biomarkers in chronic rhinosinusitis (CRS). Studies thus far have utilized tissue from various anatomic sites despite regional heterogeneity. We set out to quantify the differences in biomarker levels present in inferior turbinate versus sphenoid sinus mucosa in paired healthy control patients. We hypothesize that statistically significant differences in cytokine/chemokine expression exist between these two distinct sites. A 38-plex commercially available cytokine/chemokine Luminex Assay was performed on 54 specimens encompassing paired inferior turbinate and sphenoid sinus mucosa samples from 27 patients undergoing endoscopic anterior skull base surgery. Patients with a history of CRS were excluded. Paired sample t-tests and Fisher's exact tests were performed. Twenty-seven patients were included in the study, including 10 male and 17 female patients with an average age of 48 years. The following 8 biomarkers had statistically significant concentration differences between inferior turbinate mucosa and sphenoid mucosa sites: Flt-3L, Fractalkine, IL-12p40, IL-1Ra, IP-10, MCP-1, MIP-1β, and VEGF, with all P-values <0.01. No consensus exists regarding the optimal choice of control specimen for CRS research. We present statistically significant quantitative differences in biomarker levels between paired inferior turbinate and sphenoid mucosa samples. This confirms the presence of heterogeneity between different subsites of sinonasal mucosa and highlights the need for standardization in future CRS research.

The use of an O-arm in endonasal endoscopic operations of the skull base

BackgroundEndoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety.MethodsThe aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared.ResultsThe mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043).ConclusionsBased on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.

Navigation and non-navigation CT scan of the sinuses: comparison of the effective doses of radiation in children and adults

BackgroundThe advent of 3D navigation imaging has opened new borders to the endoscopic surgical approaches of naso-sinusal inflammatory and neoplastic disease. This technology has gained in popularity among otolaryngologists for endoscopic sinus and skull base surgeries in both adults and children. However, the increased tissue radiation required for data acquisition associated with 3D navigation protocols CT scans is a source of concern because of its potential health hazards. We aimed to compare the effective doses of radiation between 3D navigation protocols and standard protocols for sinus computed tomography (CT) scans for both the adult and pediatric population.MethodsWe performed a retrospective cohort study through electronic chart review of patients undergoing sinus CT scans (standard and 3D navigation protocols) from May 2019 to December 2019 using a Siemens Drive (VA62A) CT scanner. The effective dose of radiation was calculated in mSv for all exams. Average irradiation doses were compared using a Student’s T-Test or a Kruskall–Wallis test when appropriate.ResultsA total of 115 CT scans were selected for analysis, of which 47 were standard protocols and 68 were 3D navigation protocols CT scans. Among these, 31 exams were performed on children and 84 exams on adults. For the total population, mean effective dose in the non-navigation CT scans was 0.37 mSv (SD: 0.16, N = 47) and mean effective dose in the 3D navigation sinus CT group was 2.33 mSv (SD: 0.45, N = 68). The mean difference between the two groups was statistically significant 1.97 mSv (CI 95% − 2.1 to − 1.83; P < 0.0001). There was a sixfold increase in radiation with utilization of 3D navigation protocols. The ratio was identical when the pediatric as well as the adult subset of patients were analyzed.ConclusionIn our center, utilization of 3D navigation sinus CT protocols significantly increases radiation exposure. Otolaryngologists should be aware of this significant increase and should attempt to decrease the radiation exposure of their patients by limiting unnecessary scan orders and by evaluating 3D acquisition protocols locally with radiation physicists.Level of evidence: Level IV.Graphical

Low preoperative prealbumin levels are a strong independent predictor of postoperative cerebrospinal fluid leak following endoscopic endonasal skull base surgery

Low preoperative prealbumin levels are a strong independent predictor of postoperative cerebrospinal fluid leak following endoscopic endonasal skull base surgery

Risk factors for postoperative intracranial infections during endoscopic endonasal skull base surgery and the role of antibiotic prophylaxis

Risk factors for postoperative intracranial infections during endoscopic endonasal skull base surgery and the role of antibiotic prophylaxis

Evolution and Innovation of reconstructive technique in endoscopic endonasal skull base surgery

Evolution and Innovation of reconstructive technique in endoscopic endonasal skull base surgery

Pediatric endoscopic sinus surgery and skull base surgery in a tertiary hospital

Background: Pathology along the anterior and posterior skull base has long posed challenges to surgeons due to the difficulty accessing these locations and complexity of the surrounding neurovascular anatomy. Initial surgical management of these disorders included open craniofacial approaches and craniotomy, and these approaches are still utilized today for selected cases. However, advances in the latter half of the 20th century in optics, endoscope design, and high definition digital images allowed the development of microscopic and, more recently, endoscopic approaches to the skull base. This technology was initially developed and used in adults but has been adapted over time for use in the pediatric patient. Objectives: Assess the prevalence of pediatric endoscopic sinus surgery (ESS) and skull-base surgery and evaluation of its role in clinical practice. Patients and Methods: This study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 60 patients who subjected to ESS were included in this study. Data was then transferred to the Statistical Package of Social Science Software program, version 23 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY) to be statistically analyzed. Results: The data of 60 children were obtained from King Fahd Specialized Hospital-Dammam data base. They were classified into five groups according to the type of surgery. Most of the patients (36.7%) suffered from allergic fungal sinusitis (AFS). Their ages ranged from 0.1 to 17 years old with the Mean ± SD of 8.8 ± 5.4 years and a median of 10 years. About half of them (46.7%) were more than 10-year old. More than half of them (51.7%) were males. Most of them (60%) subjected to Functional ESS. 21.7% were diagnosed with Fungal Sinusitis and 20% diagnosed with 20% Choanal Atresia. Conclusion: The ESS is an effective way to control many different conditions, including chronic rhinosinusitis, cerebrospinal fluid Rhinorrhea, AFS, Tumors, and Choanal atresia among children population.

Commentary: Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery.

Commentary: Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery.

Endoscopic skull base and transoral surgery during COVID-19 pandemic: Minimizing droplet spread with negative-pressure otolaryngology viral isolation drape.

BackgroundThe coronavirus disease (COVID‐19) pandemic has raised concern of transmission of infectious organisms through aerosols formation in endonasal and transoral surgery.MethodsRetrospective review. We introduce the negative‐pressure otolaryngology viral isolation drape (NOVID) system to reduce the risk of aerosol. NOVID consists of a plastic drape suspended above the patient's head and surgical field with a smoke evacuator suction placed inside the chamber.ResultsFour patients underwent endonasal (4) and endo‐oral surgery (1). Fluorescein was applied to the surgical field. Black light examination of fluorescein‐treated operative fields revealed minimal contamination distant to the surgical field. In two prolonged cases with high‐speed drilling, droplets were identified under the barrier and on the tip of the smoke evacuator. Instruments and cottonoids appeared to be a greater contributor to field contamination.ConclusionsNegative‐pressure aspiration of air under a chamber barrier, which appears to successfully keep aerosol and droplet contamination to a minimum.

Endoscopic Endonasal Trans-Sphenoidal and Skull Base Surgeries in Aseer Central Hospital, Sothern Saudi Arabia

Endoscopic Endonasal Trans-Sphenoidal and Skull Base Surgeries in Aseer Central Hospital, Sothern Saudi Arabia

Radio anatomical analysis of positional relation between anterior ethmoid artery canal and ethmoid skull base in correlation with olfactory fossa

Skull base (SB) injuries happens mostly either in the thinnest or the least resistant part of skull base. The lateral lamella of cribriform plate is one of the common sites of injury during endoscopic anterior skull base surgeries. The anterior ethmoid artery (AEA) visualization is considered as a significant anatomical landmark in such surgeries. Studies correlating their positional relation with morphology of olfactory fossa remains limited. This study aims to look into the relation of AEA to that of SB in different types of olfactory fossa morphology.A retrospective radiological study was done on 100 coronal CT images from patients who were subjected to paranasal CT imaging. In bone window of coronal CT scans, the position of AEA in relation to SB was noted and the vertical distance between them was measured. Based on the distance of AEA from SB, 3 groups were subdivided as follows: Group A - &amp;#60; 2.5 mm, Group B – 2.5 to 5 mm and Group C - &amp;#62; 5 mm. The depth of the olfactory fossa was measured and categorized according to Keros classification.Out of 200 sides, AEA was found below SB in 167 out of 200 (83.5%) with majority belonging to Group A (101 out of 167). Keros type II was commonly observed among all the groups. The position of AEA below SB was seen at a greater frequency as the height of SB increased with the Keros classification and was statistically significant (P = .006)The knowledge of presence of anterior ethmoid artery outside the skull base with long lateral lamella preoperatively would help the surgeon to avoid intraoperative complications during endoscopic skull base or sinus surgeries.

Supreme Nasal Turbinate as an Additional Surgical Landmark in Endoscopic Sinus and Skull Base Surgeries

During endoscopic sinus and skull base surgeries, surgical landmarks are routinely used to guide surgeons navigating in the narrow corridor of the sinonasal region. Risk of complications is higher in difficult cases when there is excessive bleeding or alteration of the normal anatomical landmarks by tumour. An additional landmark is advantageous to prevent complications and serves as a guide. We present a case of supreme turbinate found incidentally during an endoscopic transsphenoidal surgery. Not much is known about the role of supreme turbinate. When it is present, the sphenoid ostium is located medial to its posteroinferior attachment, and behind its vertical part. Hence, the identification of this structure serves as an additional landmark besides superior turbinate during surgery.