Transnasal Endoscopic Resection Research Articles

Transnasal Endoscopic Resection of a Huge Solitary Fibrous Tumor Originated From Frontal Recess

Solitary fibrous tumor (SFT) is a spindle cell neoplasm that occurs commonly in the pleural space. One-third of SFTs arising from an extrathoracic organ are found in the head and neck region, and they arise rarely in the sinonasal tract. Most of these tumors are benign, but malignant tumors are identified in some cases. Here we report a rare sinonasal SFT arising from the frontal recess. A 32-year-old male patient with chief complaint of headache and left facial pain visited the outpatient clinic. He had suffered from paranasal pain and nasal obstruction for several months, and symptoms became more severe in the previous three months. The mass rapidly increased in size and was protruding from the left nostril when he visited the hospital. After computed tomography and magnetic resonance imaging scans, transnasal endoscopic resection of the tumor was performed, and gross total tumor removal was successfully achieved. We believe this case will be helpful for providing information regarding management of such uncommon huge sinonasal tumors originating from the frontal recess.

Endoscopic Transnasal Resection of Trigeminal Schwannoma.

Trigeminal schwannoma is a rare skull base tumor that can be managed in a variety of treatments including image observation, surgery, stereotactic radiosurgery, such as gamma knife radiosurgery (GKS), and combination of these. Endoscopic transnasal resection is very effective when the tumor is not invading far laterally, or the risk of cerebrospinal fluid (CSF) leak is estimated to be low. A 74-year-old man with a history of prostate cancer and diabetes presented with left oculomotor nerve palsy over a month. Magnetic resonance images (MRI) demonstrated a 25-mm mass in the left cavernous sinus protruding to the left orbit via the superior orbital fissure ( Fig. 1 ). The patient underwent endoscopic transnasal surgery to decompress the mass. The surgery was uneventful, and postoperative MRI demonstrated satisfactory subtotal resection of the mass ( Fig. 2 ). The final pathology returned as schwannoma. At 1-year follow-up, the tumor slowly enlarged, and the patient underwent GKS with a marginal dose of 14 Gy. At the last follow-up, 4 months after GKS, the tumor was stable. Unfortunately the patient deceased from the known prostate cancer. Endoscopic transnasal surgery was especially useful in this case, considering the preoperative known cancer state that management of this benign tumor did not ruin the quality of life of this patient while minimizing hospitalization, as achieving satisfactory tumor control with aid from postoperative GKS, minimizing complications. The link to the video can be found at: https://youtu.be/Q0Ugc2VFV4w .

A Rare Case of Sellar Metastastic Renal Cell Carcinoma Mimicking Pituitary Adenoma - a Case Report

Introduction: Metastatic sellar masses are very contributing to 2% of all sellar masses, and up to 0.87% of all metastases to the brain. Breast and lung cancer contribute for up to 60% of all sellar metastases but it is important to recognize other cancers that can also metastasize to pituitary gland. Renal Cell carcinoma (RCC) is number nine on that list. Here we present a case of rare RCC metastasis to pituitary which was mistaken as pituitary adenoma to emphasize early recognition and management of pituitary metastases which may result in better patient’s outcomes and prognosis. Case Presentation: 7 2 year-old male with a remote history of left sided RCC presented with worsening diplopia, blurry vision and headaches for 2 months. Physical exam was remarkable for right sided ptosis with right oculomotor, trochlear and abducens palsy. Computed Tomography Imaging (CT) of the brain showed hyperdense sellar/suprasellar fullness. Magnetic Resonance Imaging (MRI) with and without contrast of the brain showed 2.2 x 1.7 cm enhancing mass in the right cerebellopontine angle with local mass effect concerning for a pituitary tumor. Laboratory work-up was remarkable for hyperprolactinemia 36.5 ng/mL, low TSH <0.015 mU/L, and normal ACTH, FSH and LH levels. Patient underwent endoscopic trans-nasal resection of pituitary tumor. Surgical pathology of the tumor was consistent with metastatic renal cell carcinoma. He was discharged with appropriate multidisciplinary outpatient follow up with endocrinology, oncology and radiology. Discussion: Pituitary metastasis is very rare and often mistaken for pituitary adenoma. Only 7% of Pitutary metastases are symptomatic. Symptom presentation depends on the location of metastases. They include diabetes insipidus (45.2%), visual field defects (27.9%), hypopituitarism (23.6%), ophthalmoplegia (21%), headache (15.8%) and hyperprolactinemia (6.3%). Although, there is no gold standard imaging for sellar masses, both thin-section CT and MRI are beneficial. CT is used for visualizing bony destruction and calcification, on the other hand MRI demarcates lesions in that area. Due to its rarity, there is no standardized guideline therapy for pituitary metastasis and it should be individualized based on patient’s presentation, but it should be multidisciplinary approach of surgical resection, postoperative stereotactic radiosurgery, chemotherapy, and hormone replacement therapy. Prognosis of metastases to pituitary is very poor, with reported six to twenty-two months post resection survival. Factors contributing to prolonged survival are younger age, single/small metastases, and locally guided radiation therapy. Conclusion: This case is to shed light on early recognition of sellar metastasis as a challenging diagnosis especially in patients with rapidly growing pituitary mass and neurological symptoms with history of malignancy for better outcomes.

Treatment with endoscopic transnasal resection of hypothalamic pilocytic astrocytomas: a single-center experience

BackgroundsPilocytic astrocytomas (PAs) are World Health Organization (WHO) grade I tumors, which are relatively common, and are benign lesions in children. PAs could originate from the cerebellum, optic pathways, and third ventricular/hypothalamic region. Traditional various transcranial routes are used for hypothalamic PAs (HPAs). However, there are few studies on hypothalamic PAs treated through the endoscopic endonasal approach (EEA). This study reports the preliminary experience of the investigators and results with HPAs via expanded EEAs.MethodsAll patients with HPAs, undergone EEA in our hospital from 2017 to 2019, were retrospectively reviewed. The demographic data, clinical symptoms, complications, skull base reconstruction, prognosis, and endocrinological data were all recorded and analyzed in detail.ResultsFinally, five female patients were enrolled. The average age of patients was 28.6 ± 14.0. All patients had complaints about their menstrual disorder. One patient had severe bilateral visual impairment. Furthermore, only one patient suffered from severe headache due to acute hydrocephalus, although there were four patients with headache or dizziness. Four cases achieved gross-total resection, and one patient achieved subtotal resection. Furthermore, there was visual improvement in one patient (case 5), and postoperative worsening of vision in one patient (case 4). However, only one patient had postoperative intracranial infection. None of the patients experienced a postoperative CSF leak, and in situ bone flap (ISBF) techniques were used for two cases for skull base repair. In particular, ISBF combined with free middle turbinate mucosal flap was used for case 5. After three years of follow-up, three patients are still alive, two patients had no neurological or visual symptoms, or tumor recurrence, and one patient had severe hypothalamic dysfunction. Unfortunately, one patient died of severe postoperative hypothalamus reaction, which presented with coma, high fever, diabetes insipidus, hypernatremia and intracranial infection. The other patient died of recurrent severe pancreatitis at one year after the operation.ConclusionAlthough the data is still very limited and preliminary, EEA provides a direct approach to HPAs with acceptable prognosis in terms of tumor resection, endocrinological and visual outcomes. ISBF technique is safe and reliable for skull base reconstruction.

Retrospective Case Analysis of Transnasal Endoscopic Resection of Benign Orbital Apex Tumors: Some Thoughts on Transnasal Endoscopic Surgery.

Purpose To deeply discuss the patient selection, surgical planning, surgical techniques, and the therapeutic challenge for endoscopic transnasal resection of benign orbital apex tumors (OATs). Methods We retrospectively analyzed the cases of 18 patients (18 eyes) with orbital apex cavernous hemangioma (OACH) who underwent endoscopic transnasal approach for resection of the tumor in Zhongshan Ophthalmic Center from March 2016 to May 2020. At each follow-up visit, the patients underwent measurement of their best-corrected visual acuity (BCVA), slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Results There were 18 patients, 7 males and 11 females, with a mean age of 49.9 ± 12.6 years (range: 26 to 70 years). All 18 patients had unilateral tumors. Among the 18 cases, 13 were located in the right orbit and 5 were located in the left orbit. Sixteen patients underwent purely endoscopic transnasal surgery, and the other 2 patients underwent an endoscopic transnasal approach combined with a transcutaneous or transconjunctival surgical approach. Fourteen patients' OACHs were removed completely, 1 patient's OACH was partly removed, and 3 patients underwent pure decompression of the optic nerve. Fourteen patients gained improved or stable BCVA after surgery. Three patients showed postoperative vision decline, and 1 patient had no light perception after surgery. Conclusions Endoscopic surgery is an effective surgical technique for the treatment of benign tumors in the orbital apex. It is necessary to strictly select patients and fully evaluate the benefits and risks of tumor completely or partly removed.

Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes.

Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA. Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency. Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3-2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency. Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.

Transnasal Endoscopic Resection of the Intraconal Metastases From Renal Cell Carcinoma: a Case Report and Review of Literature.

Renal cell carcinoma (RCC) is the most common malignancy to cause metastasis to sinonasal cavity. These metastases can occasional cause invasion into the orbit. Isolated intraconal intraorbital metastasis from RCC is very rare. We hereby describe a case of 72-year-old female, who underwent right nephrectomy for RCC, 8 years back, and now presenting with a space occupying lesion in the right intraorbital intraconal compartment with no involvement of the paranasal sinuses. En bloc resection of the tumor was achieved via transnasal endoscopic approach. This is a rare case where minimally invasive surgery was done for metastatic lesion, with minimal postoperative morbidity.

Expanded endoscopic transnasal odontoidectomy and posterior stabilization: a combined approach.

Lesions of the craniovertebral junction are difficult to access, which is due to the anatomical features and high concentration of vital structures in the area. The transoral access has been most used for anterior approach to treat craniovertebral junction pathology. This method has consistently shown a high complication rate and difficulties in-patient rehabilitation. In this study we analyzed the benefits of surgical treatment of the craniovertebral junction area pathology with the transnasal approach. Four patients with C2 odontoid process invagination and brain stem compression were treated with the transnasal endoscopic resection of the pathological process combined with simultaneous occipital-cervical stabilization (OCS). Surgical procedure, anatomical findings, complications, and rehabilitation period were assessed. Transnasal treatment of C2 odontoid process lesions was applied successfully in all four cases. A modified extended transnasal approach was used. This approach is characterized by an increased operating time (238 minutes), lower complication rate, safer access (less traumatization of oropharyngeal tissue), better patient rehabilitation (no need for tracheostomy or feeding tube), better recovery and higher patient satisfaction (quick regression of the symptomatic patients). The extended transnasal access to the craniovertebral junction is a safer, more comfortable technique, which facilitates more radical treatment of lesions in this area. For brain stem compression due to C2 odontoid process invagination, a combination of transnasal resection and OCS shows excellent preliminary results. This method should be favorable over the transoral approach in certain cases, as it provides a better direct access to lesion of the craniovertebral junction and allows for more complex combined procedures.

The quality of life after transnasal microsurgical and endoscopic resection of nonfunctioning pituitary adenoma.

A pituitary tumor can be reached by a transsphenoidal approach with the use of a microscope or an endoscope. The impact of the surgical technique on the patient's quality of life (QOL) is of great interest to us. Currently, the development of both surgical techniques, especially the endoscopic one, is very rapid. Treatment outcomes are extremely important, especially in terms of patients' QOL after pituitary tumor resection, irrespective of the technical aspects. To compare the quality of life between patients who had undergone either transsphenoidal microscopic (MTS) or endoscopic (ETS) non-functioning pituitary adenoma resection. The study population consisted of 32 consecutive patients (21 for the endoscopic and 11 for the microscopic method) who had undergone pituitary adenoma resection. Their QOL was evaluated using the World Health Organization's Quality of Life assessment tool (WHOQOL-BREF), the Sino-Nasal Outcome Test (SNOT-22) and the Visual Functioning Questionnaire (VFQ-25). Questionnaires were collected before and after surgery during the patients' hospital stay and 3 months after the surgery. The patients in the 2 groups did not differ significantly in terms of age, sex, tumor size, length of hospital stay, or QOL before the surgery. Vision-related QOL (VR-QOL) significantly improved in patients undergoing endoscopic surgery (p < 0.001). There were no statistically significant differences in QOL between the study groups at any stage of the trial (p > 0.05). Significantly more patients had improved QOL after endoscopic surgery according to the WHOQOL-BREF (p = 0.005) and the VFQ-25 (p = 0.002). The novel observation in this study is the significant improvement of VR-QOL in patients after endoscopic non-functioning pituitary adenoma resection in comparison to patients having microscopic resection. The microscopic method does not exacerbate rhinological symptoms more than the endoscopic one. Endoscopic surgery seems to be more beneficial for patients with pituitary adenoma, which deteriorates VR-QOL.

Diagnostics and therapy of bilateral choanal atresia in association with CHARGE syndrome.

Bilateral choanal atresia in patients with CHARGE syndrome becomes symptomatic immediately after birth. A prompt diagnosis, the implementation of sufficient preliminary measures, and the delivery of surgical therapy are crucial. This article is intended to assist in terms of diagnostics and a therapy recommendation. We performed a retrospective study using the medical records of all newborns in the University Hospital in Bonn, diagnosed with bilateral choanal atresia and CHARGE syndrome and underwent surgery at the Department of Otorhinolaryngology, Head and Neck Surgery. A total of 21 patients have been treated with a unilateral or bilateral choanal atresia. 14 patients were primarily treated with transnasal endoscopy or underwent transnasal endoscopic surgery as a follow-up intervention (73.68%). Nine patients had a syndromal appearance, which was considered a definite diagnosis in six patients (five with CHARGE syndrome). All five patients with CHARGE syndrome received transnasal endoscopic treatment and a stent was inserted. Bilateral choanal atresia can be a life-threatening situation requiring acute measures. The therapeutic trend goes towards transnasal endoscopic resection. Primary intervention should be: minimally invasive, one-stage surgery, functional, and associated with low complication rates. Patency can be increased by saline irrigations, topical corticosteroids, endoscopic controls, and regular dilatation. The insertion of stents is controversially discussed but can be useful in syndromal patients. However, adjuvant therapy with a stent and mitomycin C is increasingly being abandoned. A significantly higher recurrence rate must be expected in association with CHARGE syndrome. Stenting should be considered on an individual basis. Continuous training and support of the parents are obligatory.

A Case of Low Grade Thyroid Like Nasopharyngeal Papillary Adenocarcinoma in Posterior Nasal Septum

Nasopharyngeal papillary adenocarcinoma of low-grade malignancy (LGNPPA) is an extremely rare neoplasm. A thyroid-like LGNPPA morphologically resembles a papillary thyroid carcinoma; the lesion is usually a polypoid or pedunculated mass &lt;1-3 cm in diameter, often in the posterosuperior wall of the nasopharynx. Here, we report a case of a thyroid-like LGNPPA in the left posterior septal wall. Surgical removal of the tumor was performed by transnasal endoscopic resection using laryngeal cutting forceps. The tumor was completely resected, bleeding was minimal, and the patient had no complaints of nasal pain, nasal congestion, or epistaxis. Further evaluation including immunohistochemistry confirmed a diagnosis of thyroid-like LGNPPA. No postoperative adjuvant treatment was administered. (J Clinical Otolaryngol 2019;30:70-73)

Diagnosis and treatment of congenital nasal dermoid and sinus cysts in 11 infants: A consort compliant study.

There have been few studies on congenital nasal dermoid and sinus cysts (NDSCs) in infants.This study was performed to obtain clinical data for the diagnosis and treatment of NDSCs in infants.We performed a retrospective analysis of 11 infants admitted with NDSCs between 2014 and 2019. Patient demographics, lesion site, preoperative radiological findings, surgical technique, intraoperative findings, and postoperative sequelae were analyzed.In total, 11 infants (average age, 19 months; lowest age, 10 months) were included in this study. All patients presented with a nasal root mass, 2 patients also had nasal tip fistula, and only 1 case had a history of preoperative infection. Preoperative enhanced computed tomography (CT) examination showed nasal surface lesion (type I) in 3, nasal intraosseous (type II) in 5, intracranial epidural (type III) in 2, and intracranial dural (type IV) in 1 patient. The main surgical methods included direct resection with a vertical midline incision (9 patients), vertical incision + transnasal endoscopic resection + skull base repair (1 patient), and transverse incision of the lower margin of the left eyebrow (1 patient). All wounds healed well without serious complications.Using the 4-type classification method in combination with the preoperative CT findings to analyze the extent of NDSC in infants is helpful for formulating the surgical plan. Using vertical incision approach alone or combined with nasal endoscopy for minimally invasive surgery can meet the needs of complete resection and reconstruction.Our results provide clinical data that can help establish standardized criteria for the diagnosis and treatment of NDSCs in infants.

Trans-nasal trans-sphenoidal endoscopic resection of spindle cell oncocytoma of adenohypophysis: The first case report in a child and a review of literature

Spindle cell oncocytoma (SCO) is a rare tumor of adenohypophysis, arising from the sellar region. So far, about 35 cases of SCO in the sellar region have been reported. In this report, we present the first case of pediatric SCO and review the literature concerning the tumor origin, clinical presentations, radiological features, and treatment modalities. An 8-year-old male was referred to our clinic with progressive visual loss in the left eye and headache over the past 6 months. Cranial magnetic resonance imaging revealed a solid adenohypophysis mass with suprasellar extension, as well as compression and displacement of the optic chiasm. The patient underwent endoscopic trans-sphenoidal resection of the tumor. The tumor was diagnosed as SCO based on the histological study. He did not receive radiation therapy. The patient's condition remained stable, with no radiological recurrence in the past follow-up 2 years after the surgery.

How aggressive should resection of inverted papilloma be? Refinement of surgical planning based on the 25-year experience of a single tertiary center.

The technique for transnasal endoscopic resection of inverted papilloma (IP) has evolved considerably during the last 20 years. The aim of the present study is to retrospectively analyze a single tertiary center series, with special emphasis on assessing the value of an "insertion-driven" technique on local control. Patients undergoing endoscopic resection for IP at the University of Brescia during the period 1991 to 2015 were enrolled. Site of origin and extension of IPs were assessed, together with presence of dysplasia and carcinoma in situ. Patients were divided in 3 cohorts: (1) historical cohort (treated before 2008), (2) contemporary "centripetal" cohort (treated with a traditional technique after 2008), and (3) contemporary "insertion-driven" cohort (treated with insertion-driven resection). Groups were compared considering outcomes and complications. The series included 210 patients. Mean follow-up was 77.8 months. Thirty-eight (18.1%) patients showed precancerous changes. Maxillary involvement (p = 0.021) and presence of precancerous changes (p = 0.013) were significantly associated with a higher risk of recurrence. Five-year local control rate before and after 2008 was 95.1% and 90.5%, respectively. The insertion-driven cohort was associated with lower disease control when IPs involved the maxillary sinus. The rate of complications was 11.9%. The insertion-driven cohort was associated with a lower rate of major complications (p = 0.098). Preoperative evidence of precancerous changes and/or involvement of maxillary sinus should prompt the surgeon to address the disease more aggressively (centripetal resection). Preoperative imaging and biopsy with abundant material may optimize the chance to stratify patients eligible for less or more conservative approaches.

Transnasal endoscopic resection of orbital cavernous hemangiomas: our experience with 23 cases.

The aim of this work was to present our single-center experience on orbital cavernous hemangiomas managed using an endonasal endoscopic approach. The study design used was one-institutional retrospective review. Twenty-three cases of orbital cavernous hemangioma were analyzed and followed up. There were 10 males and 13 females, with an average age of 46.1 years, included in our study. Seven cases were extraconal, 16 cases were intraconal, and in 10 of the patients the optic nerve was involved and compressed. Total resection of the tumor was achieved in 16 cases; of the remaining 7 cases, partial tumor resection and orbital decompression were conducted, orbital decompression was conducted in 2 cases, and orbital decompression and optic nerve decompression were conducted in 3 cases. Visual acuity in 9 patients improved significantly, as 16 of the 20 patients with a preoperative visual field defect had a smaller defect after surgery. This study adds to the literature showing that endoscopic transnasal surgery is likely a reasonable option for patients with the orbital cavernous hemangiomas medial of the optic nerve. With greater experience, skilled surgical technique, and careful operation, better clinical efficacy can be achieved.

Endonasal endoscopic sinus surgery with rhinobasis resection due to esthesioneuroblastoma: case report.

Aim: Esthesionevroblastoma is a rare malignant neuroectodermal tumor that begins development of neuroepithelial cells of the olfactory membrane. Therefore the biology of the tumor, surgery is a method of choice. Endoscopic transnasal method with craniobasal resection is favorable alternative to more invasive surgical methods in a rigorous assessment of patients. Our aim is to describe the first case in the country operated endonasal with typical clinical and histopathological findings of olfactory neuroblastoma, and to discuss opportunities for radical surgery by endoscopic endonasal sinus surgery. Material and methods: We present a patient with nasal obstruction, epistaxis, smell disturbance, headache and eye symptoms. Results: Single step transnasal endoscopic resection with craniektomia, then undergoes postoperative radiotherapy is made on the patient. One year after surgery, no clinical, endoscopic and radiologic evidence of disease recurrence. Conclusion: Esthesionevroblastoma is a rare malignant tumor that untypical because its initial symptoms are often diagnosed at later stages. Early detection and timely performed treatment is important moment for the prognosis.

Management of persistent juvenile angiofibroma after endoscopic resection: Analysis of a single institution series of 74 patients.

Management of persistent juvenile angiofibroma (pJA) after transnasal endoscopic resection is controversial. To better understand its behavior, optimize treatment, and minimize morbidity, we report our experience in pJA focusing on follow-up strategies and disease progression. A retrospective review of clinical records of all JA cases treated with endoscopic surgery at the Unit of Otorhinolaryngology of the University of Brescia between January 1994 and October 2015 was performed. Seventy-four cases were included. Mean follow-up was 113 months (6-266 months). Evolution of pJA was analyzed in 6 cases. Residual lesion size significantly decreased in 3 cases and 2 lesions did not show size variations; significant growth was detected in 1 case of intentional pJA, with diameter increasing by 2.2 mm/yr. pJAs may have the tendency to regress spontaneously or remain stable. In selected cases, avoiding treatment of nongrowing pJA in critical areas is a prudent option.

Endoscopic endonasal resection of adenoid cystic carcinoma of the sinonasal tract and skull base.

Adenoid cystic carcinoma (ACC) is a locally aggressive salivary gland malignancy prone to perineural invasion and local recurrences. In the literature, few data exist to guide treatment when this tumor involves the paranasal sinuses and skull base. We report our experience in the management of sinonasal adenoid cystic carcinoma through an endoscopic endonasal approach. Retrospective analysis of patients affected by sinonasal ACC treated through an endoscopic endonasal approach from 1997 to 2015, managed at the Universities of Varese and Brescia, Italy. Thirty-four patients were included in the analysis. The ethmoid sinus (55.9%), nasal septum (17.7%), maxillary sinus (11.7%), and sphenoid sinus (5.9%) were the primary tumor sites encountered. Twenty patients (58.8%) presented with T3 or T4, without any systemic spreading. Twenty-nine patients underwent endoscopic transnasal resection, whereas the involvement of the anterior skull base in five cases required a transnasal endoscopic craniectomy. Overall, 20 of 34 (58.8%) patients received some form of adjuvant radiotherapy. The follow-up ranged from 12 to 202 months (mean of 73.2 months). The 5-year overall, disease-specific, and recurrence-free survival rates were 86.5% ± 7.39%, 86.5% ± 7.39%, and 71.8% ± 8.67%, respectively. The endoscopic approach is safe and effective for selected sinonasal ACC, reducing the comorbidities of the external approaches while producing similar oncological results. High T-stage, grade III histology, positive surgical margins, and perineural infiltration all have an important negative prognostic value. 4 Laryngoscope, 129:1071-1077, 2019.

Long-term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma.

Although transnasal endoscopic resection (TER) of juvenile angiofibroma (JA) is unquestionably less invasive than traditional external approaches, several endonasal and neurovascular structures are sacrificed during the procedure. The aim of this study was to evaluate long-term neurological morbidity and related quality of life following TER of JA. Retrospective cohort study. All patients who underwent TER for JA at the Unit of Otorhinolaryngology-Head and Neck Surgery of the University of Brescia from 1994 to 2016 were contacted to know their availability to undergo a battery of tests aimed to assess lacrimal secretion (Schirmer test), impairment of sensitive nerves (electrophysiological threshold test), and impact on quality of life of tearing reduction and sensitivity impairment with the Ocular Surface Disease Index (OSDI) and visual analogue scale (VAS) (0-10), respectively. Thirteen patients were included. Mean follow-up was 77 months (range, 19-156 months). The median Schirmer test value was 5.5 mm and 28.5 mm for the treated and untreated sides, respectively (P = .003). Analysis of sensitivity revealed significant impairment only in the hard palate. The mean OSDI score was 6.8 (normal). The mean values of the VAS scores for hard palate, buccal mucosa, gum, and premaxillary skin were 1.7, 1.7, 1.2, and 2.3, respectively. TER for JA can result in objective reduction of lacrimal secretion and sensitivity impairment; nevertheless, their impact on quality of life is negligible. The predictable neurological morbidity of TER should be discussed during preoperative counseling. 4 Laryngoscope, 129:2184-2188, 2019.

Endonasal endoscopic surgery of choanal atresia - long term results

Choanal atresia is a rare abnormality. As neonates depend on transnasal respiration, bilateral choanal atresia causes an acute emergency. Transnasal endoscopic resection of congenital choanal atresia is a well-established therapy. However, the surgical technique has not yet been standardized. A retrospective chart review was performed with a follow-up examination between 9 to 87 months after surgery. 11 patients (7 with unilateral atresia, 4 with bilateral atresia) were included. The choana was opened and enlarged endoscopically by resection of the posterior septal wall and bony reduction up to skull base and nasal floor. Intraoperative handling, intra- and postoperative complications, restenosis and adequate respiratory function were assessed. No intraoperative complications could be observed. Three premature babies underwent surgical intervention within their first postnatal week with an average weight of 2540 g. 2/11 patients suffered from a minor episode of epistaxis as a postoperative complication. Long-term success without restenosis was 73 % (for unilateral atresia) and 100 % for bilateral (atresia). Choosing an endonasal endoscopic approach to resect choanal atresia via resection of the posterior septal wall and circular bony reduction is a successful therapy with low morbidity.