Search Results (132)

Background: Neuroendoscopy complements exoscopic visualization by providing angled views of anatomical structures hidden from the direct surgical line of sight. However, its practical indications and intraoperative contribution during exoscope-assisted skull base surgery have not been systematically evaluated. This study aimed to characterize the patterns of neuroendoscopic use and its observed intraoperative contribution during exoscope-assisted skull base surgery. Methods: We retrospectively reviewed 164 consecutive skull base procedures performed between March 2024 and June 2026. After excluding 58 pure endoscopic endonasal procedures, 106 exoscope-assisted procedures were analyzed. Neuroendoscopic assistance was used in 42 procedures, each performed in a different patient. Complete operative video recordings from these 42 procedures were retrospectively reviewed by two neurosurgeons, and the observed contribution of neuroendoscopy was classified as visualization-only, confirmatory, or decision-changing. Results: Neuroendoscopic assistance was used in 42 of 106 exoscope-assisted procedures (39.6%), including 30 aneurysms and 12 tumors. The most common indication was clip and perforator confirmation during aneurysm surgery (30/42, 71.4%). The observed contribution was classified as visualization-only in 8 procedures (19.0%), confirmatory in 20 (47.6%), and decision-changing in 14 (33.3%). Among the 14 decision-changing procedures, neuroendoscopic findings led to clip repositioning in 5 aneurysm procedures and additional tumor removal in 9 tumor procedures. No complications judged attributable to neuroendoscope insertion or manipulation were identified in the 42 procedures. Conclusions: Neuroendoscopic assistance provided additional intraoperative information during exoscope-assisted skull base surgery, with decision-changing findings identified in 14 of 42 assisted procedures. These findings characterize the observed contribution and practical indications of neuroendoscopic assistance; however, the retrospective design, selective use of neuroendoscopy, and limited sample size preclude conclusions regarding comparative efficacy or safety. Full article

Introduction: Olfactory groove schwannomas (OGSs) are exceptionally rare intracranial tumors, with fewer than 80 cases reported. Their imaging features often mimic meningiomas or esthesioneuroblastomas, complicating preoperative diagnosis. Their origin remains debated due to the absence of Schwann cells in the olfactory nerve. Research Question: To describe a rare case of olfactory groove schwannoma with ethmoidal extension, successfully treated through a combined interhemispheric and endoscopic endonasal approach, and to discuss its diagnostic and surgical implications in light of the current literature. Furthermore, to measure the respective olfactory function before and after surgery. Material and Methods: A 52-year-old man presented with transient visual disturbances, headache, lexical access difficulties, slight executive dysfunction with impaired inhibition, and anterograde verbal memory impairment. He had no olfactory complaints but olfactory testing revealed unilateral, left-sided anosmia. Preoperative MRI demonstrated a large left olfactory groove mass with solid–cystic components, bone erosion, and inferior ethmoidal extension. A combined transcranial interhemispheric and endoscopic endonasal approach was performed to achieve total resection and ensure skull base reconstruction. Results: Gross total tumor removal was achieved. Histopathological examination confirmed a WHO grade I schwannoma. Postoperative recovery was uneventful, with improvement in neuropsychological and left-sided olfactory function. There was no residual lesion on follow-up MRI. Discussion and Conclusions: OGS should be included in the differential diagnosis of anterior skull base tumors with cystic or sinonasal extension. In selected cases, a combined cranio-endoscopic approach allows safe and radical resection while minimizing morbidity. Accurate histopathological evaluation remains essential for definitive diagnosis, as radiological features alone may be misleading. Olfactory function should be systematically measured since preservation and even improvement of olfactory function are possible. This supports a non-olfactory origin of the tumor, suggesting secondary compression rather than primary involvement of the olfactory system. Full article

Background/Objectives: Expanded endoscopic endonasal approaches (EEAs) provide direct ventral access to adult intradural skull base tumors; however, postoperative complications are variably defined and reported in the literature. This review aimed to synthesize the overall spectrum of adult intradural EEA complications and distinguish pathology-specific evidence from large mixed EEA complication cohorts. Methods: A PRISMA 2020 systematic review and meta-analysis searched PubMed/MEDLINE, Embase, and Web of Science from database inception through July 2026. Eligible studies included adults or adult-separable subgroups undergoing expanded EEAs for intradural skull base tumors. The primary outcomes were CSF leak, meningitis or intracranial infection, new neurological deficit or vascular injury/stroke, hydrocephalus, mortality, and postoperative seizures. Pathology-specific adult intradural series with exact counts were quantitatively synthesized when appropriate, and large mixed EEA cohorts were summarized separately when the eligible subgroup was not separable. Results: After full-text eligibility assessment, 48 reports were retained in the extraction-status set. Three strictly adult-only exact-count reports contributed to the primary CSF leak meta-analysis, yielding a random-effects incidence of 23.0% (95% CI, 10.5–43.1%; I² = 78.7%). A sensitivity analysis adding one mixed-age cohort yielded 23.8% (95% CI, 14.5–36.6%; I² = 68.9%), while a broader sensitivity analysis including both mixed-age reports yielded 21.1% (95% CI, 12.2–33.8%; I² = 69.4%). Meningitis was reported in 6/166 patients across four studies (3.6%; 95% exact CI, 1.3–7.7%), and new neurological deficit/vascular injury/stroke was reported in 4/166 patients across four studies (2.4%; 95% exact CI, 0.7–6.1%). Postoperative seizures were reported in 4/652 patients across two studies (0.6%; 95% exact CI, 0.2–1.6%). Large mixed EEA cohorts were summarized separately because adult intradural tumor subsets could not be separated. Conclusions: CSF leak was the most consistently reported complication after expanded EEAs for adult intradural skull base tumors. The strict adult-only random-effects estimate was 23.0%, but it was based on only three studies and showed substantial heterogeneity, limiting its generalizability. Meningitis, neurological/vascular events, and seizures were uncommon in the extractable data and were summarized descriptively rather than being meta-analyzed. Large mixed EEA cohorts provide important safety context but cannot substitute for standardized adult intradural, pathology-specific reporting. Full article

Introduction: Transnasal penetrating intracranial injuries represent an exceptionally rare form of traumatic brain injury, characterized by high mortality and a substantial risk of severe neurosurgical and infectious complications. Self-inflicted injuries involving the penetration of a foreign body through the nasal cavity into the brain are exceedingly uncommon and require prompt diagnosis and a multidisciplinary treatment approach. Objective: This study aimed to present a rare clinical case of transnasal penetration of a foreign body (a ballpoint pen refill) into the brain parenchyma during a suicide attempt, and to describe the diagnostic and therapeutic approach. Case Report: A 46-year-old woman with an acute psychotic disorder was admitted following a suicide attempt involving the insertion of a ballpoint pen refill through the right nasal cavity. Computed tomography revealed a retained intracranial foreign body embedded within the brain parenchyma, traversing the cribriform plate and associated with pneumocephalus. The foreign body was successfully removed via an endoscopic endonasal approach. Owing to the cerebrospinal fluid leak that developed after removal of the foreign body, reconstruction of the anterior skull base defect was performed using fascia lata and tissue adhesive. The postoperative course was uneventful, with no neurological complications and gradual resolution of the intracerebral hemorrhagic changes and pneumocephalus. The patient was discharged without neurological deficits and was referred for psychiatric treatment with a diagnosis of catatonia accompanied by episodes of psychomotor agitation. Conclusions: Transnasal penetrating brain injuries are rare but potentially fatal. Early radiological diagnosis, meticulous preoperative planning, and an endoscopic endonasal approach enable safe removal of the foreign body and reliable reconstruction of the anterior skull base defect. Multidisciplinary collaboration among neurosurgeons, otorhinolaryngologists, radiologists, and psychiatrists is essential for achieving favorable outcomes in these patients. Full article

Background: Pediatric craniopharyngiomas are rare, histologically differentiated epithelial tumors arising in the sellar–suprasellar region. Despite their low-grade classification, these tumors are associated with significant long-term morbidity because of their proximity to critical neurovascular and hypothalamic structures. Management remains challenging and requires a careful balance between durable tumor control and the preservation of neurological, endocrine, and neurocognitive functions. Methods: This narrative review summarizes the current evidence concerning the epidemiology, molecular pathogenesis, clinical presentation, diagnostic evaluation, and treatment strategies for pediatric craniopharyngiomas. Emphasis is placed on anatomical and hypothalamic involvement-based classifications, evolving surgical philosophies, and the role of multimodal management. Results: Advances in molecular characterization have resulted in the delineation of two distinct subtypes—adamantinomatous and papillary craniopharyngiomas—with different biological drivers and therapeutic implications. Surgical management has evolved from historically aggressive gross total resection to risk-adapted, anatomy-driven approaches that prioritize hypothalamic preservation. In selected patients, subtotal resection combined with modern radiotherapy provides tumor control comparable to that of radical surgery, with reduced morbidity. Endoscopic endonasal and microsurgical transcranial approaches play complementary roles, with approach selection guided by tumor anatomy, hypothalamic involvement, and surgical expertise. Emerging targeted therapies and intracystic treatments further expand therapeutic options. Conclusions: The contemporary management of pediatric craniopharyngiomas emphasizes individualized, multidisciplinary strategies focused on functional preservation rather than anatomical radicality alone. Integration of molecular insights, advanced imaging, and long-term outcome data is essential to further improve survival and quality of life in this vulnerable population. Full article

Background: Endoscopic endonasal approaches for pituitary adenomas are associated with improved clinical and quality of life (QOL) outcomes. However, the necessity of middle turbinate resection to optimize surgical exposure remains controversial, particularly regarding its potential impact on postoperative nasal and tumor-related QOL. Methods: This prospective cohort study included adult patients undergoing endoscopic endonasal transsphenoidal resection of pituitary adenomas between 2014 and 2021 at a tertiary center. Patients were divided into those undergoing bilateral middle turbinectomy and those with turbinate preservation. Tumor-related QOL was assessed using the Anterior Skull Base Disease-Specific Questionnaire (ASBS-Q), and nasal QOL using the Sinonasal Outcome Test-22 (SNOT-22), at baseline and multiple postoperative time points up to >6 months. Clinical and surgical variables were collected and compared between groups. Results: Our study included 73 patients, 51 (69.9.%) of whom underwent middle turbinate resection and 22 (30.1%) who did not. The difference in overall ASBS-Q scores did not alter significantly between both groups during the long-term postoperative course (>6 months). SNOT-22 score differences also did not alter significantly throughout the entire postoperative course. Conclusion: Middle turbinectomy during endoscopic endonasal resection of pituitary adenomas was not associated in our cohort to adversely affect long-term nasal or tumor-related QOL. Full article

Objectives: Anterior midline skull base meningiomas, such as olfactory groove meningiomas (OGMs), planum sphenoidale meningiomas, and tuberculum sellae meningiomas pose significant surgical challenges due to their proximity to neurovascular and olfactory structures. The widespread use of the vascularized nasoseptal flap (NSF) has expanded the role of the endoscopic endonasal approach (EEA). This systematic review compares outcomes of EEA and the transcranial approach (TCA) in the NSF era. Methods: PubMed, Embase, and Scopus were searched following PRISMA guidelines for studies published January 2010 and August 2025 comparing EEA and TCA for OGMs and tuberculum sellae/planum sphenoidale (TS/PS) meningiomas with NSF reconstruction. Thirty-five studies (1866 patients) were included and outcomes were stratified by tumor subtype. Results: Gross total resection (GTR) exceeded 90% across both approaches. EEA was associated with superior visual improvement in TS/PS meningiomas, particularly with optic canal involvement, while TCA resulted in better olfactory preservation in OGMs. Cerebrospinal fluid (CSF) leak rates have declined substantially with vascularized NSF reconstruction, especially for TS/PS meningiomas. Conclusions: Both EEA and TCA achieve high GTR rates for anterior midline skull base meningiomas. EEA provides advantages for visual outcomes in TS/PS meningiomas, whereas TCA are favored for olfactory preservation in OGMs. Approach selection should be individualized based on tumor anatomy and functional priorities. Full article

Objectives: To prospectively compare the outcomes of external dacryocystorhinostomy (EX-DCR), endonasal dacryocystorhinostomy (EN-DCR), and laser-assisted transcanalicular dacryocystorhinostomy (TL-DCR) in patients with nasolacrimal duct obstruction (NLDO) and to evaluate the relationship between surgical outcomes and patient quality of life (QoL). Methods: This prospective comparative study included patients presenting with epiphora who were diagnosed with NLDO and scheduled for surgical treatment. Patients underwent EX-DCR, EN-DCR, or TL-DCR according to patient preference and nasal anatomical characteristics. All patients received bicanalicular silicone tube intubation. Follow-up examinations were performed on postoperative day 1, week 1, at month 1, and every three months thereafter. Anatomical success was defined as patency on nasolacrimal irrigation, and functional success was defined as a postoperative Munk score of ≤ 1 (complete or near-complete resolution of epiphora). QoL was assessed using the Lacrimal Symptom Questionnaire (Lac-Q) and the Glasgow Benefit Inventory (GBI). Statistical comparisons were performed between groups. Results: A total of 69 patients (45 women, 24 men; mean age 58.99 ± 14.86 years) were included, with a mean follow-up of 17.19 ± 4.07 months. The highest postoperative pain scores were observed in the EX-DCR group; with no significant intergroup differences. Anatomical success rates were 92% for EX-DCR, 90.5% for EN-DCR, and 91.3% for TL-DCR. Functional success rates were 88%, 90.5%, and 82.7%, respectively, with no statistically significant difference among techniques (p > 0.05). All groups showed postoperative improvement in Lac-Q and GBI scores. Numerically greater improvements were observed in the EN-DCR group, although intergroup differences were not statistically significant. Conclusions: EX-DCR achieved the numerically highest anatomical success rate, whereas EN-DCR demonstrated numerically greater improvement in patient-reported QoL outcomes. However, no statistically significant differences in anatomical success, functional success, or QoL measures were observed among the three techniques. Overall, all three procedures were effective surgical options for the treatment of NLDO. Full article

Background: Prolonged hospitalization after endoscopic endonasal transsphenoidal surgery for non-functioning pituitary adenomas increases costs and complications. Early identification of high-risk patients is crucial for optimizing perioperative management. Methods: In this dual-center retrospective study of 368 patients, a predictive model was developed using a training cohort (n = 268). Prolonged length of stay was defined as ≥75th percentile (≥16 days). LASSO regression selected features from clinical, radiological, and perioperative variables. Independent predictors from multivariable logistic regression were dichotomized via ROC analysis and integrated into a nomogram. Model performance was assessed internally and validated externally (n = 100). Results: Six independent predictors were identified: age > 50 years, vertical tumor diameter > 17.8 mm, anteroposterior diameter > 20.5 mm, transverse diameter > 17.8 mm, anesthesia duration > 194 min, and systolic blood pressure > 119 mmHg. The nomogram showed moderate but reproducible discrimination (AUC = 0.762 in training; 0.750 in validation). Calibration and decision curve analysis confirmed good fit and clinical utility. Conclusion: We developed and validated a practical nomogram predicting prolonged hospitalization risk using readily available perioperative variables. This tool may assist individualized risk stratification and perioperative planning in comparable clinical settings, with potential implications for patient flow and resource utilization. Full article

Background/Objectives: Seromucinous hamartoma (SH) is an extremely rare benign glandular lesion arising in the nasal cavity and paranasal sinuses, characterized by proliferation of serous and mucinous glands. Preoperative diagnosis by biopsy is extremely uncommon, making it a diagnostic challenge. We report a case of SH and discuss its diagnostic difficulties and management. Case Presentation: A 52-year-old man presented with right-sided nasal obstruction. A lobulated mass in the posterior right nasal cavity was incidentally detected during transnasal endoscopy. The lesion persisted for one year without reduction. CT, MRI, and biopsy failed to provide a definitive diagnosis. The patient was referred to our department, and endoscopic surgery under general anesthesia was performed. The tumor was removed en bloc. Histopathological examination revealed glandular proliferation of mixed serous and mucinous glands within the subepithelial stroma, consistent with SH. Discussion: Preoperative diagnosis is difficult due to insufficient biopsy depth and limited recognition of this rare entity. Since the surface epithelium shows no atypia, identification of subepithelial glandular proliferation is essential. Larger and deeper biopsy specimens and communication with pathologists may improve diagnostic yield. Surgical excision is the treatment of choice. As SH often arises in the posterior nasal cavity and is highly vascular, en bloc resection under general anesthesia is recommended. Conclusions: Recognition of SH is important to improve diagnostic accuracy. Appropriate biopsy strategy and surgical planning based on tumor location are essential. Full article

Background: Craniopharyngiomas are histologically benign but clinically aggressive epithelial tumors that pose significant surgical challenges due to their proximity to the hypothalamic–pituitary axis. While traditional transcranial approaches are well-established, the endoscopic endonasal transplanum–transtuberculum approach (EETTA) has emerged as a specialized corridor offering direct midline access. This systematic review evaluates the surgical efficacy, functional outcomes, and complication profiles of the EETTA over two decades of clinical evolution. Methods: Following PRISMA guidelines, a systematic search was conducted across five databases. Eligible studies included patients of all ages undergoing EETTA for craniopharyngioma. Data on the extent of resection (EOR), visual and endocrine outcomes, and CSF leak rates were extracted. Quality was assessed using NIH/JBI tools, and evidence was graded via AANS/CNS criteria. Results: Fifty-one studies (677 patients) were included. The cohort had a mean age of 43.4 years and predominantly suprasellar tumors (mean diameter 2.9–4.0 cm). Gross total resection (GTR) was achieved in 66.4% of cases (364/548). Postoperative visual improvement was reported in 79.8% of patients, while 7.1% experienced deterioration. Endocrine morbidity remained significant, with 120 patients developing new-onset diabetes insipidus and 105 developing new anterior pituitary deficits. The pooled CSF leak rate was 9.2%, with contemporary series frequently reporting 0% due to advanced multilayer reconstruction with nasoseptal flaps. The pooled recurrence rate was 7.8% over a mean follow-up of 37.4 months. Conclusions: The EETTA is a safe and effective primary strategy for suprasellar and retrochiasmatic craniopharyngiomas, offering more favorable visual outcomes and resection rates in this specific cohort. While endocrine dysfunction remains a pervasive challenge inherent to the tumor’s location, technical refinements in skull base reconstruction have successfully addressed historical concerns regarding CSF leaks. These findings support the use of the EETTA at high-volume centers with multidisciplinary expertise. Full article

Background: Autologous fat grafts are widely used for skull base reconstruction following endoscopic endonasal surgery. However, uncertainty regarding their postoperative volumetric evolution may complicate the distinction between expected postoperative changes and residual or recurrent disease on imaging. Methods: We performed a retrospective volumetric imaging analysis of patients undergoing endoscopic endonasal skull base surgery with reconstruction using autologous fat and the 3F technique between 2013 and 2023. Fat graft volumes were measured on postoperative day 1 CT scans and on 3-, 9-, and 15-month postoperative MRI using standardized volumetric segmentation analysis (method described in detail in the main text). It should be noted that baseline measurements were derived from CT, whereas follow-up assessments were performed using MRI. Resorption rates were correlated with demographic, pathological, surgical, and postoperative variables. Results: Thirty-four patients met inclusion criteria. Mean initial fat graft volume was 3.01 ± 2.65 cm³. Overall, fat graft volume demonstrated a consistent temporal decline, with mean reductions of 56.8% at 3 months, 75.3% at 9 months, and 81.8% at 15 months. In subgroup analysis, differences in resorption were observed according to surgical approach, with higher resorption following transsellar compared with transtuberculum approaches (87.4% vs. 74.8% at 15 months, p = 0.042). These findings were closely related to graft compartment, although compartment and surgical approach showed substantial overlap in this cohort. No significant associations were detected between resorption rate and age, sex, comorbidities, postoperative CSF leak, extent of resection, or adjuvant radiotherapy. Conclusions: Autologous fat grafts used for skull base reconstruction demonstrate substantial early postoperative resorption followed by slower progressive volume loss. Recipient anatomical compartment was associated with differences in observed resorption patterns, although this relationship should be interpreted in the context of overlap with surgical approach and limited sample size. These findings may assist in improving interpretation of postoperative imaging by clarifying the expected temporal pattern of fat graft evolution after endoscopic skull base reconstruction. Full article

Cranial crests have evolved multiple times in the evolutionary history of vertebrates, serving primarily for visual display. In duck-billed lambeosaurines, one of the most successful dinosaur clades of the Late Cretaceous, the cranial crest became hollow along the paired premaxillae and nasals, and was secondarily selected as a resonating structure atop the skull roof, facilitating acoustic signaling. Here we report the first instance of a hollow supracranial crest in a non-lambeosaurine ornithopod dinosaur, the early-branching hadrosauroid Qianjiangsaurus changshengi, where the paired accessory endonasal cavities just above the nasal cavity proper occur following the dorsoventral thickening of the nasals. This novel nasal cavity configuration is associated with the helmet-like hollow supracranial crest solely formed by the nasals. Comparative resonance modeling suggests that the nasal cavity of Q. changshengi could amplify low-frequency vocalizations similar to those of late-branching lambeosaurines. Seven analogous skull features (including the hollow supracranial crest) and similar low-frequency acoustic capabilities of nasal cavities between Q. changshengi and late-branching lambeosaurines reveal a striking morphological and functional convergence that would likely facilitate safer, more efficient social communication among hadrosauroids. This convergence can be explained by adaptive evolution under similar selection pressures, combined with developmental constraints due to gene pleiotropy. Full article

Background: Postoperative evaluation for growth hormone-producing pituitary tumors entails assessing remission via biochemical markers alongside MRI to detect residual tumors. While postoperative imaging provides important anatomical information regarding potential residual tumor, it is reasonable to ask if imaging offers largely redundant data when biochemical remission is already established. This study aimed to determine the clinical utility of post-surgical surveillance imaging in patients who achieved biochemical remission with normal age- and sex-matched IGF-1 at ~3 months postoperatively. Furthermore, we sought to evaluate the long-term durability of biochemical control in this patient subset. Methods: We conducted a retrospective analysis on patients who underwent endoscopic endonasal approach surgery for acromegaly and had a minimum of 3 years of follow-up clinical, biochemical and imaging data. Results: In total, 15 of 28 patients (54%) achieved initial biochemical remission and had a 100% sustained remission rate during the follow-up period of 3–14 years, underscoring the importance of surgical radicality for achieving durable remission. Conclusions: Our findings suggest that for patients who achieved biochemical remission following transsphenoidal surgery for acromegaly, routine postoperative imaging provides negligible additional diagnostic information from an endocrinological perspective. As such, we propose that no further postoperative imaging is needed for patients in clinical and biochemical remission. This approach offers a significant reduction in the clinical burden and healthcare costs for patients associated with long-term management of their disease. Full article

Background/Objectives: This study aims to depict trends in Endoscopic Dacryocystorhinostomy research in Asian countries. Methods: A bibliometric analysis was performed in April 2024 utilizing the SCOPUS database. The keywords “Endoscopic Dacryocystorhinostomy” OR “Endo-DCR” OR “Endonasal Endoscopic Dacryocystorhinostomy” were used. Data cleaning was then performed. Microsoft Excel and Vosviewer software were used to analyze data. Results: 730 articles and 37 keywords were yielded after exclusion. Our analysis revealed a notable increase in Endoscopic Dacrycocystorhinostomy publications from the early 2000s, with a significant surge post-2010. India and China were the leading contributors to Endoscopic Dacryocystorhinostomy research in Asia. Keywords such as “endoscopy”, “silicone tube”, and “epiphora” were commonly used. However, keywords like “mitomycin C”, “mucosal flap” and “success rate” were infrequently found. Conclusions: The emergence of Endoscopic Dacryocystorhinostomy publications witnessed a notable increase from 1972 to 2023 with most studies affiliated to India and China. Certain keywords such as “mitomycin C”, “mucosal flap”, “revision”, “laser”, “drill”, and “success rate” were infrequently used. Full article