Search Results (78)

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: 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

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: In the last few decades, endoscopic endonasal approaches (EEA) have revolutionized surgical access to the sellar region and anterior cranial fossa (ACF). One technique, the endoscopic endonasal transethmoidal transcribriform approach (EETTA), offers distinct advantages over traditional open transcranial approaches, such as reduced morbidity, shorter hospital stays, faster recovery, and a reduced risk of neurological deficit due to less brain tissue manipulation. Methods: We present a comprehensive step-by-step description of the EETTA surgical technique, illustrated through four representative cases of varying pathologies treated at our institution. The anatomical boundaries—including the lamina papyracea, anterior and posterior ethmoidal arteries, and frontal sinus—and the surgical corridor are detailed alongside indications, technical nuances, limitations, and operative recommendations. Results: Four cases demonstrate the versatility of EETTA across diverse pathologies: two olfactory groove meningiomas (including one WHO grade 2 and one recurrent case with invasive skull base involvement), an esthesioneuroblastoma (ENB), and a recurrent inverted papilloma requiring combined transcranial and endoscopic resection. Near-total or gross-total resection was achieved in all cases. The indications, nuances, and limitations of this approach are discussed, along with tips for successful surgery. Conclusions: The EETTA represents an important minimally invasive option for ACF tumors extending into the nasal cavity, with midline involvement limited medially by the lamina papyracea. Success requires a thorough understanding of skull base anatomy, meticulous multilayer reconstruction techniques, and appropriate patient selection, based on the tumor location and lateral extension. While cerebrospinal fluid (CSF) leak remains the primary concern, contemporary techniques have substantially reduced this complication rate. Full article

Background/Objectives: Endoscopic endonasal transsphenoidal surgery (ETSS) has undergone substantial evolution driven by continuous technological innovations and is increasingly established as a minimally invasive and highly precise approach for the treatment of pituitary neuroendocrine tumors (PitNETs) and selected parasellar lesions. The objective of this review is to summarize the historical development of ETSS and to provide an integrated overview of recent advances shaping contemporary neuroendoscopic surgery. Methods: A narrative review of the literature was conducted focusing on key technological and conceptual developments in ETSS, including advances in endoscopic visualization systems, artificial intelligence (AI)-based image analysis, intraoperative navigation, educational support frameworks, and skull base reconstruction techniques. Representative clinical studies and review articles were examined to contextualize current applications and limitations. Results: Recent innovations have expanded the functional capabilities of ETSS beyond pituitary surgery alone. Progress in visualization, navigation, and reconstruction techniques has contributed to improved anatomical understanding, surgical safety, and outcome optimization. Furthermore, accumulating clinical evidence supports the selective extension of ETSS indications to complex midline skull base pathologies, including craniopharyngiomas, meningiomas, and chordomas, while emphasizing the importance of appropriate patient selection. Conclusions: ETSS has evolved from a single operative technique into an integrated surgical platform supported by technological convergence. Ongoing refinement of visualization, digital assistance, and reconstructive strategies is expected to further enhance safety and precision. This review highlights current trends in ETSS and outlines future directions for innovation and clinical application in neuroendoscopic skull base surgery. Full article

Objective: Endoscopic endonasal transsphenoidal pituitary surgery is a diffuse and well-established surgical technique: over the years, the transseptal approach via a nasal mucosal incision has also gained popularity. Here we describe our preliminary experience with an entirely endoscopic one-nostril transseptal transsphenoidal approach (EONOTTA) for pituitary sellar tumor resection; the surgical corridor runs through the entire length of the nasal septum via an incision in the nasal mucosa. Methods: A total of 40 patients with a midline prevalent pituitary tumor who underwent EONOTTA from January 2022 to June 2023 were retrospectively reviewed for the evaluation of the safety and efficacy of this technique. Results: At 1 year follow-up, all patients had no recurrence, and the degree of tumor resection was comparable to that of the control group undergoing the traditional endoscopic endonasal approach. A low rate of nasal and post-surgical complications occurred; globally, EONOTTA was not time-consuming, and a better functional result was noticed, with a better quality of life for patients. Conclusions: This study confirms, in our preliminary experience, the EONOTTA’s excellent risk–benefit ratio in selected cases; for an experienced multidisciplinary team, it provides a good maneuverability and a functional outcome while preserving the integrity of the nasal mucosa. Full article

Background/Objectives: Craniopharyngiomas (CPs) are rare, generally benign tumors predominantly located in the sellar and suprasellar regions, associated with significant morbidity and complex surgical management. Despite high overall survival rates, patients frequently experience complications including visual impairment, pituitary dysfunction, diabetes insipidus (DI), and hypothalamic syndrome. Among these, hypothalamic obesity (HO) represents one of the most clinically challenging sequelae, often occurring early, lacking standardized medical treatment, and leading to substantial comorbidity and reduced quality of life. This study reports a single-center experience focusing on the relationship between skull base anatomy, surgical approach selection, and endocrinological outcomes. Methods: A retrospective analysis was conducted on patients diagnosed with CPs who underwent surgery by a dedicated team at our Department from January 2014 to January 2024. The approaches used were endoscopic (ER) and transcranial (TR). Preoperative imaging (volumetric MRI and CT scans) was analyzed using 3DSlicer (open-source software) for anatomical modeling of the tumor and skull base. Clinical outcomes were evaluated through follow-up assessments by a team of neuroendocrinologists. Data on BMI changes, DI onset, and hypopituitarism were collected. Statistical analyses consisted of descriptive comparisons and exploratory regression models. Results: Of 18 patients reviewed, 14 met the inclusion criteria. Larger sphenoid sinus volumes were associated with selection of an endoscopic endonasal approach (p = 0.0351; AUC = 0.875). In ER cases, the osteotomy area was directly related to tumor volume, independent of other anatomical parameters. Postoperatively, a significant increase in BMI (22.39 vs. 26.65 kg/m²; p = 0.0049) and in the incidence of DI (three vs. nine cases; p-value 0.0272) was observed. No clear differential association between surgical approach and endocrinological outcomes emerged in this cohort. Conclusions: Quantitative assessment of skull base anatomy using 3D modeling may support surgical approach selection in patients with craniopharyngiomas, particularly in identifying anatomical settings favorable to endoscopic endonasal surgery. Endocrinological outcomes appeared more closely related to tumor characteristics and hypothalamic involvement than to the surgical route itself. These findings support the role of individualized, anatomy-informed surgical planning within a multidisciplinary framework. Full article

Evaluation of pituitary neuroendocrine tumors remains complex depending on the exact growth pattern, involvement of critical neurovascular structures, pituitary function and endocrinological activity of the tumor. A predominant growth into the sphenoid sinus and clivus poses specific challenges. We reviewed 557 surgeries for pituitary neuroendocrine tumors in an endonasal endoscopic technique performed between 1 January 2015 and 31 August 2025 to identify 13 cases (2.3%). Clinical, radiological and surgical data were selected by chart review. Thirteen cases aged from 31 to 68 years with almost exclusively non-functioning or clinically silent tumors (92%) were identified. Clival infiltration was restricted to the dorsum sellae in 2/13 (15%), spread to the floor of the sphenoid in 6/13 (46%) and extended inferior to the sphenoid in 5/13 (38%) cases with a high rate of cavernous sinus (62%) and sphenoid sinus infiltration (69%). Complete resection was achieved in 31%, and the residual tumor was clival/sphenoidal in 5/13 cases or within the cavernous sinus in 6/13 cases. The diaphragma sellae was reported to be intact in 92% of cases, and postoperative transient arginine vasopressin deficiency did not occur. Pituitary neuroendocrine tumors predominantly growing below the sella and infiltrating the clivus and sphenoid present specific challenges with a high rate of preoperative pituitary insufficiency, frequent cavernous sinus infiltration and postoperative tumor residuals in the cavernous sinus, sphenoid bone and clivus which are sometimes difficult to delineate. The surgical approach must be tailored specifically to treat the clival infiltration zone to reduce the risk of recurrence. Full article

Objective: This study aims to examine the frequency of emergency department (ED) visits and the occurrence of postoperative nasal symptoms (PNSs) following endonasal skull base surgery (EESBS). Methods: A retrospective cohort study of patients who underwent EESBS at a tertiary referral center. The primary outcome was the frequency of ED visits within 30 days following surgery. Secondary outcomes included the incidence of PNS, readmissions, reoperations, and mortality. Results: A total of 307 patients (143 [46.6%] males, mean age: 58.03 years [interquartile range: 47–70.5]) were included in this analysis. Within 30 days following surgery, 89 patients (29%) presented to the ED, and 32 (10.4%) were readmitted. PNSs were the primary complaint in 60 (67.4%) patients, including nasal discharge in 42 (70%), epistaxis in 14 (23.3%), and obstruction in 4 (6.7%). Twenty-four (26.9%) patients had more than one PNS. Among patients presenting with nasal discharge, two were confirmed to have cerebrospinal fluid rhinorrhea. In both univariate and multivariable analyses, PNSs were not associated with nasoseptal flap harvesting, extended (beyond sella) approach, skull base reconstruction, readmissions, or reoperation. The 30-day mortality rate was 0.6%, with no association with PNS. Results remained consistent whether PNSs were analyzed as a composite outcome or as individual symptoms. Conclusions: Nearly one-third of patients visited the ED after EESBS, with two-thirds due to PNS. Most PNSs are self-limited but cause morbidity and prompt medical visits. Full article

Background: Postoperative cerebrospinal fluid (CSF) leakage remains a significant complication following endoscopic endonasal skull base surgery (EES), leading to increased morbidity. This study aimed to identify factors and interventions predicting postoperative CSF leaks after EES for intradural skull base tumors and their clinical outcomes. Methods: We retrospectively reviewed data from 542 patients who underwent EES for intradural skull base pathology at the Ottawa Hospital between October 2001 and October 2023. Patient demographics, pre-operative, intraoperative (including reconstruction type), postoperative data, and patient outcomes were collected. Results: A total of 40 patients (7.4%) developed a postoperative CSF leak. The highest rate was in patients with suprasellar lesions (5.9%), followed by anterior cranial fossa lesions (1.1%). Significant predictors included a higher mean Body Mass Index (BMI) (30.4 vs. 26.1, p = 0.001). The use of a nasoseptal flap for reconstruction was associated with a significantly lower incidence of CSF leaks (p = 0.001). Tumor location, approach type, and dural sealants were not independent factors for the development of CSF leaks. Patients with CSF leaks had significantly longer lengths of stay (16.7 vs. 9.21 days, p < 0.001), higher 30-day readmission rates (p < 0.001), and increased postoperative sepsis (p = 0.021) and diabetes insipidus (p < 0.001). Conclusion: This retrospective study shows that higher preoperative BMI is associated with a significant risk of postoperative CSF leaks after EES. Conversely, using a pedicled vascularized flap reduces the risk. Postoperative CSF leaks are linked to increased morbidity, including diabetes insipidus and sepsis, prolonged hospitalization, and higher readmission rates. Full article

We report the case of a 16-year-old girl presenting with a painless, clinically stable subcutaneous swelling of the nasal dorsum with a three-year history. Despite an extensive multidisciplinary diagnostic work-up—including dermatological, otorhinolaryngological, and radiological evaluations (ultrasound, CT, and MRI)—the nature of the lesion remained indeterminate. In order to achieve a definitive diagnosis while preserving the nasal profile aesthetics, the mass was entirely excised via an endoscope-assisted closed rhinoseptoplasty approach. Histopathological analysis revealed a spindle cell lipoma characterized by CD34 positivity and a Ki-67 proliferation index of less than 1%. This finding is extremely rare in terms of both anatomical location and patient age. The present case highlights the crucial role of histopathological examination in establishing the correct diagnosis, supported by a multidisciplinary assessment. Full article

Background: Endonasal endoscopic approaches to the skull base are still under investigation, with research aiming to achieve minimally invasive procedures that maximize resection while minimizing complications. This study shares our experience with a mononostril technique and compares it with the existing literature on mononostril approaches for sellar lesions. Methods: A systematic review of eight large series, totaling 1520 patients who underwent endoscopic mononostril transsphenoidal surgery, was performed. The surgical technique was detailed, and parameters such as resection completeness, operative time, complications, and nasal symptoms were analyzed. Results: Gross total resection ranged from 56% to 100% for non-functioning adenomas, 54% to 89% for hormone-secreting adenomas, and 83% to 100% for other sellar lesions. The most common complications were CSF leaks (1.5–4.1%) and nasal issues, such as epistaxis or sinusitis (0–6%). Internal carotid artery injury occurred in 0–1% of cases. The average surgical duration was 87 to 168 min. Conclusions: The mononostril approach offers comparable resection rates, CSF leak risks, and morbidity to binostril or microsurgical methods. The mononostril approach is fast, minimally invasive, and preserves the nasal mucosa, making it a viable option for many sellar lesions. Full article

Background/Objectives: Although endoscopic dacryocystorhinostomy (DCR) has been widely accepted as the procedure of choice for nasolacrimal duct obstruction (NLDO) management due to most etiologies, concerns regarding the reactivation of disease and involvement of surrounding structures add to hesitation in its utilization for granulomatosis with polyangiitis (GPA) patients. No study has directly compared outcomes of external vs. endoscopic DCR in GPA patients. This information can be helpful for patient counselling and choosing a personalized surgical approach for the best results. Methods: A scoping review of the literature was performed in January 2024. The following databases were searched using a combination of MeSH (Medical Subject Headings) and keywords: Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science. This scoping review is not registered. Medical records of two GPA patients who underwent endoscopic DCR at our center were reviewed. Results: The search yielded 96 articles; 15 articles met the inclusion criteria for a full review. Six studies with 22 procedures reported 100% success with endoscopic DCR. Nine studies with 122 procedures reported success in 88.5% of cases with external DCRs. Additional perioperative immunosuppression was recommended in patients with severe mucosal inflammation. The case series presents the disease course, details of surgery, and perioperative management in two GPA patients with NLDO who underwent endoscopic DCR successfully. Conclusions: Endoscopic DCR was associated with equivalent or better success rates and lower complications compared to external DCR in GPA patients. Ensuring disease remission state and appropriate immunomodulatory therapy can help prevent the proposed risk of endonasal disease reactivation with endoscopic DCR. Full article

Background/Objectives: The surgical management of trigeminal schwannomas (TSs) has evolved considerably, with increasing interest in minimally invasive approaches. We performed a meta-regression analysis to characterise temporal trends in surgical strategies for TS and to explore factors influencing outcomes. Methods: This systematic review and meta-regression followed the PRISMA 2020 guidelines. Comparative studies published in English reporting surgical treatment of TS were included. Outcomes assessed were the extent of resection (EOR), improvement or worsening of trigeminal symptoms, and postoperative complications. Meta-analyses of pooled frequencies were performed, and meta-regression analyses evaluated associations between surgical approach, tumour localization, year of publication, and outcomes. Surgical approaches were categorized as microsurgical antero-lateral (M-AL-Apr), retrosigmoid (RSA), endoscopic endonasal (EEA), and endoscopic transorbital (ETOA). Tumour localization was stratified using the Samii classification. Results: Fifteen studies (583 surgeries) were included. Endoscopic approaches accounted for 20.1% of cases, with increasing use over time (β = 0.12—p < 0.001), largely driven by transorbital access for Samii type A and C tumours. The use of M-AL-Apr declined. The pooled gross-total resection (GTR) rate was 73% (I² = 78.8%). The stratified meta-regression identified a temporal decrease in GTR for Samii type C tumours alone, while resection rates for types A, B, and D remained stable, likely reflecting the increasing proportion of anatomically complex cases in recent series Trigeminal impairment improved postoperatively in 17% (I² = 84.5%), while worsening of trigeminal symptoms was rare (β = 0.07%—I² = 0%). Complication rates were 11.6% (I² = 32.7%) but with a temporal increase (β = 0.041, p = 0.047). Tumour type was the dominant predictor of EOR, functional outcomes, and complications. Conclusions: Surgical management of TS has evolved towards minimally invasive techniques, particularly endoscopic routes, reflecting advances in technology and a focus on functional preservation. Tumour anatomy remains the key determinant of surgical outcomes, highlighting the importance of tailored, anatomy-driven surgical planning. Full article