Mini Endoscopic Septoplasty for High Localized Nasal Septum Deviation: Surgical Technique, Outcomes, and Comparison With Regular Septoplasty.

OBJECTIVES: This prospective cohort study aimed to describe the technique of mini endoscopic septoplasty for patients with a high localized nasal septum deviation in front of the middle turbinate and chronic sinusitis or nasal sinus fungus ball. Our primary objective was to investigate the indications and outcomes of this procedure, and the secondary objective was to compare it with regular endoscopic septoplasty. METHODS: Patients with chronic sinusitis or nasal sinus fungus ball and high localized nasal septum deviation underwent mini endoscopic septoplasty, while those with a broad deviation of the nasal septum underwent regular endoscopic septoplasty. The study evaluated the procedure duration, blood loss, and complications associated with both methods. All patients were followed up for 3 months. RESULTS: Thirty patients underwent mini endoscopic septoplasty; another 30 underwent regular endoscopic septoplasty. Mini endoscopic septoplasty demonstrated a significantly shorter procedure duration and lower blood loss than regular endoscopic septoplasty. Neither group experienced operative complications, such as nasal septum perforation or hematoma. CONCLUSION: Mini endoscopic septoplasty is a safe, time-efficient, and effective technique indicated for highly localized nasal septum deviations in patients with chronic sinusitis or nasal sinus fungus ball. This procedure offers advantages in terms of the surgical approach and postoperative debridement. Future research could explore the broader clinical implications of these findings.

Effect of different freezing conditions on ice crystal formation behavior and ice-growth inhibition by cryoprotectants.

BACKGROUND: The formation of ice crystals will have adverse effects on aquatic products, and the key to ensure the long-term preservation and better quality preservations of the product is to evaluate the intercellular ice crystal formation to find suitable refrigeration conditions and cryoprotectants. RESULTS: The ice crystal formation was successfully captured by using an inverted microscope cryomicroscopic system equipped with a low-temperature stage, the ice crystals formed under different freezing methods between tuna muscle cells were observed directly, the deformation degree of muscle tissue pores during crystallization was evaluated, and the effect of freeze-thaw times on tuna samples was analyzed. The effects of the use of cryoprotectant such as cellobiose and carboxylated cellulose nanofibers on ice-growth inhibition were investigated, and the reliability of the ice crystal observation results was further verified by the determination of physical properties. The results showed that carboxylated cellulose nanofibers had the best ice-growth inhibition effect, they prevented about 50% cell deformation compared with the control group, and also reduced the minimum size of ice crystal formation. In addition, the addition of cellobiose and sodium tripolyphosphate gave the ice crystals a more uniform size and roundness. CONCLUSION: The experiment proposed a stable and clear observation method for the process of intercellular ice crystal formation, and the accuracy of the observation method was further verified by some physical indicators. This may help in the selection of suitable measurement methods to directly observe ice crystal formation behavior and screen cryoprotectants. © 2024 Society of Chemical Industry.

Observation on the ice crystal formation process of large yellow croaker (Pseudosciaena crocea) and the effect of multiple cryoprotectants pre-soaking treatments on frozen quality.

By observing the formation behavior of ice crystals, the quality of food products under different freezing conditions can be intuitively judged. In this paper, large yellow croaker was taken as the research object, and a novel cryomicroscopic system was developed to directly observe the structure of ice crystals during the freezing process. The cryoprotective effects of 4% sucrose +4% sorbitol (SU + SO), 4% xylo-oligosaccharide (XO), 4% xylo-oligosaccharide + 0.3% tetrasodium pyrophosphate (XO + TSPP) and 0.2% antifreeze protein (AFP) at different freezing temperatures were investigated. And the evaluation indicators, such as cell deformation degree, equivalent diameters, roundness, elongation and fractal dimension were introduced to quantify the damage of ice crystals to muscle tissues and fibers. The results indicate that reducing the freezing temperature and adding cryoprotectants can improve the quality of large yellow croaker. AFP has the best cryoprotective effect, with a reduction in cell deformation degree of 54.78% and 67.83% compared to the Control group at -5 °C and -20 °C, respectively. SU + SO and XO have the equivalent antifreeze effect, which is slightly inferior to XO + TSPP. In addition, physical parameters of large yellow croaker samples were measured to verify the influence of ice crystal structure on product quality. Therefore, direct observation of the ice crystal formation process and evaluation of ice crystal structure can accurately reflect the quality of frozen products, which is of great significance for the development of refrigeration and preservation technology.

Application of a Novel Versatile Mini Posterior Nasoseptal Graft in Endoscopic Transsphenoidal Pituitary Adenoma Surgery.

BACKGROUND: Skull base reconstruction is a key technique in patients undergoing endoscopic transnasal skull base surgery. Although a pedicled nasoseptal flap (PNSF) is often used to repair large skull base defects with high-flow cerebrospinal fluid leakage, bone exposure of the donor site of the PNSF can result in long-term crusting. OBJECTIVE: To design a novel and versatile mini posterior nasoseptal graft for the reconstruction of defects in the sellar floor or PNSF or pedicled nasoseptal rescue flap (PNSRF) donor site in patients undergoing pituitary adenoma surgery. METHODS: Patients who underwent pituitary adenoma removal through an endoscopic endonasal approach and repair of a sellar defect or PNSF/PNSRF donor site using the mini posterior nasoseptal graft technique from January 2019 to January 2020 were retrospectively evaluated. Pituitary adenomas were removed using a binostril 4-hand technique through a transnasal transsphenoidal transsellar approach or an expanded transsellar approach. RESULTS: Mini posterior nasoseptal grafts were successfully used in 70 patients who underwent pituitary adenoma removal through an endoscopic transsphenoidal sellar approach. Mini posterior nasoseptal grafts repaired sellar defects in 40 patients and donor site defects of the contralateral PNSF/PNSRF in 30 patients. None of these patients experienced cerebrospinal fluid leakage or major complications. CONCLUSIONS: A mini posterior nasoseptal graft is a safe and effective technique for repairing sellar defects after endoscopic transnasal pituitary adenoma surgery. This technique can also be used to repair defects in PNSF/PNSRF donor sites.

Evaluation on the effect of ice glazing with different compound additives on the quality of frozen stored (-23 °C) large yellow croaker (Pseudosciaena crocea).

BACKGROUND: Compounded ice glazing has been used in large yellow croaker to improve its quality during frozen storage. The ice glazing liquid is prepared by compound use of trehalose and tea polyphenols, and the moisture, protein-related properties and freshness of the fish have been evaluated during 300 days of frozen storage. RESULTS: The results showed that the addition of trehalose effectively reduced the loss of water. At the same time, it was difficult for ice crystals to grow under the action of trehalose, the average diameter could still be maintained at 111.25-119.85 µm. The combination with tea polyphenols could effectively maintain the protein structure and keep the total volatile base nitrogen (TVB-N) and K value within 11.84 mg/100 g and 13.18%, so that the freshness of the fish was always at the first level. CONCLUSION: In a word, the ice glazing with 5% trehalose and 8% tea polyphenols had the best preservation effect, which was recommended for the frozen storage. © 2022 Society of Chemical Industry.

Transnasal Endoscopic Retrieval of a Metallic Intraorbital Intraconal Foreign Body Facilitated by an Intraoperative Magnetic Stick.

Here, we report the case of an intraorbital intraconal foreign body that was successfully retrieved by a transnasal endoscopic approach facilitated intraoperatively by a magnetic stick. A 36-year-old man was admitted to our unit with a left-sided intraorbital intraconal metallic foreign body. Following 2 failed attempts via a transconjunctiva approach, we finally recovered the foreign body using transnasal endoscopic surgery. During this procedure, a magnetic stick was used to help us locate and successfully remove the foreign body, grapeshot measuring approximately 0.5 cm in diameter. Visual acuity in the injured eye increased from 0.01 preoperatively to 0.04 6 days after surgical intervention. There were no complications. We therefore propose that in selected patients, the endoscopic transnasal approach is an effective, safe and minimally invasive approach for the removal of intraorbital intraconal foreign bodies. The intraoperative use of a magnet can facilitate the successful location and removal of magnetic metallic foreign bodies.

Stabilization of G-quadruplex DNA and inhibition of Bcl-2 expression by a pyridostatin analog.

The G-quadruplexes located in the P1 promoter of B-cell lymphoma-2 (Bcl-2) gene are implicated to regulate Bcl-2 expression. Here, we designed a new pyridostatin analog named PDF, which exhibited high specificity and stabilizing effect toward G-quadruplexes. The luciferase assay demonstrated that PDF could significantly suppress Bcl-2 transcriptional activation in human laryngeal squamous carcinoma cells (Hep-2) cells. Besides, PDF also induced cell apoptosis in vitro assays. These results provide an excellent G-quadruplex specific ligand as an efficient Bcl-2 inhibitor. These results also implicate that PDF may be a potential anticancer drug to head neck cancer.

Immunoglobulin G4-related disease in the skull base mimicking nasopharyngeal carcinoma.

Immunoglobulin G4-related disease (IgG4-RD) is a rare clinical condition. Although it has been described in the head and neck region, skull base involvement is exceedingly uncommon. We present a clinical report of a patient with IgG4-RD of the skull base that mimicked nasopharyngeal cancer. This case highlights challenges in the clinical diagnosis of this rare condition. The diagnosis could be made only on histopathologic evaluation, which showed dense fibrosis with lymphoplasmacytic infiltration by IgG4-positive plasma cells. Serum IgG4 level was also elevated. Once IgG4-RD was confirmed, treatment with glucocorticoid yielded a good clinical outcome.

[Immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve].

OBJECTIVE: To explore the application of immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve. METHODS: Ten patients with thyroid cancer invading unilateral recurrent laryngeal nerve underwent radical surgery and immediate recurrent laryngeal nerve reconstruction. The reconstructive surgical approach included recurrent laryngeal nerve decompression surgery, end-to-end anastomosis of the recurrent laryngeal nerve, anastomosis of ansa cervicalis nerve to the recurrent laryngeal nerve, and nerve-muscle pedicle (NMP) technique. Among the ten patients, one underwent nerve decompression, one underwent end-to-end anastomosis of the recurrent laryngeal nerve, seven had anastomosis of ansa cervicalis to recurrent laryngeal nerve, and one case had anastomosis of ansa cervicalis to recurrent laryngeal nerve combined with nerve-muscle pedicle (NMP) technique. The effect of surgery was evaluated by videolaryngoscopy, maximum phonation time (MPT), phonation efficiency index (PEI) and voice assessment. T-test was used in the statistical analysis. RESULTS: All of the 10 patients had no complications including tumor recurrence and hypoparathyroidism after the surgery. Their hoarseness symptoms were improved, and the patients returned to normal or near-normal voice. Postoperative videolaryngoscopy showed that paralyzed vocal cord returned to normal muscle tone and volume, and the vocal cord vibration and mucosal wave were symmetric and the patients got good glottal closure. The pre- and post-operative maximum phone times of the patients were (4.52 ± 0.89) s and (11.91 ± 1.87) s, respectively (P < 0.01). The pre- and post-operative phonation efficiency indices were (1.37 ± 0.43) s/L and (4.02 ± 1.33) s/L, respectively (P < 0.05). CONCLUSIONS: In patients with thyroid cancer invading unilateral recurrent laryngeal nerve, immediate recurrent laryngeal nerve reconstruction following radical surgery of thyroid cancer can effectively achieve recovery in phonation function and improve the quality of life of the patients.

Endoscopic endonasal transpterygoid nasopharyngectomy: Anatomical considerations and technical note.

BACKGROUND: The study was designed to identify new landmarks in the parapharyngeal segment of the internal carotid artery (ICA) for nasopharyngectomy and describe a surgical procedure of endoscopic endonasal transpterygoid nasopharyngectomy (EETPN). METHODS: Four cadaveric specimens were injected with colored silicone and subjected to CT scanning before dissection. The nasopharyngeal skull base was exposed using the endoscopic endonasal transpterygoid approach. The clinical data of four patients with nasopharyngeal malignances who underwent EETPN were reviewed. RESULTS: The lateral edge of the longus capitis muscle medially; the foramen lacerum, petrous apex spine and the stump of the levator veli palatini muscle superior laterally; and the upper parapharyngeal ICA laterally constitute the ICA-longus capitis muscle-petrous apex spine triangle which was a novel landmark for the upper parapharyngeal segment of the ICA. CONCLUSION: The ICA-longus capitis muscle-petrous apex spine triangle are important landmarks of the upper parapharyngeal segment of the ICA.

The quality properties of frozen large yellow croaker fillets during temperature fluctuation cycles: improvement by cellobiose and carboxylated cellulose nanofibers.

Frozen aquatic products undergo unavoidable quality changes owing to temperature fluctuations during frozen storage and distribution. This study investigated the effects of 1% cellobiose (CB), and 0.5 and 1% carboxylated cellulose nanofibers (CNF) on ice crystal growth and recrystallization of frozen large yellow croaker fillets exposed to temperature fluctuations. Denser and more uniformly distributed ice crystals were observed in the CB- and CNF-treated samples than in the water-treated samples. Furthermore, the addition of CB and CNF suppressed the conversion of bound water to frozen water in the samples during temperature fluctuation cycles, played a positive role in fixing the ionic and hydrogen bonds that stabilize the protein structure, limited the conformational transition from α-helix to ß-sheet, and improved protein thermal stability. Based on turbidity, zeta potential, and confocal laser scanning microscopy (CLSM) analyses, the presence of CB and CNF restricted the protein aggregation. Compared with CB, CNF molecules with abundant carboxyl functional groups and longer morphology exhibited better cryoprotective effects. Moreover, the fillets were more improved protected from mechanical damage induced by large ice crystals at a higher CNF concentration. This study reveals the potential of CB and CNF as novel cryoprotectants.

Recent advances on air heating system of cabin for pure electric vehicles: A review.

Due to the environmental protection and energy shortage, the electric vehicles (EV) is gradually replacing traditional fuel vehicles. EV generally use more energy for air conditioning system, especially EV have almost no waste heat from engine to be discharged to the passenger compartment to achieve thermal comfort in heating condition. The energy consumption of the heating system for EV will decrease the maximum mileage. Therefore, the energy saving technology for heating system is developing and applied for EV. The article introduced the advance of conventional and emerging heating system for the EV. The positive temperature coefficient (PTC) heater is a convenient heating method used in EV, but PTC heater has some defects such as low efficiency. The heat pump (HP) system is gradually replacing PTC. However, HP has various problems to be overcome, such as the heating capacity and efficiency in low temperature environment. In addition, other novel technologies are proposed to reduce the energy consumption. This article reviews the literature of novel heating methods for EV, introduces adsorption air conditioning systems (AAC), fuel combustion (FC), heat storage (HS), waste heat recovery (WHR), thermoelectric effect (TE) and magnetocaloric effect (ME). © 2017 Elsevier Inc. All rights reserved.

Trans-Nasion-Complex Approach for Endoscopic Modified Lothrop Procedure: Conception, Anatomy, and Technique.

Background: The endoscopic modified Lothrop procedure (EMLP) is an important procedure used to address frontal and anterior skull-base lesions. Two techniques were established, namely, the inside-out approach and the outside-in approach. The former technique take the frontal recess and the first olfactory filament (FOF) as key landmarks while the latter use the FOF as posterior boundary. In some cases, however, these two landmarks are not available. Therefore, we supplement the outside-in approach and named it trans-nasion-complex approach (TNCA) for EMLP that can be performed without locating these two landmarks. Methods: Two dry human skulls were used to observe the bony nasion complex. Then, five colored silicon-injected human head specimens were dissected via TNCA for EMLP. Finally, the outcomes of patients who underwent TNCA were reviewed. Results: The nasion complex is an osseous complex that consists of the nasion and its adjacent structures, including the bilateral root of nasal bones, nasal process of frontal bones, anterior portion of the perpendicular plate of the ethmoid bone that connects with the inferior aspect of the nasal bones, and portions of the bilateral frontal process of the maxillary bones. Surgical landmarks for TNCA include the anterior superior portion of the nasal septum, anterior margin and axilla of the middle turbinate, frontal process of the maxilla bone, nasal process of the frontal bone and upper part of the nasal bone. These structures form a "mushroom sign" during cadaveric dissection and surgery. Twenty-one patients underwent TNCA, of whom 9 had tumors and 12 had chronic rhinosinusitis with nasal polyps (CRSwNP). None of them had major complications. Conclusion: TNCA is expected to be a safe, and direct route for EMLP. Adequate understanding of the nasion complex and "mushroom sign" will be helpful to complete TNCA.

Comparison of Endoscopic Endonasal Approach and Lateral Microsurgical Infratemporal Fossa Approach to the Jugular Foramen: An Anatomical Study.

Objective The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. Results The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.

Influence of Multifrequency Ultrasound-Assisted Freezing on the Flavour Attributes and Myofibrillar Protein Characteristics of Cultured Large Yellow Croaker (Larimichthys crocea).

The influence of multifrequency ultrasound-assisted freezing (UAF) as compared with single- and dual-UAF on the flavour, microstructure, and myofibrillar proteins (MPs) of cultured large yellow croaker was investigated to improve food quality in a sustainable way and address the major global challenges concerning food and nutrition security in the (near) future. Multifrequency UAF-treated samples had lower total volatile basic nitrogen values during freezing than single- and dual-UAF-treated samples. Thirty-six volatile compounds were identified by solid-phase microextraction (SPME) coupled to gas chromatography-mass spectrometry (GC-MS) during freezing, and the multifrequency UAF-treated samples showed significant decreases in the relative contents of fishy flavoured compounds, including 1-penten-3-ol and 1-octen-3-ol. In addition, multifrequency UAF treatment better maintained a well-organised protein secondary structure by maintaining higher α-helical and ß-sheet contents and stabilising the tertiary structure. Scanning electron microscopy images indicated that the ice crystals developed by the multifrequency UAF were fine and uniformly distributed, resulting in less damage to the frozen large yellow croaker samples. Therefore, multifrequency UAF improved the flavour attributes and MP characteristics of the large yellow croaker samples. Overall, multifrequency UAF can serve as an efficient way for improving food quality and nutritional profile in a sustainable way.

Simultaneous Endoscopic Endonasal Decompression of the Optic Canal, Superior Orbital Fissure, and Proper Orbital Apex for Traumatic Orbital Apex Syndrome: Surgical Anatomy and Technical Note.

OBJECTIVES: Traumatic orbital apex syndrome (TOAS) is an uncommon but severe ocular complication of craniomaxillofacial fracture. The optimal surgical strategy for TOAS has not been determined. To investigate the endoscopic anatomy of the orbital apex region, propose a protocol for simultaneous endoscopic endonasal decompression of the optic canal, superior orbital fissure, and proper orbital apex (EEDCFA) for TOAS and report its use in two patients. METHODS: An endoscopic endonasal approach was utilized to dissect the orbital apex region in two silicon-injected adult cadaveric heads. The details of the procedure used for decompression of the orbital apex were determined. The effects of this procedure were determined in two patients with TOAS who underwent simultaneous decompression of the optic canal, superior orbital fissure, and proper orbital apex. RESULTS: The orbital apex consisted of three portions, the contents of the optic canal superomedially; the contents of the superior orbital fissure inferolaterally; and the converging portion, or proper orbital apex, anteriorly. From an endoscopic endonasal approach, the optic nerve, superior orbital fissure, and orbital apex convergence prominences were found to form a π-shaped configuration. This π-shaped configuration was indicative of the orbital apex and was an important landmark for decompression of the orbital apex. Endonasal decompression of the orbital apex in the two patients resulted in the satisfactory recovery of extraocular mobility, with no surgical complications. CONCLUSIONS: EEDCFA is feasible, effective, and safe for patients with TOAS caused by direct compression of displaced fracture segments. The π-shaped configuration is a valuable landmark for EEDCFA.

[Clinical and magnetic resonance imaging characteristics of isolated congenital anosmia].

OBJECTIVE: To report a series of patients with isolated congenital anosmia and summarize their clinical and magnetic resonance imaging (MRI) characteristics. METHODS: Twenty patients with isolated congenital anosmia were reviewed retrospectively. A thorough medical and chemosensory history, physical examination, nasal endoscopy, T&T olfactory testing, olfactory event-related potentials, sinonasal computed tomography scan and magnetic resonance image of olfactory pathway were performed in all patients. RESULTS: Neither ENT physical examination nor nasal endoscopy was remarkable. Subjective olfactory testing indicated all of them were of anosmia. No olfactory event-related potentials to maximal stimulus were obtained. Computed tomography scan was normal. MRI revealed the absence of olfactory bulbs and tracts in all cases. And hypoplasia or aplasia of olfactory sulcus was found in all cases. All the patients had normal sex hormone level. CONCLUSION: The diagnosis of isolated congenital anosmia is established on chief complaints, physical examination, olfactory testing and olfactory imaging. MRI of olfactory pathway is indispensable.

Lateral tarsal artery flap: an option for hypopharyngeal reconstruction in patients with hypopharyngeal carcinomas after surgery.

BACKGROUND: Hypopharyngeal reconstruction following resection of hypopharyngeal carcinoma has utilized local, regional and free tissue transfer flap options. No single surgical technique is currently in use for hypopharyngeal reconstruction that is applicable to all patients. In this article, we introduce the application of the lateral tarsal artery flap (LTA flap) as a reconstructive option following hypopharyngeal oncologic ablation. METHODS: From June 2010 to January 2012, four patients of hypopharyngeal carcinomas underwent total laryngectomy and partial pharyngectomy followed by single-stage reconstruction with LTA flaps. After operation, patients were treated with radical radiotherapy within four weeks. All the patients were followed up. RESULTS: All flaps survived, with an average size of 7.5 cm × 5.8 cm (range of 8.0-7.0 cm × 6.0-5.0 cm). There were no complications or contractures during the follow-up. Normal diets were adopted two weeks after operation. The follow-up ranged from 12-20 months (mean: 15 months). There were no distal stenosis or pharyngocutaneous fistula nor were there any donor-site complications. CONCLUSION: The LTA flap could be a viable option for hypopharyngeal reconstruction following head and neck oncologic resection. It seems that LTA flap would be a promising flap deserving extensively research.

[Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery].

OBJECTIVE: To identify the landmarks of transpterygoid approach and to report its application in a series of cases. METHODS: Two silicon-injected adult cadaveric heads(4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance. High-quality pictures were obtained. This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma. Clinical records were reviewed. RESULTS: In terms of approach dissection, important landmarks, such as the sphenopalatine foramen and artery, vidian canal and nerve, foramen rotundum and maxillary branch of trigeminal nerve, foramen ovale and mandibular branch of trigeminal nerve, as well as pterygoid segment of Eustachian tube were identified. In terms of clinical data, three patients with spontaneous CSF leak underwent repair. Six patients with benign lesions underwent complete tumor resection. In the patient with invasive fungal disease, thorough debridement was undertaken and antifungal drug was administered for one month. For these benign skull base lesions, there was no recurrence during the follow-up period. In the patient with chondrosarcoma, most of the tumor was removed in the first operation, and was followed by two endoscopic operations because of fast growth of the tumor. Final control was achieved with chemotherapy and radiation. In the patient with adenoid cystic carcinoma, tumor recurred five years after surgery, and was reoperated. CONCLUSION: An understanding of the landmarks of the transpterygoid approach is paramount for surgically dealing with disease located within and adjacent to the region of the pterygoid process of the sphenoid bone. The endoscopic endonasal transpterygoid approach is feasible and safe in selected patients with skull base lesions.

[Transnasal endoscopic anatomy of the clivus and approaches consideration].

OBJECTIVE: In-depth understanding of endoscopic anatomy of the skull base is the cornerstone of the development of endoscopic endonasal skull base surgery. The purpose of this study is to explore the anatomical landmarks of the clivus for endoscopic endonasal skull base surgery. METHOD: Eight silicon-injected adult cadaveric heads (16 sides) were dissected performing endoscopic endonasal approach. The clivus and adjacent structures were exposed; and their anatomy shown in detail. High-quality pictures were produced. RESULT: The clivus was subdivided into the upper, the middle and the lower clivus. Extracranial soft tissue landmarks and bony landmarks were presented. Intradural landmarks of the upper clivus were the interpeduncular cistern, posterior cerebral artery, posterior communicating artery, superior cerebellar artery, cranial nerve III and cerebral peduncle; intradural landmarks of the middle clivus were the prepontine cistern, basilar artery, cranial nerve VI and pons; intradural landmarks of lower clivus were premedullary cistern, vertebral artery, cranial nerve XI and medulla oblongata. Surgical routes to the clivus were the upper clivus approach, middle clivus approach, lower clivus approach and panclival approach. CONCLUSION: An understanding of the complex anatomy of the clivus is paramount for surgically dealing with the disease involved clivus and adjacent region.