Radiological Features of IgG4-Related Disease in the Head, Neck, and Skull Base.

BACKGROUND: IgG4-related disease (IgG4-RD) is increasingly recognized as a multisystemic, chronic inflammatory process characterized by histologic fibrosis with IgG4-positive plasma cell infiltration. OBJECTIVES: The purpose of this study was to characterize the imaging features of patients diagnosed with IgG4-RD in the head and neck, especially the skull base. METHODS: Our study evaluated CT and MR imaging features of IgG4-RD in the head, neck, and skull base. Images from 15 patients were retrospectively evaluated for the location, signal intensity, morphology, size, boundary, and pre- and post-contrast MRI performances. RESULTS: The lesions presented as irregular shaped, localized masses, distributed in skull base regions; 93.3% of the lesions were isointensity in T1WI (14/15). A total of 80% of the lesions were iso-hypointense in T2WI (12/15); 60% of the lesions got homogeneous enhancement (9/15); and 46.7% of the patients had cranial nerves dysfunction (7/15). The most likely involved cranial nerve was trigeminal nerves (5/15); 60% of the patients had osteolytic bone destruction or sclerosis (9/15). CONCLUSION: Typical radiological features of IgG4-RD included T1 isointensity and T2 hypointensity, homogeneous and gradual enhancement pattern in MRI, easy cranial nerve invasion, dura involvement but the absence of brain edema, and the presence of bone remodeling without destruction, blurred lesion boundaries.

Retrospective assessment of at-risk myocardium in reperfused acute myocardial infarction patients using contrast-enhanced balanced steady-state free-precession cardiovascular magnetic resonance at 3T with SPECT validation.

BACKGROUND: Contrast-enhanced (CE) steady-state free precession (SSFP) CMR at 1.5T has been shown to be a valuable alternative to T2-based methods for the detection and quantifications of area-at-risk (AAR) in acute myocardial infarction (AMI) patients. However, CE-SSFP's capacity for assessment of AAR at 3T has not been investigated. We examined the clinical utility of CE-SSFP and T2-STIR for the retrospective assessment of AAR at 3T with single-photon-emission-computed tomography (SPECT) validation. MATERIALS AND METHODS: A total of 60 AMI patients (ST-elevation AMI, n = 44;  non-ST-elevation AMI, n = 16) were recruited into the CMR study between 3 and 7 days post revascularization. All patients underwent T2-STIR, CE-bSSFP and late-gadolinium-enhancement CMR. For validation, SPECT images were acquired in a subgroup of patients (n = 30). RESULTS: In 53 of 60 patients (88 %), T2-STIR was of diagnostic quality compared with 54 of 60 (90 %) with CE-SSFP. In a head-to-head per-slice comparison (n = 365), there was no difference in AAR quantified using T2-STIR and CE-SSFP (R2 = 0.92, p < 0.001; bias:-0.4 ± 0.8 cm2, p = 0.46). On a per-patient basis, there was good agreement between CE-SSFP (n = 29) and SPECT (R2 = 0.86, p < 0.001; bias: - 1.3 ± 7.8 %LV, p = 0.39) for AAR determination. T2-STIR also showed good agreement with SPECT for AAR measurement (R2 = 0.81, p < 0.001, bias: 0.5 ± 11.1 %LV, p = 0.81). There was also a strong agreement between CE-SSFP and T2-STIR with respect to the assessment of AAR on per-patient analysis (R2 = 0.84, p < 0.001, bias: - 2.1 ± 10.1 %LV, p = 0.31). CONCLUSIONS: At 3T, both CE-SSFP and T2-STIR can retrospectively quantify the at-risk myocardium with high accuracy.

[Descending hypoglossal branch-facial nerve anastomosis in treating unilateral facial palsy after acoustic neuroma resection].

OBJECTIVE: To evaluate the efficiency of the descending hypoglossal branch-facial nerve anastomosis for the severe facial palsy after acoustic neuroma resection. METHODS: The clinical data of 14 patients (6 males, 8 females, average age 45. 6 years old) underwent descending hypoglossal branch-facial nerve anastomosis for treatment of unilateral facial palsy was analyzed retrospectively. All patients previously had undergone resection of a large acoustic neuroma. House-Brackmann (H-B) grading system was used to evaluate the pre-, post-operative and follow up facial nerve function status. 12 cases (85.7%) had long follow up, with an average follow-up period of 24. 6 months. RESULTS: 6 patients had good outcome (H-B 2 - 3 grade); 5 patients had fair outcome (H-B 3 - 4 grade) and 1 patient had poor outcome (H-B 5 grade) Only 1 patient suffered hemitongue myoparalysis owing to the operation. CONCLUSION: Descending hypoglossal branch-facial nerve anastomosis is effective for facial reanimation, and it has little impact on the function of chewing, swallowing and pronunciation of the patients compared with the traditional hypoglossal-facial nerve anastomosis.

Phenotypic characteristics of nasal mast cells in a mouse model of allergic rhinitis.

BACKGROUND: Mast cells (MCs) in the nasal respiratory mucosa (NRM) play a triggering role in the pathogenesis of allergic rhinitis (AR). Recent research evidence in mouse models of AR suggests an underlying MC-related allergic response in mouse nasal olfactory mucosa (NOM). OBJECTIVE: We sought to investigate the phenotypic characteristics of nasal MCs in a mouse model of AR. METHODS: By MC-specific staining and immunohistochemistry, we analyzed the subset, protease and IgE-binding phenotypes of nasal MCs in ovalbumin (OVA)-sensitized unchallenged and challenged mice. RESULTS: In OVA-sensitized challenged mice, increased serum OVA-specific IgE levels (p < 0.001) and eosinophil infiltration confirmed AR induction. In addition to constitutive connective tissue MCs, mucosal MCs were induced in NRM and NOM of OVA-sensitized challenged mice. Connective tissue MCs and mucosal MCs in mouse NRM and NOM were positive for mouse MC protease-1, -4, -5, -6, -7 and carboxypeptidase-A3. In line with MCs in NRM, there were increased numbers (p = 0.019) and proportions (p = 0.027) of MCs with surface-bound IgE in NOM of OVA-sensitized challenged mice. CONCLUSION: In the setting of AR, MCs in mouse NOM exhibit the same subset, protease and IgE-binding phenotypes as MCs in mouse NRM.

Clinical Observation of Various Types of Idiopathic Hypertrophic Cranial Pachymeningitis.

BACKGROUND: To assist doctors in making better treatment decisions and improve patient prognosis, it is important to determine which therapy modalities are suitable for various forms of idiopathic hypertrophic cranial pachymeningitis (IHCP). METHODS: All cases were received from the hospital medical record system, and some follow-up information was gathered through telephone follow-up. RESULTS: A total of 26 patients, 14 men and 12 women, with ages ranging from 20 to 73 years and a mean of 47.42 years, were included in the research. Regular types were less likely to recur than irregular and nodular types, focal types were less likely to recur than diffuse types, and corticosteroid-refractory types were more likely to recur than corticosteroid-sensitive types. CONCLUSIONS: The extent and shape of the lesion and susceptibility to corticosteroids are potential factors that could influence recurrence. Futhermore, this paper also proposes the fibroblasts as a new therapeutic target which may improve the quality of prognostic survival of patients.

Endoscopic Endonasal Reconstruction of Intraoperative Cerebrospinal Fluid Leak in Different Skull base Regions: Outcomes, Meningitis and Risk Factors.

OBJECTIVE: Various non-vascularized or vascularized techniques have been adopted in endoscopic endonasal surgery (EES) for repairing intraoperative cerebrospinal fluid (CSF) leaks after tumor resection. Vascularized nasoseptal flaps (VNSF), free nasoseptal grafts (FNSG), free turbinate grafts (FTG), fascia lata and mashed muscle (FLMM) are frequently used. Outcomes of those grafts applied in the defects of different regions need to be clarified. METHODS: The data from a series of 162 patients with skull base tumor who underwent EES that had intraoperative CSF leak between Jan 2012 and Jan 2021 were retrospectively analyzed. The regions included anterior skull base (ASB), sellar region, clivus and infratemporal fossa (ITF). Repair failure rate (RFR), meningitis rate and associated risk factors were assessed. RESULTS: In total, 172 reconstructions were performed in 162 patients for the four sites of the skull base. There were 7 cases (4.3%) that had postoperative CSF leaks, which required second repair. The RFR for ASB, sellar region, clivus, and ITF was 2.6%, 2.2%, 16.7%, and 0%, respectively. The clivus defect was an independent risk factor for repair failure (P<0.01). The postoperative meningitis rate was 5.6%. Repair failure was an independent risk factor for meningitis (P < 0.01). CONCLUSIONS: VNSF, FNSG, FTG, FLMM are reliable autologous materials for repairing the dural defects in different regions during EES. Clivus reconstruction remains a great challenge, which had a higher RFR and meningitis rate. Repair failure is significantly associated with postoperative meningitis.

[Clinical analysis of the treatment of maxillary odontogenic cyst by nasal endoscope fenestration through nasal base].

Objective:To investigate the feasibility and clinical effect of the surgical approach and method of transnasal fenestration under nasal endoscope for the treatment of maxillary odontogenic cyst. Methods:The clinical data of 23 cases with maxillary odontogenic cysts treated by nasal endoscopy through nasal fenestration were retrospectively analyzed. All cases underwent nasal endoscopy and CT examination before the operation. The mucosal membrane of the parietal wall of the cyst was excised through fenestration of the nasal base. The cyst fluid was removed by decompression, and the bony opening of the nasal base was trimmed and enlarged to the edge of the cyst. The intraoperative and postoperative effects were observed. Results:All cases were well exposed under the direct vision of nasal endoscope. The top wall of the cyst was removed to maximize the communication between the cyst cavity and the nasal floor. There were no complications such as nasolacrimal duct injury, turbinate atrophy, necrosis, and facial numbness. All patients were followed up for 6-12 months, and the clinical symptoms gradually disappeared after surgery. The inferior turbinate was in good shape, the cyst cavity was smooth, the cyst wall was determined, and no cyst recurrence was observed. Conclusion:The treatment of odontogenic cyst of maxilla under nasal endoscope through nasal fenestration is convenient. It has less trauma, fewer complications and a satisfactory curative effect, which is worthy of clinical promotion.

Surgical treatment of dumbbell-shaped hypoglossal schwannoma via a pure endoscopic transoral approach.

BACKGROUND: Dumbbell-shaped hypoglossal schwannomas with intradural and extradural extension are extremely rare, and complete removal of these tumors is very difficult. This report describes such lesions in three patients that were completely removed via a purely endoscopic transoral approach. METHOD: Three patients with intradural and extradural growth hypoglossal schwannomas (three women, aged 16, 42 and 43 years) were treated by direct surgery via a purely endoscopic transoral approach to the posterior fossa. RESULTS: In this series, radical resections of the dumbbell-shaped hypoglossal schwannomas were achieved in all three patients via a purely endoscopic transoral approach without creating additional cranial nerve deficits but temporary left vagus palsy in one case and a temporary left hypoglossal palsy in one case. The postoperative vagus and hypoglossal palsy had recovered in 3 months after surgery. No patient experienced complications such as postoperative cerebrospinal fluid leak, meningitis and cerebrovascular evidence. At the time of this review, the preoperative lingual motor function and muscular bulk had recovered but hemiatrophy of the tongue was still detectable. The preoperative vagus palsy had recovered by the 10th day after surgery. The hearing loss and facial palsy before surgery had completely recovered in 3 months postoperatively. No patient in our series has experienced a recurrence for the follow-up period (3-11 months). CONCLUSIONS: Dumbbell-shaped hypoglossal schwannomas tend to cause lower cranial nerve deficits, facial paralysis and hearing loss. With appropriate preoperative evaluation and careful planning of the perioperative period, complete tumor resection can be achieved via the purely endoscopic transoral approach. The endoscopic transoral approach is an effectice choice for management of dumbbell-shaped hypoglossal schwannomas.

Traumatic intracranial aneurysms due to blunt brain injury-a single center experience.

BACKGROUND: Traumatic intracranial aneurysms (TICAs) have previously been described in literature. However, the evidence of TICAs secondary to blunt brain injury have not been elucidated well, with most of the conclusions coming from isolated case reports. We have attempted to examine the epidemiology, classification, clinical presentation, therapeutic modalities, and outcomes of TICAs with our series of patients at the neurosurgery department of Xuanwu Hospital, China. METHODS: We reviewed our aneurysm database from January 1, 2005 to December 31, 2011. In particular, patients with TICAs secondary to blunt brain injury were reviewed. Variables assessed included age, sex, causes of blunt brain injury, skull fracture, location, classification, clinical presentation, time elapsed to arrive at diagnoses, treatment, and eventual outcome. Based on our assessment, we arrived at a modified classification scheme to categorize these aneurysms. RESULTS: We reviewed 2335 patients with cerebral aneurysm from January 1, 2005 to December 31, 2011. Of these, 15 patients (0.64 %) with traumatic aneurysms secondary to blunt brain injury were identified.Motor vehicle accidents (MVA) were observed to be the most common cause of injury (10 patients, 66.7 %), followed by TICAs sustained after falling down (5 patients, 33.3 %). The most common symptom at presentation was epistaxis (6 patients, 40 %), followed by ophthalmic problems (6 patients, 40 %), with both presentations seen in 1 patient. The most common diagnostic modality used was DSA in 12 patients (80 %) followed by CTA in 2 patients (13.3 %). Infraclinoid TICAs were seen in 9 patients (60 %), whereas supraclinoid TICAs were seen in 5 patients (33.3 %), with perifalx TICAs seen in 1 patient. Endovascular intervention therapies were performed in 11 patients (73.3 %), bypass surgery and trapping in 2 (13.3 %), transnasal endoscopic approach in combination with balloon assisted in 2 patients. At discharge, 2 patients had poor clinical outcomes (13.3 %), 5 had fair (33.3 %),and 8 resulted with good outcomes (53.3 %). CONCLUSIONS: TICAs arising secondary to blunt brain injury account for 0.64 % of all cerebral aneurysms. Infraclinoid, supraclinoid ICA and perifalx TICAs are the most common aneurysms arising from blunt brain injury. Our study further shows that traumatic patients presenting with recurrent epistaxis, oculomotor nerve palsy, and delayed intracranial hemorrhage should receive cerebroangiography as soon as possible. An early diagnosis and proper treatment could prove to be helpful in terms of improving final clinical outcome.

Resection of anterior cranial base meningiomas with intra- and extracranial involvement via a purely endoscopic endonasal approach.

OBJECTIVE: The complete resection of anterior cranial base meningiomas with intra- and extracranial involvement is always challenging. We describe our experience of treating such meningiomas via a purely endoscopic endonasal approach (EEA). METHODS: Eight patients with intra- and extradural meningiomas were operated via EEA. In this study, we describe the operative technique, and analyze the degree of resection, complications and the clinical outcomes. RESULTS: The complete resection of meningiomas with intra- and extracranial involvement was achieved in all patients using EEA. Preoperative visual symptoms were improved or resolved in all cases. One patient experienced a postoperative cerebrospinal fluid leak and delayed meningitis. No patient in our series experienced a new neurological deficit after surgery or recurrence in the follow-up period (18-60 months). CONCLUSION: Our limited experience indicates that EEA is feasible and safe for the complete resection of anterior cranial base meningiomas with intra- and extracranial involvement in one stage in selected cases.

Upregulation of Gp96 correlates with the radiosensitivity and five-year survival rate of nasopharyngeal carcinoma.

Gp96 (GRP94) is a chaperone that is responsible for molecular folding and assembly of proteins. To investigate correlations among Gp96 expression, sensitivity to radiotherapy and clinical features of nasopharyngeal carcinoma (NPC), the expression of Gp96 in 98 NPC samples was analyzed by immunohistochemistry and Western blotting at the protein level, and by real-time PCR at the mRNA level. Clinicopathological features, including stage, sex, grade and survival, were compared between the high and low Gp96 expression groups. As a result, Gp96 was expressed at a higher level in NPC tissues than in noncancerous nasopharyngeal mucosa (p = 0.001). Univariate analysis suggested that a higher Gp96 expression level was associated with significantly decreased disease-free and 5-year survival rates (p = 0.000, p = 0.000, respectively). Multivariate Cox proportional-hazard regression analysis, which adjusts for clinicopathological variables, indicated that it was only associated with the 5-year overall survival rate (p = 0.002). Furthermore, patients with high Gp96 expression levels were significantly more resistant to radiotherapy (p = 0.001). These data are the first indication of a positive correlation between Gp96 expression levels and radiosensitivity and 5-year survival rate. Gp96 might serve as a novel candidate marker for predicting the long-term prognostic outcome of NPC.

Associations of Endocan, FGF2, and PDGF Expression with Pituitary Neuroendocrine Tumor (PitNET) Invasiveness.

AIM: About 6-17% of pituitary neuroendocrine tumors (PitNETs) are invasive. Cavernous sinus invasion complicates neurosurgery, making total tumor resection impossible and leading to high recurrence postoperatively. This study detected Endocan, FGF2, and PDGF to examine the associations of these angiogenic factors with the invasiveness of PitNETs and to identify novel therapeutic targets in PitNETs. MATERIAL AND METHODS: Endocan mRNA amounts (qRT-PCR) in 29 human PitNET specimens obtained after surgery were assessed alongside clinical parameters (PitNET lineage, sex, age, and imaging data). In addition, qRT-PCR was used to determine the gene expression of other angiogenic markers (FGF-2 and PDGF). RESULTS: Endocan was positively associated with PitNET invasiveness. Endocan expressing specimens had elevated FGF2 amounts, and FGF2 and PDGF were negatively correlated. CONCLUSION: A complex but precise balance was found among Endocan, FGF2, and PDGF in pituitary tumorigenesis. High Endocan and FGF2 and low PDGF expression levels in invasive PitNETs show Endocan and FGF2 could be novel treatment targets in invasive PitNET.

Optimization of contrast medium protocol in CT coronary arteriography: constant injection dose rate adapted to body weight.

BACKGROUND: Fixed dose contrast medium (CM) injection protocols are often used in CT coronary arteriography (CTCA). However, vascular enhancement is related to body weight and injection dose rate. PURPOSE: To compare aortic enhancement and coronary imaging quality between a fixed dose CM injection protocol and one adapted to body weight with a constant injection dose rate in mg I/kg/s. MATERIAL AND METHODS: One hundred consecutive patients undergoing CTCA were randomized to two groups; group I received 65 mL CM (370 mg I/mL) at 5 mL/s and group II received 0.9 mL CM (370 mg I/mL) per kg during 12 s resulting in a constant injection dose rate of 28 mg I/kg/s.The groups were re-divided according to body weight: IA ≤ 70 kg, IB >70 kg, IIA ≤ 70 kg, IIB >70 kg. Aortic attenuation was measured and coronary imaging quality was graded using a four-grade scale. RESULTS: The resulting mean CM dose, aortic attenuation and score of coronary imaging quality in groups IA/IB/IIA/IIB were 24/24/19/27 g I, 437/403/448/440 HU and 2.8/2.3/2.7/2.6, respectively. CM dose and aortic attenuation were significantly different between groups IA and IIA (p < 0.001, p = 0.01), as well as between groups IB and IIB (p < 0.001, p < 0.001).There was no statistically significant difference regarding coronary imaging quality between groups IA and IIA (p = 0.30), while there was a significant difference between groups IB and IIB (p < 0.001). CONCLUSION: In CTCA, body weight-adapted CM injection protocols using a constant dose rate can help save CM doses in slimmer patients and improve aortic enhancement and coronary imaging quality in heavier patients compared to fixed dose protocols.

Endoscopic transoral approach for extracranial hypoglossal schwannoma.

OBJECTIVE: Hypoglossal nerve schwannoma, especially when inside the extracranial region, is extremely rare. This report describes a new endoscopic transoral approach for the removal of extracranial hypoglossal schwannoma. PATIENTS AND METHODS: Three patients (1 male and 2 females, aged 58-63 years) with extracranial hypoglossal schwannoma in the paroccipital condyle and the jugular foramen were treated solely by an endoscopic transoral approach. All patients presented signs of hypoglossal nerve paresis with hemiatrophy of the tongue. In addition, one of them had glossopharyngeal nerve paresis, and vagus nerve paresis was found in another patient. RESULTS: In all patients, tumors underwent successful radical intracapsular removal by the endoscopic transoral approach, as confirmed by the postoperative examinations and MRI. No complications occurred during or after surgery, except that 1 patient had swallowing difficulties and a temporary right vagus palsy during the first day after surgery. All patients were followed up for 6 months, and the lack of any recurrence has been confirmed. Muscle bulk, motor and swallowing functions, and the vagus palsy improved in all patients. CONCLUSION: The endoscopic transoral approach is a safe and useful surgical technique for the removal of intracapsular tumors, including extracranial hypoglossal schwannomas, which involves minimal invasion.

Excision of Greater Superficial Petrosal Nerve Schwannoma Via a Pure Endoscopic Endonasal Approach.

Greater superficial petrosal nerve (GSPN) schwannomas are an exceedingly rare nerve sheath tumor. The current literature search was conducted using Medline and Embase database by key search terms. Only 31 cases have been reported in the literature so far. Facial palsy, hearing loss, and xerophthalmia accounted for 48.4% (15), 41.9% (13), and 29% (9) of all cases, respectively. The middle cranial fossa approach was used in all previous reports. A retrospective review of 2 GSPN schwannomas patients treated by endoscopic endonasal approach (EEA) in our center was collected. Clinical records, including clinical features, pre- and postoperative images, surgery, and follow-up information, were reviewed. In all cases, clinical features including facial numbness and headache were found, with tinnitus in case 1, hearing loss, xerophthalmia in case 2. Imaging studies showed a solid mass that originated in the anterior of the petrous bone. Two patients were treated by EEA. Furthermore, no recurrence was found during the follow-up period (15-29 months) in both of the 2 cases after the operation. Complete resection of GSPN schwannomas can be achieved via the pure EEA. Endoscopic endonasal approach for radical removal of tumors is safe and feasible.

Treatment of Recurrent Undifferentiated Pleomorphic Sarcoma of Infratemporal Fossa by Surgery Combined With Carbon Ion Radiotherapy: One Case Report.

We retrospectively analyzed the diagnosis and treatment process of one patient with recurrent undifferentiated pleomorphic sarcoma (UPS) of infratemporal fossa and made a definite diagnosis by combining the imaging and pathological examination results. After treatment failure with 2 cycles of chemotherapy and several surgeries, UPS was eventually treated by surgery + carbon ion radiotherapy, and MRI reexamination showed no relapse. Head and neck UPS is located deeply, easily recurs after operation, and difficult to be resected completely by surgery, with a gradually shortened interval of relapse over the number of surgeries, which becomes a treatment challenge. After the last surgery, the patient received carbon ion radiotherapy, with a good therapeutic effect, and no sign of relapse just before sending this article. Based on the above advantages, we have concluded that surgery + carbon ion radiotherapy is a new effective pathway to treat head and neck UPS.

Endoscopic endonasal removal of pituitary adenomas with paraclival internal carotid artery invasion.

OBJECTIVE: To retrospectively evaluate the effectiveness of the endoscopic endonasal removal of pituitary adenomas (PAs) with paraclival internal carotid artery (ICA) invasion. METHODS: Between February 2002 and August 2009, 14 consecutive patients underwent 'pure' extended endonasal transsphenoidal endoscopic surgery for PAs with paraclival ICA invasion. The clinical outcomes of the patients were evaluated, including symptoms, the extent of the tumor, the amount of tumor removed and any complications. RESULTS: Tumor removal, as assessed by intraoperative endoscopic inspection, postoperative magnetic resonance imaging and clinical evaluation, revealed total resection (cured) in 10 out of 14 PA patients, 1 subtotal resection (controlled), and 3 partial resections (improved). Three patients had recurrences and 2 underwent re-resection. A cerebrospinal fluid leak was seen in 1 patient. There were no cases of meningitis. All of the patients who had symptoms were discharged. CONCLUSION: Extended endonasal transsphenoidal endoscopic surgery for PAs with paraclival ICA invasion is a safe and effective alternative procedure after proper training. Moreover, the technique is less invasive and effective and requires less time than traditionally utilized procedures.

[Endoscopic endonasal surgery of trigeminal schwannoma extending into the infratemporal fossa].

OBJECTIVE: To investigate the feasibility of removing extracranial trigeminal schwannomas located in the infratemporal fossa by using a purely endoscopic endonasal approach. METHODS: From November 2004 to July 2009, 8 patients with extracranial trigeminal schwannomas located in the infratemporal fossa (4 male patients and 4 female patients, age ranged 31 - 62 years) were surgically treated by using a purely endoscopic endonasal approach. RESULTS: The maximum diameters of the tumors ranged from 3 to 7 cm. All tumors were completely removed. The operation time was 40 to 120 min, blood loss was 300 to 1500 ml. The clinical symptoms of some patients were relieved or improved. There were no intraoperative and postoperative complications, no deaths in this series. No relapse happened during the follow-up. CONCLUSIONS: The purely endoscopic endonasal approach may provide a minimally invasive and safe approach to remove extracranial trigeminal schwannomas extending into the infratemporal fossa. Radical resection is associated with an excellent long-term outcome in this series.

Superior turbinate management and olfactory outcome after endoscopic endonasal transsphenoidal surgery for pituitary adenoma: a propensity score-matched cohort study.

BACKGROUND: Surgical management of the superior turbinate (ST) is required to access the sella in endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenoma. Two common ST management techniques include partial resection of the ST (PRST) and intentional lateralization of the ST (ILST). Given the concentrated distribution of the olfactory nerve fibers on the medial surface of the ST, in this study we aimed to ascertain whether PRST worsens the objective olfactory outcome when compared with ILST. METHODS: A retrospective, propensity score-matched cohort study was performed at a tertiary referral center. A total of 232 adult patients undergoing EETS for pituitary adenoma were analyzed. The threshold test (STT) and the 12-item identification test (SIT-12) from "Sniffin' Sticks" were administered for separate nostrils preoperatively and 6 months postoperatively. RESULTS: Of 232 patients, 109 had right-sided PRST and 123 received right-sided ILST. Propensity score matching-controlling for olfactory-related confounding factors, including gender, age, medical comorbidities, surgical technique, and preoperative olfaction-resulted in 74 matched pairs. When comparing the 6-month postoperative olfactory performance of the right nostril, the STT score was significantly lower in the PRST group than the ILST group (p = 0.036, η2 for effect size estimate = 0.030), but the SIT-12 scores were similar in the 2 groups (p = 0.325). Overall, the olfactory outcomes for the right nostril did not qualitatively differ between the PRST and ILST groups (p = 0.401). CONCLUSION: Despite its association with threshold impairment, PRST in EETS does not seem to carry an additional risk of postoperative olfactory dysfunction.

Involvement of mitogen-activated protein kinases and nuclear factor kappa B pathways in signaling COX-2 expression in chronic rhinosinusitis.

OBJECTIVE: To investigate the signal pathways involved in cyclooxygenase-2 (COX-2) expression in chronic rhinosinusitis (CRS). METHODS: The expressions of COX-2, p38 mitogen-activated protein kinase (p38MAPK), extracellular signal-regulated kinase (ERK), and nuclear factor kappa B (NF-kappaB) in nasal mucosa were detected by immunohistological stain and polymerase chain reaction (PCR). Their expressions and prostaglandin E2 (PGE(2)) release were determined by PCR, Western blot and enzyme immunoassay (EIA) in human nasal epithelia (HNE) cells after lipopolysaccharide (LPS) induction, and/or small interfering RNA (siRNA) transfection. RESULTS: Positive protein expressions of COX-2, p38MAPK, ERK, NF-kappaB subunits were detected in epithelial and inflammatory cells. Their mRNA levels were significantly higher in CRS than controls (P < 0.05). The expressions varied in time and concentration-dependent manner in LPS-induced HNE cells. COX-2 expression was suppressed by siRNAs of P38MAPK, ERK, and NF-kappaB; however, COX-2-specific siRNA had no blocking effect on them. SiRNAs of P38MAPK or ERK could block NF-kappaB, but NF-kappaB-specific siRNA had no blocking effect on the former. SiRNA of p38MAPK, or ERK did not inhibit each other. CONCLUSION: Upregulation of COX-2 expression suggested its role as a mediator in CRS. ERK and p38MAPK pathways were involved in signaling COX-2 through NF-kappaB pathway.