N6-Methyladenosine RNA Modification Landscape in the Occurrence and Recurrence of Nasopharyngeal Carcinoma.

Background: Nasopharyngeal carcinoma (NPC) is a type of squamous head and neck cancer with variable geographic distributions, with the highest incidence in Southeast Asia. Its primary treatment is radiotherapy due to its high radio sensitivity. However, the N6-methyladenosine (m6A) landscape in NPC, including recurrent NPC, has not been reported. Methods: In this study, m6A RNA immunoprecipitation (RIP) sequencing and microarray sequencing were performed on 12 tissue samples tissues of patients with primary and recurrent NPC. The expression profiles of m6A-related and non-coding RNAs were constructed and explored. Then, function experiments were performed to evaluate the effects of methyltransferase (METTL)3, METTL14 and WT1 associated protein (WTAP) on progressions of NPC. Finally, immunohistochemistry (IHC) and survival analysis were performed to confirm the correlation between METTL3, METTL14 and WTAP and NPC patients' clinical outcomes. Results: This study mapped m6A RNA modification and RNA expression profiles in normal nasopharynx, primary NPC, and recurrent NPC tissues. This study also explored the role of m6A modificators in NPC development and recurrence. METTL3, METTL14, and WTAP could promote invasion and metastasis of NPC, and that these three proteins could induce radiotherapy resistance in NPC cells through DNA repair. Moreover, we found that METTL3, METTL14, and WTAP promoted an increase in exosomes within NPC microenvironment. Conclusions: This study suggests that the alteration of m6A modification in primary and recurrent NPCs may play an important role in the development and progression of NPC.

Ethanol Metabolism Dynamics in Clostridium ljungdahlii Grown on Carbon Monoxide.

Bioethanol production from syngas using acetogenic bacteria has attracted considerable attention in recent years. However, low ethanol yield is the biggest challenge that prevents the commercialization of syngas fermentation into biofuels using microbial catalysts. The present study demonstrated that ethanol metabolism plays an important role in recycling NADH/NAD+ during autotrophic growth. Deletion of bifunctional aldehyde/alcohol dehydrogenase (adhE) genes leads to significant growth deficiencies in gas fermentation. Using specific fermentation technology in which the gas pressure and pH were constantly controlled at 0.1 MPa and 6.0, respectively, we revealed that ethanol was formed during the exponential phase, closely accompanied by biomass production. Then, ethanol was oxidized to acetate via the aldehyde ferredoxin oxidoreductase pathway in Clostridium ljungdahlii A metabolic experiment using 13C-labeled ethanol and acetate, redox balance analysis, and comparative transcriptomic analysis demonstrated that ethanol production and reuse shared the metabolic pathway but occurred at different growth phases.IMPORTANCE Ethanol production from carbon monoxide (CO) as a carbon and energy source by Clostridium ljungdahlii and "Clostridium autoethanogenum" is currently being commercialized. During gas fermentation, ethanol synthesis is NADH-dependent. However, ethanol oxidation and its regulatory mechanism remain incompletely understood. Energy metabolism analysis demonstrated that reduced ferredoxin is the sole source of NADH formation by the Rnf-ATPase system, which provides ATP for cell growth during CO fermentation. Therefore, ethanol production is tightly linked to biomass production (ATP production). Clarification of the mechanism of ethanol oxidation and biosynthesis can provide an important reference for generating high-ethanol-yield strains of C. ljungdahlii in the future.

[Effect of STIL on the Gene Expression Profile of Gastric Cancer Cells].

Objective To explore the molecular mechanism underlying gastric carcinogenesis and progression by using gene expression profiling array together with bioinformatics. Methods Lentivirus short hairpin RNA targeting STIL(ShSTIL)and scrambled sequence RNA(ShCon)were transduced into the gastric cancer cell line SGC-7901.RNA extraction,complementary DNA synthesis,construction of biotin-labelled amplified RNA probes,and hybridization with gene expression profile were consecutively performed.We collected corresponding data and analyzed differentially expressing genes(DEGs),followed by the analysis of gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)enrichment,transcription factor regulating network,and protein-protein interacting networks. Results Compared with ShCon,a total of 417 and 87 genes were respectively down-regulated and up-regulated,respectively,in the ShSTIL group(P<0.05,fold change>1 or <-1).GO and KEGG enrichment analysis indicated that genes regulated by STIL were localized in cytoplasm,extracellular exosome,Golgi apparatus and various biomembranes,and were implicated in the ubiquitin-mediated proteolysis,P53 signaling pathway,and pathways regulating pluripotency of stem cells.Evaluation on genes enriched in KEGG pathways,regulation of transcription factors,and protein-protein interacting network demonstrated that IGF1R,STUB1,SKP2,and FOXO1 were localized at the centre of the network and played a key role in the development and progression of gastric cancer. Conclusion Through the protein-protein interactions,STIL may activate E3 ubiquitin ligase STUB1 or SKP2,promote the proteolysis of FOXO1-a transcription factor,regulate the expression of IGF1R,and thus promote gastric carcinogenesis and progression.

Direct Involvement of the Master Nitrogen Metabolism Regulator GlnR in Antibiotic Biosynthesis in Streptomyces.

GlnR, an OmpR-like orphan two-component system response regulator, is a master regulator of nitrogen metabolism in the genus Streptomyces In this work, evidence that GlnR is also directly involved in the regulation of antibiotic biosynthesis is provided. In the model strain Streptomyces coelicolor M145, an in-frame deletion of glnR resulted in markedly increased actinorhodin (ACT) production but reduced undecylprodigiosin (RED) biosynthesis when exposed to R2YE culture medium. Transcriptional analysis coupled with DNA binding studies revealed that GlnR represses ACT but activates RED production directly via the pathway-specific activator genes actII-ORF4 and redZ, respectively. The precise GlnR-binding sites upstream of these two target genes were defined. In addition, the direct involvement of GlnR in antibiotic biosynthesis was further identified in Streptomyces avermitilis, which produces the important anthelmintic agent avermectin. We found that S. avermitilis GlnR (GlnRsav) could stimulate avermectin but repress oligomycin production directly through the respective pathway-specific activator genes, aveR and olmRI/RII To the best of our knowledge, this report describes the first experimental evidence demonstrating that GlnR regulates antibiotic biosynthesis directly through pathway-specific regulators in Streptomyces Our results suggest that GlnR-mediated regulation of antibiotic biosynthesis is likely to be universal in streptomycetes. These findings also indicate that GlnR is not only a master nitrogen regulator but also an important controller of secondary metabolism, which may help to balance nitrogen metabolism and antibiotic biosynthesis in streptomycetes.

Androgen actions on endothelium functions and cardiovascular diseases.

The roles of androgens on cardiovascular physiology and pathophysiology are controversial as both beneficial and detrimental effects have been reported. Although the reasons for this discrepancy are unclear, multiple factors such as genetic and epigenetic variation, sex-specificity, hormone interactions, drug preparation and route of administration may contribute. Recently, growing evidence suggests that androgens exhibit beneficial effects on cardiovascular function though the mechanism remains to be elucidated. Endothelial cells (ECs) which line the interior surface of blood vessels are distributed throughout the circulatory system, and play a crucial role in cardiovascular function. Endothelial progenitor cells (EPCs) are considered an indispensable element for the reconstitution and maintenance of an intact endothelial layer. Endothelial dysfunction is regarded as an initiating step in development of atherosclerosis and cardiovascular diseases. The modulation of endothelial functions by androgens through either genomic or nongenomic signal pathways is one possible mechanism by which androgens act on the cardiovascular system. Obtaining insight into the mechanisms by which androgens affect EC and EPC functions will allow us to determine whether androgens possess beneficial effects on the cardiovascular system. This in turn may be critical in the prevention and therapy of cardiovascular diseases. This article seeks to review recent progress in androgen regulation of endothelial function, the sex-specificity of androgen actions, and its clinical applications in the cardiovascular system.

Methods to observe and weaken the influence of pregnancy-associated plasma protein-A on endothelial cell function.

OBJECTIVE: To investigate the effect of pregnancy-associated plasma protein-A (PAPP-A) on human umbilical vein endothelial cell (HUVEC) contraction and relaxation function. We also investigated some effects of pregnancy serum, which was voluntarily provided by women who were 9 months pregnant, on PAPP-A function and endothelial cell function. METHODS: HUVECs were cultured in vitro with PAPP-A at 0, 50, 100, and 200 ng/mL for 0, 12, 24, 48 hours. HUVECs were also pretreated for 12 hours with pregnancy serum before in vitro culture in the presence or absence of PAPP-A (50 ng/mL). Nitric oxide (NO) levels in cell supernatants were assessed using spectrophotometry. Endothelin-1 (ET-1) levels were determined using immunohistochemistry assays and quantified by mean optical density (MOD). RESULTS: The NO levels of HUVECs in the PAPP-A groups were significantly lower compared to the control group (P<0.05), whereas ET-1 levels in PAPP-A HUVECs were significantly higher compared to the control group (P<0.05.) Additionally, these effects were dose-dependent. The NO levels of HUVECs in the PAPP-A groups with pregnancy serum were higher compared to the control group (P<0.05). ET-1 levels in PAPP-A HUVECs with pregnancy serum were lower than in the control group (P<0.05). CONCLUSIONS: PAPP-A may affect HUVEC contraction and relaxation by reducing NO secretion and increasing ET-1 levels. In addition, pregnancy serum may affect PAPP-A function on vascular endothelial cells.

The effects of catheter-based radiofrequency renal denervation on renal function and renal artery structure in patients with resistant hypertension.

There are no clinical studies on the effects of catheter-based radiofrequency renal denervation (RDN) on renal artery structure using 64-detector computed tomography (CT). A total of 39 patients with resistant hypertension received RDN and 38 patients received drug treatment. Mean systolic pressure and diastolic pressure in the RDN group decreased after 1, 3, 6, and 12 months of procedure (P<.05) and urinary protein level significantly decreased after 6 and 12 months (P<.05). The diameter, length, and sectional area of the renal artery; number of cases of atherosclerosis; and plaque burden of 64-detector CT renal arteriography did not change at 12 months of follow-up (P<.05), whereas the plaque burden increased significantly in the control group (P<.05). RDN significantly and persistently reduced blood pressure and decreased urinary protein excretion rate in patients with resistant hypertension and did not exhibit any adverse effect on renal function and renal artery structure.

[Resection of parapharyngeal neoplasms via styloid diaphragm approach].

OBJECTIVE: To evaluate the surgical technique and efficacy of the resection of parapharyngeal space neoplasm via styloid diaphragm approach. METHODS: Thirty-three cases underwent the resection of parapharyngeal space tumors via styloid diaphragm approach from Jan 2005 to Jan 2011 were reviewed. Of the cases, 28 were with benign tumors treated by surgery alone, and 5 were malignant tumors treated by surgery plus postoperative radical radiotherapy. RESULTS: The parapharyngeal neoplasms in all cases were completely resected via styloid diaphragm approach. The postoperative follow-up ranged from 13 months to 7 years (median = 4.6 years). No tumor recurrence was found in 30 cases, but 3 cases experienced tumor recurrence, including 1 chondrosarcoma (3 years after surgery and chemoradiotherapy), 1 chordoma and 1 adenoid cystic carcinoma (5 years after surgery and radiotherapy). Severe postoperative complications were not observed, but 2 cases showed mild mouth askew and fully recovered after 3 months, and 1 case was complicated with hoarseness and cough symptoms that disappeared after heteropathy. CONCLUSION: Resection of parapharyngeal neoplasms via styloid diaphragm approach is an ideal surgical technique, with well-exposed surgical field, less tissue injury, and less postoperative complication.

[Effect of renal sympathetic denervation on left ventricular hypertrophy and inflammatory factors in spontaneously hypertensive rats].

OBJECTIVE: To investigate the effect of renal sympathetic denervation on left ventricular hypertrophy and inflammatory factors in spontaneously hypertensive rats. METHODS: Thirty six spontaneously hypertensive rats (SHR) were divided into 3 groups with 12 animals in each group: SHR control group,operation group and sham operation group. Bilateral renal sympathectomy or sham operation were performed in operation and sham groups,respectively; another 12 WKY rats served as normal controls. The blood pressure and body weight were examined weekly. The animals were sacrificed at w1 and w6, rat hearts were collected and left ventricular mass index (LVMI) was calculated. The expression of TLR4,TNF-α and IL-6 in heart tissue were detected by immunohistochemistry and Western blot. RESULTS: The systolic blood pressure [(201.67 ± 11.09) mmHg compared with (140.0 ± 10.86)mmHg,P<0.05],diastolic blood pressure [(144.50 ± 10.48)mmHg compared with (78.50 ± 7.32)mmHg,P<0.05], LVMI (2.44 ± 0.05 compared with 1.93 ± 0.05,P<0.05),the expression of TLR4 (0.298 ± 0.004 compared with 0.126 ± 0.004, P<0.05), NF-κB (0.249 ± 0.006 compared with 0.195 ± 0.005, P<0.05),TNF-α(0.323 ± 0.004 compared with 0.146 ± 0.004,P <0.05), IL-6 (0.283 ± 0.005 compared with 0.207 ± 0.006, P<0.05) in SHR control group were significantly higher than those in WKY group. Compared to sham operation group,the systolic blood pressure (157.30 ± 9.35 compared with 197.30 ± 11.5, P<0.05),diastolic blood pressure (112.50 ± 6.25 compared with 146.80 ± 7.6, P<0.05),LVMI (2.32 ± 0.04 compared with 2.57 ± 0.09, P<0.05, TLR4 (0.198 ± 0.006 compared with 0.317 ± 0.008, P<0.05), NF-κB (0.208 ± 0.006 compared with 0.332 ± 0.007, P<0.05), TNF-α(0.27 ± 0.009 compared with 0.375 ± 0.004,P<0.05), IL-6 (0.218 ± 0.004 compared with 0.376 ± 0.009, P<0.05) in operation group were all decreased at w1 after sympathectomy. Six weeks after the operation,there were no significant differences in systolic blood pressure (197.50 ± 12.13 compared with 208.83 ± 10.23,P>0.05) and diastolic blood pressure (150.33 ± 7.74 compared with 151.50 ± 8.22, P>0.05) between denervated and sham-operated SHRs; however,the LVMI (2.46 ± 0.07 compared with 2.81 ± 0.05,P<0.05) and the expression of TLR4(0.301 ± 0.009 compared with 0.567 ± 0.006, P<0.05), NF-κB (0.251 ± 0.004 compared with 0.476 ± 0.009,P<0.05),TNF-α(0.324 ± 0.005 compared with 0.535 ± 0.006, P<0.05,IL-6 (0.285 ± 0.009 compared with 0.549 ± 0.007, P<0.05) in operation group were still significantly lower than those in sham operation group. CONCLUSION: Renal sympathetic denervation can significantly delay the progression of LVH in SHR, which may associated with lowering blood pressure and decreasing expression of TLR4, NF-κB,TNF-α, IL-6 in myocardial tissue.

Three of four GlnR binding sites are essential for GlnR-mediated activation of transcription of the Amycolatopsis mediterranei nas operon.

In Amycolatopsis mediterranei U32, genes responsible for nitrate assimilation formed one operon, nasACKBDEF, whose transcription is induced by the addition of nitrate. Here, we characterized GlnR as a direct transcriptional activator for the nas operon. The GlnR-protected DNA sequences in the promoter region of the nas operon were characterized by DNase I footprinting assay, the previously deduced Streptomyces coelicolor double 22-bp GlnR binding consensus sequences comprising a1, b1, a2, and b2 sites were identified, and the sites were then mutated individually to test their roles in both the binding of GlnR in vitro and the GlnR-mediated transcriptional activation in vivo. The results clearly showed that only three GlnR binding sites (a1, b1, and b2 sites) were required by GlnR for its specific binding to the nas promoter region and efficient activation of the transcription of the nas operon in U32, while the a2 site seemed unnecessary.

Endoscopic surgery of cavernous sinus tumors originating from the extradura.

In the present study, we explored the effects of various endoscopic approaches in patients with cavernous sinus (CS) tumors. Five endoscopic approaches, including the endoscopic transseptal transsphenoidal approach, extended endoscopic transseptal transsphenoidal approach, extended transnasal transmaxillary approach, extranasal extended maxillary sinus approach, and endoscopic transnasal transpterygoid approach, were selected for the resection of CS tumors from 36 patients. Thirty gross total tumors and 6 subtotal tumors were removed. After a follow-up period of 6 months to 3 years, 30 patients were determined to be recurrence-free, and 2 patients had unchanged residual tumors. One patient with a recurrent pituitary adenoma underwent a second surgery, and 1 patient with chordoma died because of an intracavernous carotid artery rupture 18 months after the operation. Various endoscopic approaches tailored to the origin and extent of the CS tumor were proven efficacious for the maximal and precise removal of CS tumors while avoiding vital structures.

Effect of orange peel essential oil on oxidative stress in AOM animals.

The processing parameters of pump speed, inlet air temperature, outlet air temperature and homogenization pressure were evaluated. Encapsulation efficiency is high with a satisfied releasing rate. Then, acute otitis media (AOM) animal model was built and diet containing orange peel essential oil microcapsules were administrated to AOM animals. Pharmacological test showed that orange peel essential oil treatment could decrease serum and cochlea malondialdehyde (MDA), immunoglobulins A (IgA), immunoglobulins G (IgG), immunoglobulins M (IgM) levels and increase antioxidant enzymes activities. It can be concluded that orange peel essential oil treatment could decrease oxidative injury in acute otitis media rats.

[Endoscopic posterior septectomy for patients with nasopharyngeal tumor].

OBJECTIVE: To explore the techniques, advantages and disadvantages, indications and cautions of a surgical approach for the resection of nasopharyngeal tumor. METHODS: Ten cases with nasopharyngeal tumors were recruited in this study, of them, 3 cases with residual nasopharyngeal carcinoma after chemoradiotherapy, 2 cases with cavernous angioma, 2 cases with benign mixed tumor, 1 malignant mixed tumor, 1 adenoid cystic carcinoma, and 1 chordoma. All patients underwent endoscopic resection of posteroinferior quarter part of nasal septum, and then the removal of nasopharyngeal tumors through bilateral transnasal approach. RESULTS: Total resection of the tumor was achieved for all cases without severe surgical complications. All cases with benign tumors, with following-up of 6-18 months, showed no recurrence. Of 6 cases with malignant tumors, with following-up of 12-48 months, 5 cases showed no recurrence, and 1 case was suspected to relapse one year postoperatively, but not with any lesion enlargement after another 6 month follow-up. CONCLUSIONS: Posteroinferior quarter part of nasal septectomy is preferred for endoscopic resection of nasopharyngeal tumors because it can provide a panoramic view on nasopharyngeal cavity and tumors, thus, facilitating the removal of nasopharyngeal tumors.

[Prevention and management of complications of endoscopic surgery for nasal-skull base neoplasms].

OBJECTIVE: To analyze the surgical complications of endoscopic nasal-skull base surgery. The secondary objective was to propose the preliminary strategies for prevention and treatment of complications. METHODS: One hundred and thirty two patients with nasal-skull base tumors undergoing endoscopic or endoscope-assisted surgery were included in this study. Surgical approaches included endoscopic endonasal transethmoidal approaches, endoscopic endonasal transseptal transsphenoidal approach, extended endoscopic endonasal transseptal transsphenoidal approach, endoscopic transmaxillary posttrial wall approach, extended endoscopic transmaxillary posttrial wall approach, endoscopic nasal lateral wall dissection, maxillary osteotomy approach and endoscopic transoropharyngeal approach. These approaches were selectively used to resect the tumors in the area of nasal-skull base. RESULTS: The total resection of the tumors was obtained in 104 patients (104/132, 78.8%), with 29.5% (39/132) incidence of complications, including profuse bleeding, nerve injury, cerebrospinal fluid leakage, diabetes insipidus, electrolyte imbalance, hyperglycemia, and psychological disturbance. No catastrophic complications, sequelae and operative mortality encountered. Four months to 8 years' follow up (median 3.0 years) indicated that recurrence rate of the benign tumor was 9% (9/100) without died case, and 3-year and 5-year survival rates of the malignant tumor were 75.0% and 55.6%, respectively. CONCLUSIONS: Strategies proved to be effective in reduction of the overall incidence of the complications, especially in minimizing the catastrophic complications and sequelae. The strategies were as follows: first, according to original site, extension and characteristics of the tumor, designing appropriate endoscopic approaches for the treatment of skull base tumor; second, recognizing reliable surgical access points and safe plane of the dissection; third, predicting surgical risks preoperatively and proposing the corresponding plan to avoid these risks; fourth, acquainted with the endoscopic skills and familiarized the skull base structures; lastly, ensuring the correct management of the interdisciplinary problems with close collaboration with the interdisciplinary medical personnels.

[A preliminary study of endoscopic transoral trans-posteriorwall pharynx resection of hypo-clivus chordoma].

OBJECTIVE: To introduce a endoscopic surgical approach for hypo-clivus chordoma, and to explore the clinical value of the endoscopic resection of hypo-clivus chordoma. METHODS: Three hypo-clivus chordoma were resected by endoscopic transoral tans-posteriorwall pharynx approach. RESULTS: The MR image showed that total removal of the tumor was achieved in 2 patients and subtotal resection was received in one patient. No severe postoperative complications and sequelae occurred. In 6 months to 2 years' follow-up, the MRI showed that 2 patients had no residue tumor, and one patient died due to recurrence of the tumor 1 year after operation. CONCLUSION: The endoscopic transoral tans-posteriorwall pharynx approach might be valuable in the treatment of the hypo-clivus chordoma. The use of the endoscope allows for direct access to the hypo-clivus lesions while minimizing the chances of surrounding anatomic structure injury. In addition, this approach has the advantages of quick recovery, avoidance of catastrophic complications and sequelae. Especially, various angle view of the endoscope provides a panoramic view of the hypo-clivus, thus exposing and resecting hide lesion which can not be exposed by other approaches. This approach might facilitate complete resection of the chordoma with maximal preservation of normal tissues.

[Surgical approaches for different stages of nasopharyngeal angiofibromas].

OBJECTIVE: To explore the optical surgical approaches for the resection of early and advanced stage of nasopharyngeal angiofibromas. METHODS: Twenty two male patients aged 9 - 30 years (median 16 years) hospitalized in Xiangya Hospital from June 2003 to July 2006 with nasopharyngeal angiofibroma were recruited. Five operative approaches were selected according classification of juvenile nasopharyngeal angiofibroma described by Fisch. Six cases with stage I nasopharyngeal angiofibroma underwent endoscopic transnasal surgery. Six cases with stage II and 2 cases with stage III underwent endoscopic endonasal middle meatal transmaxillary-antrum approach. Three cases with stage III and 2 cases with stage IV underwent endoscopic endonasal middle and inferior meatal approach with extended transmaxillary-antrum resection. One case with stage IV underwent microscopic preauricula infratemporal fossa approaches combined with endoscopic endonasal middle and inferior meatal transantral approach. Two cases with stage IV underwent nasomaxillary osteotomy approach. RESULTS: After surgery, CT scan or MR image showed that total removal of the tumor was achieved in 21 patients. One patient who received subtotal resection were performed by second endoscopic surgery and obtained total resection. No postoperative complications have been encountered in all treated patients. Nine months to 3 years follow up indicated that no cases recurred after surgery. CONCLUSIONS: Appropriate surgical approach should be selected according to the clinical classification and whether the tumor has extended into whole nasal cavity, lateral fossa infratemporalis, intracranial or not. Such approaches might better facilitate the complete removal of nasopharyngeal angiofibromas and reduce the surgery-related injury.

Resection of extensive sellar tumors with extended endoscopic transseptal transsphenoidal approach.

The endoscope has recently been used to extensive sellar lesions, but the extended areas of the lesions and operative techniques vary from each study. Here we present our experience with extended endoscopic transseptal transsphenoidal (EETT) approach to 16 patients with extensive sellar lesion and evaluate the feasibility of EETT in different extensive sellar tumor resection. Sixteen patients with extensive sellar lesion were operated by EETT approach in this study. The approach included unilateral posterior septum mucosa resection, posterior septectomy, extended ethmoidectomy and sphenoidoctomy, four tumoral circumferences (bilateral, superior, inferior aspects) isolated and subsequently tumoral removal from outside to inside of the tumors obtained. This surgical procedure is satisfactory for sellar lesion with different juxtasellar extension. After surgery, CT scan and MR image showed that total removal of the tumor was achieved in 10 patients. Six patients who received subtotal resection were treated with postoperative radiation therapy or gamma knife surgery. Two patients developed postoperative cerebrospinal fluid leak that was successfully managed by conservative treatment within 6 days after surgery. No other new postoperative endocrinological or neurological defects occurred. Six months to 5 years follow up indicated that all 16 patients with the visual disturbances and 4 patients with endocrine impairments have recovered or improved. One patient with malignant meningioma died due to recurrence of the tumor 2 years postoperation. Another one patient with malignant inverted papilloma recurred 1 year postoperation and underwent operation and radiation therapy again. The EETT approach might better facilitate the removal of different extensive sellar lesions with maximal preservation of important anatomical structures and nasal function.