Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study.

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study.

J Neurosurg. 2016 Jan 1;:1-12

Authors: Conrad J, Ayyad A, Wüster C, Omran W, Weber MM, Konerding MA, Müller-Forell W, Giese A, Oertel J

Abstract
OBJECTIVE Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. METHODS Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. RESULTS In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups. In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous. CONCLUSIONS Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area.

PMID: 26722858 [PubMed - as supplied by publisher]

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Surgically resected skull base meningiomas demonstrate a divergent postoperative recurrence pattern compared with non-skull base meningiomas.

Surgically resected skull base meningiomas demonstrate a divergent postoperative recurrence pattern compared with non-skull base meningiomas.

J Neurosurg. 2016 Jan 1;:1-10

Authors: Mansouri A, Klironomos G, Taslimi S, Kilian A, Gentili F, Khan OH, Aldape K, Zadeh G

Abstract
OBJECTIVE The objective of this study was to identify the natural history and clinical predictors of postoperative recurrence of skull base and non-skull base meningiomas. METHODS The authors performed a retrospective hospital-based study of all patients with meningioma referred to their institution from September 1993 to January 2014. The cohort constituted both patients with a first-time presentation and those with evidence of recurrence. Kaplan-Meier curves were constructed for analysis of recurrence and differences were assessed using the log-rank test. Cox proportional hazard regression was used to identify potential predictors of recurrence. RESULTS Overall, 398 intracranial meningiomas were reviewed, including 269 (68%) non-skull base and 129 (32%) skull base meningiomas (median follow-up 30.2 months, interquartile range [IQR] 8.5-76 months). The 10-year recurrence-free survival rates for patients with gross-total resection (GTR) and subtotal resection (STR) were 90% and 43%, respectively. Skull base tumors were associated with a lower proliferation index (0.041 vs 0.062, p = 0.001), higher likelihood of WHO Grade I (85.3% vs 69.1%, p = 0.003), and younger patient age (55.2 vs 58.3 years, p = 0.01). Meningiomas in all locations demonstrated an average recurrence rate of 30% at 100 months of follow-up. Subsequently, the recurrence of skull base meningiomas plateaued whereas non-skull base lesions had an 80% recurrence rate at 230 months follow-up (p = 0.02). On univariate analysis, a prior history of recurrence (p < 0.001), initial WHO grade following resection (p < 0.001), and the inability to obtain GTR (p < 0.001) were predictors of future recurrence. On multivariate analysis a prior history of recurrence (p = 0.02) and an STR (p < 0.01) were independent predictors of a recurrence. Assessing only patients with primary presentations, STR and WHO Grades II and III were independent predictors of recurrence (p < 0.001 for both). CONCLUSIONS Patients with skull base meningiomas present at a younger age and have less aggressive lesions overall. Extent of resection is a key predictor of recurrence and long-term follow-up of meningiomas is necessary, especially for non-skull base tumors. In skull base meningiomas, recurrence risk plateaus approximately 100 months after surgery, suggesting that for this specific cohort, follow-up after 100 months can be less frequent.

PMID: 26722844 [PubMed - as supplied by publisher]

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Endoscopic-assisted interhemispheric parieto-occipital transtentorial approach for microsurgical resection of a pineal region tumor: operative video and technical nuances.

Endoscopic-assisted interhemispheric parieto-occipital transtentorial approach for microsurgical resection of a pineal region tumor: operative video and technical nuances.

Neurosurg Focus. 2016 Jan;40(VideoSuppl1):1

Authors: Liu JK

Abstract
The angle of the straight sinus and tentorium cerebelli can often influence the choice of surgical approach to the pineal region. The supracerebellar infratentorial approach can be technically challenging and a relative contraindication in cases where the angle of the straight sinus and tentorium is very steep. Similarly, an occipital transtentorial approach, which uses a low occipital craniotomy at the junction of the superior sagittal sinus and transverse sinus, may not provide the best trajectory to the pineal region in patients with a steep tentorium. In addition, this approach often necessitates retraction on the occipital lobe to access the tentorial incisura and pineal region, which can increase the risk of visual compromise. In this operative video, the author demonstrates an alternative route using an endoscopic-assisted interhemispheric parieto-occipital transtentorial approach to a pineal region tumor in a patient with a steep straight sinus and tentorium. The approach provided a shorter route and more direct trajectory to the tumor at the tentorial incisura, and avoided direct fixed retraction on the occipital lobe when performed using the lateral position, thereby minimizing visual complications. This video atlas demonstrates the operative technique and surgical nuances, including the application of endoscopic-assisted microsurgical resection and operative pearls for preservation of the deep cerebral veins. In summary, the parieto-occipital transtentorial approach with endoscopic assistance is an important approach in the armamentarium for surgical management of pineal region tumors. The video can be found here: https://youtu.be/Ph4veG14aTk .

PMID: 26722692 [PubMed - as supplied by publisher]

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Endoscopic-assisted posterior interhemispheric retrocallosal transfalcine approach for microsurgical resection of a pineal region falcotentorial meningioma: operative video and technical nuances.

Endoscopic-assisted posterior interhemispheric retrocallosal transfalcine approach for microsurgical resection of a pineal region falcotentorial meningioma: operative video and technical nuances.

Neurosurg Focus. 2016 Jan;40(VideoSuppl1):1

Authors: Liu JK, Cohen MA

Abstract
Falcotentorial meningiomas are rare tumors of the pineal region that arise from the dural folds where the falx and tentorium meet and are often intimately related to the vein of Galen and straight sinus. These lesions often present with signs and symptoms related to hydrocephalus and brainstem compression. Surgical resection of falcotentorial meningiomas remains the definitive treatment, with a variety of surgical approaches used to resect these lesions. The choice of approach depends on several factors, including the size and location of the tumor relative to the vein of Galen complex. Falcotentorial meningiomas can be technically challenging to remove with significant risk of morbidity because of the close proximity to and occasional invasion of the vein of Galen and straight sinus. In this operative video, the authors demonstrate an illustrative step-by-step technique for endoscopic-assisted microsurgical resection of a falcotentorial meningioma using the posterior interhemispheric retrocallosal transfalcine approach for a superiorly positioned falcotentorial meningioma. The surgical nuances are discussed, including the surgical anatomy, gravity-assisted interhemispheric approach in the lateral position, retrocallosal dissection, transfalcine exposure, tumor removal, and preservation of the vein of Galen complex. In summary, the posterior interhemispheric retrocallosal transfalcine approach is a useful surgical strategy for select superiorly positioned falcotentorial meningiomas. The video can be found here: https://youtu.be/d8mdunsRacs .

PMID: 26722688 [PubMed - as supplied by publisher]

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Combined bi-occipital suboccipital transsinus transtentorial approach for resection of a pineal region falcotentorial meningioma: operative video and technical nuances.

Combined bi-occipital suboccipital transsinus transtentorial approach for resection of a pineal region falcotentorial meningioma: operative video and technical nuances.

Neurosurg Focus. 2016 Jan;40(VideoSuppl1):1

Authors: Liu JK

Abstract
Large deep-seated meningiomas of the falcotentorial region present a formidable surgical challenge. In this operative video, the author demonstrates the combined bi-occipital suboccipital transsinus transtentorial approach for microsurgical resection of a large falcotentorial meningioma. This approach involves division of the less dominant transverse sinus after assessment of the venous pressure before and after clipping of the sinus with continuous neurophysiologic monitoring. Mild retraction of the occipital lobe and cerebellum results in a wide supra- and infratentorial exposure of extensive pineal region tumors. This video atlas demonstrates the operative technique and surgical nuances, including patient positioning, supra- and infratentorial craniotomy, transsinus transtentorial incision, and tumor removal with preservation of the vein of Galen complex. In summary, the combined bi-occipital suboccipital transsinus transtentorial approach provides a wide supra- and infratentorial surgical corridor for removal of select falcotentorial meningiomas. The video can be found here: https://youtu.be/3aD8h2uwBAo .

PMID: 26722686 [PubMed - as supplied by publisher]

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Subfrontal trans-lamina terminalis approach to a third ventricular craniopharyngioma.

Subfrontal trans-lamina terminalis approach to a third ventricular craniopharyngioma.

Neurosurg Focus. 2016 Jan;40(VideoSuppl1):1

Authors: Choudhri O, Chang SD

Abstract
Craniopharyngiomas are benign, partly cystic epithelial tumors that can rarely occur in a retrochiasmatic location with involvement of the third ventricle. The lamina terminalis is an important neurosurgical corridor to these craniopharyngiomas in the anterior portion of the third ventricle. We present a video case of a large midline suprasellar and third ventricular craniopharyngioma in a 32-year-old male with visual disturbances. The tumor was approached with a subfrontal translamina terminalis exposure, and a gross-total resection of the tumor was achieved. This surgery involved working through a lamina terminalis fenestration around the optic nerve, optic chiasm, optic tracts, and the anterior communicating artery complex. This video illustrates the techniques employed in performing a transbasal anterior skull base approach to the third ventricle and demonstrates vivid surgical anatomy of neurovascular structures around the lamina terminalis. The video can be found here: https://youtu.be/fCYMgx8SnKs .

PMID: 26722678 [PubMed - as supplied by publisher]

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Familial chordoma: A case report and review of the literature.

Familial chordoma: A case report and review of the literature.

Oncol Lett. 2015 Nov;10(5):2937-2940

Authors: Wang KE, Wu Z, Tian K, Wang L, Hao S, Zhang L, Zhang J

Abstract
Familial skull base chordoma is a rare tumor derived from the remnants of the embryonic notochord. The present study describes the clinical presentation of 4 cases of skull base chordomas in a family. A 15-year-old female received staged surgeries and was pathologically confirmed with a diagnosis of skull base chordoma. Among the patient's family, 2 members had previously undergone surgery and were pathologically confirmed with chordomas; 1 family member had also received radiation therapy. Furthermore, the patient's cousin, an 18-year-old male, was confirmed to have this condition by epipharyngoscopy. All confirmed cases within the family remained alive with the condition. A literature review of familial chordoma was undertaken and 8 chordoma pedigrees were found. Familial chordoma was rare, with an estimated rate of 0.4% in all chordomas. The skull base was the predominant location for familial chordoma. Compared with sporadic chordoma, familial chordomas were diagnosed at a younger age. The brachyury gene was strongly associated with familial chordomas, however, the exact pathogenesis and genetics mechanisms remains unclear.

PMID: 26722267 [PubMed - as supplied by publisher]

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A Case of a Depressed Patient With Major Titanium Cranial Base Reconstruction Successfully Treated by ECT.

Related Articles

A Case of a Depressed Patient With Major Titanium Cranial Base Reconstruction Successfully Treated by ECT.

Am J Psychiatry. 2015 Oct;172(10):1024-5

Authors: Shiwaku H, Masaki H, Yasugi D, Narushima K

PMID: 26423486 [PubMed - indexed for MEDLINE]

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SYNOVIAL SARCOMA OF THE LARYNX.

SYNOVIAL SARCOMA OF THE LARYNX.

J Ayub Med Coll Abbottabad. 2015 Jul-Sep;27(3):729-30

Authors: Javed N, Iqbal J

Abstract
Synovial sarcoma is a mesenchymal spindle cell tumour that displays variable epithelial differentiation. It most commonly occurs in lower extremities. Head and neck is a rare site for synovial sarcoma accounting for less than 10%. Larynx is an extremely rare site and only 16 cases with laryngeal location have been reported. Immunohistochemistry is important for correct diagnosis. Surgical excision of the tumour with clear margins and local radiotherapy is effective in local control. Chemotherapy is indicated in the presence of distant metastasis. Case of a 16 years old female is presented with hoarseness of voice and mass in supraglottic region. Lateral pharangotomy and excision of mass revealed synovial sarcoma. She had been treated with adjuvant radiotherapy in September 2012. She was fine and coming for regular follow up.

PMID: 26721054 [PubMed - in process]

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Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature.

Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature.

Int Arch Otorhinolaryngol. 2016 Jan;20(1):69-75

Authors: Cabral Junior F, Pinna MH, Alves RD, Malerbi AF, Bento RF

Abstract
Introduction Current data show that binaural hearing is superior to unilateral hearing, specifically in the understanding of speech in noisy environments. Furthermore, unilateral hearing reduce onés ability to localize sound. Objectives This study provides a systematic review of recent studies to evaluate the outcomes of cochlear implantation in patients with single-sided deafness (SSD) with regards to speech discrimination, sound localization and tinnitus suppression. Data Synthesis We performed a search in the PubMed, Cochrane Library and Lilacs databases to assess studies related to cochlear implantation in patients with unilateral deafness. After critical appraisal, eleven studies were selected for data extraction and analysis of demographic, study design and outcome data. Conclusion Although some studies have shown encouraging results on cochlear implantation and SSD, all fail to provide a high level of evidence. Larger studies are necessary to define the tangible benefits of cochlear implantation in patients with SSD.

PMID: 26722349 [PubMed]

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Sialendoscopy: what is it and what is its awareness?

Sialendoscopy: what is it and what is its awareness?

Eur Arch Otorhinolaryngol. 2015 Dec 31;

Authors: Prasad S, Pezier T, Faure F, Marchal F

Abstract
In expanding the scope of sialendoscopy across the globe and assessing the impact of training activities at the European Sialendoscopy Training Centre, this study was conducted to find out the knowledge and attitude among respondents as well as identify potential obstacles to the initiation of the procedure. Delegates attending the 2011 International Federation of Otorhinolaryngological Societies meeting received a set of five questions. There were a total of 257 responses from 57 countries. Nearly all (238/257) were practising in the academic setting. A significant number of respondents had heard about sialendoscopy (231/257). An equal number found it interesting and were keen to learn more about the procedure (233/257). More than 85 % (219/257) respondents expressed their desire to start sialendoscopy. Hurdles to overcome included financial limitations (110) and "not enough knowledge" (100). Awareness about the existence of the procedure was rather high although the knowledge was limited. Several of the responders seemed keen on starting it, but had not done so due to financial limitations. However, there was a high rate of bias owing to the limited number of responders per country precluding a country-wise inference of awareness. Moreover, meetings of this nature tend to be attended by academics who in general seem to be more aware of new developments than their non-academic peers. Future surveys can address these issues as part of ensuring the universal adoption of sialendoscopy.

PMID: 26721245 [PubMed - as supplied by publisher]

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Preoperative external tissue expansion for complex cranial reconstructions.

Preoperative external tissue expansion for complex cranial reconstructions.

J Neurosurg. 2016 Jan 1;:1-8

Authors: Reinard KA, Zakaria HM, Qatanani A, Lee IY, Rock JP, Houin HP

Abstract
OBJECTIVE Reconstruction of large solitary cranial defects after multiple craniotomies is challenging because scalp contraction generally requires more than simple subcutaneous undermining to ensure effective and cosmetically appealing closure. In plastic and reconstructive surgery, soft tissue expansion is considered the gold standard for reconstructing scalp defects; however, these techniques are not well known nor are they routinely practiced among neurosurgeons. The authors here describe a simple external tissue expansion technique that is associated with low morbidity and results in high cosmetic satisfaction among patients. METHODS The authors reviewed the medical records of patients with large cranial defects (> 5 cm) following multiple complicated craniotomies who had undergone reconstructive cranioplasty with preoperative tissue expansion using the DermaClose RC device. In addition to gathering data on patient age, sex, primary pathology, number of craniotomies and/or craniectomies, history of radiation therapy, and duration of external scalp tissue expansion, the authors screened patient charts for cerebrospinal fluid (CSF) leak, meningitis, intracranial abscess formation, dermatitis, and patient satisfaction rates. RESULTS The 6 identified patients (5 female, 1 male) had an age range from 36 to 70 years. All patients had complicating factors such as recalcitrant scalp infections after multiple craniotomies or cranial radiation, which led to secondary scalp tissue scarring and retraction. All patients were deemed to be potential candidates for rotational flaps with or without skin grafts. All patients underwent the same preoperative tissue expansion followed by standard cranial bone reconstruction. None of the patients developed CSF leak, meningitis, intracranial abscess, dermatitis, or permanent cosmetic defects. None of the patients required a reoperation. Mean follow-up was 117 days. CONCLUSIONS Preoperative scalp tissue expansion with the DermaClose RC device allows for simple and reliable completion of complicated cranial reconstruction with low morbidity rates and high cosmetic satisfaction among patients.

PMID: 26722853 [PubMed - as supplied by publisher]

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MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA.

MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA.

J Ayub Med Coll Abbottabad. 2015 Jul-Sep;27(3):539-42

Authors: Khan SA, Khan B, Khan AA, Afridi EA, Mehmood S, Muhammad G, Hussain I, Zadran KK, Bhatti SN

Abstract
BACKGROUND: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD.
METHODS: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months.
RESULTS: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4%) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2%) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3%) cases, both CSA and AICA in 3 (5.6%) cases, venous compressions in only 1 (1.8%) patient and thick arachnoid adhesions were seen in 10 (18.9%) patients. Postoperatively, 33 (68%) patients were pain free, in 14 (26.45%) patients pain was significantly improved whereas in 3 (5.6%) patients there was mild improvement in symptoms. Three (5.6%) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2%) patients post-operatively, 4 (7.5%) patients developed wound infection and 1 (1.8%) patient developed aseptic meningitis. Three (5.6%) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy.
CONCLUSION: MVD is a safe and effective surgical option for treating patients with idiopathic TGN with better surgical outcome and fewer complications.

PMID: 26721002 [PubMed - in process]

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Inflammatory myofibroblastic tumor of the larynx: report of a case and review of the literature.

Inflammatory myofibroblastic tumor of the larynx: report of a case and review of the literature.

Int J Clin Exp Pathol. 2015;8(10):13557-60

Authors: Yan Q, Hu XL

Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, most commonly seen in children and adolescents. It can occur in nearly every part of the body. Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm mostly seen in the lungs, but also in extrapulmonary sites. But it may rarely be seen in the vical cord. We report a case of a 73-year-old men presented with hoarseness and cough. Laryngoscopy reveals a large non-ulcerated, red subepithelial mass arising from the right vical cord. Magnetic resonance imaging (MRI) scan revealed a mass in the right vical cord, and magnetic resonance imaging (MRI) enhanced scan showed the mass of the right vical cord inhomogeneous enhancement. The patient underwent right cordectomy with KTP laser, and further assessment of the tissue demonstrated a pathologic diagnosis of IMT.

PMID: 26722573 [PubMed - in process]

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Clinical Study of Extrapulmonary Head and Neck Tuberculosis: A Single-Institute 10-year Experience.

Clinical Study of Extrapulmonary Head and Neck Tuberculosis: A Single-Institute 10-year Experience.

Int Arch Otorhinolaryngol. 2016 Jan;20(1):30-3

Authors: Oishi M, Okamoto S, Teranishi Y, Yokota C, Takano S, Iguchi H

Abstract
Introduction Although the incidence of tuberculosis (TB) in Japan has been decreasing yearly, Japan remains ranked as an intermediate-burden country for TB. Objective This study aims to investigate the current situation of head and neck extrapulmonary TB (EPTB) diagnosed in our department. Methods We retrospectively reviewed the clinical records of 47 patients diagnosed with EPTB in the head and neck in our department between January 2005 and December 2014. The extracted data included sex and age distribution, development site, chief complaint, presence or absence of concomitant active pulmonary TB (PTB) or history of TB, tuberculin skin test (TST) results, interferon-gamma release assay (IGRA) results, and duration from the first visit to the final diagnosis of EPTB. Results The subjects consisted of 20 men and 27 women, and age ranged from 6 to 84 years. The most common site was the cervical lymph nodes (30 patients), with the supraclavicular nodes being the most commonly affected (60%). Histopathological examination was performed on 28 patients. TST was positive in 9 out of 9 patients and the IGRA was positive in 18 out of 19 patients. We observed concomitant PTB in 15 out of the 47 patients. Mean duration from the first visit to the final diagnosis of EPTB was 56 days. Conclusion The clinical symptoms of TB, especially those in the head and neck region, are varied. Otolaryngologists should be especially aware of the extrapulmonary manifestations of TB to ensure early diagnosis and treatment from the public health viewpoint.

PMID: 26722342 [PubMed]

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Leptomeningeal metastasis from early glottic laryngeal cancer: A case report.

Leptomeningeal metastasis from early glottic laryngeal cancer: A case report.

Oncol Lett. 2015 Nov;10(5):2915-2918

Authors: Pan Z, Yang G, Qu L, Yuan T, Pang X, Wang Y, Shi W, Dong L

Abstract
The present study reports the case of a 53-year-old man with leptomeningeal metastasis from early glottic laryngeal cancer. The patient had been diagnosed with squamous cell carcinoma of the glottic larynx 9 years previously. The current symptoms included a recurring headache that had persisted for 1 month and vomiting for 1 week. A magnetic resonance imaging scan of the head revealed multiple enhancing lesions in the brain and multiple line-like enhancements in the brain fold. Computed tomography scans of the head, neck, chest and abdomen showed no nodular lesions. Cytological examination of the cerebral spinal fluid (CSF) revealed malignant cells with a scattered distribution pattern. The patient received intra-CSF methotrexate chemotherapy concurrent with whole-brain radiotherapy, which relieved the neurological symptoms. To the best of our knowledge, this is the first case of cytologically-confirmed LM from early glottic laryngeal cancer.

PMID: 26722263 [PubMed - as supplied by publisher]

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SYNOVIAL SARCOMA OF THE LARYNX.

SYNOVIAL SARCOMA OF THE LARYNX.

J Ayub Med Coll Abbottabad. 2015 Jul-Sep;27(3):729-30

Authors: Javed N, Iqbal J

Abstract
Synovial sarcoma is a mesenchymal spindle cell tumour that displays variable epithelial differentiation. It most commonly occurs in lower extremities. Head and neck is a rare site for synovial sarcoma accounting for less than 10%. Larynx is an extremely rare site and only 16 cases with laryngeal location have been reported. Immunohistochemistry is important for correct diagnosis. Surgical excision of the tumour with clear margins and local radiotherapy is effective in local control. Chemotherapy is indicated in the presence of distant metastasis. Case of a 16 years old female is presented with hoarseness of voice and mass in supraglottic region. Lateral pharangotomy and excision of mass revealed synovial sarcoma. She had been treated with adjuvant radiotherapy in September 2012. She was fine and coming for regular follow up.

PMID: 26721054 [PubMed - in process]

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Long-term Results of Endoscopically Assisted Pediatric Cholesteatoma Surgery.

Long-term Results of Endoscopically Assisted Pediatric Cholesteatoma Surgery.

Otolaryngol Head Neck Surg. 2015 Dec 31;

Authors: Sarcu D, Isaacson G

Abstract
OBJECTIVE: Routine endoscopic examination during primary surgery decreased the rate of residual cholesteatoma to 18% in our early experience. Based on this, we stopped performing routine second-look surgery in children who were endoscopically free of cholesteatoma at the end of primary surgery. We sought to investigate if second-look procedures after endoscopic-assisted surgery could safely be performed only in children at a high risk of residual disease (extensive inflammation, spontaneously ruptured or fragmented cholesteatoma, residual disease intentionally left).
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary pediatric otolaryngology practice.
SUBJECTS AND METHODS: Children aged 1 to 16 years who were treated for cholesteatoma over 15-year period by a single surgeon. Extent of disease and endoscopic findings were compared with rates of residual disease. Time to diagnosis of residual disease and prognostic factors were analyzed.
RESULTS: Forty-two children underwent endoscopically assisted middle ear surgery for cholesteatoma. Of 42 children, 7 (17%) had additional disease found by endoscopy that was missed by microscopy alone. Twelve children at high risk had second looks; 5 (42%) had residual disease. Of 30 children, 2 (7%) presented with macroscopically evident residual cholesteatoma after no planned second look on office follow-up and subsequently underwent reoperation and were cured.
CONCLUSIONS: Selective second-look surgery in high-risk children did not adversely affect outcome as compared with the low-risk group. Cholesteatoma was identified endoscopically in 7 of 42 (17%) children thought to be microscopically free of disease at initial surgery. The endoscope may aid in visualization of difficult middle ear recesses when used to complement microscopy. Further investigation with multicenter data is needed.

PMID: 26721891 [PubMed - as supplied by publisher]

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Book Review: Functional Reconstructive Nasal Surgery.

Book Review: Functional Reconstructive Nasal Surgery.

Ann Otol Rhinol Laryngol. 2015 Dec 31;

Authors: Stupak HD

PMID: 26721793 [PubMed - as supplied by publisher]

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