搜索结果：Journal of neurological surgery. Part B, Skull base

Skull base surgery is a highly innovative, multidisciplinary field that brings together teams of neurosurgeons, otolaryngology-head and neck surgeons (OHNS), plastic surgeons, ophthalmologists, radiation oncologists, and others. However, not long ago, the nascent field was instead characterized by isolated individual brilliance. This paper explores the contributions of several key players toward breaking silos and transforming the field into what it is today. Our analysis centers on the formation of the North American Skull Base Society (NASBS), and the instrumental role that it played in the development of skull base surgery. We interviewed 12 past presidents of the NASBS and 2 prominent figures in skull base surgery. The contents of those 20 hours and 38 minutes of interviews and documents from initial NASBS meetings were analyzed. Key moments were segmented into short video clips, which complement this manuscript and are available on the NASBS website. A compelling narrative of collaboration, mentorship, and tenacity emerged from our analysis. In the 20th century, the field of skull base surgery was characterized mainly by courageous but isolated efforts by neurosurgeons and OHNS surgeons. Through mentorship, collaboration, and incredible innovation, it has since grown into a multidisciplinary, cutting-edge specialty that utilizes the strengths of several medical specialties. This transformation was largely facilitated by the formation of the NASBS in 1989, which enabled worldwide communication and collaboration among those dedicated to advancing the field. The growth of skull base surgery in North America and the instrumental role of the NASBS highlight the power of collaboration and innovation. It is important to recognize and celebrate the key players who facilitated the creation and success of the NASBS, which continues to unite young members across countless disciplines under one banner.

Many studies have focused on Gruber's ligament and Dorello's canal. However, only scant studies have analyzed these structures via histological analysis. Furthermore, the histology studies for these structures did not sufficiently evaluate them and their surrounding anatomical relationships. Therefore, this study aims to assess the comprehensive morphology of Gruber's ligament and Dorello's canal. Histological observation in coronal and sagittal sections and microsurgical observations (using both conventional and inferior approaches) were conducted on Gruber's ligament, Dorello's canal, and related structures. Histological observation revealed that the only extension of the dura was found between the petrous apex and the clivus. Microsurgical dissection using the conventional approach identified a fibrous band, whereas the inferior approach did not reveal any distinct connective tissue other than dura. Our multidirectional approach demonstrated that Gruber's ligament is part of the dura between the petrous apex and clivus. The petrous apex end was artificially separated from the dura along the medial wall of the cavernous sinus. The previously reported variations of Gruber's ligament, such as duplication or absence, can now be explained by our findings. Gruber's ligament is simply a part of the dura at the skull base. The extension of the dura between the petrous apex and clivus, which forms part of a mesh-like structure rather than a distinct ligament, traditionally has been termed Gruber's ligament.

Surgical treatment of skull base pathologies is frequently discussed in the context of endoscopic endonasal or transcranial approaches. Combined endoscopic and open approaches have been utilized in a staged or sequential fashion, with the goal of reducing the risk of postoperative cerebrospinal fluid leak, morbidity, wound infection/complication, and failure to achieve adequate reconstruction. However, few studies have described the concurrent use of endoscopic endonasal and transcranial approaches to safely address complex skull base pathologies. We treated 13 patients with primary skull base tumors (sinonasal undifferentiated carcinoma/esthesioneuroblastoma), recurrent tumors, infection, and skull base defect/encephalocele. Out of the thirteen patients, eight had undergone prior endoscopic and/or open transcranial approaches for resection of their pathologies. Additionally, 3/13 patients underwent radiation or chemotherapy radiation prior to the combined approach. The desired clinical outcome (i.e., gross total tumor resection, resolution of infection, and skull base resection/repair) was achieved in 12/13 cases. One case had subtotal resection (Simpson grade III) of an olfactory groove meningioma. Postoperatively, there was one 30-day mortality due to pulmonary infarction, one case with hydrocephalus requiring ventriculoperitoneal shunt placement, and one flap infection due to postoperative cocaine use resulting in revisions and hospice. Importantly, no patients experienced postoperative CSF leaks, including those who underwent postoperative chemotherapy/radiation. This case series suggests that a concurrent combined endoscopic transcranial approach, in carefully selected patients, can treat a wide range of complex and recurrent skull base pathologies resistant to previous treatment, with a reasonable rate of postoperative wound/leak complications.

Anterior skull base surgery is commonly used for the surgical treatment of a variety of skull base lesions. One uncommon, but serious postoperative complication of this procedure is meningitis. Prophylactic antibiotics are widely used but with considerable variability in duration and regimes due to lack of guidelines. This systematic review was carried out to determine the benefit of prophylactic antibiotics in preventing meningitis in patients undergoing endonasal anterior skull base surgery. The review was undertaken according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Online searches including PubMed, MEDLINE, EMBASE, Cochrane, and gray literature were performed up to May 2, 2024. Articles reporting on patients undergoing endoscopic anterior skull base surgery, the use or not of prophylactic antibiotics, and follow-up outcomes were included for selection. Data extracted included demographics, pathology, prophylactic antibiotic duration/type, nasal pack use, cerebrospinal fluid (CSF) leaks, meningitis rates, sinusitis rates, and other complications. A total of 32 studies were included in this systematic review, totaling 26,477 patients published between 1981 and 2023. The overall rate of developing meningitis with any duration of use of antibiotics was 2%. Patients receiving intraoperative antibiotics alone had a higher rate of subsequent meningitis (3%) compared with patients receiving a postoperative course of 24 hours or a longer course (1%). Patients who had an intraoperative or postoperative CSF leak had a higher rate of meningitis (10%) than those without (0%). This review indicates that postoperative antibiotic course may be more effective in preventing meningitis. Patients who develop a CSF leak have a higher risk of developing meningitis.

As the scope of endoscopic techniques continues to evolve in the treatment of advanced sinonasal malignancies, the primary challenge is the reconstruction of the resulting anterior skull base dural defect. This study aimed to assess the efficacy of vascularized pericranial flap reconstruction in addressing anterior skull base defects in sinonasal malignancies, particularly when alternative reconstructive methods, such as nasoseptal flaps, are not viable. We conducted a retrospective review of nine patients who underwent endoscopic resection of sinonasal malignancy followed by vascularized pericranial flap. Our analysis aimed to evaluate the surgical methods utilized, identify any complications that occurred, and assess the postoperative results of the patients. Excluding the singular instance of tension pneumocephalus that emerged during the immediate postoperative period, necessitating surgical intervention, our clinical experience was devoid of any complications, with a median follow-up duration of 18 months. It is worth noting that no cases of cerebrospinal fluid leaks or meningitis were reported. Moreover, the follow-up check endoscopy verified the successful integration of the flap and its efficacious coverage of the resection site. This study underscores the benefits of using vascularized pericranial flaps as an alternative solution for anterior skull base reconstruction in sinonasal malignancies. The availability of the pericranial flap in the local region, along with its robust blood supply, and the positive outcomes observed in this preliminary series collectively indicate its potential as an integral component of multi-layered reconstruction techniques for addressing anterior skull base defects.

The expanded endonasal approach (EEA) is historically associated with high rates of postoperative cerebrospinal fluid (CSF) leak. Therefore, many surgeons advocate for routine lumbar drain (LD) placement despite mixed evidence of their efficacy. We report outcomes for anterior and central skull base reconstructions after EEA without LDs. A retrospective review was conducted evaluating consecutive patients undergoing EEAs for resection of central and anterior skull base pathology from 2015 to 2024 at two academic institutions. Incidence of postoperative CSF leak. Eighty-five patients underwent a total of 89 EEAs. Patients were predominantly female (62.9%) with an average age of 45.1 years (range 11 months-84 years). Tumors included primarily craniopharyngiomas (49.4%) and meningiomas (46.1%). No LDs were placed perioperatively, and there was an 100% intraoperative high-flow CSF leak rate. Skull base reconstruction was performed using pedicled nasoseptal flaps (NSFs) in all cases, tensor fascia lata grafts in 82 cases, and fat grafts in 78 cases. The postoperative CSF leak rate was 7.9%. Suprasellar tumors were associated with lower rates of postoperative CSF leak compared with tuberculum sella and planum sphenoidale pathology ( p  = 0.030), whereas meningiomas trended toward higher CSF leak rates compared with craniopharyngiomas ( p  = 0.059). We report a low rate of postoperative CSF leak without LD placement after EEA. Our results suggest that successful skull base reconstructions may be performed with multilayered closures using vascularized NSFs without the need for routine CSF diversion.

Endoscopic endonasal approach has revolutionized the surgery of benign nose and paranasal sinus tumors. In this study we describe our experience with this approach for schwannomas of anterior skull base which are extremely rare, vascular tumors of this region. We also discuss the strategic management and their outcomes to enlighten the existing literature. Ambispective study. A total of eight cases of anterior skull base schwannoma were included. These cases were operated between 2018 and 2023 at a tertiary institute. Institutional ethical committee approval was obtained. Medical records were obtained, and perioperative details (intraoperative findings, imaging findings, complications) were noted. Postoperative follow-up was done to note the outcomes of the patient. There were five male and three female patients. All patients were between 20 and 40 years of age. All patients underwent contrast CT as well as MRI preoperatively. Most common symptoms in our series were nasal obstruction and intermittent epistaxis. The various sites involved were ethmoid labyrinth, maxillary sinus, septum, and olfactory fossa. All the cases were operated endoscopically. Endoscopic approach can be utilized in almost all cases of benign anterior skull base tumors with superior postoperative outcomes. Although there is a steep learning curve, use of subtle modifications of this technique help achieve better results. At the same time, it is imperative to understand that the surgeon should also be well versed with open approaches to help navigate difficult cases.

Skull base osteomyelitis is a potentially life-threatening infection typically seen in elderly diabetic or immunocompromised patients. Internal carotid artery pseudoaneurysm caused by skull base osteomyelitis is a very rare complication. We present here three such instances to share our clinical experience and insights gained in the management of these cases. A retrospective clinical audit of 142 skull base osteomyelitis patients (January 2010-May 2023) revealed three cases complicated by pseudoaneurysm at the cervicopetrous junction, with Pseudomonas being the primary causative organism. Two patients underwent successful endovascular coiling and survived after prolonged antipseudomonal therapy. A literature review of 12 similar cases also showed Pseudomonas as the dominant pathogen, whereas 1 case each was caused by tuberculosis and fungal infection. Most patients received antimicrobial therapy for more than 3 months. Follow-up data were unavailable for seven patients; among the remaining cases, all survived except one. Internal carotid artery mycotic pseudoaneurysm is a rare yet potentially devastating complication of skull base osteomyelitis. Timely diagnosis and aggressive treatment are crucial to prevent catastrophic outcomes. Endovascular therapy has emerged as the primary modality for the management of these aneurysms. In the absence of surgical debridement for treatment of skull base osteomyelitis, prolonged antimicrobial therapy (at least 3 months) is essential.

The use of genomic testing for patients with anterior skull base malignancies has grown dramatically. There are no clear guidelines on indications for testing. As the literature on the subject is still in early stages, there is a need for expert consensus. We conducted a modified Delphi expert consensus process with high-volume North American cranial base surgical programs. A modified Delphi consensus approach was used, following the method laid out by the American Academy of Otolaryngology-Head and Neck Surgery, and included 13 high-volume care centers. An otolaryngologist was appointed at each location to serve as the institutional representative. Participant responses to Delphi surveys were tabulated to determine consensus. Thirteen teams responded comprising 23 otolaryngologists and 10 neurosurgeons. Overall, 11 of 12 institutions reported genomic testing to be fairly or easily available at their location, and 22 of 38 initial statements achieved consensus. Statements achieving consensus focused on primary and recurrent rare tumors without possibility of margin-negative resection, those with family history of anterior skull base malignancies, or rare tumors with distant metastasis. Statements regarding routine genomic sequencing or for primary tumors and cost of care did not achieve consensus. Expert multidisciplinary teams agreed on several appropriate settings for genomic sequencing in patients with anterior skull base malignancies, including recurrence, distant metastasis, and the inability to achieve a margin-negative resection. Further research is needed to explicitly clarify the role of genomic sequencing in this rare disease group.

Cerebrospinal fluid (CSF) rhinorrhea is a sign of a breach in the bony skull base. It should be verified, localized, and repaired surgically to alleviate the risk of intracranial infection. Endonasal endoscopic surgery is the standard technique for skull base reconstruction in these patients. The current study was undertaken to evaluate a large case series of patients with CSF rhinorrhea who underwent surgery, focusing on symptoms, etiology, specifics of skull base defects, reconstruction techniques, outcomes, and complications. All patients with CSF rhinorrhea who were treated endoscopically for a skull base defect from 2010 to 2023 in a tertiary referral hospital were included. In this retrospective study, 263 patients were included. The chief presenting symptom was rhinorrhea. Spontaneous CSF leak was the most common etiologic factor, whereas accidental trauma accounted for about one-third of the cases. In cases of spontaneous CSF rhinorrhea, the most common sites of skull base defects were the cribriform plate, lateral lamella of the ethmoid, and the lateral recess of the sphenoid. The frontal sinus was the most common site of defect in cases of accidental traumatic CSF rhinorrhea. In the majority of cases, a two-layer technique using inlay fat and onlay fascia was employed for skull base reconstruction. Recurrences, including technical failures, missed skull base defects, and late new skull base defects, were observed in 10 cases (3.8%). Three patients developed meningitis in the early postoperative period, but all recovered uneventfully. Given the high success rate and low morbidity, all patients with CSF rhinorrhea should be counseled to undergo endoscopic surgery early.

Using multivariate models of social determinants of health (SDoH) featuring census-level Yost Index-socioeconomic status (SES) measures, to determine whether community-level SDoH factors quantifiably influence skull base chordoma-chondrosarcoma disparities more than individual-level SDoH factors on care-prognostic differences nationally. Retrospective cohort, skull base chordomas/chondrosarcoma patients diagnosed between 2010 and 2018 from SEER (Surveillance, Epidemiology, and End Results) were analyzed by multivariate, age-adjusted regressions and Cox proportional hazards models; covariates of sex, race-ethnicity, census-level rurality-urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing). Mortality, late-staging, first-line/nonfirst-line treatment, delay-in-treatment. Across 1,530 skull base chordomas and chondrosarcomas, delay-of-treatment featured a markedly positive independent predictor of minority race/ethnicity (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.27-1.34; p &#x2009;<&#x2009;0.001). Five-year all-cause mortality showed markedly positive predictors of male-sex (1.82; 1.30-2.56; p &#x2009;<&#x2009;0.001), minority race/ethnicity (OR, 1.94; 95% CI, 1.32-2.87; p &#x2009;=&#x2009;0.001), and decreasing Yost-SES (OR, 1.61; 95% CI, 1.14-2.26; p &#x2009;=&#x2009;0.006). Three-year all-cause mortality featured markedly positive predictors of male-sex (OR, 1.82; 95% CI, 1.30-2.56; p &#x2009;<&#x2009;0.001) and minority race/ethnicity (OR, 1.75; 95% CI, 1.18-2.58; p &#x2009;=&#x2009;0.005). Receipt of nonfirst-line radiation therapy showed a markedly positive independent predictor of minority race/ethnicity (OR, 1.34; 95% CI, 1.06-1.71; p &#x2009;=&#x2009;0.016). Receipt of first-line primary surgery showed a markedly negative independent predictor of decreasing Yost-SES (OR, 0.71; 95% CI, 0.53-0.96; p &#x2009;=&#x2009;0.024). Advanced-staging showed a markedly positive independent predictor of decreasing Yost-SES (OR, 1.85; 95% CI, 1.19-2.89; p &#x2009;=&#x2009;0.006). Through interactional models of individual- and community-level social determinant factors, this study observed detrimental, interrelated SDoH associations with poorer care and prognosis of chordoma and chondrosarcoma patients while quantifiably delineating the strength of factor association with observed disparities.

To determine if using fibrin sealants (FS) during skull base (SB) surgery reduces complications. PubMed, Cochrane, Web of Science, and Embase databases were searched for studies of patients who underwent SB surgery with use of an FS. A systematic review was conducted according to PRISMA guidelines. Primary outcomes included incidence of cerebrospinal fluid (CSF) leak, revision surgery, infection, and drain placement. Methods for meta-analysis were performed including tests of homogeneity and both fixed-effects and random-effects models. A total of 30 articles met the inclusion criteria. There were 3,681 patients, including 2,220 patients who received FS and 1,461 patients who did not. The most common surgical approaches were posterior fossa (27.4%) and transsphenoidal (18.2%). The FS group was less likely to have a lumbar drain placed (1.7% versus 8.1% of the control group). The difference in drain placement incidence between groups for the studies which included both groups was -0.135 (95% CI [-0.285, 0.016], p &#x2009;=&#x2009;0.079) for the random-effects model and -0.038 (95% CI [-0.068, -0.008], p &#x2009;=&#x2009;0.014) for the fixed-effects model. The incidence of CSF leak was 11.3% in the control group and 6.8% in the FS group. The rate of infection was higher in the control group (6.1%) compared with the FS group (3.3%), although not statistically significant. The rate of revision surgery was similar between the two groups (3.0% in the control group versus 2.4% in the FS group). Patients who underwent SB surgery with FS may have lower incidences of drain placement than patients whose surgery did not involve FS.

Over the past several decades expanded endonasal approaches have advanced significantly, paralleling the increasing importance of skull base defect reconstruction. The nasoseptal flap (NSF) is first line for most skull base reconstruction but may fail for complex or recurrent cerebrospinal fluid (CSF) leaks in central skull base. The inferior turbinate flap (ITF) presents an alternative due to proximity and robust vascular supply. This cadaveric study compares the NSF and ITF in central skull base repairs, detailing indications, limitations, and dimensions. We analyzed five cadaveric head specimens provided by the Medical College of Georgia Department of Anatomy. The NSF and ITF were raised bilaterally on each head, yielding 20 flaps in total. Length and width of each flap were measured, and total coverage area was calculated. SPSS (ver.20.0) was used for statistical analysis. Differences in mean width, length, and coverage area between the NSF and ITF were analyzed using Student's two-independent sample t -test, with p -values <0.05 considered statistically significant. The NSF was significantly longer (64.6&#x2009;mm) than ITF (42.8&#x2009;mm), but the ITF was wider (46.6&#x2009;mm) than NSF (36.5&#x2009;mm). NSF had a larger mean coverage area (23.6&#x2009;cm 2 ) than ITF (19.9&#x2009;cm 2 ) ( p &#x2009;=&#x2009;0.053). While the NSF provides superior coverage, the ITF is a viable option in the reconstruction ladder for central skull base defects when NSF fails, offering advantages in terms of proximity, vascular supply, and lower morbidity over other rescue flaps. Surgical technique in harvesting this flap should be known to any skull base surgeon over other more complex reconstruction flaps.

This study aimed to determine the incidence and risk factors for postoperative pulmonary complications (PPCs) following endoscopic endonasal surgery (ESS). Retrospective review from January 2023 to May 2023. Tertiary academic center. One hundred EES cases, of which 97 met the inclusion criteria. The primary outcome was the incidence of PPC. Univariable and multivariable analyses were used to assess preoperative variables, demographics, and respiratory comorbidities; intraoperative variables of surgery and duration of intubation, endotracheal tube (ETT) size, estimated blood loss (EBL), gastric tube use during surgery; postoperative cerebrospinal fluid (CSF) leak, and length of hospital stay as predictors of PPC. Ninety-seven patients met the inclusion criteria. Twenty-nine developed PPC including increased oxygen requirement (14.4%), pneumonia (9.3%), atelectasis (3.1%), respiratory failure (2.1%), and pulmonary embolism (2.1%). Sixty-four percent were clinically significant PPC. PPC was associated with age ( p &#x2009;<&#x2009;0.007), longer duration of surgery ( p &#x2009;<&#x2009;0.001), longer duration of intubation ( p &#x2009;<&#x2009;0.001), postoperative intubation ( p &#x2009;<&#x2009;0.001), higher EBL ( p &#x2009;=&#x2009;0.022), and longer length of hospital stay ( p &#x2009;<&#x2009;0.001). There was no significant association between PPC and sex ( p &#x2009;=&#x2009;0.705), body mass index (BMI; p &#x2009;=&#x2009;0.403), gastric tube presence ( p &#x2009;=&#x2009;0.778), ETT size ( p &#x2009;=&#x2009;0.636), and preoperative history of pulmonary disease ( p &#x2009;=&#x2009;0.403). The incidence of PPC in patients undergoing EES is significant. Targeting perioperative risk factors including age &#x2265;65, duration of intubation, postsurgical intubation status, and intraoperative blood loss should have a meaningful impact on decreasing PPC. The contribution of silent intraoperative aspiration during surgery needs to be investigated further in high-risk patient populations.

The purpose of this study was to introduce a watertight duraplasty with artificial dural grafts for anterior skull base (ASB) reconstruction. Between November 2019 and October 2023, we used artificial dural grafts for the ASB reconstruction in 10 cases of recurrent benign cranionasal communicating tumors. Through a transcranial subfrontal approach, the tumor was totally removed and the skull base defect was repaired using the NormalGEN and DuraMax artificial dural grafts. Clinical and imaging follow-ups were conducted to screen for the occurrence of postoperative cerebrospinal fluid (CSF) leakage, intracranial infection, and encephalocele. Gross total resection of tumor and ASB reconstruction with the artificial dural grafts were achieved in 10 patients. The patients were followed up clinically for 11 to 52 months (mean 26.0 months) and underwent medical imaging follow-up for 6 to 36 months (mean 18.4 months). One patient presented with CSF leakage on day 47 after the operation. Another patient endured intracranial infection without CSF leakage on the fifth day after the operation. Both patients were cured. No encephalocele was observed during the follow-up period. All the patients achieved a favorable recovery. Following transcranial resection of benign cranionasal communicating tumors, we utilized artificial dural grafts for ASB reconstruction when the frontal pericranium was impaired by tumor invasion or previous surgery. Our initial experience and postoperative follow-up have proven that the method is feasible and reliable in selected cases.

Delayed facial nerve palsy (DFNP) is a complication of microsurgical resection of vestibular schwannoma (VS). This study aims to clarify the definition and incidence of DFNP, as well as evaluate long-term CNVII prognosis in affected patients. PubMed, Embase, and Scopus databases. A systematic literature search was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Full-text publications were included if they reported DFNP incidence, CNVII prognosis, demographic data, and how they defined DFNP. Ten studies with 2,122 patients who underwent surgical resection for VS were included. Meta-analysis demonstrated a mean incidence of DFNP of 13%, with a mean recovery to House-Brackmann (HB) I/II of 85%. Definitions of DFNP varied widely. Four studies utilized a broad definition of DFNP, without requiring any specific level of change in HB grade in the postoperative period. Two studies defined DFNP as deterioration of CNVII function by at least one HB grade, and an additional four studies defined DFNP as deterioration of CNVII function by at least two HB grades. The prognosis of CNVII function after DFNP was favorable with 85% of patients regaining function to HB grade I/II within 12 months. Given the heterogeneity in definitions of DFNP, it remains challenging to determine the true incidence of DFNP after VS resection. Grading DFNP by degree of severity would improve studies of this entity. We propose utilizing a novel DFNP Severity Scale to more accurately track prognosis in patients with DFNP based on pre- and postoperative HB scores. Level III-systematic review of nonrandomized cohort studies and retrospective reviews.

Professor Albert J. Rhoton Jr., MD, is renowned for his groundbreaking dissections, marking a monumental achievement in the field of neuroanatomy. Alongside his anatomical contributions, he also passed on his knowledge and skills to numerous fellows, leaving behind a profound legacy. Despite the widespread recognition of his influence, little quantitative work has been done to characterize the scholarly impact of his alumni. Data were collected on Rhoton fellows, including fellowship years, country of origin, current institutions, and titles, practice settings, and leadership roles. Scholarly productivity was evaluated by assessing publication counts, including publications before and after the fellowship, and publications focused on surgical anatomy. Additionally, H-indices and citation counts were recorded. Other variables analyzed included ownership of a surgical anatomy laboratory, and participation in organizing hands-on courses. We analyzed 118 alumni from diverse countries. There was a significant increase in publication output following the fellowship, with publications rising from an average of 7 to 76 ( p &#x2009;<&#x2009;0.001). Fellows from high-income countries had higher research productivity than those from middle-income countries, with greater average H-index ( p &#x2009;=&#x2009;0.003), publication count ( p &#x2009;=&#x2009;0.01), and citation score ( p &#x2009;=&#x2009;0.003). Overall, 65% of fellows pursued academic practice, with 18% owning a laboratory and 30% involved in hands-on courses. Dr. Rhoton's mentorship has shaped a generation of neurosurgeons who continue his legacy. His fellows have established careers worldwide, leading in academia, professional organizations, and surgical training. Their global impact underscores the lasting value of structured mentorship in neurosurgery.

This study aimed to better learn how pituitary surgery centers around the world perform the reconstruction step of endoscopic endonasal transsphenoidal pituitary surgery and to understand the rationale behind their strategies. Survey. Representatives of 311 centers across 54 countries were invited. Online 15-question questionnaire. Representatives of 121 centers from 36 countries responded to the survey. We recorded a preference for multilayer reconstruction in all scenarios presented. In cases of intraoperative cerebrospinal fluid (CSF) leak and extended approaches, respondents reported greater use of autologous materials, such as fat grafts, fascia lata, and pedicled flaps. Although there was no statistical significance for most of the scenarios analyzed, we observed a greater tendency to use pedicled flaps in centers with ENT specialists on the team and a lower likelihood of using them in centers with a higher surgical volume. For cases where no CSF leak is expected preoperatively, the overall preference was for the use of rescue flaps (56.10%), especially in centers in which an ENT surgeon was present (69.77%). Once a nasoseptal flap has been created, the preference is for the nasal septum to heal by secondary intention (52.23%). This survey provides additional evidence of the wide variability in practice and strategies among specialized pituitary/skull base surgery centers worldwide. Trends toward multilayer reconstruction, use of the nasoseptal flaps, and autologous grafts were observed. The presence of an otolaryngologist on the team influences the reconstruction strategy adopted at the institution.

Olfactory neuroblastoma (ONB) is a rare head and neck cancer arising from the upper nasal cavity, with limited systemic therapeutic options due to a poor understanding of its genomic landscape. This study aims to utilize a patient-level genomic repository to identify potential therapeutic targets and improve disease modeling in ONB. Retrospective genomic analysis. Data analysis was performed using the American Association for Cancer Research (AACR) Project Genomics Evidence Neoplasia Information Exchange (GENIE) database. Patients with confirmed ONB who have undergone targeted sequencing within GENIE. Data were analyzed for recurrent somatic mutations, along with their clinical and demographic correlations, with significance set at p &#x2009;<&#x2009;0.05. A high prevalence of mutations in TP53 (tumor protein p53) and FRK (fibroblast growth factor receptor kinase) genes was identified. A moderate prevalence of mutations in NOTCH3 (notch receptor 3), SMARCA4 (SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily A, member 4), RET (rearranged during transfection), and CTCF (CCCTC-binding factor) was also identified. The mutation patterns differed between pediatric and adult ONB cases. Specific mutations were enriched in metastatic tumors compared with primary tumors. This study provides a genomic profile for ONB, identifying key mutations and potential therapeutic targets. The identification of frequently mutated genes like TP53 and FRK suggests potential targets for novel therapies. The observation that certain genes are mutated in pediatric ONB but not adult ONB (and vice versa), and the presence of specific mutations in metastatic tumors that are absent in primary tumors, offers valuable insights for future precision medicine and the design of targeted therapeutic interventions for these distinct clinical presentations.