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Eur J Hum Genet
. 2019 Oct;27(10):1599-1610. doi: 10.1038/s41431-019-0457-7. Epub 2019 Jun 21.
Small Posterior Fossa in Chiari I Malformation Affected Families Is Significantly Linked to 1q43-44 and 12q23-24.11 Using Whole Exome Sequencing
Anthony M Musolf 1, Winson S C Ho 2, Kyle A Long 1, Zhengping Zhuang 2 3, Davis P Argersinger 2, Haiming Sun 1 4, Bilal A Moiz 1, Claire L Simpson 1 5, Elena G Mendelevich 6, Enver I Bogdanov 6, Joan E Bailey-Wilson 1, John D Heiss 7
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PMID: 31227808 PMCID: PMC6777520 (available on 2020-10-01) DOI: 10.1038/s41431-019-0457-7
Free PMC article
Abstract
The posterior fossa of the cranium contains the cerebellum and brainstem. Processes that reduce the volume of the posterior fossa squeeze the cerebellum and brainstem caudally, resulting in Chiari I malformation (CM1). CM1 causes neck pain, balance issues, decreased motor skills and headaches in those affected. We have posterior fossa measurements and whole exome sequence data on individuals from 7 extended families from Russia that have a family history of CM1. We performed parametric linkage analyses using an autosomal dominant inheritance model with a disease allele frequency of 0.01 and a penetrance of 0.8 for carriers and 0.0 for non-carriers. Variant-based two-point linkage analysis and gene-based linkage analysis was performed. Our results found a genome-wide significant signal on chromosome 1q43-44 (max HLOD = 3.3) in the variant-based analysis and 12q23 (max HLOD = 4.2) in the gene-based analysis. In both cases, the signal was driven by a single (different) family that contained a long, linked haplotype across the region in question. Using functional annotation, we were able to identify several rare nonsynonymous variants that were enriched in each family. The best candidate genes were rs765865412:G>A in MYBPC1 for the 12q haplotype and rs61749963:A>G in COX20 for the 1q haplotype. Good candidate variants in the 1q haplotype were also identified in CEP170 and AKT. Further laboratory work is planned to verify the causality of these genes.

Conflict of interest statement
The authors declare that they have no conflict of interest.

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2
Comparative Study J Chem Neuroanat
. 2019 Mar;96:126-133. doi: 10.1016/j.jchemneu.2019.01.003. Epub 2019 Jan 10.
Differentiation of Human Mesenchymal Stem Cells (MSC) to Dopaminergic Neurons: A Comparison Between Wharton's Jelly and Olfactory Mucosa as Sources of MSCs
Rafieh Alizadeh 1, Zohreh Bagher 1, Seyed Kamran Kamrava 1, Masoumeh Falah 1, Hatef Ghasemi Hamidabadi 2, Mahdi Eskandarian Boroujeni 3, Fatemeh Mohammadi 4, Sepideh Khodaverdi 5, Arash Zare-Sadeghi 6, Arta Olya 3, Ali Komeili 7
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PMID: 30639339 DOI: 10.1016/j.jchemneu.2019.01.003
Abstract
The generation of dopaminergic neurons from stem cells is a potential therapeutic approach to treat neurodegenerative disorders, such as Parkinson's disease. The current study aims to investigate the potential of two different types of mesenchymal stem cells derived from human Wharton's jelly and nasal cavity for differentiation into dopaminergic neurons. The differentiation capacities of both cell types were evaluated using real-time PCR, immunocytochemistry, flow cytometry and HPLC. Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) are noted for their capability to differentiate into mesodermal and non-mesodermal cells, including neurons. However, it was demonstrated that having the same neuroectodermal origin as the nervous system, the olfactory ectomesenchymal stem cells (OE-MSCs) expressed the neural marker MAP2 as well as dopaminergic markers such as tyrosine hydroxylase (TH), dopamine transporter (DAT) and PITX3 to a greater extent than the WJ-MSCs both at the level of mRNA and protein. Furthermore, quantitative flow cytometric evaluation of these markers at 12 days post-induction supported the above-mentioned results. Finally, the assessment of the functionality of differentiated cells and their ability to synthesize dopamine measured by HPLC revealed that the OE-MSC-derived dopaminergic cells released almost the same amount of dopamine as that secreted by WJ-MSC-derived cells. Thus it showed the difference in their functionality to be negligible. Overall, it may be concluded that higher proliferation and differentiation capacity of OE-MSCs, along with their easier harvestability and autologous transplantability compared with WJ-MSCs, makes them a better cell source for stem cell therapy of neurodegenerative disorders which are caused by degeneration of dopaminergic neurons.

Keywords: Dopaminergic neuron; Neurodegenerative disorder; Olfactory ectomesenchymal stem cells; Wharton’s jelly-derived mesenchymal stem cells.

Copyright © 2019 Elsevier B.V. All rights reserved.

Cited by 4 articles
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3
Br J Neurosurg
. 2020 Jun 15;1-7. doi: 10.1080/02688697.2020.1779659. Online ahead of print.
Surgical Outcomes in Patients With Endoscopic Versus Transcranial Approach for Skull Base Malignancies: A 10-year Institutional Experience
John W Rutland 1, Corey M Gill 1, Travis Ladner 1, David Goldrich 2, Dillan F Villavisanis 2, Alex Devarajan 1, Akila Pai 1, Amir Banihashemi 3, Brett A Miles 2, Sonam Sharma 4, Priti Balchandani 5, Joshua B Bederson 1, Alfred M Iloreta 2, Raj K Shrivastava 1
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PMID: 32538686 DOI: 10.1080/02688697.2020.1779659
Abstract
Object: The authors performed an extensive comparison between patients treated with open versus an endoscopic approach for skull base malignancy with emphasis on surgical outcomes.Methods: A single-institution retrospective review of 60 patients who underwent surgery for skull base malignancy between 2009 and 2018 was performed. Disease features, surgical resection, post-operative morbidities, adjuvant treatment, recurrence, and survival rates were compared between 30 patients who received purely open surgery and 30 patients who underwent purely endoscopic resection for a skull base malignancy.Results: Of the 60 patients with skull base malignancy, 30 underwent open resection and 30 underwent endoscopic resection. The most common hisotype for endoscopic resection was squamous cell carcinoma (26.7%), olfactory neuroblastoma (16.7%), and sarcoma (10.0%), and 43.3%, 13.3%, and 10.0% for the open resection cohort, respectively. There were no statistical differences in gross total resection, surgical-associated cranial neuropathy, or ability to achieve negative margins between the groups (p > 0.1, all comparisons). Patients who underwent endoscopic resection had shorter surgeries (320.3 ± 158.5 minutes vs. 495.3 ± 187.6 minutes (p = 0.0003), less intraoperative blood loss (282.2 ± 333.6 ml vs. 696.7 ± 500.2 ml (p < 0.0001), and shorter length of stay (3.5 ± 3.7 days vs. 8.8 ± 6.0 days (p < 0.0001). Additionally, patients treated endoscopically initiated adjuvant radiation treatment more quickly (48.0 ± 20.3 days vs. 72.0 ± 20.5 days (p = 0.01).Conclusions: An endoscopic endonasal approach facilitates a clinically meaningful improvement in surgical outcomes for skull base malignancies.

Keywords: Skull base surgery; endoscopic surgery; gross total resection; malignancy; transcranial surgery.

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4
Acta Neurochir (Wien)
. 2019 Dec;161(12):2583-2586. doi: 10.1007/s00701-019-04066-1. Epub 2019 Oct 15.
How I Do It: Extradural Clinoidectomy
Walter C Jean 1
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PMID: 31617013 DOI: 10.1007/s00701-019-04066-1
Abstract
Background: Removal of the anterior clinoid process expands the anterolateral corridor. Performed extradurally, the dura provides intracranial contents some protection.

Methods: The anatomy of the anterior clinoid process is described along with variants of the surrounding structures. In addition to an operative video, the anatomy and surgical technique is demonstrated in virtual reality space to enhance the didactic clarity.

Conclusion: The anatomical nuances of the lesser sphenoid wing in general, and the anterior clinoid process in particular, are complex. A demonstration in virtual reality takes advantage of the technological flexibility of multi-angled perspectives and focuses on the relevant key structures.

Keywords: Anterior clinoid process; Carotid artery; Optic nerve; Optic strut; Virtual reality.

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5
Int J Oral Maxillofac Surg
. 2020 Jun 11;S0901-5027(20)30176-4. doi: 10.1016/j.ijom.2020.05.007. Online ahead of print.
Navigation-guided Core Needle Biopsy for Skull Base and Parapharyngeal Lesions: A Five-Year Experience
J-H Zhu 1, R Yang 2, Y-X Guo 3, J Wang 4, X-J Liu 5, C-B Guo 6
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PMID: 32536458 DOI: 10.1016/j.ijom.2020.05.007
Abstract
The aim of this study was to evaluate the diagnostic accuracy of navigation-guided core needle biopsy for skull base and parapharyngeal lesions. Twenty patients with skull base and parapharyngeal lesions were included in this study. The preoperative design and intraoperative real-time image guiding was done using an optical navigation system. A spring-loaded semi-automatic biopsy gun and biopsy needle were used for specimen harvesting. Accuracy was established on the basis of the postoperative pathology. All patients underwent needle biopsy successfully without any immediate or delayed complications. The subzygomatic approach was adopted in all cases. The number of passes ranged from three to five. The diagnostic accuracy was 90% (18/20). Navigation-guided core needle biopsy offers an easy approach for the diagnosis of skull base and parapharyngeal lesions, with a high yield of specimens and good patient tolerance.

Keywords: core needle biopsy; navigation; skull base; tumour.

Copyright © 2020. Published by Elsevier Ltd.

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6
Review Neuroendocrinology
. 2020 Jun 15. doi: 10.1159/000509386. Online ahead of print.
Skull Base Chordomas and Chondrosarcomas
Natalia Kremenevski, Sven-Martin Schlaffer, Roland Coras, Thomas Mehari Kinfe, Thomas Graillon, Michael Buchfelder
PMID: 32541136 DOI: 10.1159/000509386
Abstract
Skull base chordomas account for less than 0.2% and chondrosarcomas for less than 0.15% of all intracranial tumors. Although their clinical and imaging presentation is similar, they derive from different origins. Chordomas arise from embryonic remnants of the primitive notochord and chondrosarcomas from primitive mesenchymal cells or from the embryonic rest of the cranial cartilaginous matrix. Both entities are characterized by infiltration and destruction of surrounding bone and soft tissue and a high locoregional recurrence rate. Chondrosarcomas, when treated with similar complex strategies, display a much better prognosis then chordomas. The overall survival is approximately 65% for chordomas and 80% for chondrosarcomas at 5 years and 30% and 50% respectively at 10 years. Chordomas are divided into three histological types: classical (conventional), chondroid, and dedifferentiated. Chondrosarcomas have conventional, mesenchymal, clear cell, and dedifferentiated subgroups. Both tumor entities often present with nonspecific symptoms and headaches are the most reported initial symptom. Computed tomography and magnetic resonance imaging are required for defining localization and extent of tumor growth. The treatment philosophy is to maximize tumor resection, minimize morbidity and preserve function. Neurosurgical approaches commonly used for the resection of intracranial chordomas and chondrosarcomas are transsphenoidal, transbasal, cranio-orbitozygomatic, transzygomatic extended middle fossa, transcondylar and transmaxillary approaches. Chordomas and chondrosarcomas are not sensitive to chemotherapy and there are no approved drugs for their treatment. The present treatment concept is a combination of surgical resection with a maximal excision and preserving patients' quality of life by adjuvant radiotherapy for both, chordomas and chondrosarcomas.

© 2020 S. Karger AG, Basel.

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7
Surg Radiol Anat
. 2020 Jun 14. doi: 10.1007/s00276-020-02516-5. Online ahead of print.
Morphometric Assessment of Important Landmarks on Skull Intended for Vidian Nerve Surgery
Hulya Ucerler 1, Zuhre Asli Aktan Ikiz 2, Mustafa Deniz Yoruk 3, Erengul Boduc 4, Lokman Ozturk 2
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PMID: 32537673 DOI: 10.1007/s00276-020-02516-5
Abstract
Purpose: The aim of our study was to determine guide parameters for clinicians by morphometric assessment of important landmarks on cranium intended for Vidian nerve surgery.

Methods: For the study, 23 half-skull bases, 40 skull bases and 40 skulls were obtained from the Department of Anatomy, Ege University Medicine Faculty. The vertical distances were measured using a digital caliper to the nearest 0.01 mm.

Results: The anterior opening of the Vidian canal (pterygoid canal) was observed as oval shaped on 57 specimens (31.1%), funnel shaped on 58 specimens (31.7%), round shaped on 64 specimens (35%) and septated on 4 specimens (2.2%). Vidian canal was embedded into the body of sphenoid on 55 specimens (52.4%) (embedded type) and protruded to sphenoidal sinus on 50 specimens (47.6%) (protruded type). 21 specimens of 50 were partial and 29 specimens were total. There were dehiscences on 21 specimens of 50 protruded type on the base of sphenoidal sinus (20%). Anterior opening of the Vidian canal was assessed according to medial lamina of pterygoid process. It was located medially in 169 of the specimens (92.3%) and laterally in 14 specimens (7.7%).

Conclusion: Vidian canal and Vidian nerve are deeply located structures on skull. Vidian canal and surrounding structures are important landmarks for microsurgery and endoscopic approaches to Vidian nerve. We consider that knowledge of anatomical features of Vidian canal and preoperative imaging by CT (computed tomography) will be supportive when choosing and planning a safe surgical approach.

Keywords: Skull; Sphenoidal sinus; Vidian canal; Vidian nerve; Vidian neurectomy.

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8
Review Curr Opin Otolaryngol Head Neck Surg
. 2020 Feb;28(1):6-10. doi: 10.1097/MOO.0000000000000593.
What Is the Evidence for Macrolide Therapy in Chronic Rhinosinusitis?
Marina N Cavada 1 2, Jessica W Grayson 3, Raymond Sacks 1 2 4 5
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PMID: 31834028 DOI: 10.1097/MOO.0000000000000593
Abstract
Purpose of review: To assess the most recent evidence for macrolide therapy in chronic rhinosinusitis (CRS).

Recent findings: Macrolides play a significant role in a select group of patients with CRS. Low-serum and tissue eosinophilia in patients who do not respond to corticosteroid therapy appeared to be an effective predictor of a CRS phenotype suitable for a trial of long-term macrolide therapy. Therapies using half a dose for longer than 12 weeks have noted good outcomes.

Summary: The anti-inflammatory and immunomodulatory effects of macrolides have been demonstrated in several studies. Macrolides have shown an important role in patients who are nonresponsive to corticosteroid therapies, therefore patient selection is key. Previous inconsistencies in results may be due to poor patient selection.

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9
Case Reports J Neuroophthalmol
. 2019 Sep;39(3):405-407. doi: 10.1097/WNO.0000000000000742.
Petroclival Meningioma Presenting With an Ipsilateral Sixth Nerve Palsy and a Contralateral Homonymous Quadrantanopia: A Unique and Topographically Localizing Syndrome
Ardalan Sharifi 1, Lance J Lyons, Aroucha Vickers, Andrew G Lee
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PMID: 30664101 DOI: 10.1097/WNO.0000000000000742
Abstract
An 84-year-old woman reported onset of headaches, diplopia, and blurred vision. On examination, she was found to have a left sixth nerve palsy and an incongruous right homonymous hemianopia. Brain MRI demonstrated a left petroclival meningioma, causing this unusual combination of clinical findings. The patient was treated with radiation therapy and has remained stable over 4 years of follow-up.

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10
Cureus
. 2020 May 11;12(5):e8060. doi: 10.7759/cureus.8060.
Surgical Management of Choanal Atresia With Intranasal Hegar's Dilator and Transnasal Endoscopic Excision: A 20-year Retrospective Comparative Study
Mohammad A Alshareef 1, Abdullah S Assalem 2, Fatimah Alzubaidi 3, Basem Damanhouri Sr 3, Tariq A Al-Aidarous 4
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PMID: 32537278 PMCID: PMC7286581 DOI: 10.7759/cureus.8060
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Abstract
Background Although choanal atresia (CA) was first described 250 years ago, its description and understanding remain incomplete, as is the distinction between unilateral and bilateral CA. Among the surgical techniques introduced to manage this condition are intranasal Hegar's dilator (IHD) and transnasal endoscopic excision (TNEE). Objectives This study retrospectively evaluated the outcomes and effectiveness of IHD and TNEE in the treatment of patients with CA, including differences in the incidence of re-stenosis with these techniques. Methods Patients diagnosed with CA who underwent surgical interventions in the Otolaryngology Department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, between 1997 and 2017 were analyzed. Postoperative outcomes including re-stenosis rates were compared in patients who underwent IHD and TNEE. Factors associated with patient outcomes were analyzed, including ages at diagnosis and surgery, nationality, gender, type of atresia (unilateral/bilateral and bony/membranous/mixed), surgical intervention (IHD or TNEE), and re-stenosis and need for revision surgery after IHD and TNEE. Results A total of 30 patients were diagnosed with CA, including 21 (70%) girls and 9 (30%) boys. Of them, 18 (60%) patients were diagnosed at younger than one month of age, 28 (93%) were Saudi nationals, and 20 (67.70%) were aged younger than three months at the time of surgery. Of these 30 patients, 17 (56.70%, all Saudi nationals) underwent IHD, and 13 (43.30%), including 15 Saudi nationals, underwent TNEE. The 17 patients who underwent IHD included 13 (76.50%) girls and 4 (23.50%) boys, whereas the 13 patients who underwent TNEE included 8 (61.50%) girls and 5 (38.50%) boys. Fifteen patients (50%) had mixed-type CA, nine (30%) had bony-type CA, and six (20%) had membranous-type CA. Twenty-six (86.67%) patients underwent primary surgery, whereas four (13.33%) underwent revision surgery; of the latter, three (75%) had undergone primary IHD, and one had undergone primary TNEE. Only one (3.33%) patient experienced re-stenosis after revision surgery, which consisted of IHD. Twelve patients (40%) underwent stenting, with one developing re-stenosis. The relationships between surgical approach and re-stenosis after primary and secondary surgery were not statistically significant. Conclusion The outcomes in patients with CA treated with IHD and TNEE are comparable. Rates of re-stenosis and need for revision surgery do not differ significantly in patients treated with these surgical approaches.

Keywords: choanal atresia; endoscopy; excision; hegar’s dilator; intranasal; surgery; transnasal.

Copyright © 2020, Alshareef et al.

Conflict of interest statement
The authors have declared that no competing interests exist.

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11
Comparative Study BMC Surg
. 2020 Jan 29;20(1):18. doi: 10.1186/s12893-020-0685-3.
Comparison of Quality of Life Between Patients Undergoing Trans-Oral Endoscopic Thyroid Surgery and Conventional Open Surgery
Pornthep Kasemsiri 1 2 3, Srongpaun Trakulkajornsak 4, Piyapong Bamroong 5, Kanokkarn Mahawerawat 5, Patorn Piromchai 4, Teeraporn Ratanaanekchai 4 6
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PMID: 31996201 PMCID: PMC6988280 DOI: 10.1186/s12893-020-0685-3
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Abstract
Background: Trans-oral endoscopic thyroidectomy allows obviating scar of the neck that expects to gain quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore, this study compared the QOL outcomes, including cosmetic outcomes, between thyroidectomy by trans-oral endoscopy and conventional open surgery.

Methods: A study was conducted from January 30, 2017 to November 10, 2018. Thirty-two and 38 patients underwent trans-oral endoscopic thyroid surgery and conventional open surgery, respectively. Their quality of life was evaluated at 2, 6, and 12 weeks postoperatively using a thyroid surgery-specific questionnaire and a 36-item short-form questionnaire.

Results: Trans-oral endoscopic group, patients were younger and presented with smaller thyroid nodules (p < 0.05). Regarding surgical outcomes, there were no statistically significant differences between the two groups. Mean operative time was significantly longer in the trans-oral endoscopic group (p < 0.05). The quality of life parameters in the trans-oral endoscopic group was significantly better than in the conventional surgery group (p < 0.05). These parameters included reduction of physical activity, psychosocial impairment, the role of physic, and emotion at 2 weeks after surgery; swallowing impairment, psychosocial impairment, the role of physic, social function and mental health 6 weeks after surgery; tingling and feeling of vitality at 12 weeks after surgery. Cosmetic outcomes and overall satisfaction were significantly better in the trans-oral endoscopic group than in the conventional surgery group at all of our follow up times (p < 0.05).

Conclusions: The trans-oral endoscopic approach allows real scarless on the skin with better cosmetic and QOL outcomes.

Trial registration: This trial was retrospectively registered at the ClinicalTrial.gov (NCT03048539), registered on 4 March 2017.

Keywords: Endoscopy; Quality of life; Scarring; Thyroidectomy.

Conflict of interest statement
The authors declare that they have no competing interests.

23 references
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12
Med Phys
. 2020 Jun 15. doi: 10.1002/mp.14329. Online ahead of print.
Linear Energy Transfer Weighted Beam Orientation Optimization for Intensity-Modulated Proton Therapy
Wenbo Gu 1, Dan Ruan 1, Wei Zou 2, Lei Dong 2, Ke Sheng 1
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PMID: 32542711 DOI: 10.1002/mp.14329
Abstract
Purpose: In IMPT, unaccounted-for variation in biological effectiveness contributes to the discrepancy between the constant relative biological effectiveness (RBE) model prediction and experimental observation. It is desirable to incorporate biological doses in treatment planning to improve modeling accuracy and consequently achieve a higher therapeutic ratio. This study addresses this demand by developing a method to incorporate linear energy transfer (LET) into beam orientation optimization (BOO).

Methods: Instead of RBE-weighted dose, this LET weighted BOO (LETwBOO) framework uses the dose and LET product (LET × D) as the biological surrogate. The problem is formulated with a physical dose fidelity term, a LET × D constraint term, and a group sparsity term. The LET × D of OARs are penalized for minimizing the biological effect while maintaining the physical dose objectives. Group sparsity is used to reduce the number of active beams from 600-800 non-coplanar candidate beams to between 2 and 4. This LETwBOO method was tested on three skull-base tumor (SBT) patients and three bilateral head-and-neck (H&N) patients. The LETwBOO plans were compared with IMPT plans using manually selected beams with only physical dose constraint (MAN) and the initial MAN plan reoptimized with additional LET × D constraint (LETwMAN).

Results: The LETwBOO plans show superior physical dose and LET × D sparing. On average, the [mean, maximal] doses of OARs in LETwBOO are reduced by [2.85, 4.6] GyRBE from the MAN plans in the SBT cases and reduced by [0.9, 2.5] GyRBE in the H&N cases, while LETwMAN is comparable to MAN. cLET×Ds of PTVs are comparable in LETwBOO and LETwMAN, where c is a scaling factor of 0.04 μm/keV. On average, in the SBT cases, LETwBOO reduces the OAR [mean, maximal] cLET×D by [1.1, 2.9] Gy from the MAN plans, compared to the reduction by LETwMAN from MAN of [0.7, 1.7] Gy. In the H&N cases, LETwBOO reduces the OAR [mean, maximal] cLET×D by [0.8, 2.6] Gy from the MAN plans, compared to the reduction by LETwMAN from MAN of [0.3, 1.2] Gy.

Conclusion: We developed a novel LET weighted BOO method for IMPT to generated plans with improved physical and biological OAR sparing compared with the plans unaccounted for biological effects from BOO.

This article is protected by copyright. All rights reserved.

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13
Oper Neurosurg (Hagerstown)
. 2020 Jun 15;opaa140. doi: 10.1093/ons/opaa140. Online ahead of print.
Masseter-to-Facial Cranial Nerve Anastomosis: A Report of 30 Cases
Alexander V Zotov 1, Jamil A Rzaev 1, Sergey V Chernov 1, Alexander B Dmitriev 1, Anton V Kalinovsky 1, Aldo Spallone 2 3
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PMID: 32542367 DOI: 10.1093/ons/opaa140
Abstract
Background: Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor surgery. Several donor nerves have been used in the past for facial reanimation. We report the results of 30 cases of masseter-to-facial anastomosis.

Objective: To prospectively evaluate the efficacy of V to VII anastomosis after FP.

Methods: In a prospective study, we included 30 consecutive patients with FP (20 women and 10 men) whose mean age was 48.8 yr (32-76 yr). In almost all cases, FP developed after cerebellopontine angle tumor surgery (29 patients), whereas in one case, FP occurred after skull base trauma. Pre- and postoperative evaluation of facial nerve function was performed using the House-Brackmann (HB) scale and the Sokolovsky scale, as well as by electromyography. Follow-up ranged from 11 to 51 mo and averaged 22 mo.

Results: All patients achieved functional recovery of the facial nerve from VI to either III or IV HB degree. Patients with short time FP showed significantly better postoperative recovery.

Conclusion: The results of the V to VII anastomosis demonstrate a significant improvement of facial nerve function and virtually no complications.

Keywords: Anastomosis; Facial nerve; Facial nerve palsy; House-Brackmann scale; Masseter nerve; Masseter-to-facial anastomosis.

Copyright © 2020 by the Congress of Neurological Surgeons.

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14
Ear Nose Throat J
. 2020 Jun 16;145561320934217. doi: 10.1177/0145561320934217. Online ahead of print.
Otogenic Pneumocephalus After Tegmen Bone Reconstruction: A Case Report
Tawfiq Khurayzi 1, Bayan Jan 1, Reenad Bedaiwi 1, Abdulrazaq Ajlan 2, Sherif Elwatidy 2, Salman Alhabib 1, Abdurrhaman Alsanosi 1
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PMID: 32543228 DOI: 10.1177/0145561320934217
Abstract
Pneumocephalus is usually induced by trauma, infections, tumors of the skull base, and surgical interventions. Spontaneous pneumocephalus occurs due to a defect in the temporal bone with no obvious cause. Few cases have been reported with spontaneous otogenic pneumocephalus. However, delayed postoperative pneumocephalus is rarely reported in the literature. Here, we present a case of otogenic pneumocephalus through Eustachian tube (ET) preceded by nose blowing 10 days after surgical treatment of meningoencephalocele of the right middle ear (ME) cleft and reconstruction of tegmen and dural defects. Pneumocephalus was provoked by decreased intracranial pressure (ICP) secondary to placement of lumbar drain, which caused direct communication between unsutured dural defect and the defective posterior wall of external auditory canal skin. A revision surgery of combined transmastoid/middle cranial fossa approach was performed for intracranial decompression followed by appropriate closure by suturing the dura, obliterating the ET and ME.

Keywords: Eustachian tube obliteration; combined mastoid/middle fossa approach; meningoencephalocele; pneumocephalus; tegmen bone defect.

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15
Oper Neurosurg (Hagerstown)
. 2020 Jun 15;opaa162. doi: 10.1093/ons/opaa162. Online ahead of print.
Tentorial Peeling: Surgical Extradural Navigation to Protect the Temporal Lobe in the Focused Combined Transpetrosal Approach
Claudio H F Vidal 1, Joab A Nicácio 1, Yoav Hahn 2 3, Silvio S Caldas Neto 4, Caetano J Coimbra 2 3
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PMID: 32542323 DOI: 10.1093/ons/opaa162
Abstract
Background: Transpetrosal approaches have been used for treatment of tumors in the petroclival region for many years. Injury to the temporal lobe, however, has been a potential drawback of the techniques described to date.

Objective: To describe modifications of the transpetrosal surgical technique, which allows extradural manipulation of the temporal lobe during the focused combined transpetrosal approach. This extra layer of protection avoids mechanical brain retraction, direct trauma to the temporal lobe and disruption of the local venous structures.

Methods: The present manuscript describes an innovative technical nuance based on the combination of the focused combined transpetrosal approach, the peeling of the dural layers of the tentorium, and the reverse peeling of the middle fossa dura mater. Ample illustrative material is provided and illustrative cases are presented.

Conclusion: Peeling of the dural layers of the tentorium is a promising modification of the transpetrosal approach to increase the safety of the temporal lobe manipulation.

Keywords: Meningioma; Petrous bone; Skull base neoplasms; Surgery; Temporal bone; Temporal lobe.

Copyright © 2020 by the Congress of Neurological Surgeons.

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16
Rinsho Shinkeigaku
. 2020 Jun 13. doi: 10.5692/clinicalneurol.60.cn-001411. Online ahead of print.
[MPO-ANCA-associated Hypertrophic Pachymeningitis With Monoclonal Gammopathy of Undetermined Significance: A Case Report]
[Article in Japanese]
Yukino Funayama 1, Genya Watanabe 1, Kenichi Tsukita 1, Hiroyoshi Suzuki 2, Hiroshi Uenohara 3, Yasushi Suzuki 1
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PMID: 32536662 DOI: 10.5692/clinicalneurol.60.cn-001411
Abstract
A 66-year-old woman presented with dysesthesia over the right side of her face, hypoglossal nerve dysfunction, dysphagia, and dysgeusia of the right side. A MRI scan of the brain revealed cerebral dural thickening on the right side of the skull base, and histopathological examination revealed granulomatous inflammation of the dura. Based on paranasal sinusitis, bronchodilatation, laboratory tests showing weakly positive MPO-ANCA, intact renal function, and the patient's favorable response to steroids, we diagnosed the patient with limited granulomatosis with polyangiitis (GPA). Reportedly, autoimmune disease might occur in patients with exacerbation of monoclonal gammopathy of undetermined significance, which was observed in this case. This suggests the utility of immunoelectrophoresis.

Keywords: ANCA-associated vasculitis; MPO-ANCA; granulomatosis with polyangiitis; hypertrophic pachymeningitis; monoclonal gammopathy of undetermined significance.

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17
Oper Neurosurg (Hagerstown)
. 2020 Jun 15;opaa175. doi: 10.1093/ons/opaa175. Online ahead of print.
Endoscopic Endonasal Resection-Olfactory Groove Meningioma: 2-Dimensional Operative Video
Pierre-Olivier Champagne 1, Carl H Snyderman 2, Paul A Gardner 1
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PMID: 32542385 DOI: 10.1093/ons/opaa175
Abstract
Olfactory groove meningiomas can represent a surgical challenge, and controversy persists in regard to the optimal approach corridor.1,2 This video exemplifies the endoscopic endonasal resection of a voluminous olfactory groove meningioma. Focus is given on the key aspects of the procedure, complication avoidance, nuances of the technique, and advantages pertaining to this approach.3-6 The patient consented for the conception and publication of this video.

Keywords: Endoscopic endonasal approach; Meningioma; Olfactory groove; Skull base.

Copyright © 2020 by the Congress of Neurological Surgeons.

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