Riccardo Lenzi

Transoral endoscopic anatomy of the parapharyngeal space: A step‐by‐step logical approach with surgical considerations

Surgical approaches to the parapharyngeal spaces are challenging. Little is known about the transoral perspective of the anatomy of the parapharyngeal space. Thus, transoral approaches are seldom performed, and only for small‐sized tumors.

Transnasal endoscopic surgery for selected orbital cavernous hemangiomas: our preliminary experience.

Endoscopic transnasal approaches to the orbit have been recently described and they have been proposed as an option in the surgical management of medial and inferior orbital lesions.

Cerebellar Infarctions Mimicking Acute Peripheral Vertigo How to Avoid Misdiagnosis

Objective To determine the prevalence of cases of missed cerebellar stroke mimicking acute peripheral vertigo (APV), the so-called pseudo-APV, and to identify the clinical indicators useful for differentiating APV from cerebellar infarction that presents as isolated vertigo. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods We conducted a retrospective chart review of cases of missed cerebellar infarction over the past 5 years. All patients had first undergone an otoneurological evaluation and computed tomography brain scan in the emergency department before a complete bedside examination was performed in our otoneurological unit. Results We identified 11 patients with pseudo-APV (2.8% of all the cases presenting to our unit complaining of acute vertigo). Spontaneous nystagmus (of central type in 2 cases) was recorded in all patients. The Head Impulse Test was clearly negative in 9 cases. The duration of vertigo lasted more than 72 hours in 7 patients. In 4 patients, delayed neurological signs followed acute vertigo 2 to 3 days after the onset. Magnetic resonance imaging showed 8 cases of infarction in the posterior-inferior cerebellar artery territory; in 1 patient, an involvement of the anterior-inferior cerebellar artery territory was recorded; 2 patients showed a hemispheric ischemic cerebellar involvement. Conclusions Pseudo-APV is not an uncommon diagnosis in otoneurological practice. The presence of moderate-severe imbalance and the persistence of vertigo for more than 72 h from the onset, together with the results of bedside examination tests (spontaneous nystagmus and Head Impulse Test), are useful indicators for recognizing a cerebellar ischemic origin in cases of acute vertigo.

Endoscopic endonasal craniotomy in the management of selected ethmoidal malignancies: the University of Pisa experience.

The authors reviewed the medical records of patients who had undergone endoscopic endonasal craniotomy in our department between 2005 and 2009. Thirteen patients were included in this study: 12 males and 1 female. Patients were affected by ethmoidal malignancies abutting or involving the anterior skull base. In all the patients the anterior skull base was drilled down. Nine patients underwent dural resection. The procedure always included a skull base reconstruction. Postoperative complications included CSF leak, subdural haematoma and pneumocephalus. Our results show that endoscopic endonasal surgery can be a viable alternative to anterior craniofacial resection in the management of selected ethmoidal malignancies. The limited morbidity and high success rate fit well with the data in the literature and make this treatment option advisable.

Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus

The authors reviewed the medical records of patients who had undergone endoscopic management of sphenoid sinus (SS) cerebrospinal fluid (CSF) leaks in our department between 2005 and 2007. Eight patients were included in this study: 4 males and 4 females. CSF fistulae were due to trauma, surgery, and some were idiopathic. In all the patients, a multilayer skull base closure was performed. No SS obliteration was carried out. One patient required revision surgery for persistent CSF leak. Multilayer skull base closure is confirmed as the preferred option in sphenoid CSF leaks. The limited morbidity and high success rate fit well with the data in the literature and make this treatment option advisable.

Ectopic olfactory neuroblastoma arising in the pterygopalatine fossa.

Esthesioneuroblastomas (ENBs) are uncommon tumors of neuroectodermal origin thought to arise from the basal cells of the olfactory neuroepithelium and are usually located in the superior nasal vault, intimately associated with the cribriform niche. These tumors have rarely been reported to be ectopic or to occur in other sites, such as the maxillary sinus. We report a unique case of an ENB arising in the pterygopalatine fossa (PPF) that was removed endoscopically. This article was approved by the ethical committee of the University of Pisa. A 69-year-old woman referred to our center presented with numbness and pain on the left side of her face, espe-

Top-cited articles of the last 30 years (1985–2014) in otolaryngology – head and neck surgery

BACKGROUND The frequency with which a scientific article is cited by other studies is one way to measure its academic influence. METHODS A comprehensive search was performed to identify journal articles in the otorhinolaryngology subject category of the 2013 Journal Citation Report Science Edition over the last 30 years (1985-2014). The 100 most cited articles were reviewed and basic information including the publication year, country of origin, source journal, article type and research field was collected. RESULTS The 100 most cited articles were published in 15 of the 44 otorhinolaryngology journals. The number of citations per article ranged between 208 and 1559. The leading research field was otology and neurotology (n = 50), followed by rhinology (n = 23) and head and neck surgery (n = 11). Most papers originated in the USA (n = 64). CONCLUSION The possibility of an article being cited is influenced by the publication language, country of origin and source journal.

Subdural haematoma after endoscopic skull base surgery: Case report and lesson learned

We report a case of a left fronto-temporo-parietal subdural haematoma that emerged as a complication of an endonasal endoscopic resection of a sinonasal adenocarcinoma of the left ethmoidal region. During the first surgical intervention, following oncological principles, the dura mater above the ethmoidal plate was removed and a skull base plasty was performed. In the post-operative phase a massive cerebrospinal fluid leak was observed and a revision duraplasty was performed the following day. Subsequently the patient was discharged on day 8 with no signs of CSF leakage. At the three month follow-up MR examination a subdural haematoma was observed and then treated by the neurosurgeon in a standard fashion. The collection was quite asymptomatic and discovered accidentally. We strongly advise the role of early post-op neuroimaging in every patient undergoing skull base procedures. We maintain that a massive CSF leak, that causes a significant reduction of intracranial pressure, should be managed as a surgical emergency, in order to reduce the risk of subdural haematoma.

A rare case of primary systemic amyloidosis of the neck with massive cervical lymph node involvement: a case report and review of the literature

Amyloidosis is a term applied to a diverse group of disorders that share the deposition of amyloid protein in various extracellular tissues. Systemic amyloidosis may involve almost any organ system in the body including regions in the head and neck; however, neck lymph node involvement is rare, with only five previous cases reported. We present the case of a primary systemic AL amyloidosis with hepatic, cervical, retroperitoneal, axillary and inguinal lymphnode localizations, unresponsive to medical therapy and treated with a surgical approach followed by autologous bone marrow transplantation. We review the pertinent literature with exclusive attention to the otorhinolaryngologic aspect.

A useful maneuver to simplify sellar floor repair following endoscopic transnasal pituitary surgery.

The watertight closure of the skull base after endonasal surgery is and has always been critical in cranial base surgery. Nowadays, endoscopic transsphenoidal surgery is the standard of treatment for most of the sellar tumors. Reconstruction of the sella is not always deemed necessary, and generally it is reserved for patients with macroadenomas or with intraoperative evidence of cerebrospinal fluid leak. We herein report our experience with a simple maneuver that, in our opinion, simplifies sellar floor reconstruction.