Surgical site infection is a major cause of morbidity. Standard pre-operative nasal decolonisation depends on patient-led, multiday topical antibiotics, which suffer from poor adherence and contribute to antimicrobial resistance. Clinician-delivered nasal photodisinfection offers an immediate, non-antibiotic alternative.

A single-centre before-and-after service evaluation compared surgical site infection outcomes before and after implementation of a pre-operative nasal photodisinfection protocol in adults undergoing endoscopic anterior skull base surgery. The primary outcome was 30-day surgical site infection; secondary outcomes were post-operative meningitis and excess bed-stay.

Two hundred patients were included (105 standard; 95 photodisinfection). Surgical site infection occurred in 15 patients (14.6 per cent) with standard care versus 3 (3.2 per cent) after photodisinfection, an absolute risk reduction of 11.4 per cent (95 per cent CI 3.7–19.1; p = 0.0059). Meningitis occurred in five standard-care patients and none after photodisinfection. Compliance was 100 per cent, with no adverse events.

Photodisinfection was associated with substantially reduced surgical site infection.

This study aimed to evaluate the clinical applications, observed haemostatic outcomes of a self-assembling peptide haemostat (PuraBond®) across a range of ENT surgical procedures using a large UK observational registry.

A two-cycle observational study of 600 patients at University Hospitals Birmingham NHS Foundation Trust (September 2019–July 2024). Data collected included patient demographics, comorbidities, anticoagulation status, surgical details, intra-operative haemostatic outcomes and post-operative complications.

Intra-operative haemostasis was documented without the need for additional haemostatic intervention in 99.8% of cases (599/600). Immediate haemostasis-related complication rate was 0.2% (1/600). The overall complication rate was 3% per cent, with most complications unrelated to haemostasis or the use of PuraBond. The study limitations include participant heterogeneity, absence of a control group and small subspeciality sample sizes underscoring the need for comparative studies.

This registry demonstrates PuraBond’s broad applicability in ENT surgery as an adjunct to routine haemostats and provides essential groundwork for designing future comparative trials.

This study aimed to examine anatomical factors predicting anterior ethmoidal artery type.

Paranasal sinus computed tomography images from adult patients were reviewed. Anterior ethmoidal artery types were categorised based on skull base relationship: type A (embedded within skull base), type B (in a protruding canal) and type C (separated from skull base). Statistical analyses encompassed inter-type comparisons, multinomial logistic regression and correlation analysis.

Anterior ethmoidal artery types differed significantly in lateral lamella height and Keros classification, with type C showing the greatest lateral lamella height and predominant Keros III. Type C was additionally characterised by enlarged frontal sinus volume, increased volume and height of frontal recess anterior cells and higher supraorbital ethmoid cell prevalence. The anterior ethmoidal artery–skull base distance demonstrated significantly positive correlations with lateral lamella height, frontal sinus volume and the volume and height of frontal recess anterior cells.

More extensive pneumatisation of frontal sinus and ethmoid cells and increased lateral lamella height might predict a free-running anterior ethmoidal artery.

To evaluate clinical characteristics, complications and survival outcomes in patients undergoing lateral temporal bone resection for malignancy at a tertiary skull base centre.

This retrospective cohort study analysed patients treated between 2004 and 2023 at a UK tertiary referral centre. Data collected included demographics, histological diagnosis, stage, surgical approach, reconstruction and adjuvant therapy. Complications and survival were examined using descriptive statistics, Kaplan–Meier survival curves and Cox proportional hazards modelling.

Eighty-nine patients were included (mean age, 67.2 years; 69.7 per cent male). Squamous cell carcinoma (SCC) was the most frequent diagnosis (58.4 per cent) and lateral temporal bone resection was the predominant procedure (73.0 per cent). Post-operative complications occurred in 25.8 per cent of patients, with haematoma the most common complication. Median follow up was 19 months. The 5-year overall survival rate was 50 per cent, with significant differences by cancer stage and patient age.

Surgical management of lateral temporal bone malignancies, predominantly SCC, carries significant morbidity, while survival and complication rates mirror published literature, with outcomes chiefly influenced by age and cancer stage rather than nodal status.

To show our experience in performing endoscopic-assisted maxillectomy (EAM), with the aim of facilitating delineation of tumour resection and improve the achievement of free tumour resection margins.

Patients undergoing EAM between 2021 and 2024 were reviewed. During the endoscopic approach, the medial and lateral plates of the pterygoid were drilled, taking as reference the superior margin of the inferior turbinate.

Six patients underwent an EAM surgery. The maxillectomy was completed with an external transfacial approach in four patients and with a transoral approach in two. No intraoperative complications were observed. Five patients had postoperative flap dehiscence; two cases healed spontaneously and three cases required surgery.

EAM allows delimitation of the posterior limit of tumour resection in total or subtotal maxillectomies. This endoscopic approach facilitates the drilling of the pterygoid process to complete the posterior osteotomy, which is a complex manoeuvre during the exclusive external approach.

The study aim is to validate the utility and implications of the Manjila jugular bulb classification.

A retrospective study of 182 patients who underwent lateral skull base or otologic surgery was conducted. Pre-operative temporal bone computed tomography and magnetic resonance imagery scans were reviewed, and the classification was independently applied by a neuroradiologist and neuro-otologist. Concordance among imaging, intra-operative findings, complications, and functional outcomes was assessed.

Substantial agreement was found between imaging and intra-operative findings (Cohen’s kappa = 0.78). High-riding jugular bulbs were present in 13.7 per cent of cases, with complications such as venous bleeding (5.5 per cent) and cranial nerve palsy (2.7 per cent). Surgical approaches were altered in 25 per cent of cases. Functional outcomes, including hearing and facial nerve preservation, were not correlated with jugular bulb grades.

The classification demonstrated strong concordance with intra-operative findings, emphasising the importance of pre-operative identification for tailored surgical planning.

Surgical resection for pterygopalatine fossa schwannomas can be challenging due to the complex anatomy and potential morbidity. Gamma knife radiosurgery (GKRS) offers a minimally invasive alternative with precise targeting and minimal damage to surrounding structures.

A 21-year-old female patient who had a history of progressive left-sided facial numbness over the past year and was diagnosed with progressive pterygopalatine fossa schwannoma underwent gamma knife radiosurgery. The radiological and clinical outcomes of the patient were evaluated over a period of 15 years, with the patient remaining symptom-free and experiencing no adverse effects from the treatment.

The patient’s positive outcome, with significant tumour reduction and symptom relief, underscores the potential of this non-invasive technique as a primary treatment modality for schwannomas in challenging anatomical locations.

To evaluate clinical outcomes and volumetric changes following endoscopic endonasal approach (EEA) for tuberculum sellae (TS) and planum sphenoidale (PS) meningiomas. Key objectives included evaluating pre- and postoperative tumor volumes, visual assessments and EEA-related complications.

A single-center retrospective study was conducted at Foothills Medical Centre, University of Calgary, Canada, from 2009 to 2022 including 24 patients meeting inclusion criteria for midline skull base tumors, confirmed as WHO Grade I or II meningiomas with optic canal extension.

EEA achieved gross total resection in 87.5% of cases, with a mean tumor volume reduction of 92.24%. Postoperatively, 91.67% exhibited visual improvement or stability. Cerebrospinal fluid leaks occurred in 12.5% of cases, necessitating revision surgery in one case. Persistent postoperative endocrine dysfunction affected 4.17%. Preoperative tumor volume did not demonstrate a correlation with complications.

This study delivers reproducible data for pre- and postoperative tumor volume following the EEA after TS or PS meningiomas. The EEA demonstrated favorable radiographic and clinical outcomes in TS and PS meningiomas, achieving gross total resection with minimal morbidity.

This study aimed to assess degree of audiovestibular handicap in patients with vestibular schwannoma.

Audiovestibular handicap was assessed using the Hearing Handicap Inventory, Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Patients completed questionnaires at presentation and at least one year following treatment with microsurgery, stereotactic radiosurgery or observation. Changes in audiovestibular handicap and factors affecting audiovestibular handicap were assessed.

All handicap scores increased at follow up, but not significantly. The Tinnitus Handicap Inventory and Dizziness Handicap Inventory scores predicted tinnitus and dizziness respectively. The Hearing Handicap Inventory was not predictive of hearing loss. Age predicted Tinnitus Handicap Inventory score and microsurgery was associated with a deterioration in Dizziness Handicap Inventory score.

Audiovestibular handicap is common in patients with vestibular schwannoma, with 75 per cent having some degree of handicap in at least one inventory. The overall burden of handicap was, however, low. The increased audiovestibular handicap over time was not statistically significant, irrespective of treatment modality.

Lateral skull base procedures, such as translabyrinthine approach (TLA), are challenging. An autonomous surgical robot might be a solution to these challenges. Our aim is to explore in an early phase the economic consequences of an autonomous surgical robot compared with conventional TLA.

An early decision analytic model was constructed in order to perform a step-wise threshold analyses and a sensitivity analysis to analyze the impact of the several factors on the incremental costs.

Using surgical robot results in incremental costs – EUR 5,562 per procedure – compared to conventional TLA. These costs are most reduced by higher number of procedures, followed by lower price of the robot, saved operation time, and reduced risk of complication, respectively.

The incremental costs of using an autonomous surgical robot can be decreased by choosing applications with a high turnover rate, a long operation time, and a high complication rate.

Transorbital endoscopic approaches are becoming increasingly popular for skull base pathologies; the superior lateral orbital portal is one such approach to the middle cranial fossa. This paper provides a technical description that maximises the surgical portal and minimises morbidity.

A superior lid crease incision is made extending laterally and the orbital rim is exposed. A subperiosteal dissection of the lateral and superior orbit is performed, with elevation of periosteum off Whitnall's tubercle, ligation of the recurrent branch of the middle meningeal artery, and identification of the superior orbital fissure. The lacrimal keyhole is then drilled away. The middle cranial fossa is accessed by drilling posterior to the orbital rim to expose: the temporalis muscle anterior-laterally, the dura of the temporal lobe posterior-laterally, the anterior cranial fossa superiorly and the periorbita medially.

These surgical steps can maximise the surgical portal and minimise morbidity, with avoidance of injury to surrounding structures.

There are currently no guidelines for simultaneous vestibular schwannoma surgery and cochlear implantation. This paper therefore provides our experience and our results regarding predictive parameters of good hearing.

Morphological appearance of the cochlear nerve after tumour resection was used as the main criterion for implantation in the case series. Patients were then divided into responders and non-responders to cochlear implantation, and potential outcome predicting factors were evaluated in the two groups.

Nine of the 16 patients showed a response to cochlear implantation. Pre-surgery serviceable hearing was significantly more common in the responder group, while no difference was found in the two groups for other variables.

This study highlights how the morphological appearance of the cochlear nerve can be useful to predict the hearing outcome and indicates that satisfactory hearing results are closely related to pre-surgery serviceable hearing.

This study aimed to evaluate odour measurements after endoscopic repair of cerebrospinal fluid fistulas.

Demographic characteristics, cerebrospinal fluid leak location, surgical procedure, aetiology and smell test results were retrospectively reviewed.

A total of 27 patients were included. The mean age was 43.52 years. The aetiology was spontaneous in 13 patients (48.1 per cent) and traumatic in 14 patients (51.9 per cent). The skull base defect was at the cribriform plate in 15 patients (55.6 per cent), the frontal sinus posterior wall in 4 patients (14.8 per cent), the sphenoid sinus posterior wall in 4 patients (14.8 per cent), around the anterior ethmoid artery in 2 patients (7.4 per cent), at the ethmoid roof in 1 patient (3.7 per cent) and at the sphenoid sinus posterolateral wall in 1 patient (3.7 per cent). After the comparison of pre-operative and post-operative values in identification, discrimination and threshold categories, a statistically significant difference was seen only in the threshold category (p = 0.014).

The results demonstrated that endoscopic repair of cerebrospinal fluid leak is safe in terms of olfactory functions.

To determine the association between frontal sinus pneumatisation and concomitant anatomical variations in paranasal sinuses as seen on computed tomography.

A total of 403 patients who underwent paranasal sinus computed tomography were allocated to three groups according to the degree of frontal sinus pneumatisation (type 1 – hypoplasia; type 2 – medium size; and type 3 – hyperplasia). In this unique model, the prevalence of ipsilateral variations on paranasal sinuses on each side of the head were analysed separately within each pneumatisation group.

The type 3 frontal sinus pneumatisation group showed a greater association with ipsilateral variations of the sphenoid bone. Variations included pneumatisation of the anterior clinoid process, lateral sphenoid recess, pterygoid process and greater wing, and exposure of Vidian canal. This group also showed significant associations with male gender, and the presence of frontal and Onodi cells.

Interpretation of the paranasal sinus variations is imperative for pre-operative evaluation in functional endoscopic sinus surgery, particularly in patients with frontal sinus hyperplasia. Attention to variation on the ipsilateral side is informative.

The prevalence of the optic canal anatomical variants across the sphenoid sinus varies widely among different ethnic groups. This study aimed to analyse the anatomical variants of the optic canal and their relationship to sphenoid sinus pneumatisation in a Hispanic population.

A review of 320 sphenoid sinuses by high-resolution computed tomography was performed. DeLano's classification of the optic canal, presence of dehiscence, septa insertion, sphenoid sinus pneumatisation and presence of Onodi cells were established.

Dehiscence of the optic canal was observed in 4.7 per cent (n = 15) of the analysed sinuses. Type 4 and 3 optic canals were significantly more frequent among postsellar sphenoid sinuses than other patterns of sphenoid sinus pneumatisation (p = 0.002 and p = 0.018). A type 4 optic canal has a higher tendency to present inserted septum than other optic canal types (p = 0.014).

This study described the optic canal variants in a Hispanic population, which complements existing literature addressing other ethnicities.

The past two decades have seen a widespread adoption of endoscopic skull base surgery with the use of nasoseptal flaps. Attention has been diverted in recent times to evaluate the quality of life of these patients.

This systematic review aimed to evaluate the available literature to compare the quality of life after endoscopic skull base surgery with or without nasoseptal flaps.

This systemic review was conducted using PubMed, Embase and Cochrane Library databases for literature published after 2009.

The majority of studies concluded that there was no statistically significant difference in the quality of life associated with the use of nasoseptal flaps. Post-operatively, more extensive surgery, peri-operative radiotherapy, smoking and younger age were associated with poorer quality of life.

While the use of nasoseptal flaps can have negative effects on patients’ quality of life in terms of sinonasal symptoms, this systematic review found no difference in quality of life associated with the use or non-use of a nasoseptal flap.

The increased incidence of necrotising otitis externa over the last decade has had a significant burden on healthcare providers. Several factors may affect outcome, and stratifying risk may allow personalised treatment.

Retrospectively identified patients were prospectively surveyed over 12 months. The Cox proportional hazards model was used to identify predictors of poor prognosis.

Twenty-six patients with necrotising otitis externa (average age of 80 years) were admitted from 2018 to 2019. At one year, 19 per cent mortality was observed. A high Charlson Comorbidity Index was associated with increased mortality (p = 0.03), prolonged in-patient stay (p = 0.047) and increased odds of adverse outcomes (odds ratio = 1.48, 95 per cent confidence interval = 0.26–2.67, p = 0.019). The Charlson Comorbidity Index in our prognostic model was validated using the receiver operating characteristic curve (area under the curve = 0.76). Charlson Comorbidity Index score of 5 or more independently predicted one-year morbidity and mortality (hazard ratio = 1.30, 95 per cent confidence interval = 0.94–1.79, p = 0.03).

Risk-stratifying patients may enable clinicians to holistically counsel patients and tailor their treatment to improve their prognosis and subsequently alleviate the burden of necrotising otitis externa.

Lateral temporal bone resections are used in the management of locally advanced peri-auricular cutaneous squamous cell carcinomas, but there is still conflicting evidence regarding the staging, surgical and adjuvant treatment decisions.

A retrospective analysis was performed on all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma between January 2015 and December 2019 at a dedicated tertiary oncology referral centre.

Twenty-nine patients were included, with a median age of 77 years. Computed tomography, magnetic resonance imaging and positron emission tomography showed good diagnostic accuracy in identifying disease in the parotid gland, external auditory canal and mastoid bone, but had poor sensitivity in identifying cervical nodal metastasis. Six patients had recurrence at a median of 4.8 months post-operatively. Tumour differentiation (p = 0.0040) and post-operative radiotherapy (p = 0.0199) were associated with significantly better recurrence-free survival.

Lateral temporal bone resection for peri-auricular cutaneous squamous cell carcinoma requires careful surgical planning using clinico-radiological correlation, particularly in patients with poorly differentiated tumours.

Necrotising otitis externa is increasingly being seen and treated within the UK. The aim of this study was to explore the potential cost of a cohort of patients with necrotising otitis externa presenting to a single tertiary NHS trust.

This was a retrospective study with data from 14 patients with confirmed necrotising otitis externa who were treated, monitored, discharged or who died between October 2016 and November 2018. Direct costs using the tariffs from the 2018 to 2019 financial year included in-patient stay, imaging, peripheral inserted central catheter line cost, ENT and out-patient parenteral antibiotic therapy visits and antimicrobial duration.

The mean cost of treatment per patient was £17 615 (range, £9407 to £38 230) with an extreme outlier costing more than £122 000.

Awareness and education at a primary care level and research into robust imaging to aid termination of treatment may lower costs in the future by catching pathology early and reducing treatment duration.