Since December 2019, a pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally.¹ A spectrum of disease severity has been reported, with main symptoms that include fever, fatigue, dry cough, myalgia, and dyspnea. Previous strains of coronavirus have been demonstrated to invade the central nervous system through the olfactory neuroepithelium and propagate from within the olfactory bulb.² Furthermore, nasal epithelial cells display the highest expression of the SARS-CoV-2 receptor, angiotensin-converting enzyme 2, in the respiratory tree.³

Since December 2019, a pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly from Wuhan, Hubei Province, China, to all over the world.¹ As of April 20, 2020, SARS-CoV-2 has been responsible for 2 414 595 infections and 165 174 deaths worldwide, with Italy accounting for 178 972 cases and 23 660 deaths.² The clinical spectrum of COVID-19 ranges from an asymptomatic or mild flu-like illness to a severe pneumonia and systemic disease requiring critical care. Main symptoms are fever, dry or productive cough, and dyspnea.³

Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “Remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict their growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

Purpose To estimate the prevalence of smell or taste impairment in household contacts of mildly symptomatic home-isolated SARS-CoV-2-positive patients. Methods Cross-sectional study based on ad hoc questions. Results Of 214 mildly symptomatic COVID-19 patients managed at home under self-isolation, 179 reported to have at least one household contact, with the total number of no study participants contacts being 296. Among 175 household contacts not tested for SARS-CoV-2 infection, 67 (38.3%) had SARS-CoV-2 compatible symptoms, 39 (22.3%) had loss of smell or taste with 7 (4.0%) having loss of smell or taste in the absence of other symptoms. The prevalence of smell or taste impairment was 1.5% in patients tested negative compared to 63.0% of those tested positive for SARS-CoV-2 (p < 0.001). Conclusion Smell or taste impairment are quite common in not-tested household contacts of mildly symptomatic home-isolated SARS-CoV-2-positive patients. This should be taken into account when estimating the burden of loss of sense of smell and taste during COVID-19 pandemic, and further highlights the value of loss of sense of smell and taste as a marker of infection.

Il carcinoma del sacco endolinfatico è un tumore molto raro come evidente dai dati presenti in letteratura ove anche centri di esperienza riferiscono tuttavia casistiche limitate. E’ un tumore maligno a lenta crescita, con tendenza all’invasione locale e scarsa tendenza alla disseminazione metastatica. L’insorgenza spesso tardiva dei sintomi e la difficoltà ad eseguire indagini bioptiche a livello della sede di origine, parete posteriore della rocca, ha reso la diagnosi di questo tumore spesso difficile, nonostante si riconoscano attualmente dati radiologici patognomonici della neoplasia. Patterns tipici di presentazione sono evidenziabili alla RM con mezzo di contrasto e alla TC per osso a strato sottile, rendendo nella maggior parte dei casi possibile la diagnosi radiologica. L’incidenza del tumore del sacco endolinfatico è maggiore nei pazienti affetti da sindrome di von Hippel Lindau (VHL), con una frequenza del 25% che fa parte del quadro sindromico. Negli anni dal 2012 al 2015 abbiamo osservato 7 casi, uno di essi con manifestazione della patologia bilaterale, tutti affetti da VHL. Quattro tra questi sono stati sottoposti a chirurgia presso il nostro centro per un totale di 5 procedure chirurgiche. Ogni caso è stato descritto dettagliatamente analizzando sintomi, intervallo tra comparsa dei sintomi, diagnosi e terapia. Non vi è stata morbidità post-operatoria aggiuntiva nei pazienti in cui la diagnosi e la terapia sono state precoci, mentre la gestione di tumori localmente avanzati è stata associata a deficit neurologici postoperatori, in particolare del VII, IX e X nervo cranico. I siti anatomici critici di coinvolgimento della malattia che hanno coinciso con un pianificato rischio di danno neuronale sono risultati essere il canale di Falloppio, il forame giugulare, l’apice della rocca petrosa. L’estensione intradurale nella fossa cranica posteriore è stato un altro elemento caratterizzante i tumori in stadio avanzato. I tumori del sacco endolinfatico che lo screening permette di evidenziare precocemente nei pazienti VHL, hanno buona prognosi quando affrontati precocemente, compatibilmente con le esigenze terapeutiche della malattia di base.

Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) experience locoregional recurrence, which is associated with poor outcome. In the course of follow-up for patients surviving ...