Objective: Diffusion of endoscopic techniques for the resection of ethmoid bone malignancies through a transcribriform approach (TA) has raised new challenges regarding reconstruction options to reduce post‐operative complications. Although there is consensus on the advantages of vascularized flaps over free grafts for large defects, no standard protocol exists on reconstruction procedures. In addition, although the pedicled nasoseptal flap has been extensively discussed, few studies have been published on extranasal pedicled flaps. The aim of this manuscript is to provide a detailed description of a reconstruction technique for large anterior skull base defects with the pericranial flap as part of a multilayered reconstruction. Moreover, patients treated with this approach were retrospectively assessed for post‐operative complications.Methods: A detailed description of the reconstruction procedure as performed in our departments is provided. Pictures depicting the main surgical steps are also included. In addition, preliminary functional results from a retrospective series of patients who underwent a TA and subsequent pericranial flap‐based multilayer reconstruction for ethmoid roof malignancies between 2016 and 2022 at two institutional centers are reported.Results: 16 patients were included in the study. Nine patients (56.3%) underwent adjuvant radiotherapy. Two patients had a biochemically‐confirmed postoperative CSF leak. Only one of the two patients required surgical revision. During follow‐up (mean 13 months), no other early nor delayed complications were observed.Conclusion: A standardized surgical technique with pericranial flap as part of a multilayered reconstruction for large anterior skull base defects following resection of sinonasal malignancies is proposed, which appears to be a safe choice when endonasal flaps are not available.Level of Evidence: Level 4 Laryngoscope, 133:2942–2947, 2023

Purpose: To evaluate surgical and audiological outcomes of different endoscopic ossiculoplasty (endo-OPL) techniques and prosthesis materials. Methods: In this multicenter retrospective study, 292 patients underwent endo-OPL for various ossicular chain pathologies at three university hospitals between 2017 and 2023. We analyzed pre- and postoperative hearing metrics, perforation characteristics, surgical procedures, prosthesis types, and complication rates. Results: The cohort showed significant audiological improvement, with the mean preoperative air-bone gap (ABG) reducing from 26.88 dB (SD ± 12.73) to 19.94 dB (SD ± 10.90) at the last follow-up (FU; mean 20.7 months ± 15.53) ( p = 0.001), and a graft success rate of 94.2%. Significant postoperative ABG improvements were observed with bony partial ossicular replacement prostheses (PORP) ( p < 0.001), titanium total ossicular replacement prostheses (TORP) ( p = 0.008), and semi-synthetic TORP ( p = 0.016). Both cement PORP and bony PORP groups showed consistent ABG improvements over two FU visits. Conversely, titanium based PORP and TORP demonstrated initial improvements but later showed deterioration. Prosthesis extrusion and dislocation rates were 8.4% and 4.2% for titanium PORP, and 0% and 5.2% for titanium TORP, respectively, at the last FU. Endo-OPL combined with additional mastoidectomy ( n = 59) did not yield significant ABG improvements. Conclusion: This multicenter study supports the efficacy of endo-OPL as a valuable technique to improve hearing outcomes in patients with conductive or mixed hearing loss. It highlights the superior performance of specific prosthesis materials and demonstrates that endo-OPL without additional mastoidectomy provides better hearing results, emphasizing the benefits of mastoid preservation in exclusive endoscopic procedures.

Objective: 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.Methods: 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.Results: 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.Conclusion: 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.

Background: Petrous apex cholesterol granulomas (PACGs) are benign inflammatory cystic lesions of the temporal bone. Usually, asymptomatic patients may develop symptoms as the lesions expand. The diagnosis is based on both CT and MRI scans and the management relies on “wait and scan” or surgery. This paper aims at evaluating surgical outcomes and proposing a CT-based classification and a management algorithm. Methods: Patients with PACGs who were surgically treated between 2014 and 2024 were included. Symptoms, imaging, approach type and complications were considered. CT scans were classified as Type A (preserved apex cellularity), Type B (erosion of the apex cellularity), and Type C (involvement of the noble structures bone boundaries). The possible connection of the lesion with the infracochlear, perilabyrinthine and sphenoidal cellularity was assessed. Results: Nineteen patients with symptoms like diplopia, headache and sensorineural hearing loss were included. According to our classification, 1/19 patients was Type A, 4/19 were Type B and 14/19 were Type C. Five patients underwent a total resection, seven a subtotal and seven a surgical drainage. Only two complications were recorded, and 17/19 patients showed symptom regression and stability during follow-up. Conclusions: While the management of PACGs is still controversial, according to our classification and surgical outcomes, Type A, being mostly asymptomatic, should be managed with “wait and scan”, Type B should undergo surgery when symptoms are present, while Type C should always undergo surgery because of their invasiveness and potential complications. When possible, a drainage should be attempted; otherwise, a surgical resection is chosen, and its completeness depends on the preoperative general and hearing status.