Background: Biphenotypic sinonasal sarcoma is a rare low-grade tumor arising from the sinonasal tract, featuring locally aggressive biological behavior, with a tendency to invade the orbit and skull base. There are no defined guidelines of treatment; thus, the management varies among different institutions. The aim of the present study is to provide a modular system of surgical approaches according to the lesion pattern of growth from a literature review. Materials and Methods: A comprehensive and detailed literature review on the PubMed and Embase online electronic databases on biphenotypic sinonasal sarcoma with orbital invasion was conducted. A personal case exhibiting peculiar features was also added. Demographic (patient’s sex and age), clinical (presenting symptoms and time to treatment), neuroradiological (anatomical origin and pattern of growth), and treatment (type of treatment, surgical approach, extent of resection, peri- and postoperative complications, and adjuvant therapies) data, as well as clinical outcome, recurrence rates, and overall survival, were analyzed. Results: Thirty-one patients harboring biphenotypic sinonasal sarcoma with orbital invasion were identified. Tumors mainly affected female patients (66.7%) and a middle-aged population (median 55.2 years old). Simultaneous skull base involvement occurred in most cases (80.6%). Surgery was performed in all but one case (97%), as unique treatment (59%) or in association with radio—(23.5%) and/or chemotherapy (5.9%/2.9%), allowing for gross total tumor resection in most cases (66.7%). The endoscopic endonasal approach was the most adopted surgical corridor (51.7%). The local recurrence rate was 19.3%, and only two cases of tumor-related mortality occurred. Conclusions: Surgery is the only curative treatment, with the main goal to restore/improve/arrest progression of clinical manifestations. The endoscopic endonasal route represents the master approach for lesions confined to the midline. Microsurgical transcranial and endoscopic transorbital approaches have a complementary role for addressing the lesion’s component with large intracranial extension or affecting the paramedian aspect of the anterior cranial fossa and superior–lateral orbital compartment, respectively. The approach selection should be made case by case according to the tumor pattern of growth.

Background/Objectives: Degenerative lumbar spinal stenosis (LSS) is a prevalent cause of disability in elderly populations, often treated with decompressive surgery. However, postoperative functional outcomes are variable and influenced by factors beyond neural compression alone. This study aimed to investigate the prognostic significance of the Goutallier Classification System (GS), a radiological index of paravertebral muscle fatty degeneration, in predicting long-term postoperative disability and pain in elderly patients undergoing decompression for LSS. Methods: A retrospective cohort study was conducted on 100 elderly patients who underwent primary lumbar decompression surgery for LSS between January 2020 and July 2022, with a minimum two-year follow-up. Patients were stratified according to their preoperative GS grades assessed via MRI. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain were collected preoperatively and at follow-up. Changes in the ODI and VAS (ΔODI and ΔVAS) were analyzed to evaluate associations between GS grades and functional outcomes. Results: Significant improvements in the ODI (from 41.0 ± 17.5 to 16.9 ± 8.2) and VAS (from 6.23 ± 2.52 to 3.75 ± 2.38) were observed postoperatively (p < 0.01). However, higher GS grades were associated with greater residual disability and pain at follow-up, as well as with smaller postoperative improvements in these scores (p < 0.01 for ODI; p = 0.01 for VAS). Gender differences were noted, with females predominating in higher GS grades. No significant differences in comorbidities or complication rates were identified across GS subgroups. Conclusions: Preoperative paravertebral muscle degeneration, as measured by the GS, emerged as a significant predictor of postoperative disability and pain in elderly LSS patients. Incorporating GS assessment into preoperative planning may refine surgical risk stratification and inform shared decision-making to optimize long-term functional recovery.