Objectives/Hypothesis: The introduction of intranasal pedicled flaps has reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks to less than 5%. Nevertheless, in malignant tumors those flaps are not always available because of nasal septum invasion. Minimally invasive pericranial flaps (PCF) are associated with minimal adverse effects and good cosmetic appearance. In spite of that, there are only a few reports of this reconstructive technic limited to short surgical series and radio-anatomical analysis. Clinical results of a surgical cohort are presented. Study Design: Cohort prospective study. Methods: Clinical data, including age, gender, stage, histopathological findings, rate of complications and appearance of PCF at fifth day and two months postoperative were recorded. Postoperative morbidities were recorded as wound abnormalities, nasosinusal, orbital and central nervous system complications. Chi-squared test was used to correlate qualitative variables and Student-t-test to correlated qualitative and quantitative variables. Items were considered statistically significant with a p value of less than 0.05 (confidence Interval of 95%). Results: Thirty patients (18 males and 12 females) were registered. Mean age was 51.5 years ± 23.0 and range between 20 and 71 years. The most common histological subtypes were scamous cell carcinoma and adenocarcinoma. Complete resection of the tumor was achieved in all patients including surgical margins. Length of the PCF varies between 9.9 cm and 13.9 cm with a mean of 11.8 cm. There was an association between length of the flaps and the covering structure with the nose apex relation. None patient experienced postoperative cerebrospinal fluid (CSF) leak, frontal sinusitis or other complications. Conclusions: Minimally invasive PCF constitute a good

Purpose: To describe the results of endonasal endoscopic resection for primary and secondary orbital lesions.Design: A retrospective cohort study was performed. Subjects:The clinical data of patients with primary and secondary orbital tumors who received treatment with endonasal endoscopic surgery from Agost 2016 to July 2017 in the Department of Head and Neck Surgery of the National Institute of Oncology and Radiobiology (Cuba) were analysed.Intervention: All surgeries were performed by using Karl Storz 00, 450 and 700, 4 mm diameter; 18 cm rod-lens rigid telescopes (Karl Storz and Co, Tuttlingen, Germany). Endonasal endoscopic transethmoidal route was the primary approach, and according to the tumor size, histology and location, a transantral route was aggregate. Main outcome measures:Demographic data, histology nature of the lesions, clinical presentation, surgical route, frozen section margins and complications relative to treatment were obtained. Grade of resection was measured.Results: From total of 12 patients that were interview, 7 were male and 5 female. Age range was 20-70 years and a mean age of 50.2 years. According to nature of the lesions, seven patients have malignant neoplasm and three patients have non-neoplasic disorders. Transethmoidal route was performed in 4 patients and transethmoidal/ transantral in 8 patients. Total resection was achieved in 11 patients (92%). Frozen section margins were negative in all patients. All patients experienced complete resolution of the presenting symptoms with no evidence of optic nerve injury. Two patients presented transient ophtalmoparesis. Conclusion:Endonasal endoscopic surgery is a safe, successful and minimally invasive technique for resecting extra-intraconal primary and secondary orbital tumors; especially those arise posterior to the ocular glove and inferomedially of optic nerve. There are some important key points to take account in order to prevent complications.

Introduction The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium. Objective To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach. Case Report 59-year-old male patient with history of increasing frontoorbital, bilateral, fluctuating headache and exophthalmos. There was no other associated clinical abnormality. Computed Tomography (CT) and Magnetic Resonance Image (MRI) scans confirmed an expansive mass of sphenoid sinus, suggesting mucocele. The patient was submitted to endonasal endoscopic surgery with posterior ethmoidotomy, large sphenoidotomy, and marsupialization of the lesion. Conclusion Mucoceles of the sphenoid sinus are a very rare condition with variable clinical and radiological presentation. Surgical treatment is absolutely indicated and early treatment avoids visual damage that can be permanent. Endonasal endoscopic approach with drainage and marsupialization of sphenoid sinus, using a transnasal corridor, is a safe and effective treatment modality.