ObjectivesAmong the transsphenoidal (TSS) approaches to pituitary tumors, the microscopic approach (MA) has historically been the predominant technique with the increasing adoption of the endoscopic approach (EA). This study investigates national trends in TSS approaches and postoperative outcomes for MA and EA through 2021.MethodsThe TriNetX database was queried for patients undergoing TSS (MA and EA) between 2010 and 2021. Data were collected on demographics, geographic distribution of surgical centers, postoperative complications, stereotactic radiosurgery (SRT), repeat surgery, and postoperative emergency department (ED) visits.Results8644 TSS cases were queried between 2010 and 2021. MA rates were highest until 2013 when rates of EA (52%) surpassed MA (48%) and continued to increase through 2021 (81%). From 2010 to 2015 EA had higher odds of a postoperative CSF leak (OR 3.40) and diabetes insipidus (DI (OR 2.30)) versus MA (p < 0.05); from 2016 to 2021 differences were not significant. Although there was no significant difference among approaches from 2010 to 2015 for syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia, or bacterial meningitis, from 2016 to 2021 EA had lower odds of SIADH (OR 0.54) and hyponatremia (OR 0.71), and higher odds of meningitis (OR 1.79) versus MA (p < 0.05). EA had higher odds of additional surgery (either EA or MA) after initial surgery from 2010 to 2021. From 2010 to 2015 EA had lower odds of postoperative SRT compared to MA, whereas in 2016–2021 there was no statistical difference among approaches.ConclusionThis study demonstrates increasing EA adoption for TSS in the United States since 2013. Complication rates have overall improved for EA compared to MA, potentially as a result of improving surgeon familiarity and experience.Level of Evidence4 Laryngoscope, 133:2135–2140, 2023

Pancreatic neuroendocrine tumors, or pNETs, represent a rare and clinically heterogenous subset of pancreatic neoplasms. One such pNET, the insulinoma, is found to be malignant in just 4% of all insulinomas. Due to the exceedingly uncommon occurrence of these tumors, there is controversy regarding the optimal evidence-based management for these patients. We therefore report on a 70-year-old male patient admitted with 3 months of episodic confusion with concurrent hypoglycemia. The patient was found to have inappropriately elevated endogenous insulin levels during these episodes, and somatostatin-receptor subtype 2 selective imaging revealed a pancreatic mass metastatic to local lymph nodes, spleen, and the liver. Fine needle aspiration of pancreatic and liver lesions confirmed the diagnosis of a low grade pancreatic neuroendocrine tumor. Molecular analysis of tumor tissue revealed a novel mutational profile consistent with pNET. The patient was initiated on octreotide therapy. However, treatment with octreotide alone demonstrated limited efficacy in controlling the patient’s symptoms, prompting consideration of other therapies.

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IntroductionChronic rhinosinusitis with nasal polyposis (CRSwNP) is often treated with endoscopic sinus surgery (ESS), however, patients may require revision surgery due to recurrence. To date, no studies have compared outcomes for combined surgery and biologic therapy for CRSwNP compared to biologic therapy alone.MethodsRetrospective case‐control study of CRSwNP patients who underwent ESS while on dupilumab or mepolizumab (ESS‐biologic cohort), compared to CRSwNP patients on biologic therapy (biologic‐only controls). Cohorts were matched according to indication, aspirin exacerbated respiratory disease (AERD), sinonasal outcome test‐22 (SNOT‐22), and total polyp scores.Results16 patients underwent ESS while on biologic therapy (13 dupilumab and 3 mepolizumab). 16 patients were biologic‐only controls. There were no significant differences between indication, baseline SNOT‐22 scores, polyp scores, and AERD status between cohorts. Patients underwent surgery a median of 33 days after starting biologic therapy. After 12 months of follow up, the total polyp score for the ESS‐biologic cohort decreased from 4.73 to 0.09, compared to biologic‐only controls 5.22 to 3.38 (95% CI of Difference: ‐5.37 to ‐1.38, Cohen's d: 2.40, p = 0.005). In the ESS‐dupilumab sub‐analysis, the ESS‐dupilumab cohort had a significant reduction in polyp burden 4.85 to 0.00 compared to controls 4.88 to 3.50 (95% CI of Difference: ‐5.68 to ‐1.32, Cohen's d: ‐1.69, p = 0.009).ConclusionIn CRSwNP patients, combined ESS and biologic therapy results in a significant and sustained decrease in polyp burden compared to biologic therapy alone. Larger studies are warranted to further examine the impact of combined therapy.This article is protected by copyright. All rights reserved