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Background: Cerebrospinal fluid (CSF) leak is a serious complication of endoscopic endonasal surgery for pituitary adenoma; leading to a more serious and financial burden of the surgery. Prediction of the occurrence of such sequale and proper plaining for reconstruction can reduce its prevalence and associated morbidities. Purpose: To determine the predictors and risk factors associated with intra/and postoperative cerebrospinal fluid (CSF) leaks in endoscopic endonasal pituitary surgery. Methods: A retrospective study included 150 patients who underwent endoscopic endonasal approach for resection of pituitary adenomas between 2015 and 2018. We analyzed the association between CSF leaks (intra/post-operative) and perioperative variables including patients' demographic data, medical comorbidities, tumor characteristics and operative data (rates of intraoperative leak, reconstructive techniques). Results: 34 patients (22.6%) out of the 150 patients had an overall, CSF leak: 26 (76.5%) patients had intraoperative leaks; 5 patients out of them continued to have a postoperative leak. 8 patients (23.5%) had postoperative leak. Based on multiple logistic regression model analysis; increased body mass index (BMI), associated hydrocephalus, suprasellar extension and recurrent tumors had a significant association with intraoperative CSF leaks, while only BMI and hydrocephalus predicted postoperative CSF leaks. Conclusion: Elevated BMI, suprasellar extension of the tumor, recurrence or previous radiation are all important risk factors that have been proved in this study to have statistically significant association with the incidence of CSF leak. In high risk patients for CSF leakage: adequate reconstruction planis advised to avoid such morbidity.

Objective Endoscopic ear surgery (EES) is a growing and well-recognized field in the modern era. EES had a stepwise journey of development. This journey is pretty comparable to the endoscopic sinus surgery development. Methods Online literature search was performed to give a concise review on the development and recent applications of EES and in addition to clarify the reported advantages and disadvantages of EES. Results EES has a more recent application than ESS that started decades after endoscopic sinus surgery (ESS). The use of endoscope in ear surgery gives a wide-angled detailed view of the middle ear structures. It gives the ability to look around the corners offering less disease persistence than the microscopic approaches. EES is useful in cases of narrow and angled external auditory canal as it bypasses the narrowest segment of EAC. However, it lacks the 3D perception and enables one hand surgery which could be difficult to manage bleeding. Applications of EES extended from tympanoplasty, stapedotomy, cholesteatoma surgery, and middle ear ventilation in chronic inflammatory conditions to the neurotologic applications in lateral skull base surgery. Conclusion EES is an extremely growing field with many applications in otology and neurotology. The advantages of endoscopic applications outweigh the disadvantages. It has a stepwise learning curve and offer better teaching ability.

Objective: this article describes a case of pediatric orbital fracture emphasizing on the important complications that need urgent intervention. Methods: a case report with description of the case with zygomatic and orbital fracture with serious complications as retrorbital hematoma and inferior rectus entrapment. In addition, we described the urgent intervention done for the case. Results:optimum timing of the management was the key for the case. Immediate lateral canthotomy and inferior cantholysis in addition to entrapped muscle release from the fracture with reduction and fixation of the fracture lines led to excellent and satisfactory results. Conclusion: careful examination and management of pediatric orbital fractures represent the cornerstone for this entity of maxillofacial injury. Retrorbital hematoma and inferior rectus muscle entrapment are raer but serious complications of pediatric zygomatic fractures and they need immediate management.