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Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Clival chordomas are locally aggressive tumors that are challenging to treat because of their unique biology, proximity to key neurovascular structures and poor prognosis. Currently, chordomas are optimally managed with aggressive surgery, whilst preserving key structures, and postoperative radiation in a multidisciplinary setting with an experienced team. The advancement of molecular techniques offers exciting future diagnostic and therapeutic options in the management of chordomas.

Awareness of the specific imaging appearances of pseudoaneurysms of the hand and their complications may improve the accuracy of radiologic diagnosis, advance the preoperative workup, and prevent possible clinical complications such as digital gangrene, nerve dysfunction, and aneurysm rupture.

Steroid-eluting implants are well tolerated and an effective addition to the armamentarium utilized in the management of chronic rhinosinusitis. Future developments for the use of drug-eluting implants in chronic rhinosinusitis are discussed.

Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.

The pedicled nasoseptal flap (NSF) has dramatically reduced postoperative cerebrospinal fluid leakage following endoscopic endonasal approach (EEA) surgery. Although rare, its arterial supply may be damaged during harvest or may be preoperatively damaged for numerous reasons. Early recognition permits harvesting a contralateral flap before sacrificing its pedicle as part of the surgical exposure or use of an alternative flap. Technical feasibility study and case series. Tertiary care university-associated medical center. Five patients requiring an EEA with NSF reconstruction. During NSF harvest, intravenous indocyanine green (IVICG) was administered, and a customized endoscopic system was used to visualize the emerging fluorescence. At the end of each case, just before final positioning of the NSF, additional IVICG was administered, and the custom endoscope was again introduced to evaluate fluorescence. In four patients, the entire NSF fluoresced brightly with IVICG on initial harvest and before final positioning. One patient showed heterogeneous fluorescence of the pedicle and distal parts of the NSF at both stages. All NSFs healed well without complication. IVICG facilitates real-time evaluation NSF's arterial supply. This may provide early recognition of arterial compromise, allowing the harvest of alternate flaps or modification of surgery.