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Epidemic associated with Health conditions Targeted through the Country wide School-Based Verification System amid Primary School Individuals inside Saudi Persia, 2019.
Despite these advantages, postoperative complications can occur after endoscopic endonasal surgery, as in any surgical intervention; however, complications after these procedures are less severe and less frequent compared with traditional open approaches. The most common complications observed include skull base reconstruction failure, intraoperative vascular lesions, and orbital or central nervous system complications. check details Thus, endoscopic endonasal resection, when properly planned and performed by experienced surgeons, is an acceptable treatment for well-selected skull base malignancies with long-term outcomes comparable to those achieved with traditional external approaches.Anterior skull base (ASB) tumors can be classified into three groups according to their site of origin (1) sinonasal neoplasms involving or extending through the anterior cranial base; (2) neoplasms which arise from the bony framework of the base itself; (3) neoplasms originating from adjacent intracranial structures. With few exceptions, most of these tumors have a non-specific appearance on CT and MRI, which limits the role of imaging in terms of characterization. However, treatment planning (transnasal endoscopic surgery in particular) mostly depends upon the tumor map, exploiting the potential of modern cross-sectional imaging. As a result, the radiologist who has to evaluate a neoplasm involving the ASB needs to be fully aware of all the technical solutions available and the specific strengths/weaknesses of the different imaging techniques. Knowledge of radiological anatomy (and its variants) is also essential, which includes the ability to translate the CT appearance of structures into the equivalent MR signal (and vice versa). These main prerequisites have to be combined with up-to-date knowledge of treatment options and surgical procedures in order to be able to create a reporting checklist covering all the aspects that are essential for clinical decision making.The anterior skull base is a complex anatomic site which may be involved by a large number of biologically heterogenous neoplasms. They arise from the epithelium, both surface mucosa and glands, as well as soft tissues, bone, and cartilage. Many benign and malignant tumours in the anterior skull base are similar to their counterparts in other anatomic sites. Interestingly, unique tumours including teratocarcinosarcoma, olfactory neuroblastoma, and angiofibroma can also be found. Recognition of overlapping morphologic features of entities encountered in this anatomic site and the corresponding differential diagnosis is critical. The integration of both morphologic features and immunohistochemical evaluation is essential for correct diagnostic interpretation. This is particularly notable in small round blue cell tumours for which morphologic lineage differentiation is lacking, thus requiring immunohistochemical characterisation. Moreover, challenges in accessing tissue for diagnosis leads to limited biopsies that require proper handling for adequate assessment. Histologic evaluation combined with communication between surgeons and pathologists are necessary components in the work-up and evaluation of these rare tumours.Olfactory neuroblastoma is a rare tumor. Nasal endoscopy typically identifies a soft mass arising from the olfactory cleft. Computer tomography and magnetic resonance imaging are mandatory for staging (in association with 18F-fluorodeoxyglucose positron emission tomography) in high-grade and/or high-stage tumors. Biopsy must be representative to confirm a diagnosis and for grading purposes. Two complementary classifications are described one (Kadish) based on clinical-radiological analysis, and the other (Hyams) on histological criteria. Based on Hyams grading, studies have pointed out that grades III-IV entail significantly different behavior and prognosis. A multimodal approach, which may combine surgery, chemotherapy, and radiotherapy, is essential to manage these tumors. Treatment schedules which include surgery seem to be superior to others. Surgery classically consisted of anterior craniofacial resection to obtain good exposure. However, the role of transnasal endoscopic surgery has expanded because of its association with fewer complications, shorter hospital stays, and comparable oncologic results to the open surgical techniques. Unilateral endoscopic craniectomy can be performed for limited lesions to avoid definitive anosmia. Treatment that includes radio- and chemotherapy is recommended for advanced and high-grade tumors. The role of neoadjuvant chemotherapy in advanced-stage lesions is emerging. The main prognostic factors associated with poor patient outcome are Hyams grade III-IV, Kadish C-D, and positive surgical margins. Lifelong follow up is recommended.This review of sinonasal adenocarcinoma, both intestinal and non-intestinal type, aims at providing a comprehensive overview of etiological factors, diagnostic workup, histological subtypes, advances in molecular characterization and the genetic basis, current optimal treatment strategies, resulting oncological outcome, and prognostic factors modifying the final treatment results. The current treatment of choice remains surgical resection with a curative intent, using the least invasive approach that allows for removal of the entire tumor with negative margins, supplemented with postoperative high-quality intensity-modulated radiotherapy in the majority of patients. To date, chemotherapy remains reserved for the palliative setting. The progress in understanding the underlying molecular biological mechanisms has not yet translated into standard of care applications.In the coming years, further developments can be expected in the field of diagnosis and management of tumors involving the anterior skull base, and especially malignant tumors of the sinonasal tract, which account for the majority of lesions affecting this anatomic area. Advances in genomics and radiomics will undoubtedly lead to better profiling of tumor biology, with consequent refinement of treatment according to the principles of precision medicine. Similarly, the continuous evolution of morphologic and metabolic imaging will improve the accuracy of pretreatment staging and posttreatment surveillance. Finally, the relentless development of technology in complementary fields (i.e., bioengineering, regenerative medicine, robotics, navigation systems, optical imaging) will refine the safety and accuracy of surgery. As a consequence of these innovations, all healthcare professionals involved in the management of anterior skull base tumors need to consolidate their multidisciplinary efforts for improving the patient's quality of life and survival outcomes.
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