OBJECTIVETumors involving Meckel’s cave remain extremely challenging because of the surrounding complex neurovascular structures and deep-seated location. The authors investigated a new minimal-access technique using the endoscopic transorbital approach (eTOA) through the superior eyelid crease to Meckel’s cave and middle cranial fossa lesions and reviewed the most useful surgical procedures and pitfalls of this approach.METHODSBetween September 2016 and January 2018, the authors performed eTOA in 9 patients with tumors involving Meckel’s cave and the middle cranial fossa. The lesions included trigeminal schwannoma in 4 patients, meningioma in 2 patients, metastatic brain tumor in 1 patient, chondrosarcoma in 1 patient, and dermoid cyst in 1 patient. In 7 of the 9 patients, eTOA alone was performed, while the other 2 patients underwent a combined eTOA and endoscopic endonasal approach or retrosigmoid craniotomy. Data including details of surgical techniques and clinical outcomes were recorded.RESULTSGross-total resection was performed in 7 of the 9 patients (77.8%). Four patients underwent extended eTOA (with lateral orbital rim osteotomy). Drilling of the trapezoid sphenoid floor, a middle fossa “peeling” technique, and full visualization of Meckel’s cave were applied to approach the lesions. Tumors were exposed and removed extradurally in 3 patients and intradurally in 6 patients. There was no postoperative CSF leak.CONCLUSIONSThe eTOA affords a direct route to access Meckel’s cave and middle cranial fossa lesions. With experience, this novel approach can be successfully applied to selected skull base lesions. To achieve successful removal of the tumor, emphasis should be placed on the importance of adequately removing the greater sphenoid wing and vertical crest. However, because of limited working space eTOA may not be an ideal approach for posterior fossa lesions.

The seasonal variation of semidiurnal internal tides in the East/Japan Sea was investigated using 25 month long output from a real-time ocean forecasting system. The z coordinate eddy-resolving high-resolution numerical model, called the RIAM ocean model, incorporates data assimilation that nudges temperature and salinity fields together with volume transport through the Korea Strait to produce realistic oceanic currents and stratification. In addition to atmospheric forcing, it includes tidal forcing of 16 major components along open boundaries. The model generates energetic semidiurnal internal tides around the northern entrance of the Korea Strait. Energy conversion from barotropic to baroclinic (internal) tides varies seasonally with maxima in September (ranging 0.48-0.52 GW) and minima in March (ranging 0.11-0.16 GW). This seasonal variation is induced by the seasonality in stratification near the southwestern East/Japan Sea. The propagation distance of the internal tides is associated with generation intensity and wavelength. From late summer to early winter, the semidiurnal internal tides travel relatively far from the generation region due to stratification changes; its energy dissipates less as a result of longer wavelengths. Our results suggest that spatiotemporal variation of internal-tide-induced mixing due to the seasonality in the generation, propagation, and dissipation of internal tides should be considered for a more realistic simulation of water masses and circulation in models of the East/Japan Sea.

Four current-meter moorings and 12 pressure sensor–equipped inverted echo sounders (PIES) were deployed during summer 2011 in the South China Sea. The goal of the experiment was to obtain synoptic observations of the large-amplitude nonlinear internal waves from the near field to the far field as they propagated west-northwest across the sea. The program was unique because it was the first to observe the latitudinal variability of the wave crests in addition to the transformations along a single east–west transect. The waves were strongest down the center of the PIES array along roughly 20°45′N and were weaker off axis in both directions. Both a-waves and b-waves arrived earlier in the south than the north, but with different lag times indicating different propagation directions and therefore different sources. The waves were classified by their arrival patterns and source locations and not by their amplitude or packet structure. The Stanford Unstructured Nonhydrostatic Terrain-Following Adaptive Navier–Stokes Simulator (SUNTANS) model, calibrated against the array, showed that the a-waves developed out of the internal tide spawned in the southern portion of the Luzon Strait and the b-waves originated in the north. The northern tides were refracted and suffered large dissipative losses over the shallow portion of the western ridge, whereas the southern tides propagated west-northwest unimpeded, which resulted in a-waves that were larger and appeared sooner than the b-waves. The results were consistent with previous observations that can now be understood in light of the full three-dimensional structure of the internal waves and tides in the northeastern South China Sea.

Near‐inertial waves (NIWs), a fundamental oceanic response to wind forcing, play an important role in dynamical processes related to ocean mixing and hence have attracted sustained interest. Herein, we investigate temporally and spatially varying NIW distributions in the mixed and deep layers of the East/Japan Sea (EJS) using high‐resolution hourly‐wind‐forced data‐assimilated ocean model outputs. Temporally, the kinetic energy of NIWs in the mixed and deep layers is higher in fall and winter than in spring and summer, showing maxima in December, corresponding to wind forcings of both wind stress and wind‐current resonance. Spatially, the NIW energy in the mixed layer is higher on the northern side of the subpolar front (SPF), although there are no significant spatial differences in the wind forcings. Because of intensive background currents and their vorticities in the upper layer on the southern side of the SPF, vertical transfer of NIW energy is facilitated, shown by a shorter e‐folding decay time scale of NIWs in the mixed layer on the southern side of the SPF. The NIW kinetic energy in the deep layer of 400–1,000 m is higher on the southern side than on the northern side, an opposite spatial pattern to that in the mixed layer, but consistent with a previous observational study. Our results confirm that energetic anticyclonic circulations with negative relative vorticity in the upper layer on the southern side enable vertical penetration of NIW energy from the mixed layer to the deep layer more effectively.

OBJECTIVE The endoscopic endonasal approach for treating primary skull base malignancies involving the clivus is a formidable task. The authors hypothesized that tumor involvement of nearby critical anatomical structures creates hurdles to endoscopic gross-total resection (GTR). The aim of this study was to retrospectively review the clinical outcomes of patients who underwent an endoscopic endonasal approach to treat primary malignancies involving the clivus and to analyze prognostic factors for GTR. METHODS Between January 2009 and November 2015, 42 patients underwent the endoscopic endonasal approach for resection of primary skull base malignancies involving the clivus at 2 independent institutions. Clinical data; tumor locations within the clivus; and anatomical involvement of the cavernous or paraclival internal carotid artery, cisternal trigeminal nerve, hypoglossal canal, and dura mater were investigated to assess the extent of resection. Possible prognostic factors affecting GTR were also analyzed. RESULTS Of the 42 patients, 37 were diagnosed with chordomas and 5 were diagnosed with chondrosarcomas. The mean (± SD) preoperative tumor volume was 25.2 ± 30.5 cm (range 0.8-166.7 cm). GTR was achieved in 28 patients (66.7%) and subtotal resection in 14 patients (33.3%). All tumors were classified as upper (n = 17), middle (n = 17), or lower (n = 8) clival tumors based on clival involvement, and as central (24 [57.1%]) or paramedian (18 [42.9%]) based on laterality of the tumor. Univariate analysis identified the tumor laterality (OR 6.25, 95% CI 1.51-25.86; p = 0.011) as significantly predictive of GTR. In addition, the laterality of the tumor was found to be a statistically significant predictor in multivariate analysis (OR 41.16, 95% CI 1.12-1512.65; p = 0.043). CONCLUSIONS An endoscopic endonasal approach can provide favorable clinical and surgical outcomes. However, the tumor laterality should be considered as a potential obstacle to total removal.