Objective Endoscopic resection of sinonasal cancer has become an alternative to open craniofacial surgery and leads to safe and satisfying results in emerging numbers. Randomized study data comparing outcomes between approaches are missing. Hence, it remains unclear which subgroups of patients might profit most from each technique. We aimed to identify such patient and tumor characteristics and gather information for future prospective study design. Study Design Case series with chart review. Setting Tertiary academic center. Subjects and Methods This study is based on a retrospective chart review of 225 patients undergoing open craniofacial or endoscopic resection for sinonasal malignancy between 1993 and 2015 at Munich University Hospital. Statistical analyses include t test, chi-square, Kaplan-Meier charts, and univariate and multivariate analyses. Results The sample size was similar between the endoscopic and open surgery groups. Tumors were significantly larger in patients who underwent open craniofacial resection. The risk of notable bleeding (P = .041) was lower and hospital stay shorter (P = .001) for endoscopic interventions of all tumor stages. Rates of overall (P = .024) and disease-specific (P = .036) survival were significantly improved for endoscopic cases; improved recurrence-free survival rates did not achieve statistical significance (P = .357). For cases matched for tumor size, this improvement was confirmed for T3 tumors (P = .038). Regional and distant metastatic tumor spread generally worsened survival in both surgical subgroups. Multivariate Cox regression analysis revealed independent prognosticators for overall survival. Conclusion Endoscopic tumor resection remains a suitable option for distinct indications and showed improved outcome in intermediate-stage tumors in our collective. Further randomized studies acknowledging the here-identified factors are needed to improve future therapy guidelines and patient care.

The clinical picture of the so-called subforaminal stenosis headache (Gutmann) and its surgical treatment (Roesner) have been presented. We have analyzed our findings in 119 patients and 55 operations. The clinical picture is characterized by increasing pain in the upper cervical and occipital region which in later stages may be accompanied also by other symptoms like disturbances of concentration, memory, libido, and potency, as well in some cases by symptoms similar to those of a secondary chronic myelopathy. The syndrome is caused by a subforaminal stenosis of the dural sac which regularly is compressed by the posterior atlas arch in connection with either morphological variations of the base of the skull or by static-functional deviations of the cranio-cervical region. The compression of the dural sac of the cranio-cervical region results in an impairment of its air chamber function, and additionally may disturb the connections between the intracranial and intraspinal venous plexus. By both factors the physiologically important smoothing function of the CSF space of the cranio-cervical region concerning intracranial pressure changes is disturbed. Treatment of choice is a laminectomy of the dorsal arch of the atlas and an osteoclastic dilatation of the foramen magnum but without opening of the dura. The results of this procedure are excellent.