Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Russel T. Wagner, OMS-I 1,2 ; Amin B. Kassam, MD 1 ; Taylor E. James, OMS-I 1,2 ; Melanie B. Fukui, MD 1 ; Sammy Khalili, MD 1 ; Neil S. Mundi, MD 1 ; Stephen J. Winkler, MD 1 1 Intent Medical Group, Northwest Community Hospital, Arlington Heights, Illinois; 2 VCOM-Louisiana 41 GLOBE-SPARING MANAGEMENT OF ADVANCED SINONASAL UNDIFFERENTIATED CARCINOMA WITH ORBITAL APEX INVOLVEMENT: HIGHLIGHTING MULTIDISCIPLINARY, MOLECULARLY-DRIVEN CARE

Russel T. Wagner, OMS-I 1,2 ; Hannah Walsh, BS 1 ; Wesley P. Launey, OMS-I 2 ; Coedyn J.E. Leonard, OMS-I 2 ; Amin Kassam, MD 1 ; Neil Mundi, MD 1 ; Melanie Fukui, MD 1 ; Jacopo Berardinelli, MD 1 ; Russ P. Nockels, MD 1 1 Intent Medical Group, Northwest Community Hospital, Arlington Heights, Illinois; 2 VCOM-Louisiana 42 INTRACRANIAL HYPOTENSION SECONDARY TO A SPONTANEOUS CERVICAL NERVE ROOT LEAK REPAIRED USING A CHIMERIC ROTATIONAL PARASPINAL FLAP: A MULTIDISCIPLINARY SURGICAL APPROACH

Context: Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy that often presents with advanced skull base and orbital invasion. Standard management typically involves exenteration, yet outcomes remain poor, and consensus guidelines are lacking. This case highlights a novel, multidisciplinary, molecularly-driven approach to achieve globe preservation and oncologic control in a patient initially considered for palliative care. Clinical Presentation: A 69-year-old male presented with SNUC invading the left orbit and anterior cranial fossa, with rapid vision loss suggestive of orbital apex syndrome. High dose corticosteroids were promptly initiated to stabilize optic nerve function. Comprehensive molecular profiling (Tempus) identified actionable targets that guided personalized induction chemotherapy (ICE regimen with disulfiram/ copper) and IMRT. Following significant tumor response, globe-sparing resection was performed via an expanded endonasal and bicoronal craniofacial approach, using robotic exoscopic visualization (ROVOT-m) and stereotactic neuronavigation. Postoperative disease surveillance incorporated Signatera

molecular residual disease (MRD) testing. Neoadjuvant therapy led to substantial tumor reduction, enabling successful resection while preserving the globe and optic nerve. Pathology demonstrated only microscopic residual disease with predominantly negative margins. Postoperatively, the patient experienced preserved visual function and no evidence of local recurrence at two years. MRD surveillance has facilitated ongoing systemic monitoring, correlating with clinical status. Conclusions: This case demonstrates the feasibility and potential impact of combining molecularly-targeted systemic therapy, precision microsurgery, and MRD monitoring in the management of advanced orbital SNUC. In the absence of established treatment guidelines, this approach offers a promising, individualized framework prioritizing both oncologic control and functional preservation.

Context: Spontaneous intracranial hypotension (SIH) caused by a cerebrospinal fluid (CSF) leak due to a subtle dural defect often leads to debilitating orthostatic headaches and subdural fluid collection. Various surgical techniques have been described for iatrogenic leaks but not for spontaneous cervical nerve root leaks. Clinical Presentation: A 35-year-old female presented with progressive neck pain, severe orthostatic headaches, and bilateral subdural fluid collection. Imaging revealed a Type 1b ventral dural tear at the right C8 nerve root. A posterior cervical approach exposing the nerve roots located the subtle leak site. A team comprising neurosurgeons and a head and neck reconstructive surgeon harvested and positioned a paraspinal musculature flap, fashioned into two leaflets, to envelop the nerve roots ventrally and dorsally. Fibrin sealant and muscle plugs reinforced the closure. Postoperatively, the patient experienced rapid resolution of orthostatic headaches. At six months, she reported only mild, intermittent neck tightness without headache recurrence or evidence of CSF leakage.

Conclusions: A multidisciplinary surgical approach utilizing a chimeric rotational paraspinal flap to repair a spontaneous cervical CSF leak at the right C8 nerve root provided robust, vascularized coverage with resolution of SIH signs and symptoms. This flap based technique offers a durable solution for challenging CSF leaks.

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2026 Research Recognition Day