This article discusses the rare surgical pathology of CSF fistulas of the lateral recess of the sphenoid sinus, which account for 7.7% of all skull base leaks. The authors present three clinical cases of patients with spontaneous cerebrospinal fluid leaks from this area and their surgical treatments. The treatments involved transsphenoidal and transpterygoid endoscopic approaches, with varying postoperative results. The key finding is that the success of the plastic surgery for CSF fistulas in this area does not depend on the type of endonasal surgical approach. Instead, it hinges on the quality of the plastic and the preoperative level of CSF pressure. This contributes to the literature by highlighting the importance of these factors in surgical success.

This study evaluates the outcomes of prolonged use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in patients with COVID-19 related acute respiratory distress syndrome (ARDS). The research is based on a single-center retrospective review of patients requiring V-V ECMO support for over 50 days.

Key findings:

• The median age of the patients was 48 years, with 72% being male.
• The median duration of ECMO support was 84 days.
• 61% of patients had right ventricular dysfunction and 72% had pneumothoraces.
• The mortality rate was 33%.
• 61% of patients were discharged, with 3 requiring a lung transplant.

The study suggests that prolonged V-V ECMO can yield comparable outcomes to shorter-duration treatments, given the availability of the device and staffing. This could potentially justify its use in a highly selected patient population.