We encountered two cases of pleomorphic adenoma arising from the nasal septum, which were resected by endoscopic intranasal operation.

　Case 1: A 70-year-old woman was admitted to our hospital with the complaint of epistaxis. Endoscopic examination revealed a mass with a smooth surface located in the nasal septum. Nasal enhanced CT revealed a well-circumscribed solid mass with slight rim enhancement in the right nasal cavity, with no evidence of bone destruction. On contrast MRI, the tumor was visualized as a low signal intensity on T1-weighted images and as a high signal intensity on T2-weighted images.
　Case 2: A 56-year-old man presented to us complaining of right-sided epistaxis. Examination revealed a hemorrhagic mass with a smooth surface located in the nasal septum. Nasal enhanced CT scan revealed a well-circumscribed solid mass with slight enhancement of the rim in the right nasal cavity, with no evidence of bone destruction. On MRI, the tumor was visualized as a iso signal intensity on T1-weighted images and as a high signal intensity on T2-weighted images.
　Pleomorphic adenoma usually occurs in the major salivary glands, and rarely arises from the nasal septum. Pleomorphic adenoma has also been reported to rarely show malignant transformation, which indicates the need for careful postoperative observation of the patients.

　Febrile neutropenia is a serious adverse effect of chemotherapy, and early diagnosis and prompt treatment are essential. We report our experience of the use of pegfilgrastim, a continuous granulocyte colony stimulating factor that was approved for use in Japan in September, 2014, for the treatment of febrile neutropenia developing during chemotherapy in two cases of head and neck cancer.

　The first patient was a 62-year-old man who received chemoradiotherapy (CBDCA: AUC 5mg/ml/min, ETP: 80 mg/m²×3 days) for neuroendocrine carcinoma of the epipharynx. On day 8 of the first course of chemotherapy, the patient developed fever (38.9°) and grade 4 (G4) neutropenia (80/mm³) and was diagnosed as having FN.
　The second patient was a 72-year-old man, who received induction chemotherapy (CDDP: 60 mg/m²×1 day, DOC: 60 mg/m²×1 day, 5-FU: 750 mg/m²×5 days) for supraglottic squamous cell carcinoma. He developed G4 neutropenia (144/mm³) on day 7 of the first course of chemotherapy, developed a fever (38.3°), and was diagnosed as having FN on day 8 of chemotherapy. In both cases, pegfilgrastim was used as secondary prophylaxis from the second course of chemotherapy, and effectively prevented further development of FN, enabling safe completion of the treatment.
　There are few reports of the experience of using pegfilgrastim for the treatment of FN in cases of head and neck carcinoma. Our experience indicates that the use of pegfilgrastim as secondary prophylaxis is also useful for preventing FN during chemotherapy in patients with head and neck cancer. But There are few reports of usage experiences of pegfilgrastim and the problems when long-term use in Japan However, further experience needs to be accumulated and the effects of long-term use still need to be evaluated in Japan.

　An endoscopic view usually provides us two-dimensional (2D) imagery while a three-dimensional (3D) image is ideal for performing surgical manipulation on the skull base as with most surgical microscopes. An endoscopy system with 3D imagery has been developed but it is not popular yet because of the expensive and limited choice of strabismus endoscopes for 3D image systems. Recently, the head-mounted display (HMD) system, a novel personalized image monitoring system, has been developed and used in a medical setting. We report here the availability of the HMD system in an endoscopic skull base surgery based on our investigative trials.

　As an advantage, a head-mounted monitor provides the sensation of immersion into the surgical field and a pseudo-3D effect to both surgeon and endoscope-holding assistant, especially while an endoscope is being moved. During surgical manipulation using a 3 or 4-handed technique by surgeon and assistant, they could perform their roles in comfortable head and body positions since the endoscopic imagery was in front of their eyes regardless of head position. In addition, when needed CT/MRI images of be superimposed on the head-mounted monitor view simply by using a foot switch. Many types of strabismus endoscopes were available for use with the HMD systems.
　On the other hand, skillful coordination among surgeon, assistant and scrub nurse was required since wearing the head-mounted device restricted the user from looking around. In addition, since a head-mounted device weighs 490 gram, a decrease in device weight may be required for extended time usage.
　In conclusion, although more improvements are desirable, the HMD system is useful in endoscopic skull base surgery when surgical staff wish to perform their manipulations comfortably and with a 3D view of the surgical field.

　The operation moving picture is useful for clinicians and medical students to study the operation. However, the video recorded recording media such as the video tape, the compact disc and Blue-ray disc are often troublesome to manage when the number of these media becomes to be large. To provide a management system by which a user can view a desirable movie at a viewing desired time is very important. So, in order to fulfill the wish, we constructed a new specially-developed server system managing an operation moving picture by ourselves.

　In our moving picture server system, the users can search the movie based on the key words as follows: the date and time of each operation, the name of the patients and operator, and the name of the operation methods and disease. They can access server system from their own computer through the local LAN only if they use their own ID and password. With respect to the robustness, the RAID-5 system is used. In addition, the data is backed up from time to time a single hard disk.

　The number of surgeon who performs ESS in sitting position is increasing in recently. ESS has been changing to be complex and difficult surgical procedure. The ESS surgeon can use bilateral foot in sitting position for several different types of foot controllers. Holding endoscope is also tight in sitting position. On the other hand, sitting position required hand-eye coordination during ESS. It is slightly taken time to learn sitting position, but there are a lot of advantages to start with sitting position in the initial education of ESS.

DIEGO^® ELITE, is a newcomer for microdebrider provided from Olympus Co.. DIEGO^® ELITE is featuring declog, gun grip, and coagulator functions. Declog is easy to remove stack clots. Gun grip shaver is very comfortable to use and easy to keep using with light weight body. And bipolar or monopolar microdebrider may reduce intraoperative blood loss and operating time during nasal polyp surgery. DIEGO^® ELITE has a great potential abilities for ESS.

　Since the navigation surgery started in otolaryngology and head and neck surgery, about 20 years has passed. The total number of institutions taken the navigation surgery was 136/163 (83%), in which the university hospital was 68 (42%), municipal hospital/medical center was 68 (42%), particularly diffusion rate rose by the university hospital. Regarding the registration, the surface method was the mainstream, and its time was shortened around 15 minutes as well as convenience. About precision and error, the intraoperative average error was one or two mm. The number of navigation surgery cases considerably increased in the nasal surgery with 11,473 cases (91%). On the other hand, the number of otology and head and neck surgery were 9%. The ratio of “the absolute need” was 36% in ear cases, 26% in nasal cases and drastically increased 71% in head and neck cases. The answer to the question “which part you were necessary to be concrete” was the confirmation of the petrous part lesion, the meatal atresia, the orientation of the subtotal excision of temporal bone, unusual cochlear implant in the otology, a paranasal cyst, a chronic sinusitis recurrence (a frontal sinus), a nasal cavity tumor (papilloma etc.), choanal atresia, a recurrence of the nasolacrimal duct in rhinology, and skull base surgery, maxillary cancer, pituitary gland surgery, clivus surgery, epipharynx angiofibroma and endoscopic endonasal skull base surgery in head and neck field. The necessity of the navigation surgery was “need” in 153/163 institutions (83%), “not need” in 0 (0%), “unclear” in 8 (5%). About the complication, three liquorrhea was reported. The development as a new technology is expected in future.

　Background: Bone contouring is currently the best treatment for fibro-osseous lesions after bone growth arrest. Navigation systems available for this surgery allow intra-operative visualization. However, assessment after contouring surgery with the navigation system has rarely been reported.

　Method: To assess the utility of this surgery we used a 3D (three dimensions) resection rate. This is defined as real contoured volume measured with postoperative CT data divided by planned volume to contour preoperatively.
　Result: We used this method to contour fibro-osseous lesions in five patients. 3D resection volume was 8114.9mm³ (3109mm³-19779mm³) in average. 3D resection rate was 63.9% (50.6%-87.7%) in average. These data present reasonable resection rate compared with other reports. All patients achieved acceptable facial contour line and improvement in symptoms.
　Conclusions: 3D resection rate is a new quantitative method measuring the rate of resected area for a targeted bulging bone. This rate presents a simple and easy assessment for surgical contouring of the orbital fibro-osseous lesions.

　Navigation system (navigation) for endoscopic sinus surgery (ESS) is useful to avoid complication of orbit, optic nerve or the base of skull. The navigation was used in 6% (111/1842) between September 2004 and July 2015. There were 61 men and 50 women with a mean age of 55 years old (16-84). ESS was performed on all patients under general anesthesia, and extranasal surgery was additionally performed on nine patients.

　The disease consisted of chronic rhinosinusitis (CRS, n=40), paranasal cysts (n=39), sinonasal tumors (n=19), fibrous dysplasia (n=4), thyroid gland ophthalmopathy (n=4), paranasal fungal diseases (n=2), idiopathic cerebrospinal fluid rhinorrhea (n=2), optic canal fracture (n=1). Frontal sinus was the most lesion to require the navigation (n=56). As reasons using the navigation in patients with CRS, there were pansinusitis (n=31), postoperative stage (n=21), and lesions adjacent to orbit or skull base (n=8).
　Using the navigation for ESS, we could safely perform on all patients without any complications during surgery. Use of the navigation is thought to be more indicated.

　Capture of the navigation screen can provide objective and accurate surgical logs. We reported our recording and multicam synchronous editing HD video system during image guided surgery.

　The use of the newly developed mobile cone-beam CT for intraoperative imaging was reported. The image quality was good enough to visualize a remaining cyst and herniated orbital contents in a frontal sinus cyst drainage, and the proper placement of the electrode and the receiver-stimulator during a cochlear implantation. Compared to intraoperative MRI, information about soft tissues were limited, however, the required time was much shorter.

　With the development of analysis technology, high-quality biological materials have been increasingly important for researches. Cryopreservation of fresh samples is recommended with regard to quality control.

　We consider that support system which enables closer cooperation with pathologists is essential for collection of tissue samples from specimens, lest the procedure should interfere with the pathological diagnosis.
　Thus, we manage to set up the platform of Biobank and establish its guideline for the acquisition, maintenance and provision of the quality of biological resources in a secure manner.

　The endoscopic skull base surgery minimally invasive approach uses the nose and sinuses as natural corridors to access tumors and lesions in critical areas at the base of the skull. This approach allows surgeons to treat many hard-to-reach tumors, even those once considered “inoperable,” without disturbing the face or skull. The role assignment of ENT doctor is, driving the endoscope and make a corridor, then reconstruct the skull base and nasal cavity. The support equipments, such as the image guided system or the high-speed burs are key to success of the endoscopic skull base surgery.