Vivian F. Kaul, Micah K. Harris, Masanari Kato, Guilherme Finger, Thomas Gao, Douglas A. Hardesty, Daniel M. Prevedello, Yin Ren, Oliver F. Adunka
Objective The aims of the study are (1) to evaluate the extended middle fossa approach (eMCF) for resection of tumors in the petroclivus and anterior cerebellopontine angle (CPA) and (2) to compare surgical outcomes between elderly (≥65 years) and nonelderly patients.
Design Retrospective cohort.
Setting Tertiary referral center.
Participants Adults with petroclival, anterior CPA, or posterior fossa lesions who underwent an eMCF approach from 2012 to 2021 were included in the study.
Main Outcome Measure Demographics, symptoms, cranial nerve (CN) function, and postoperative outcomes.
Results Twenty-nine patients (mean age of 55 years, 59% females) were identified. Eleven (38%) were ≥65 years (65–79 years). The most common pathology was meningioma (n = 13, 45%), followed by vestibular schwannoma (n = 4, 14%) and squamous cell carcinoma (n = 3, 10%). Nineteen tumors (65.5%) were located in the petroclivus, 7 (24%) involved the cavernous sinus, and 10 (34%) were located in the posterior fossa. The mean tumor maximal diameter was 3.4 cm (range: 1.3–7.9 cm). Gross total tumor resection was accomplished in 15 (52%) patients. Most patients (n = 23, 79%) did not develop new CN deficits postoperatively. Of the 13 patients who had complete pre- and postoperative audiometric data, 69% (n = 9) maintained their hearing. Comparing the elderly versus nonelderly patients, there were no significant differences in the development of new CN palsies (p = 0.14), length of stay (p = 0.91), or incidence of postoperative complications (p = 0.30).
Conclusions The eMCF approach provides exposure to the petroclival region, anterior CPA cistern, and posterior fossa for a variety of pathologies. It has a favorable safety profile in the elderly (≥65 years) population with low morbidity.
{"title":"Outcomes of Extended Middle Fossa Approach for Petroclival Tumors in the Elderly","authors":"Vivian F. Kaul, Micah K. Harris, Masanari Kato, Guilherme Finger, Thomas Gao, Douglas A. Hardesty, Daniel M. Prevedello, Yin Ren, Oliver F. Adunka","doi":"10.1055/a-2219-2551","DOIUrl":"https://doi.org/10.1055/a-2219-2551","url":null,"abstract":"<p>\u0000<b>Objective</b> The aims of the study are (1) to evaluate the extended middle fossa approach (eMCF) for resection of tumors in the petroclivus and anterior cerebellopontine angle (CPA) and (2) to compare surgical outcomes between elderly (≥65 years) and nonelderly patients.</p> <p>\u0000<b>Design</b> Retrospective cohort.</p> <p>\u0000<b>Setting</b> Tertiary referral center.</p> <p>\u0000<b>Participants</b> Adults with petroclival, anterior CPA, or posterior fossa lesions who underwent an eMCF approach from 2012 to 2021 were included in the study.</p> <p>\u0000<b>Main Outcome Measure</b> Demographics, symptoms, cranial nerve (CN) function, and postoperative outcomes.</p> <p>\u0000<b>Results</b> Twenty-nine patients (mean age of 55 years, 59% females) were identified. Eleven (38%) were ≥65 years (65–79 years). The most common pathology was meningioma (<i>n</i> = 13, 45%), followed by vestibular schwannoma (<i>n</i> = 4, 14%) and squamous cell carcinoma (<i>n</i> = 3, 10%). Nineteen tumors (65.5%) were located in the petroclivus, 7 (24%) involved the cavernous sinus, and 10 (34%) were located in the posterior fossa. The mean tumor maximal diameter was 3.4 cm (range: 1.3–7.9 cm). Gross total tumor resection was accomplished in 15 (52%) patients. Most patients (<i>n</i> = 23, 79%) did not develop new CN deficits postoperatively. Of the 13 patients who had complete pre- and postoperative audiometric data, 69% (<i>n</i> = 9) maintained their hearing. Comparing the elderly versus nonelderly patients, there were no significant differences in the development of new CN palsies (<i>p</i> = 0.14), length of stay (<i>p</i> = 0.91), or incidence of postoperative complications (<i>p</i> = 0.30).</p> <p>\u0000<b>Conclusions</b> The eMCF approach provides exposure to the petroclival region, anterior CPA cistern, and posterior fossa for a variety of pathologies. It has a favorable safety profile in the elderly (≥65 years) population with low morbidity.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"38 5 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives The aim of this study was to determine the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (CE-MRI) for the detection of perineural spread (PNS) in head and neck cancer patients. Methods A systematic review of PubMed, Embase, Scopus, Web of Science and Cochrane Library databases was performed up to May 20, 2022. We included diagnostic accuracy studies that used CE-MRI for the diagnosis of PNS in patients with head and neck cancer, using histopathology from surgical specimens as the reference standard. Potential bias and applicability of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADUS-2) tool. Pooled joint effect sizes of sensitivity and specificity were calculated by applying bivariate random-effects meta-analysis model. Results Nine studies with 259 patients were included. The pooled sensitivity and specificity of CE-MRI for detecting PNS were 89% (95% confidence interval [CI]: 73–96) and 83% (95% CI: 73–90), respectively. Stratifying by MRI strength, 1.5 T had a higher sensitivity of 97% (95% CI: 47–100) compared with 3 T, which had a sensitivity of 83% (95% CI: 72–90). Both 1.5- and 3-T MRI had a similar specificity in detecting PNS of 85% (95% CI: 63–95) and 84% (95% CI: 75–91), respectively. Conclusions CE-MRI provides good diagnostic test accuracy for the detection of PNS in head and neck cancer. Current evidence suggests 1.5-T MRI provides greater sensitivity compared with 3-T MRI.
{"title":"Diagnostic Accuracy of Contrast-Enhanced MRI for Detection of Perineural Spread in Head and Neck Cancer: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1055/s-0043-1777793","DOIUrl":"https://doi.org/10.1055/s-0043-1777793","url":null,"abstract":"Objectives The aim of this study was to determine the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (CE-MRI) for the detection of perineural spread (PNS) in head and neck cancer patients. Methods A systematic review of PubMed, Embase, Scopus, Web of Science and Cochrane Library databases was performed up to May 20, 2022. We included diagnostic accuracy studies that used CE-MRI for the diagnosis of PNS in patients with head and neck cancer, using histopathology from surgical specimens as the reference standard. Potential bias and applicability of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADUS-2) tool. Pooled joint effect sizes of sensitivity and specificity were calculated by applying bivariate random-effects meta-analysis model. Results Nine studies with 259 patients were included. The pooled sensitivity and specificity of CE-MRI for detecting PNS were 89% (95% confidence interval [CI]: 73–96) and 83% (95% CI: 73–90), respectively. Stratifying by MRI strength, 1.5 T had a higher sensitivity of 97% (95% CI: 47–100) compared with 3 T, which had a sensitivity of 83% (95% CI: 72–90). Both 1.5- and 3-T MRI had a similar specificity in detecting PNS of 85% (95% CI: 63–95) and 84% (95% CI: 75–91), respectively. Conclusions CE-MRI provides good diagnostic test accuracy for the detection of PNS in head and neck cancer. Current evidence suggests 1.5-T MRI provides greater sensitivity compared with 3-T MRI.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"25 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parker Tumlin, Zayd Al-Asadi, Meghan Turner, Hassan H. Ramadan, Chadi A. Makary
Background Prior studies showed that female patients with chronic rhinosinusitis (CRS) suffer a worse disease-specific quality of life (QoL).
Goal The aim of this study is to investigate gender differences in sinonasal QoL outcomes in patients requiring endoscopic endonasal skull base surgeries (EESBS).
Methods Cross-sectional analysis of patients presenting to our clinic from August 2020 to December 2022 with skull base tumors, spontaneous cerebrospinal fluid (CSF) rhinorrhea, or Grave's orbitopathy (for orbital decompression) was performed. Baseline and postsurgical QoL were measured using the 22-item Sinonasal Outcome Test (SNOT-22). Patients' demographics and comorbidities were reviewed. Patients with concomitant CRS were excluded.
Results Eighty-six patients were included (54 with skull base tumors, 17 Grave's orbitopathy, and 15 spontaneous CSF rhinorrhea). The mean age of the patients was 52 years (range: 12.4–81.5 years), and 51.6% of the patients were females. There was no age difference between female and male patients. Smoking history, asthma, and allergic rhinitis were also similar between the two groups. Female patients had a significantly higher incidence of depression (58.3 vs. 32.4%, p = 0.018) and migraine (50.0 vs. 21.6%, p = 0.007). Female patients had a significantly worse overall SNOT-22 scores at baseline (33.6 vs. 18.2, p = 0.001), at the 3-month follow-up (29.7 vs. 15.5, p = 0.002), and at the 6-month follow-up (33.5 vs. 14.9, p = 0.005). This worse QoL was seen mainly in the ear/facial, sleep, and psychological domains. Linear regression of the SNOT-22 scores and its subdomains adjusting for comorbidities showed that migraine was found to be the most significant determinant of gender differences in the QoL.
Conclusion Female patients who undergo EESBS show higher overall SNOT-22 scores secondary to higher incidence of migraine.
既往研究表明，女性慢性鼻窦炎(CRS)患者的疾病特异性生活质量(QoL)较差。目的探讨鼻内镜下颅底手术(EESBS)患者鼻窦生活质量的性别差异。方法对2020年8月至2022年12月在我院就诊的颅底肿瘤、自发性脑脊液(CSF)鼻漏或graves眼病(眼眶减压)患者进行横断面分析。基线和术后生活质量采用22项鼻窦预后测试(SNOT-22)进行测量。回顾了患者的人口统计学和合并症。排除伴有CRS的患者。结果本组共86例，其中颅底肿瘤54例，graves眼病17例，自发性脑脊液鼻漏15例。患者平均年龄52岁(12.4 ~ 81.5岁)，女性占51.6%。男女患者无年龄差异。吸烟史、哮喘和过敏性鼻炎在两组之间也相似。女性患者抑郁症(58.3%比32.4%，p = 0.018)和偏头痛(50.0%比21.6%，p = 0.007)的发生率显著高于女性患者。女性患者在基线时(33.6 vs. 18.2, p = 0.001)、3个月随访时(29.7 vs. 15.5, p = 0.002)和6个月随访时(33.5 vs. 14.9, p = 0.005)的SNOT-22总分明显较差。这种较差的生活质量主要出现在耳朵/面部、睡眠和心理领域。对SNOT-22评分及其调整合并症的子域进行线性回归，发现偏头痛是影响生活质量性别差异的最显著因素。结论接受EESBS治疗的女性患者在偏头痛发生率较高的同时，SNOT-22评分也较高。
{"title":"Gender Differences in Quality-of-Life Outcome in Patients Undergoing Endoscopic Endonasal Skull Base Surgery","authors":"Parker Tumlin, Zayd Al-Asadi, Meghan Turner, Hassan H. Ramadan, Chadi A. Makary","doi":"10.1055/a-2215-6027","DOIUrl":"https://doi.org/10.1055/a-2215-6027","url":null,"abstract":"<p>\u0000<b>Background</b> Prior studies showed that female patients with chronic rhinosinusitis (CRS) suffer a worse disease-specific quality of life (QoL).</p> <p>\u0000<b>Goal</b> The aim of this study is to investigate gender differences in sinonasal QoL outcomes in patients requiring endoscopic endonasal skull base surgeries (EESBS).</p> <p>\u0000<b>Methods</b> Cross-sectional analysis of patients presenting to our clinic from August 2020 to December 2022 with skull base tumors, spontaneous cerebrospinal fluid (CSF) rhinorrhea, or Grave's orbitopathy (for orbital decompression) was performed. Baseline and postsurgical QoL were measured using the 22-item Sinonasal Outcome Test (SNOT-22). Patients' demographics and comorbidities were reviewed. Patients with concomitant CRS were excluded.</p> <p>\u0000<b>Results</b> Eighty-six patients were included (54 with skull base tumors, 17 Grave's orbitopathy, and 15 spontaneous CSF rhinorrhea). The mean age of the patients was 52 years (range: 12.4–81.5 years), and 51.6% of the patients were females. There was no age difference between female and male patients. Smoking history, asthma, and allergic rhinitis were also similar between the two groups. Female patients had a significantly higher incidence of depression (58.3 vs. 32.4%, <i>p</i> = 0.018) and migraine (50.0 vs. 21.6%, <i>p</i> = 0.007). Female patients had a significantly worse overall SNOT-22 scores at baseline (33.6 vs. 18.2, <i>p</i> = 0.001), at the 3-month follow-up (29.7 vs. 15.5, <i>p</i> = 0.002), and at the 6-month follow-up (33.5 vs. 14.9, <i>p</i> = 0.005). This worse QoL was seen mainly in the ear/facial, sleep, and psychological domains. Linear regression of the SNOT-22 scores and its subdomains adjusting for comorbidities showed that migraine was found to be the most significant determinant of gender differences in the QoL.</p> <p>\u0000<b>Conclusion</b> Female patients who undergo EESBS show higher overall SNOT-22 scores secondary to higher incidence of migraine.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"22 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction The first line treatment for prolactinomas is currently dopamine agonists (DAs). Medical management is prolonged, associated with side effects, financial, and psychological burdens. In dedicated centers, pituitary surgery is a low-risk alternative. We evaluated outcome measures of medical and surgical treatment, to assess, if the role of surgery is underestimated.
Methods We reviewed the charts of 4,660 pituitary patients, managed at the University of Colorado, from 2004 to 2019. The final analysis included 154 patients with prolactinomas, managed medically, and 120 patients, treated surgically. Primary outcome measures were percentage of tumor volume reduction and prolactin level (ng/mL). Mann–Whitney test was used for quantitative variables, contingency tables, and chi-square tests for qualitative variables. Statistical significance was set at p < 0.05.
Results DAs alone were more frequently used for microprolactinomas and Knosp grade 0 adenomas. Surgery was more often performed for macroprolactinomas, giant adenomas, tumors with suprasellar extension, mixed consistency, and sellar floor erosion. Among macroprolactinomas, mean tumor volume reduction after treatment with DAs alone, DAs and surgery, and surgery alone was 53.8, 94.9, and 94.1%, respectively. Prolactin levels after treatment were not significantly different. Continuous DA treatment was required in 94.3% patients in the medical group versus 39.6% in the surgical group.
Conclusions Surgery for macroprolactinomas achieved greater tumor volume reduction and dose reduction or discontinuation of DAs. Prolactin levels achieved did not differ significantly between the groups. Over 60% of patients, undergoing surgery, were able to discontinue DAs. The current treatment paradigm may underestimate the role of surgery in the management of prolactinomas.
{"title":"Outcome Measures for Medical and Surgical Treatment of Prolactinomas. Is the Role of Surgery Underestimated?","authors":"Andrius Anuzis, Kevin O. Lillehei","doi":"10.1055/a-2212-0504","DOIUrl":"https://doi.org/10.1055/a-2212-0504","url":null,"abstract":"<p>\u0000<b>Introduction</b> The first line treatment for prolactinomas is currently dopamine agonists (DAs). Medical management is prolonged, associated with side effects, financial, and psychological burdens. In dedicated centers, pituitary surgery is a low-risk alternative. We evaluated outcome measures of medical and surgical treatment, to assess, if the role of surgery is underestimated.</p> <p>\u0000<b>Methods</b> We reviewed the charts of 4,660 pituitary patients, managed at the University of Colorado, from 2004 to 2019. The final analysis included 154 patients with prolactinomas, managed medically, and 120 patients, treated surgically. Primary outcome measures were percentage of tumor volume reduction and prolactin level (ng/mL). Mann–Whitney test was used for quantitative variables, contingency tables, and chi-square tests for qualitative variables. Statistical significance was set at <i>p</i> < 0.05.</p> <p>\u0000<b>Results</b> DAs alone were more frequently used for microprolactinomas and Knosp grade 0 adenomas. Surgery was more often performed for macroprolactinomas, giant adenomas, tumors with suprasellar extension, mixed consistency, and sellar floor erosion. Among macroprolactinomas, mean tumor volume reduction after treatment with DAs alone, DAs and surgery, and surgery alone was 53.8, 94.9, and 94.1%, respectively. Prolactin levels after treatment were not significantly different. Continuous DA treatment was required in 94.3% patients in the medical group versus 39.6% in the surgical group.</p> <p>\u0000<b>Conclusions</b> Surgery for macroprolactinomas achieved greater tumor volume reduction and dose reduction or discontinuation of DAs. Prolactin levels achieved did not differ significantly between the groups. Over 60% of patients, undergoing surgery, were able to discontinue DAs. The current treatment paradigm may underestimate the role of surgery in the management of prolactinomas.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"64 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haydn Hoffman, Brendan B. Maloney, Dan Y. Draytsel, Harish Babu
Objectives We sought to perform a systematic review and meta-analysis of outcomes after surgical resection of jugular foramen schwannomas (JFSs).
Design A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Setting PubMed, Scopus, and Embase databases were searched.
Participants Case series of at least five patients undergoing surgical resection of JFSs were included.
Main Outcome Measures Primary outcomes included gross total resection (GTR) and near total resection (NTR) rates, as well as a composite of the two (GTR + NTR). Additional outcomes included new or worsening cranial nerve (CN) palsies and cerebrospinal fluid (CSF) leak. Random effects models were used to generate pooled outcomes.
Results A total of 25 studies comprising 567 patients were included in the study. The proportions of each tumor grade were the following: grade A (33.1%), grade B (16.1%), grade C (9.2%), and grade D (41.6%). The pooled rate of GTR was 81% (95% confidence interval [CI]: 70–88; I2 = 78.9%) and the composite GTR + NTR rate was 88% (95% CI: 81–93; I2 = 66.4%). Rates of new or worsening CN palsies were the following: 12% hearing loss (95% CI: 7–20; I2 = 69.4%), 27% dysphagia (95% CI: 20–36; I2 = 66%), 20% hoarseness (95% CI: 14–28; I2 = 62.6%), and 19% facial palsy (95% CI: 13–28; I2 = 64.6%). The pooled rate of CSF leak was 9% (95% CI: 6–15; I2 = 43.9%).
Conclusion The literature suggests high GTR rates of JFSs can be achieved. However, new CN deficits are not uncommon.
{"title":"Outcomes after Surgical Resection of Jugular Foramen Schwannomas: Systematic Review and Meta-Analysis","authors":"Haydn Hoffman, Brendan B. Maloney, Dan Y. Draytsel, Harish Babu","doi":"10.1055/a-2215-6209","DOIUrl":"https://doi.org/10.1055/a-2215-6209","url":null,"abstract":"<p>\u0000<b>Objectives</b> We sought to perform a systematic review and meta-analysis of outcomes after surgical resection of jugular foramen schwannomas (JFSs).</p> <p>\u0000<b>Design</b> A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p> <p>\u0000<b>Setting</b> PubMed, Scopus, and Embase databases were searched.</p> <p>\u0000<b>Participants</b> Case series of at least five patients undergoing surgical resection of JFSs were included.</p> <p>\u0000<b>Main Outcome Measures</b> Primary outcomes included gross total resection (GTR) and near total resection (NTR) rates, as well as a composite of the two (GTR + NTR). Additional outcomes included new or worsening cranial nerve (CN) palsies and cerebrospinal fluid (CSF) leak. Random effects models were used to generate pooled outcomes.</p> <p>\u0000<b>Results</b> A total of 25 studies comprising 567 patients were included in the study. The proportions of each tumor grade were the following: grade A (33.1%), grade B (16.1%), grade C (9.2%), and grade D (41.6%). The pooled rate of GTR was 81% (95% confidence interval [CI]: 70–88; <i>I</i>\u0000<sup>2</sup> = 78.9%) and the composite GTR + NTR rate was 88% (95% CI: 81–93; <i>I</i>\u0000<sup>2</sup> = 66.4%). Rates of new or worsening CN palsies were the following: 12% hearing loss (95% CI: 7–20; <i>I</i>\u0000<sup>2</sup> = 69.4%), 27% dysphagia (95% CI: 20–36; <i>I</i>\u0000<sup>2</sup> = 66%), 20% hoarseness (95% CI: 14–28; <i>I</i>\u0000<sup>2</sup> = 62.6%), and 19% facial palsy (95% CI: 13–28; <i>I</i>\u0000<sup>2</sup> = 64.6%). The pooled rate of CSF leak was 9% (95% CI: 6–15; <i>I</i>\u0000<sup>2</sup> = 43.9%).</p> <p>\u0000<b>Conclusion</b> The literature suggests high GTR rates of JFSs can be achieved. However, new CN deficits are not uncommon.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"6 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Abiri, Derek H. Liu, Theodore V Nguyen, Jonathan C. Pang, Sina J. Torabi, Edward C Kuan
Background: There is emerging evidence to suggest the role of induction chemotherapy (IC) in definitive management of locoregionally advanced sinonasal squamous cell carcinoma (SNSCC). We evaluated the influence of IC on survival and predictors of its use in SNSCC patients. Methods: The 2004-2017 National Cancer Database was queried for patients with locoregionally advanced SNSCC (T4/M0). Treatments were stratified into 7 groups: definitive chemoradiation (CRT), IC with definitive CRT (IC+CRT), IC+CRT with salvage surgery (IC+CRT+Sx), definitive surgery (Sx), IC with definitive surgery (IC+Sx), definitive surgery with adjuvant radiation or CRT (Sx+ATx), or IC+Sx+ATx. Cox proportional-hazards regression assessed overall survival (OS) and logistic regression identified predictors of IC. Results: Of 3162 patients, 1088 (34.4%) were female with a mean age of 63.4 ± 13.4 years. The 2- and 5-year OS rates were 58.6% and 42.0%, respectively. Compared to CRT, Sx+ATx (HR: 0.663; p<0.001), IC+Sx (HR: 0.606; p=0.005), or IC+Sx+ATx (HR: 0.468; p=0.001) exhibited reduced mortality. Among patients who were treated with definitive surgery, those receiving IC had additional OS benefit (all p<0.05). Older age (OR: 0.607; p<0.001), female sex (OR: 0.759; p=0.028), black race (OR: 1.650; p<0.001, T4b stage (OR: 1.674; p<0.001), and higher N stage (OR: 1.395; p<0.001) were predictors of IC. Conclusions: IC prior to definitive surgery with or without adjuvant therapy exhibited the highest OS for locoregionally advanced SNSCC. Age, sex, race, and T/N staging were predictors of IC. Multimodal treatment regimens involving surgery as the primary modality may, therefore, provide the greatest therapeutic response.
{"title":"Induction Chemotherapy for Locoregionally Advanced Sinonasal Squamous Cell Carcinoma","authors":"A. Abiri, Derek H. Liu, Theodore V Nguyen, Jonathan C. Pang, Sina J. Torabi, Edward C Kuan","doi":"10.1055/a-2226-8414","DOIUrl":"https://doi.org/10.1055/a-2226-8414","url":null,"abstract":"Background: There is emerging evidence to suggest the role of induction chemotherapy (IC) in definitive management of locoregionally advanced sinonasal squamous cell carcinoma (SNSCC). We evaluated the influence of IC on survival and predictors of its use in SNSCC patients.\u0000Methods: The 2004-2017 National Cancer Database was queried for patients with locoregionally advanced SNSCC (T4/M0). Treatments were stratified into 7 groups: definitive chemoradiation (CRT), IC with definitive CRT (IC+CRT), IC+CRT with salvage surgery (IC+CRT+Sx), definitive surgery (Sx), IC with definitive surgery (IC+Sx), definitive surgery with adjuvant radiation or CRT (Sx+ATx), or IC+Sx+ATx. Cox proportional-hazards regression assessed overall survival (OS) and logistic regression identified predictors of IC.\u0000Results: Of 3162 patients, 1088 (34.4%) were female with a mean age of 63.4 ± 13.4 years. The 2- and 5-year OS rates were 58.6% and 42.0%, respectively. Compared to CRT, Sx+ATx (HR: 0.663; p<0.001), IC+Sx (HR: 0.606; p=0.005), or IC+Sx+ATx (HR: 0.468; p=0.001) exhibited reduced mortality. Among patients who were treated with definitive surgery, those receiving IC had additional OS benefit (all p<0.05). Older age (OR: 0.607; p<0.001), female sex (OR: 0.759; p=0.028), black race (OR: 1.650; p<0.001, T4b stage (OR: 1.674; p<0.001), and higher N stage (OR: 1.395; p<0.001) were predictors of IC.\u0000Conclusions: IC prior to definitive surgery with or without adjuvant therapy exhibited the highest OS for locoregionally advanced SNSCC. Age, sex, race, and T/N staging were predictors of IC. Multimodal treatment regimens involving surgery as the primary modality may, therefore, provide the greatest therapeutic response.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"31 2","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rose Dimitroyannis, Sharanya Thodupunoori, Sean Polster, Paramita Das, Christopher R. Roxbury
Background: There has been increased interest in how residents train in the subspecialty of skull base surgery. Examining which training methods are popular and effective to optimize residency learning is necessary, especially with new training adjuncts available to the modern trainee. In this study, we survey North American Skull Base Society (NASBS) members to analyze endoscopic skull base surgery education methods. Methods: The NASBS membership was surveyed regarding endoscopic skull base surgery teaching and feedback methods using a Likert scale via an anonymized REDCAP form over four months. Results: With a response rate of 10.1%, we found that informal teaching methods and verbal qualitative feedback were rated significantly more effective than other teaching and feedback methods (p<0.01). When comparing the opinions of otolaryngologists and neurosurgeons, otolaryngologists were less likely to believe feedback is most effective with a shared grading scale (p<0.01). Physicians with more than ten years of experience post-training felt model-based and rubric-based teaching were used more frequently (p<0.01). Respondents indicated that standardization and use of simulation, artificial intelligence, and virtual reality should be at the forefront of educational practices used in the field in the coming 5-10 years. Conclusion: Despite the current emphasis on informal training, respondents pointed to standardization and simulation as methods of endoscopic skull base surgery education that should be used more in the future. These results indicate an unmet need in skull base education. Future multi-institutional initiatives with NASBS membership participation are warranted.
{"title":"Residency Education Practices in Endoscopic Skull Base Surgery","authors":"Rose Dimitroyannis, Sharanya Thodupunoori, Sean Polster, Paramita Das, Christopher R. Roxbury","doi":"10.1055/a-2226-8294","DOIUrl":"https://doi.org/10.1055/a-2226-8294","url":null,"abstract":"Background: There has been increased interest in how residents train in the subspecialty of skull base surgery. Examining which training methods are popular and effective to optimize residency learning is necessary, especially with new training adjuncts available to the modern trainee. In this study, we survey North American Skull Base Society (NASBS) members to analyze endoscopic skull base surgery education methods. \u0000 \u0000Methods: The NASBS membership was surveyed regarding endoscopic skull base surgery teaching and feedback methods using a Likert scale via an anonymized REDCAP form over four months. \u0000 \u0000Results: With a response rate of 10.1%, we found that informal teaching methods and verbal qualitative feedback were rated significantly more effective than other teaching and feedback methods (p<0.01). When comparing the opinions of otolaryngologists and neurosurgeons, otolaryngologists were less likely to believe feedback is most effective with a shared grading scale (p<0.01). Physicians with more than ten years of experience post-training felt model-based and rubric-based teaching were used more frequently (p<0.01). Respondents indicated that standardization and use of simulation, artificial intelligence, and virtual reality should be at the forefront of educational practices used in the field in the coming 5-10 years. \u0000\u0000Conclusion: Despite the current emphasis on informal training, respondents pointed to standardization and simulation as methods of endoscopic skull base surgery education that should be used more in the future. These results indicate an unmet need in skull base education. Future multi-institutional initiatives with NASBS membership participation are warranted.\u0000","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"13 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joachim Starup-Hansen, Simon Williams, Alexandra Valetopoulou, Danyal Z. Khan, H. Layard Horsfall, Jigishaa Moudgil-Joshi, Oliver Burton, Hala Kanona, Shakeel Saeed, William Muirhead, Hani J. Marcus, Patrick Grover
Objective: Despite advances in skull-base reconstruction techniques, CSF leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery. Methods: A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesised into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described. Results: All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extra-cranial soft tissue, post-operative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR 1.3%-8.44%). Conclusions: The intra-operative strategies used to prevent CSF leaks during RS VS surgery vary significantly between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multi-centre service evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol.
{"title":"Skull base repair following resection of vestibular schwannoma: a systematic review (Part 1: The Retrosigmoid Approach)","authors":"Joachim Starup-Hansen, Simon Williams, Alexandra Valetopoulou, Danyal Z. Khan, H. Layard Horsfall, Jigishaa Moudgil-Joshi, Oliver Burton, Hala Kanona, Shakeel Saeed, William Muirhead, Hani J. Marcus, Patrick Grover","doi":"10.1055/a-2222-0184","DOIUrl":"https://doi.org/10.1055/a-2222-0184","url":null,"abstract":"Objective: Despite advances in skull-base reconstruction techniques, CSF leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery.\u0000\u0000Methods: A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesised into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described.\u0000\u0000Results: All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extra-cranial soft tissue, post-operative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR 1.3%-8.44%).\u0000\u0000Conclusions: The intra-operative strategies used to prevent CSF leaks during RS VS surgery vary significantly between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multi-centre service evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"17 23","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joachim Starup-Hansen, Simon Williams, Alexandra Valetopoulou, Danyal Z. Khan, H. Layard Horsfall, Jigishaa Moudgil-Joshi, Oliver Burton, Hala Kanona, Shakeel Saeed, William Muirhead, Hani J. Marcus, Patrick Grover
Objectives: Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesise the repair techniques and materials used in TL VS surgery to prevent CSF leaks. Design: A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted. Results: All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, post-operative dressings and CSF diversion. The median post-operative incidence of CSF leaks was 6% (IQR 0-10%). Conclusions: This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that consider all operative stages described by our taxonomy.
{"title":"Skull base repair following resection of vestibular schwannoma: a systematic review (Part 2: The Translabyrinthine Approach)","authors":"Joachim Starup-Hansen, Simon Williams, Alexandra Valetopoulou, Danyal Z. Khan, H. Layard Horsfall, Jigishaa Moudgil-Joshi, Oliver Burton, Hala Kanona, Shakeel Saeed, William Muirhead, Hani J. Marcus, Patrick Grover","doi":"10.1055/a-2222-0016","DOIUrl":"https://doi.org/10.1055/a-2222-0016","url":null,"abstract":"Objectives: \u0000Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesise the repair techniques and materials used in TL VS surgery to prevent CSF leaks. \u0000\u0000Design: A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted.\u0000\u0000Results: All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, post-operative dressings and CSF diversion. The median post-operative incidence of CSF leaks was 6% (IQR 0-10%).\u0000\u0000Conclusions: This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that consider all operative stages described by our taxonomy.\u0000","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"63 9","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138604932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter M. Wingrove, Keerthi N. Arani, Carl H. Snyderman, Paul A. Gardner, David T. Fernandes Cabral, Georgios A. Zenonos, Eric W. Wang, Joseph Chabot, Juan C. Fernandez-Miranda, Yue-Fang Chang, Marion A. Hughes
Objectives Our objective was to determine if decreased contrast enhancement on postoperative magnetic resonance imaging (MRI) is associated with an increased risk of complication in patients who have undergone nasoseptal flap (NSF) reconstruction.
Design/Setting This was a single-institution retrospective study of patients who underwent a first-time endoscopic endonasal approach (EEA) with NSF reconstruction.
Participants Patients underwent an EEA to the skull base with NSF reconstruction and received postoperative MRI within 3 weeks of the operation.
Main Outcome Measures MR exams were scored on the degree of contrast enhancement at first postoperative MRI. An enhancement score of 4 indicated ≥75% enhancement of the NSF. A score of 3 indicated enhancement ≥50% and <75% enhancement of the NSF. A score of 2 indicated ≥25% and <50% enhancement of the NSF. Complications (e.g., cerebrospinal fluid [CSF] leak, meningitis, empyema, cerebritis, brain abscess, flap necrosis, and flap migration) were retrieved from our institution's skull base database. Logistic regression was used to determine the effect of the MRI enhancement score on the odds of developing a complication.
Results Out of 99 patients in the study, six had complications. Patients who underwent NSF reconstruction of skull base defects were found to have 19 times higher odds of complication (p = 0.007) if they had had an NSF enhancement score of 2 on their postoperative MRI when compared with patients with complete or near complete NSF enhancement (score 4).
Conclusions Quantifying NSF enhancement with an MRI may help surgeons better predict which of their patients are at an increased risk of complication.
{"title":"Association of Decreased Enhancement of Nasoseptal Flap on Postoperative Magnetic Resonance Imaging with the Risk of Complication","authors":"Peter M. Wingrove, Keerthi N. Arani, Carl H. Snyderman, Paul A. Gardner, David T. Fernandes Cabral, Georgios A. Zenonos, Eric W. Wang, Joseph Chabot, Juan C. Fernandez-Miranda, Yue-Fang Chang, Marion A. Hughes","doi":"10.1055/s-0043-1776007","DOIUrl":"https://doi.org/10.1055/s-0043-1776007","url":null,"abstract":"<p>\u0000<b>Objectives</b> Our objective was to determine if decreased contrast enhancement on postoperative magnetic resonance imaging (MRI) is associated with an increased risk of complication in patients who have undergone nasoseptal flap (NSF) reconstruction.</p> <p>\u0000<b>Design/Setting</b> This was a single-institution retrospective study of patients who underwent a first-time endoscopic endonasal approach (EEA) with NSF reconstruction.</p> <p>\u0000<b>Participants</b> Patients underwent an EEA to the skull base with NSF reconstruction and received postoperative MRI within 3 weeks of the operation.</p> <p>\u0000<b>Main Outcome Measures</b> MR exams were scored on the degree of contrast enhancement at first postoperative MRI. An enhancement score of 4 indicated ≥75% enhancement of the NSF. A score of 3 indicated enhancement ≥50% and <75% enhancement of the NSF. A score of 2 indicated ≥25% and <50% enhancement of the NSF. Complications (e.g., cerebrospinal fluid [CSF] leak, meningitis, empyema, cerebritis, brain abscess, flap necrosis, and flap migration) were retrieved from our institution's skull base database. Logistic regression was used to determine the effect of the MRI enhancement score on the odds of developing a complication.</p> <p>\u0000<b>Results</b> Out of 99 patients in the study, six had complications. Patients who underwent NSF reconstruction of skull base defects were found to have 19 times higher odds of complication (<i>p</i> = 0.007) if they had had an NSF enhancement score of 2 on their postoperative MRI when compared with patients with complete or near complete NSF enhancement (score 4).</p> <p>\u0000<b>Conclusions</b> Quantifying NSF enhancement with an MRI may help surgeons better predict which of their patients are at an increased risk of complication.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"36 5-6","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138509915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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