Background We aimed to determine the incidence and risk factors for development of diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) after transsphenoidal hypophysectomy (TSH) for resection of a pituitary adenoma.
Methods This was a retrospective study of 403 adult patients undergoing TSH for pituitary adenoma. Clinical variables, tumor characteristics, and operative factors were collected. Incidences of DI and SIADH were determined, including timing in the perioperative period. Independent predictors of developing DI and SIADH were identified using multivariable logistic regression.
Results Following TSH, 21.3% of patients developed DI at a mean 2.6 days and 7.4% developed SIADH at a mean 4.7 days. DI was negatively associated with older age (odds ratio [OR] = 0.98, 95% confidence interval [CI]: 0.96–0.99, p = 0.029). DI was positively associated with female sex (OR = 2.26, 95% CI: 1.24–4.11, p = 0.008), increase in anteroposterior tumor size (OR = 1.54, 95% CI: 1.11–2.13, p = 0.010), intraoperative cerebrospinal fluid (CSF) leak (OR = 2.29, 95% CI: 1.25–4.19, p = 0.008), and every 100 mL of estimated blood loss (EBL) (OR = 1.18, 95% CI: 1.01–1.39, p = 0.046). Development of SIADH was positively associated with intraoperative CSF leak (OR = 3.56, 95% CI: 1.24–10.21, p = 0.018) on multivariate analysis.
Conclusion DI and SIADH occur in the minority of patients undergoing TSH, but vigilance for their development must be maintained for days after the surgery. Development of DI after TSH is multifactorial, having possible patient-specific risk factors and risk related to the complexity of surgical dissection, reflected by tumor size, intraoperative CSF leak, and EBL. Development of SIADH could be associated with intraoperative CSF leak occurrence.
Introduction Social determinants of health (SDOH) are associated with differential outcomes after pituitary tumor treatment. However, the specific impact of SDOH is not well characterized. One reason may be the lack of collection and reporting of sociodemographic variables in the literature. This study aims to evaluate the frequency of reporting and distribution of participants' sex, race, ethnicity, income, and education level within pituitary surgery literature. We will compare the reported clinical research population demographics to the 2020 U.S. census.
Methods A systematic review was performed by searching PubMed, Cochrane, and Embase databases for pituitary surgery clinical research published between July 1, 2021 to June 30, 2022. We excluded studies that lacked a comparison group, were not original research (i.e., systematic reviews, meta-analysis), or included national databases and registry data.
Results The final analysis included 92 studies. A total of 99% of studies collected data on subject sex. On average 49% (range: 14–100%) of study populations were male. Only 4% (n = 4) studies included racial demographic data. Two studies included information on participants' ethnicity and two included education background. No studies included income or insurance data. Four U.S. studies included demographic distribution, and the reported race and ethnicity percentages are similar to the U.S. 2020 census distribution.
Conclusions Most clinical pituitary research collects and reports data on participant sex. However, very few studies collect and report data on other sociodemographic variables that can play a role in outcomes. The lack of sociodemographic information in clinical research literature makes it difficult to determine the role of SDOH on pituitary surgery outcomes.
Background Transpterygoid approaches to the skull base require dissection of the sphenopalatine artery, potentially compromising the option to harvest an ipsilateral nasoseptal flap (NSF) for reconstruction. In cases where other reconstructive options are limited, it may be necessary to utilize a NSF ipsilateral to the transpterygoid approach. Here, we describe the technique of NSF pedicle preservation with reconstruction outcomes.
Methods This was a retrospective single-institution review of all expanded endonasal skull base cases utilizing a NSF ipsilateral to a transpterygoid approach. Reconstruction outcomes collected include intraoperative fluorescence with indocyanine green (ICG), postoperative magnetic resonance imaging (MRI) gadolinium enhancement, endoscopic assessment, and reconstruction-related complications.
Results Twenty-one cases were included in this study (mean age 51.0 ± 20.6 years, 61.9% female). Indications for NSF ipsilateral to the transpterygoid approach included: bilateral transpterygoid approach (52.4%), revision reconstruction (23.8%), or significant septal deviation (19.0%). Twelve of 14 (85.7%) flaps demonstrated intraoperative perfusion with ICG, 15 of 15 (100%) enhanced on postoperative MRI, and 21 of 21 (100%) flaps had a healthy, viable appearance on postoperative endoscopy. There were no instances of flap necrosis or postoperative cerebrospinal fluid leaks. Technical keys to optimize mobilization of the pedicle include wide decompression of the sphenopalatine foramen and release of neurovascular tethering points of the pterygopalatine fossa. These steps allow for wide skull base exposure with preservation of the sphenopalatine artery.
Conclusion With this technique, the transpterygoid approach can be performed in a manner that preserves the pedicle for an ipsilateral NSF and achieve an excellent reconstructive outcome.
Introduction Traditional open mastoidectomy is performed through a retro-auricular incision to expose the mastoid cortex. Few have addressed the possibility of performing an endoscopic minimally invasive mastoidectomy.
Objective Our objective was to test the feasibility of performing an endoscopic mastoidectomy through a 1 cm incision and burr hole.
Methods Ten cadaver heads (20 mastoids) were used for this morphometric study. We performed an endoscopic mastoidectomy through a 1 cm burr hole located over the antrum. The goals were to reach predetermined landmarks and maximize the drilling of cancellous mastoid bone. Computed tomography (CT) imaging was acquired at baseline, after endoscopic approach and after traditional open mastoidectomy. The scans were then analyzed with volumetric measurements of each mastoid.
Results Endoscopic mastoidectomy facilitated access to most anatomical landmarks. While open mastoidectomy enabled greater extents of mastoidectomy and tegmen exposure, the endoscopic approach exposed 76% of mastoid and 69.9% of the tegmen achievable by the open approach. Additionally, baseline mastoid volume and tegmen surface area positively correlated with the extent of mastoidectomy and tegmen exposure, respectively. Baseline mastoid volume negatively correlated with the percentage of mastoid drilled and tegmen exposed.
Conclusion We demonstrated the feasibility of an endoscopic mastoidectomy through a standardized postauricular burr hole. This approach reduces the incision size and the need for soft tissue dissection. Burr hole mastoidectomy is facilitated using angled scopes which are not reliant on 0-degree line-of-sight. Although the endoscopic approach afforded slightly less exposure, the location and burr hole size can be adjusted depending on the clinical indications.
Objectives Our objective was to elucidate the demographic, academic, and career attributes of North American Skull Base Society (NASBS) presidents and determine how leadership of this society has changed over time.
Design Thirty-one NASBS presidents have served between 1990 and 2021. Demographic and scholarly variables were recorded from publicly available sources. To determine how trends in NASBS presidents have changed over time, linear and logistic regressions were conducted on continuous and categorical variables, respectively.
Setting Virtual setting was used for this study.
Participants There were no active participants in the study.
Main Outcome Measures Academic metrics of NASBS presidents were the main outcome measure.
Results NASBS presidents had a mean age of 53.3 ± 6.1 years at election and were all male. The most common institution at which former presidents trained (n = 4) and practiced (n = 3) was the University of Pittsburgh. Otolaryngologists comprised 41.9% (n = 13) of the cohort, neurosurgeons made up 38.8% (n = 12), and the remaining 19.3% (n = 6) were from other specialties. NASBS presidents from neurosurgery (p = 0.033) and other specialties (p = 0.014) were more likely to hold the rank of chair compared with those from otolaryngology. Over time, there has been a linear increase in years of research experience at the time of election (p = 0.048). There remains a lack of diversity of gender and race.
Conclusions NASBS presidents have demonstrated increased research activity over time, favoring long-term academic careers. Knowledge of these trends and attributes, which demonstrate an increase in skull base literature, growth of the NASBS, and a need for increased diversity in the field, is important for stewarding the future of the NASBS and promoting equity.
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.
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.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：