Alper Dincer, J. Tabor, Alexandros F. Pappajohn, Joseph O’Brien, Saul Morales-Velaro, Miri Kim, J. Moliterno
Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS. Patient data from 2015-2020 were obtained from the ACS-NSQIP database and were included in this study if they had a procedure corresponding to a microvascular decompression with the current procedural terminology (CPT) code 61458. Patient demographics, comorbidities, and outcomes were analyzed. The overall rate of reoperation in the cohort is 3.2% and 7.2% for patients with morbid obesity (BMI > 40) (p=0.006). Patients with morbid obesity were more likely to have comorbidities such as hypertension (60.9 vs. 33.5%; p<0.0001) and diabetes (16.3 vs. 7.7%; p=0.0002), and increased procedure duration (179 vs. 164 minutes; p=0.02). Indications for reoperation include CSF leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reo
{"title":"Morbid Obesity and Diabetes Increase the Risk of Reoperation Following Microvascular Decompression: A NSQIP Analysis of 1,303 Patients","authors":"Alper Dincer, J. Tabor, Alexandros F. Pappajohn, Joseph O’Brien, Saul Morales-Velaro, Miri Kim, J. Moliterno","doi":"10.1055/a-2263-1778","DOIUrl":"https://doi.org/10.1055/a-2263-1778","url":null,"abstract":"Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS.\u0000\u0000Patient data from 2015-2020 were obtained from the ACS-NSQIP database and were included in this study if they had a procedure corresponding to a microvascular decompression with the current procedural terminology (CPT) code 61458. Patient demographics, comorbidities, and outcomes were analyzed. \u0000\u0000The overall rate of reoperation in the cohort is 3.2% and 7.2% for patients with morbid obesity (BMI > 40) (p=0.006). Patients with morbid obesity were more likely to have comorbidities such as hypertension (60.9 vs. 33.5%; p<0.0001) and diabetes (16.3 vs. 7.7%; p=0.0002), and increased procedure duration (179 vs. 164 minutes; p=0.02). Indications for reoperation include CSF leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. \u0000\u0000We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reo","PeriodicalId":508259,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"14 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139795402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alper Dincer, J. Tabor, Alexandros F. Pappajohn, Joseph O’Brien, Saul Morales-Velaro, Miri Kim, J. Moliterno
Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS. Patient data from 2015-2020 were obtained from the ACS-NSQIP database and were included in this study if they had a procedure corresponding to a microvascular decompression with the current procedural terminology (CPT) code 61458. Patient demographics, comorbidities, and outcomes were analyzed. The overall rate of reoperation in the cohort is 3.2% and 7.2% for patients with morbid obesity (BMI > 40) (p=0.006). Patients with morbid obesity were more likely to have comorbidities such as hypertension (60.9 vs. 33.5%; p<0.0001) and diabetes (16.3 vs. 7.7%; p=0.0002), and increased procedure duration (179 vs. 164 minutes; p=0.02). Indications for reoperation include CSF leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reo
{"title":"Morbid Obesity and Diabetes Increase the Risk of Reoperation Following Microvascular Decompression: A NSQIP Analysis of 1,303 Patients","authors":"Alper Dincer, J. Tabor, Alexandros F. Pappajohn, Joseph O’Brien, Saul Morales-Velaro, Miri Kim, J. Moliterno","doi":"10.1055/a-2263-1778","DOIUrl":"https://doi.org/10.1055/a-2263-1778","url":null,"abstract":"Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS.\u0000\u0000Patient data from 2015-2020 were obtained from the ACS-NSQIP database and were included in this study if they had a procedure corresponding to a microvascular decompression with the current procedural terminology (CPT) code 61458. Patient demographics, comorbidities, and outcomes were analyzed. \u0000\u0000The overall rate of reoperation in the cohort is 3.2% and 7.2% for patients with morbid obesity (BMI > 40) (p=0.006). Patients with morbid obesity were more likely to have comorbidities such as hypertension (60.9 vs. 33.5%; p<0.0001) and diabetes (16.3 vs. 7.7%; p=0.0002), and increased procedure duration (179 vs. 164 minutes; p=0.02). Indications for reoperation include CSF leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. \u0000\u0000We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reo","PeriodicalId":508259,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"78 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139855454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xin Lei Goh, Justin Chee Rui Tzen, Alex Tham Chengyao
Primary extracranial meningiomas of the sinonasal tract (PEMS) with no intracranial extension are rare. Our study presents the largest systematic review to date, providing a comprehensive overview and comparison of the characteristics, treatment and prognosis of PEMS, with comparison to primary intracranial meningiomas (PIMS). A systematic review was conducted according to PRISMA guidelines on PubMed, Embase, and Google Scholar up to 1st November, 2022. A total of 70 documented cases from 64 articles were included. Data analysis was performed to compare low-grade (WHO Grade I) and high-grade (Grade II, III) PEMS. Majority of patients were symptomatic with nasal symptoms (72.1%); followed by eye symptoms (41.2%) and facial swellings (41.2%). The nasal cavity was the most commonly affected site (70.0%). Most tumors were WHO Grade 1 (87.5%) with meningothelial histological subtype. PEMS have a predilection for involvement of surrounding structures, with more than half reporting erosion of sinonasal walls or orbital involvement (64.3%). Nevertheless, PEMS have a favourable prognosis, with high survival rates (95.3%) and low rate of recurrence (8.5%). Mainstay of treatment is surgical resection. There are no clear defining clinical features of PEMS, hence it is imperative for clinicians to prioritise histological diagnosis to guide further management. A conclusive diagnosis of PEMS requires imaging and potential intraoperative assessment. Prognosis is likely dependent on both WHO grading and the ability to achieve complete surgical extirpation. Endoscopic resection is recommended even in high-grade PEMS for localised and resectable disease. Radiotherapy may be reserved for unresectable or recurrent tumours as salvage therapy.
{"title":"Primary Extracranial Meningiomas of the Sinonasal Tract: A Systematic Review","authors":"Xin Lei Goh, Justin Chee Rui Tzen, Alex Tham Chengyao","doi":"10.1055/a-2263-1881","DOIUrl":"https://doi.org/10.1055/a-2263-1881","url":null,"abstract":"Primary extracranial meningiomas of the sinonasal tract (PEMS) with no intracranial extension are rare. Our study presents the largest systematic review to date, providing a comprehensive overview and comparison of the characteristics, treatment and prognosis of PEMS, with comparison to primary intracranial meningiomas (PIMS).\u0000\u0000A systematic review was conducted according to PRISMA guidelines on PubMed, Embase, and Google Scholar up to 1st November, 2022. A total of 70 documented cases from 64 articles were included. Data analysis was performed to compare low-grade (WHO Grade I) and high-grade (Grade II, III) PEMS.\u0000\u0000Majority of patients were symptomatic with nasal symptoms (72.1%); followed by eye symptoms (41.2%) and facial swellings (41.2%). The nasal cavity was the most commonly affected site (70.0%). Most tumors were WHO Grade 1 (87.5%) with meningothelial histological subtype. PEMS have a predilection for involvement of surrounding structures, with more than half reporting erosion of sinonasal walls or orbital involvement (64.3%). Nevertheless, PEMS have a favourable prognosis, with high survival rates (95.3%) and low rate of recurrence (8.5%). Mainstay of treatment is surgical resection.\u0000\u0000There are no clear defining clinical features of PEMS, hence it is imperative for clinicians to prioritise histological diagnosis to guide further management. A conclusive diagnosis of PEMS requires imaging and potential intraoperative assessment. Prognosis is likely dependent on both WHO grading and the ability to achieve complete surgical extirpation. Endoscopic resection is recommended even in high-grade PEMS for localised and resectable disease. Radiotherapy may be reserved for unresectable or recurrent tumours as salvage therapy.","PeriodicalId":508259,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139856995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xin Lei Goh, Justin Chee Rui Tzen, Alex Tham Chengyao
Primary extracranial meningiomas of the sinonasal tract (PEMS) with no intracranial extension are rare. Our study presents the largest systematic review to date, providing a comprehensive overview and comparison of the characteristics, treatment and prognosis of PEMS, with comparison to primary intracranial meningiomas (PIMS). A systematic review was conducted according to PRISMA guidelines on PubMed, Embase, and Google Scholar up to 1st November, 2022. A total of 70 documented cases from 64 articles were included. Data analysis was performed to compare low-grade (WHO Grade I) and high-grade (Grade II, III) PEMS. Majority of patients were symptomatic with nasal symptoms (72.1%); followed by eye symptoms (41.2%) and facial swellings (41.2%). The nasal cavity was the most commonly affected site (70.0%). Most tumors were WHO Grade 1 (87.5%) with meningothelial histological subtype. PEMS have a predilection for involvement of surrounding structures, with more than half reporting erosion of sinonasal walls or orbital involvement (64.3%). Nevertheless, PEMS have a favourable prognosis, with high survival rates (95.3%) and low rate of recurrence (8.5%). Mainstay of treatment is surgical resection. There are no clear defining clinical features of PEMS, hence it is imperative for clinicians to prioritise histological diagnosis to guide further management. A conclusive diagnosis of PEMS requires imaging and potential intraoperative assessment. Prognosis is likely dependent on both WHO grading and the ability to achieve complete surgical extirpation. Endoscopic resection is recommended even in high-grade PEMS for localised and resectable disease. Radiotherapy may be reserved for unresectable or recurrent tumours as salvage therapy.
{"title":"Primary Extracranial Meningiomas of the Sinonasal Tract: A Systematic Review","authors":"Xin Lei Goh, Justin Chee Rui Tzen, Alex Tham Chengyao","doi":"10.1055/a-2263-1881","DOIUrl":"https://doi.org/10.1055/a-2263-1881","url":null,"abstract":"Primary extracranial meningiomas of the sinonasal tract (PEMS) with no intracranial extension are rare. Our study presents the largest systematic review to date, providing a comprehensive overview and comparison of the characteristics, treatment and prognosis of PEMS, with comparison to primary intracranial meningiomas (PIMS).\u0000\u0000A systematic review was conducted according to PRISMA guidelines on PubMed, Embase, and Google Scholar up to 1st November, 2022. A total of 70 documented cases from 64 articles were included. Data analysis was performed to compare low-grade (WHO Grade I) and high-grade (Grade II, III) PEMS.\u0000\u0000Majority of patients were symptomatic with nasal symptoms (72.1%); followed by eye symptoms (41.2%) and facial swellings (41.2%). The nasal cavity was the most commonly affected site (70.0%). Most tumors were WHO Grade 1 (87.5%) with meningothelial histological subtype. PEMS have a predilection for involvement of surrounding structures, with more than half reporting erosion of sinonasal walls or orbital involvement (64.3%). Nevertheless, PEMS have a favourable prognosis, with high survival rates (95.3%) and low rate of recurrence (8.5%). Mainstay of treatment is surgical resection.\u0000\u0000There are no clear defining clinical features of PEMS, hence it is imperative for clinicians to prioritise histological diagnosis to guide further management. A conclusive diagnosis of PEMS requires imaging and potential intraoperative assessment. Prognosis is likely dependent on both WHO grading and the ability to achieve complete surgical extirpation. Endoscopic resection is recommended even in high-grade PEMS for localised and resectable disease. Radiotherapy may be reserved for unresectable or recurrent tumours as salvage therapy.","PeriodicalId":508259,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139797265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cochlear-facial dehiscence is a relatively new diagnosis which occurs when the bony partition between the labyrinthine segment of the facial nerve and the cochlea is dehiscent. This is considered one of several third window lesions which produce varying degrees of auditory and vestibular symptoms. Imaging studies have identified a consistently higher incidence of cochlear-facial dehiscence when compared to the only histopathologic study present in the literature. This research effort adds to the literature using uniform CT scan images across over 226 ears (114 patients) to identify the radiographic incidence of cochlear-facial dehiscence in normal patients without ear pathology or symptoms. This study identified an incidence of 18.1% of the ears analyzed having dehiscence without any correlation to age or gender. When dehiscence was not identified, the mean thickness of bone between the cochlea and the facial nerve was 0.60 +/- 0.24mm.
{"title":"A CT Radiologic Assessment of the Incidence of Cochlear-Facial Dehiscence and the Thickness of Bone Between the Cochlea and Facial Nerve Among Normal Temporal Bones","authors":"Diba Nayeri, Quinton S. Gopen","doi":"10.1055/a-2253-8865","DOIUrl":"https://doi.org/10.1055/a-2253-8865","url":null,"abstract":"Cochlear-facial dehiscence is a relatively new diagnosis which occurs when the bony partition between the labyrinthine segment of the facial nerve and the cochlea is dehiscent. This is considered one of several third window lesions which produce varying degrees of auditory and vestibular symptoms. Imaging studies have identified a consistently higher incidence of cochlear-facial dehiscence when compared to the only histopathologic study present in the literature. This research effort adds to the literature using uniform CT scan images across over 226 ears (114 patients) to identify the radiographic incidence of cochlear-facial dehiscence in normal patients without ear pathology or symptoms. This study identified an incidence of 18.1% of the ears analyzed having dehiscence without any correlation to age or gender. When dehiscence was not identified, the mean thickness of bone between the cochlea and the facial nerve was 0.60 +/- 0.24mm.","PeriodicalId":508259,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"5 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139595993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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