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Elsamouly HM, Zaghloul A, Younis A, Hadeya A, Ayad AA, Hendawy MA, Alaghory IM, Barania M, Ellabbad M, Attia M. Endoscopic Reconstruction of the Sellar Floor by Extended Inferior Turbinate Flap in Recurrent Pituitary Tumors. J Neurol Surg B Skull Base 2024; 85:509-516. [PMID: 39228889 PMCID: PMC11368452 DOI: 10.1055/a-2114-4792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/19/2023] [Indexed: 09/05/2024] Open
Abstract
Objective This aim of this study was to address the outcome of endoscopic reconstruction of the sellar floor by extended inferior turbinate flap. Patients and Methods This is a retrospective study of 34 patients with a recurrent pituitary tumor. They were treated between March 2018 and December 2021 by endoscopic extended endonasal approach with the reconstruction of the sellar floor by an extended posterior pedicle inferior turbinate flap. The clinical and radiological follow-up was performed immediately postoperation and regularly every 3 months up to 1 year, and the available data from the last follow-up visit were included in the analysis. Results The patients' age ranged between 40 and 65 years, with a slight female predominance (55.9%). Headache was the main presentation (47.1%), and functional tumors were found in 50.0% patients. Visual disturbances were field defects among 61.8% and papilledema among 52.9% patients. Preoperative endoscopy revealed postseptectomy as the significant finding (73.5%), followed by postseptectomy and adhesion (14.7%) and finally postseptectomy and hypertrophied inferior turbinate (11.8%). Total tumor resection was achieved in 76.5%, visual improvement was recorded in 52.9%, and no complications were reported in 82.4% patients. Cerebrospinal fluid (CSF) leak was not reported in any of the studied patients. Finally, total resection was significantly associated with younger age, non-functioning tumor and improvement of headache. Conclusion The extended inferior turbinate flap is an effective and safe approach for sellar floor reconstruction in endoscopic endonasal surgery for recurrent pituitary tumors. The extension overcomes the relatively small inferior flap and its limited arc of rotation.
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Affiliation(s)
- Hatem M. Elsamouly
- Department of Neurosurgery, Al-Azhar University Damietta Faculty of Medicine, New Damietta, Damietta, Egypt
| | - Ahmed Zaghloul
- Department of Otorhinolaryngology, Al-Azhar University Damietta Faculty of Medicine, New Damietta, Damietta, Egypt
| | - Ahmed Younis
- Department of Otorhinolaryngology, Al-Azhar University Damietta Faculty of Medicine, New Damietta, Damietta, Egypt
| | - Abdelgawad Hadeya
- Department of Otorhinolaryngology, Al-Azhar University Damietta Faculty of Medicine, New Damietta, Damietta, Egypt
| | - Ahmed Adel Ayad
- Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Cairo, Egypt
| | - Mansor Ali Hendawy
- Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Cairo, Egypt
| | - Islam M. Alaghory
- Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Cairo, Egypt
| | - Mohamed Barania
- Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Cairo, Egypt
| | - Mohamed Ellabbad
- Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Cairo, Egypt
| | - Mohamed Attia
- Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Cairo, Egypt
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Sommer B, Konietzko I, Bonk MN, Schaller T, Märkl B, Kahl KH, Stüben G, Zenk J, Shiban E. Dural reconstruction with or without a bone graft of paranasal and anterior skullbase malignancies: Retrospective single-center analysis of 11 cases and review of literature. BRAIN & SPINE 2023; 4:102740. [PMID: 38510629 PMCID: PMC10951748 DOI: 10.1016/j.bas.2023.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 03/22/2024]
Abstract
Introduction The reconstruction of frontobasal defects following oncologic resections of paranasal and anterior skull base (ASB) malignancies remains challenging. Ineffective reconstruction could lead to cerebrospinal fluid leak, meningitis, and tension pneumocephalus. Research question Aim of this investigation was to analyse postoperative complication rates with or without bone graft for anterior skull base reconstruction. Material and methods In this retrospective study, we included patients following resection of paranasal and/or anterior skull base malignancies between October 2013 and December 2022. Complications were analysed with regards to the type of skull base reconstruction. Results Eleven patients were identified (2 female, 9 male, age (median, SD) 64 ± 14.1 years (range 38-81). There were nine cases of paranasal sinus and nasal cavity carcinomas and two cases of olfactory neuroblastomas. Overall survival was 22.5 ± 28 months (range: 5-78), progression free survival was 17.0 ± 20.3 months (range: 11-78). Bone skull base reconstruction using a split graft was performed in three cases. Postoperative complications requiring surgical intervention were seen in 33% (one tension pneumocephalus) of cases in the bone reconstruction group and 50% (three patients with cerebrospinal fluid leak, one infection) in the non-bone reconstruction group. Discussion and conclusion The structural reinforcement of structural bone chip grafting might provide additional support of the ASB and prevent CSF leakage or encephalocele. Especially in large (>10 cm2) bone defects of advanced sinonasal malignancies extending into the middle cranial fossa, the full armamentarium of reconstruction possibilities should be considered.
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Affiliation(s)
- Björn Sommer
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Ina Konietzko
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Maximilian Niklas Bonk
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Tina Schaller
- Department of Pathology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Bruno Märkl
- Department of Pathology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Klaus Henning Kahl
- Department of Radiation Therapy, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Georg Stüben
- Department of Radiation Therapy, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Johannes Zenk
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Overview of Pituitary Surgery. Otolaryngol Clin North Am 2022; 55:205-221. [DOI: 10.1016/j.otc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Galli J, Morelli F, Rigante M, Paludetti G. Management of cerebrospinal fluid leak: the importance of multidisciplinary approach. ACTA ACUST UNITED AC 2021; 41:S18-S29. [PMID: 34060517 PMCID: PMC8172102 DOI: 10.14639/0392-100x-suppl.1-41-2021-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/08/2021] [Indexed: 01/20/2023]
Abstract
Cerebrospinal fluid (CSF) leak remains a rare condition, characterized by serious complications and potentially fatal. According to different etiologies, CSF leaks may be classified into two main categories: traumatic and spontaneous. Spontaneous fistulas seem to be mainly related to obesity and idiopathic intracranial hypertension. Diagnosis is both clinical and radiological. During the last three decades, surgical treatment has mostly shifted to endonasal endoscopic approach, which widely demonstrated to be more effective than invasive intracranial ones. Post-operative complications, long-term sequelae and hospital stay are strongly reduced thanks to endoscopic approach. The diagnosis and treatment of CSF leaks represent a difficult and challenge task. The main effort seems to be related to the precise localization of the leak. An accurate assessment of both predisposing factors and comorbidities is mandatory in case of spontaneous leaks. However, a clinical multidisciplinary evaluation as well as treatment, is essential to decrease the rate of failure of surgery. The presence of a dedicated instruments, the Skull Base Team, the knowledge of reconstructive materials and techniques represents a decisive result in therapeutical management even if for each patient an effective therapeutic algorithm can be obtained considering the correct leak detection and characteristics. In conclusion the strict teamwork with neurosurgeons, neuroradiologists, ophtalmologists will enable the development also of innovative biomaterials, which could spread and standardize multi-layer techniques, nowadays still related to surgeon preferences.
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Affiliation(s)
- Jacopo Galli
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Morelli
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Rigante
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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Yang J, Wei R, Song X, Sun X, Wang H, Liu Q, Hu L, Yu H, Wang D. Risk of second primary malignancy after minor salivary gland cancer: A Surveillance, Epidemiology, and End Results database analysis. Head Neck 2021; 43:1769-1779. [PMID: 33590552 DOI: 10.1002/hed.26641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 12/20/2020] [Accepted: 02/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Minor salivary gland cancer (MiSGC) is a group of tumors with varied disease course in the head and neck. We evaluated the risk of a second primary malignancy (SPM) in MiSGC patients and identified possible prognostic factors for survival using a large population database. METHODS We used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data to evaluate the risk and prognosis of SPM in patients diagnosed with MiSGC. RESULTS The risk of SPM increased in MiSGC patients compared with the endemic rate. The risk of SPM was slightly greater in female patients and who underwent radiotherapy. Age at primary diagnosis, sex, race, year of diagnosis, SEER stage, radiotherapy, SPM, histology, and tumor site were significant survival prognostic indicators of MiSGC patients. CONCLUSION Radiotherapy and female sex were risk factors for SPM after MiSGC. Long-term surveillance for SPM was important in MiSGC patients.
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Affiliation(s)
- Jingyi Yang
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Ruoyan Wei
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xiaole Song
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xicai Sun
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Li Hu
- Department of Experimental Center, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.,Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor, Chinese Academy of Medical Sciences, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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7
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Reconstruction after endoscopic surgery for skull base malignancies. J Neurooncol 2020; 150:463-468. [DOI: 10.1007/s11060-020-03465-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/20/2020] [Indexed: 11/24/2022]
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8
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Liu JK, Silva NA, Sevak IA, Eloy JA. Transbasal versus endoscopic endonasal versus combined approaches for olfactory groove meningiomas: importance of approach selection. Neurosurg Focus 2019; 44:E8. [PMID: 29606049 DOI: 10.3171/2018.1.focus17722] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There has been much debate regarding the optimal surgical approach for resecting olfactory groove meningiomas (OGMs). In this paper, the authors analyzed the factors involved in approach selection and reviewed the surgical outcomes in a series of OGMs. METHODS A retrospective review of 28 consecutive OGMs from a prospective database was conducted. Each tumor was treated via one of 3 approaches: transbasal approach (n = 15), pure endoscopic endonasal approach (EEA; n = 5), and combined (endoscope-assisted) transbasal-EEA (n = 8). RESULTS The mean tumor volume was greatest in the transbasal (92.02 cm3) and combined (101.15 cm3) groups. Both groups had significant lateral dural extension over the orbits (transbasal 73.3%, p < 0.001; combined 100%), while the transbasal group had the most cerebral edema (73.3%, p < 0.001) and vascular involvement (66.7%, p < 0.001), and the least presence of a cortical cuff (33.3%, p = 0.019). All tumors in the combined group were recurrent tumors that invaded into the sinonasal cavity. The purely EEA group had the smallest mean tumor volume (33.33 cm3), all with a cortical cuff and no lateral dural extension. Gross-total resection was achieved in 80% of transbasal, 100% of EEA, and 62.5% of combined cases. Near-total resection (> 95%) was achieved in 20% of transbasal and 37.5% of combined cases, all due to tumor adherence to the critical neurovascular structures. The rate of CSF leakage was 0% in the transbasal and combined groups, and there was 1 leak in the EEA group (20%), resulting in an overall CSF leakage rate of 3.6%. Olfaction was preserved in 66.7% in the transbasal group. There was no significant difference in length of stay or 30-day readmission rate between the 3 groups. The mean modified Rankin Scale score was 0.79 after the transbasal approach, 2.0 after EEA, and 2.4 after the combined approach (p = 0.0604). The mean follow-up was 14.5 months (range 1-76 months). CONCLUSIONS The transbasal approach provided the best clinical outcomes with the lowest rate of complications for large tumors (> 40 mm) and for smaller tumors (< 40 mm) with intact olfaction. The role of EEA appears to be limited to smaller, appropriately selected tumors in which olfaction is already absent. EEA also plays an important adjunctive role when combined with the transbasal approach for recurrent OGMs invading the sinonasal cavity. Careful patient selection using an individualized, tailored strategy is important to optimize surgical outcomes.
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Affiliation(s)
- James K Liu
- Departments of1Neurological Surgery.,3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | | | - Jean Anderson Eloy
- Departments of1Neurological Surgery.,4Ophthalmology and Visual Sciences, Rutgers New Jersey Medical School; and
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Chen PG, Clampitt MR, Chorath KT, Lin RP, Weitzel EK, McMains KC, Bunegin L. Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model. Am J Rhinol Allergy 2019; 33:757-762. [DOI: 10.1177/1945892419866310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Large skull base defects can be challenging to repair. This study uses a controlled ex vivo model to examine the failure pressures of various dural repairs of large skull base defects using mucosa with fibrin glue under 3 conditions: No Additional Support of the repair, support with a Foley catheter (Direct Support), and with Foley catheter contact over a rigid acrylic plate (Diffuse Support). Methods Failure pressures of dural repairs with and without support were determined in a porcine model using an ex vivo closed testing apparatus. In addition, 20 mm × 15 mm dural defects were created. Skull base repairs were performed using porcine dura as an underlay graft followed by a septal mucosa overlay. Saline was infused at 30 mL/h, applying even force to the underside of the graft until repair failure occurred for each condition (none, direct, and diffuse support). Five trials were performed per repair type for a total of 15 repairs. Results The mean failure pressures were as follows: No Additional Support, 6.494 ± 2.553 mm Hg; Direct Support, 5.103 ± 3.913 mm Hg; and Diffuse Support, 15.649 ± 2.638 mm Hg. A post hoc Bonferroni-Holm test demonstrated significant difference between No Additional Support and Diffuse Support ( P = .001), as well as Direct Support and Diffuse Support ( P = .002). Conclusion Support of dural repairs in this model withstood higher pressures when the Foley catheter’s support is distributed evenly using a flat acrylic plate. Use of this plate is the only repair tested in this model that tolerated normal adult supine intracranial pressures.
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Affiliation(s)
- Philip G. Chen
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Michael R. Clampitt
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kevin T. Chorath
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Ryan P. Lin
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Erik K. Weitzel
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
| | - Kevin C. McMains
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
| | - Leonid Bunegin
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
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Reconstructive considerations in low and middle-income countries. Curr Opin Otolaryngol Head Neck Surg 2018; 26:340-346. [PMID: 30124522 DOI: 10.1097/moo.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Surgical mission trips in head and neck surgery are common. There are an increasing number of surgical groups performing complex reconstructions in low and middle-income countries (LMIC). Consideration of reconstructive options that are location and patient specific are critical for optimum patient care and local physician education. RECENT FINDINGS The pectoralis muscle regional flap is a versatile and reliable option and has been shown to reconstruct defects in nearly every head and neck subsite. Additional regional flap options described are the supraclavicular island flap and submental island flap. There are 15 published case series describing experience with performing microvascular reconstructions in LMIC. The average success rate was 87.1%. Both loupe and microscope magnification are used. SUMMARY Complex reconstructions are successfully being performed in LMIC. Although microvascular reconstruction is being utilized by some groups, local and patient-specific factors should be carefully considered, as many regional and local flap options available provide the same reconstruction benefit while minimizing operating room time, resources, and postoperative care needs.
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Wannemuehler TJ, Rabbani CC, Burgeson JE, Illing EA, Walgama ES, Wu AW, Ting JY. Survey of endoscopic skull base surgery practice patterns among otolaryngologists. Laryngoscope Investig Otolaryngol 2018; 3:143-155. [PMID: 30062128 PMCID: PMC6057222 DOI: 10.1002/lio2.149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/18/2018] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Endoscopic skull base surgery (ESBS) is a rapidly expanding field. Despite divergent reported preferences for reconstructive techniques and perioperative management, limited data exist regarding contemporary practice patterns among otolaryngologists performing ESBS. This study aims to elucidate current practice patterns, primarily the volumes of cases performed and secondarily a variety of other perioperative preferences. Methods An anonymous 32‐item electronic survey examining perioperative ESBS preferences was distributed to the American Rhinologic Society membership. Statistical significance between variables was determined utilizing Student t, chi‐square, and Fisher exact tests. Results Seventy otolaryngologists completed the survey. The effective response rate was approximately 22.5%. Sixty percent of respondents were in full‐time academic practice and 70% had completed rhinology/skull base fellowships. Annually, 43.3 mean ESBS cases were performed (29.1 private practice vs. 52.9 academic practice, P = .009). Academic practice averaged 24.1 expanded cases versus only 11 in private practice (P = .01). Of respondents, 55.7% stood on the same side as the neurosurgeon and 72.9% remained present for the entire case. Current procedural terminology coding and antibiotic regimens were widely divergent; 31.4% never placed lumbar drains preoperatively, while 41.4% did so for anticipated high‐flow cerebrospinal fluid leaks. While considerable variation in reconstructive techniques were noted, intradural defect repairs utilized vascularized flaps 86.3% of the time versus only 51.3% for extradural repairs (P < 0.001). Major complications were rare. Postoperative restrictions varied considerably, with most activity limitations between 2–8 weeks and positive airway pressure use for 2–6 weeks. Most respondents started saline irrigations 0–2 weeks postoperatively. Conclusions Based on responses from fellowship‐ and non‐fellowship‐trained otolaryngologists in various practice settings, there remains considerable variation in the perioperative management of patients undergoing ESBS. Level of Evidence 5
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Affiliation(s)
- Todd J Wannemuehler
- Department of Otolaryngology-Head & Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Cyrus C Rabbani
- Department of Otolaryngology-Head & Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Jack E Burgeson
- Department of Otolaryngology-Head & Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Elisa A Illing
- Department of Otolaryngology-Head & Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Evan S Walgama
- Department of Otolaryngology-Head & Neck Surgery Cedars Sinai Medical Center Los Angeles California U.S.A
| | - Arthur W Wu
- Department of Otolaryngology-Head & Neck Surgery Cedars Sinai Medical Center Los Angeles California U.S.A
| | - Jonathan Y Ting
- Department of Otolaryngology-Head & Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
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Gabriel PJ, Eloy JA, Liu JK. Letter to the editor of Acta Neurochirurgica: simultaneous pericranial and nasoseptal "double-flap" reconstruction after combined transcranial and endoscopic endonasal resection of anterior skull base tumors. Acta Neurochir (Wien) 2018; 160:77-78. [PMID: 29170846 DOI: 10.1007/s00701-017-3395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
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