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Gurses ME, Lu VM, Gecici NN, Shah KH, Gökalp E, Bashti M, Haider S, Komotar RJ. Utilizing tubular retractors in colloid cyst resection: A single surgeon experience. Surg Neurol Int 2024; 15:179. [PMID: 38840593 PMCID: PMC11152534 DOI: 10.25259/sni_231_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
Background Colloid cysts are intracranial lesions originating from abnormalities in the primitive neuroepithelium folding of the third ventricle. Various surgical approaches have been explored for the management of colloid cysts, each carrying its own set of advantages and limitations. Tubular retractors developed recently alleviate retraction pressure through radial distribution, potentially offering benefits for colloid cyst resection. This study aims to introduce and assess a modified microsurgical method utilizing the tubular retractor for addressing colloid cysts. Methods The study included a retrospective assessment of patients who had colloid cysts and who were treated between 2015 and 2023 by one experienced surgeon. The demographic, clinical, radiological, histological, and surgical data regarding these patients were evaluated. The patients were assessed using the colloid cyst risk score, indicating a risk for obstructive hydrocephalus. Results The minimally invasive microsurgical approach was successfully applied to all 22 identified patients. No postoperative surgical complications were reported. Gross total resection was achieved in 21 (95.5%) patients. The early complication rate was 22.7% (n = 5). There were no postoperative seizures, permanent neurological deficits, or venous injuries. The average hospital stay was 3 days. There was no evidence of recurrence at an average follow-up length of 25.9 months. Conclusion The transtubular approach is an effective, safe method for treating colloid cysts. It achieves complete cyst removal with minimal complications, offering the benefits of less invasiveness, improved visualization, and reduced tissue disruption, strengthening its role in colloid cyst surgery.
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Affiliation(s)
| | - Victor M. Lu
- Department of Neurosurgery, Miami University, Miami, United States
| | | | | | - Elif Gökalp
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Malek Bashti
- Department of Neurosurgery, Miami University, Miami, United States
| | - Sameah Haider
- Department of Neurosurgery, Miami University, Miami, United States
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Ibáñez-Botella G, Narváez IF, Pugliese B, Ros B, Arráez MA. Endoscopic resection of third ventricle colloid cysts using an ultrasonic aspirator. Neurosurg Rev 2024; 47:117. [PMID: 38491331 DOI: 10.1007/s10143-024-02293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 03/18/2024]
Abstract
An important step in the performance of endoscopic resection of colloid cysts of the third ventricle is the forced aspiration of cyst contents. The different consistencies these cysts may have can limit their complete resection and increase the likelihood of complications. The introduction of the ultrasonic neuroendoscopic aspirator allows cysts to be emptied more easily than with a conventional rigid aspirator, improving the feasibility of resection even in more solid cysts. The ability to regulate ultrasound and aspiration increases safety in a reduced and highly morbid space such as the third ventricle. Our objective was to determine the safety and efficiency of the ultrasonic aspirator for endoscopic resection of colloid cysts of the third ventricle. This was a retrospective descriptive study of patients with colloid cysts of the third ventricle undergoing neuroendoscopic resection using an ultrasonic aspirator between 2016-2023. Clinical, radiological, and procedural variables were studied. Mean, median and range were analyzed for quantitative variables and percentages and frequencies for qualitative variables. We present a series of 11 patients with colloid cysts of the third ventricle. The mean age was 44 years (27-69). All had biventricular hydrocephalus, with a mean cyst diameter of 15 mm (9-20). The lateral ventricle was accessed using the transforaminal approach in seven patients and the transchoroidal approach in three patients. All patients underwent septostomy. The mean endoscopy time was 40 min (29-68). Complete resection was possible in 10 patients. Median follow-up was 16 months (1-65) with 100% clinical improvement. At the end of follow-up, no patient had recurrence of the lesion. Based on our experience, the ultrasonic aspirator can be used safely and effectively for the resection of colloid cysts of the third ventricle, achieving high rates of complete resection with minimal postoperative complications.
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Affiliation(s)
- G Ibáñez-Botella
- Neurosurgery Department, Regional University Hospital, Carlos Haya Avenue, 29010, Málaga, Spain.
| | - I F Narváez
- Neurosurgery Department, Regional University Hospital, Carlos Haya Avenue, 29010, Málaga, Spain
| | - B Pugliese
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOC Città della Salute e della Scienza, University of Turin, 10126, Turin, Italy
| | - B Ros
- Neurosurgery Department, Regional University Hospital, Carlos Haya Avenue, 29010, Málaga, Spain
| | - M A Arráez
- Neurosurgery Department, Regional University Hospital, Carlos Haya Avenue, 29010, Málaga, Spain
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Sefcikova V, Wong QHW, Samandouras G. Practical, Stereotactic, Low-Profile Technique for Transcortical/Transventricular Colloid Cyst Removal Independent of Ventricular Size: Technical Note and Analysis of Approaches. Oper Neurosurg (Hagerstown) 2023; 24:e61-e67. [PMID: 36637308 DOI: 10.1227/ons.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In the presence of a dilated foramen of Monro, a transcortical, transforaminal approach is considered the safest and simplest approach for resection of colloid cysts. However, in the presence of small or normal frontal horns, numerous microsurgical approaches and, often complicated, variations have been described, invariably employing forms of stereotactic navigation. OBJECTIVE To report an alternative, accurate, microsurgical stereotactic low-profile technique. METHODS The small frontal horn is stereotactically targeted as previously described. Routine equipment is used to accurately create a novel, rigid, atraumatic surgical corridor. RESULTS After a 7-mm corticotomy, a peel-away catheter carrying the AxiEM stylet engages the target set as the frontal horn. All joints of the endoscope holder are locked, allowing only catheter advancement (y axis) while lateral (x axis) or anteroposterior (z axis) movements are secure. Two, 7-mm retractor blades are inserted. The extremely consistent anatomy of the foramen of Monro allows en bloc microsurgical removal without unnecessary coagulation of cyst wall or choroid plexus. CONCLUSION Despite a plethora of approaches to the rostral third ventricle, in the presence of normal or small frontal horns, including creation of transcallosal/interforniceal, suprachoroidal (or transchoroidal), and sub-choroidal, colloid cyst resection does not necessarily need to be convoluted. Technical nuances of an accurate, practical, minimally invasive technique are described.
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Affiliation(s)
- Viktoria Sefcikova
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK.,The University of Queensland Medical School, Brisbane, QLD, Australia
| | - Queenie Hoi-Wing Wong
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.,Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - George Samandouras
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, UK.,Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Beaumont TL, Limbrick DD, Patel B, Chicoine MR, Rich KM, Dacey RG. Surgical management of colloid cysts of the third ventricle: a single-institution comparison of endoscopic and microsurgical resection. J Neurosurg 2022; 137:905-913. [PMID: 35148502 DOI: 10.3171/2021.11.jns211317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Colloid cysts of the third ventricle are histologically benign lesions that can cause obstructive hydrocephalus and death. Historically, colloid cysts have been removed by open microsurgical approaches. More recently, minimally invasive endoscopic and port-based techniques have offered decreased complications and length of stay, with improved patient satisfaction. METHODS A single-center retrospective analysis of patients with colloid cysts who underwent surgery at a large tertiary care hospital was performed. The cohort was assessed based on the surgical approach, comparing endoscopic resection to open microsurgical resection. The primary endpoint was rate of perioperative complications. Univariate analysis was used to assess several procedure-related variables and the cost of treatment. Multivariate analysis was used to assess predictors of perioperative complications. Total inpatient cost for each case was extracted from the health system financial database. RESULTS The study included 78 patients with colloid cysts who underwent resection either via an endoscopic approach (n = 33) or through a craniotomy (n = 45) with an interhemispheric-transcallosal or transcortical-transventricular approach. Nearly all patients were symptomatic, and half had obstructive hydrocephalus. Endoscopic resection was associated with reduced operative time (3.2 vs 4.9 hours, p < 0.001); lower complication rate (6.1% vs 33.1%, p = 0.009); reduced length of stay (4.1 vs 8.9 days, p < 0.001); and improved discharge to home (100% vs 75.6%, p = 0.008) compared to microsurgical resection. Coagulated residual cyst wall remnants were more common after endoscopic resection (63.6% vs 19.0%, p < 0.001) although this was not associated with a significantly increased rate of reoperation for recurrence. The mean follow-up was longer in the microsurgical resection group (3.1 vs 4.9 years, p = 0.016). The total inpatient cost of endoscopic resection was, on average, one-half (47%) that of microsurgical resection. When complications were encountered, the total inpatient cost of microsurgical resection was 4 times greater than that of endoscopic resection where no major complications were observed. The increased cost-effectiveness of endoscopic resection remained during reoperation. CONCLUSIONS Endoscopic resection of colloid cysts of the third ventricle offers a significant reduction in perioperative complications when compared to microsurgical resection. Endoscopic resection optimizes nearly all procedure-related variables compared to microsurgical resection, and reduces total inpatient cost by > 50%. However, endoscopic resection is associated with a significantly increased likelihood of residual coagulated cyst wall remnants that could increase the rate of reoperation for recurrence. Taken together, endoscopic resection represents a safe and effective minimally invasive approach for removal of colloid cysts.
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Tosi U, Uribe-Cardenas R, Lara-Reyna J, Villamater FN, Perera I, Stieg PE, Tsiouris AJ, Souweidane MM. Transseptal interforniceal endoscopic removal of superiorly recessed colloid cysts. J Neurosurg 2022; 137:813-819. [PMID: 35090131 DOI: 10.3171/2021.11.jns211754] [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: 07/16/2021] [Accepted: 11/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Transforaminal endoscopic colloid cyst resection is well described. However, some anatomical colloid cyst variants may warrant a modified approach. Rarely, colloid cysts separate the forniceal columns and grow superiorly within the leaflets of the septum pellucidum. Thus, the authors' goal was to characterize the imaging features, clinical presentation, surgical strategy, and outcomes of patients with this superiorly recessed colloid cyst variant. METHODS A retrospective evaluation of patients who underwent endoscopic resection of colloid cysts from 1999 to 2020 was performed. The patients were dichotomized depending on whether the cyst was located predominately below the forniceal columns or was superiorly recessed (forniceal column separation with variable intraseptal extension). This comparative cohort study focused on clinical presentation, imaging features, operative technique, and patient outcome. RESULTS In total, 182 patients were identified. Seventeen patients had colloid cysts that were defined as superiorly recessed and underwent transseptal interforniceal removal, and 165 patients underwent a standard transforaminal approach. Patients had similar demographic characteristics. However, transseptal cysts were on average larger (17.8 mm vs 11.4 mm, p < 0.0001), and these patients had a greater frontal-occipital horn ratio (0.45 vs 0.41, p = 0.012). They were also more likely to have undergone a previous resection (p = 0.02). The two cohorts had similar surgical outcomes, with no differences in extent of resection, recurrence, or complications. CONCLUSIONS Superiorly recessed intraseptal colloid cysts are larger and tend to splay the bodies of the fornix, thus requiring a parasagittal transseptal interforniceal endoscopic approach. This achieves complete removal with comparatively negligible morbidity or rare recurrence (5.9%).
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Affiliation(s)
- Umberto Tosi
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Rafael Uribe-Cardenas
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Jacques Lara-Reyna
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Francis N Villamater
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Imali Perera
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Philip E Stieg
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Apostolos John Tsiouris
- 3Department of Radiology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Mark M Souweidane
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; and
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May G, Lammy S, Kumar A, Hegde A, St George EJ. First reported case of hydrocephalus in jointly diagnosed bacterial meningitis and a colloid cyst: how Ockham's razor became Hickam's dictum. Br J Neurosurg 2022; 36:420-423. [PMID: 35608085 DOI: 10.1080/02688697.2022.2077911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We report the first case in the literature of acute hydrocephalus due to a simultaneous diagnosis of bacterial (not asceptic) meningitis and a colloid cyst. Diagnosing disease is the cornerstone skill of a medical practitioner. Both education and experience allow for sharpening of this skill throughout years of medical practice. Disease is fraught with nuances and inconsistencies which can render an accurate diagnosis a difficult task. Medical practitioners can be guilty of cognitive biases such as Ockham's razor. We present the case of a patient with an initial diagnosis of obstructive hydrocephalus secondary to a colloid cyst. However, pneumococcal meningitis blunted Ockham's razor in favour of Hickam's dictum.
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Affiliation(s)
- Gareth May
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Simon Lammy
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Aditaya Kumar
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Ajay Hegde
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
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Li SR, Handzel RM, Tonetti D, Kennedy J, Shapiro K, Rosengart MR, Hall DE, Seymour C, Tzeng E, Reitz KM. Consensus Current Procedural Terminology Code Definition of Source Control for Sepsis. J Surg Res 2022; 275:327-335. [PMID: 35325636 DOI: 10.1016/j.jss.2022.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Unlike antibiotic and perfusion support, guidelines for sepsis source control lack high-quality evidence and are ungraded. Internally valid administrative data methods are needed to identify cases representing source control procedures to evaluate outcomes. METHODS Over five modified Delphi rounds, two independent reviewers identified Current Procedural Terminology (CPT) codes pertinent to source control. In each round, codes with perfect agreement were retained or excluded, whereas disagreements were reviewed by the panelists. Manual review of 400 patient records meeting Sepsis-3 criteria (2010-2017) clinically adjudicated which encounters included source control procedures (gold standard). The performance of consensus codes was compared with the gold standard to assess sensitivity, specificity, predictive values, and likelihood ratios. RESULTS Of 5752 CPT codes, 609 consensus codes represented source control procedures. Of 400 hospitalizations for sepsis, 39 (9.8%; 95% confidence interval [CI] 7.0%-13.1%) underwent gold standard source control procedures and 29 (7.3%; 95% CI 4.9-10.3%) consensus code-defined source control procedures. Thirty consensus codes were identified (20.0% gastrointestinal/intraabdominal, 10.0% genitourinary, 13.3% hepatopancreatobiliary, 23.3% orthopedic/cranial, 23.3% soft tissue, and 10.0% intrathoracic), which had 61.5% (95% CI 44.6%-76.6%) sensitivity, 98.6% (95% CI 96.8%-99.6%) specificity, 83.2% (95% CI 66.6%-92.4%) positive, and 95.9% (95% CI 93.9%-97.2%) negative predictive values. With pretest probability at sample prevalence, an identified consensus code had a posttest probability of 83.0% (95% CI 66.0%-92.0%), whereas consensus code absence had a probability of 4.0% (95% CI 3.0-6.0) for undergoing a source control procedure. CONCLUSIONS Using modified Delphi methodology, we created and validated CPT codes identifying source control procedures, providing a framework for evaluation of the surgical care of patients with sepsis.
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Affiliation(s)
- Shimena R Li
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Robert M Handzel
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel Tonetti
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason Kennedy
- Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine Shapiro
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Seymour
- Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edith Tzeng
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine M Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Comparison of microscopic and endoscopic resection of third-ventricular colloid cysts: A Systematic Review and Meta-Analysis. Clin Neurol Neurosurg 2022; 215:107179. [DOI: 10.1016/j.clineuro.2022.107179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/15/2023]
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Dietz N, Sharma M, John K, Wang D, Ugiliweneza B, Mokshagundam S, Bjurström MF, Boakye M, Williams BJ, Andaluz N. 90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients. J Neurol Surg B Skull Base 2021; 83:515-525. [DOI: 10.1055/s-0041-1740395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/05/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Context Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown.
Objective This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection.
Design This study is presented as a retrospective cohort analysis (2000–2016) with 2 years of follow-up.
Setting The study included national inpatient hospitalization and outpatient visits.
Patients Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC).
Interventions This study investigated transphenoidal or subfrontal approach for tumor resection.
Main Outcome Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study.
Results Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; p < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; p < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; p < 0.0001).
Conclusion ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Kevin John
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | | | - Martin F. Bjurström
- Department of Anesthesiology and Intensive Care, Skane University Hospital, Lund Sweden
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Brian J. Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Norberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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Colloid cysts: Neuropsychological outcome, quality of life and long-term control after endoscopic gross total resection. Clin Neurol Neurosurg 2021; 209:106951. [PMID: 34547641 DOI: 10.1016/j.clineuro.2021.106951] [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: 08/20/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Endoscopy is increasingly being adopted for removing colloid cysts. However, the neuropsychological outcome and quality of life (QOL) have not been studied in detail. This study is to evaluate the efficacy of endoscopic excision on cognitive measures and QOL. METHODS Patients with colloid cysts larger than 7 mm, undergoing endoscopy were prospectively studied concerning clinico-radiology, cognitive parameters (age and education adjusted), extent of resection and recurrence. A cross-sectional QOL assessment was additionally performed on endoscopic patients in comparison with cases who underwent microsurgery or standalone ventriculo-peritoneal (VP) shunt. RESULTS A total of 22 endoscopic patients with a mean age of 34 years and a mean cyst diameter of 19 mm were studied. Gross total resection(GTR) could be achieved in all. Over a mean follow-up of 53.4 months, none had a recurrence, ventriculomegaly, or retreatment. Among neuropsychological parameters, digit span was the most affected before surgery. There was a broad-based improvement in the mean global cognitive score from 40.63(±10.4) at baseline to 50.25(±5.8) after endoscopy with maximum improvement in 'immediate recall.' The change in scores also had a significant inverse correlation with cyst size, with cysts larger than 18 mm, resulting in lower scores following endoscopy(R=-0.9, P=0.01). QOL was significantly influenced by visual and cognitive impairments and was better among endoscopic patients than similar microsurgery or VP shunt controls, with a significant difference in social and environmental domains(P=0.02). CONCLUSION Endoscopy is effective in achieving GTR and long-term control, with neuropsychological improvement correlated with cyst size. This is probably the first report to show QOL is influenced by cognitive parameters and is better following endoscopy than after microsurgery or VP shunt.
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11
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Zymberg ST, Riechelmann GS, da Costa MDS, Ramalho CO, Cavalheiro S. Third ventricle colloid cysts: An endoscopic case series emphasizing technical variations. Surg Neurol Int 2021; 12:376. [PMID: 34513143 PMCID: PMC8422505 DOI: 10.25259/sni_446_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/03/2021] [Indexed: 11/04/2022] Open
Abstract
Background Colloid cyst treatment with purely endoscopic surgery is considered to be safe and effective. Complete capsule removal for gross total resection is usually recommended to prevent recurrence but may not always be safely feasible. Our objective was to assess the results of endoscopic surgery using mainly aspiration and coagulation without complete capsule resection and discuss the rationale for the procedure. Methods A retrospective review was conducted of 45 consecutive symptomatic patients with third ventricle colloid cysts that were surgically treated with purely endoscopic surgery from 1997 to 2018. Results Mean age was 35.4 years. Male-to-female ratio was 1:1. Clinical presentation included predominantly headache (80%). Transforaminal was the most used route (71.1%) followed by transeptal (24.5%) and interforniceal (4.4%). Capsule was intentionally not removed in 42 patients (93.3%) and cyst remnants were absent on postoperative MRI in 36 (85%). Mild complications occurred in 8 patients (17.8%). Surgery was statistically associated with cyst volume and ventricular size reduction. There were no serious complications, shunts or deaths. Follow-up did not show any recurrence or remnant growth that needed further treatment. Conclusion Gross total resection may not be the main objective for every situation. Subtotal resection without capsule removal seems to be safer while preserving good results, especially in a limited resource environment. Remnants left behind should be followed but tend to remain clinically asymptomatic for the most part. Surgical planning allows the surgeon to choose among the different resection routes and techniques available. Decisions are predominantly based on preoperative imaging and intraoperative findings.
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Affiliation(s)
- Samuel Tau Zymberg
- Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Sergio Cavalheiro
- Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
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12
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Elshamy W, Burkard J, Gerges M, Erginoglu U, Aycan A, Ozaydin B, Dempsey RJ, Baskaya MK. Surgical approaches for resection of third ventricle colloid cysts: meta-analysis. Neurosurg Rev 2021; 44:3029-3038. [PMID: 33590366 DOI: 10.1007/s10143-021-01486-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
Although outcome studies and systematic reviews have been published on the surgical treatment of third ventricle colloid cysts (TVCC), there are no meta-analyses that compare the outcomes for various surgical approaches. This meta-analysis assesses the outcomes and complications for transcortical, transcallosal, and endoscopic surgical approaches used to excise TVCCs. A meta-analysis of surgically excised TVCCs was performed with an assessment of outcome for transcortical, transcallosal, and endoscopic approaches. A random-effects model analyzed the extent of surgical excision. The analysis included reports that compared at least two of these surgical approaches, for a total of 11 studies comprising a population of 301 patients. The transcortical approach was associated with a higher incidence of complete excision compared to the endoscopic approach (OR = 0.137, p = 0.041), with no significant differences observed between transcortical and transcallosal approaches, and between transcallosal and endoscopic approaches. Comparison between endoscopic and pooled microsurgical approaches was also insignificant (OR = 0.22, p = 1). The risk of motor weakness was increased with the transcortical approach compared to the endoscopic approach (OR = 6.10, p = 0.018). There were no significant differences between transcortical and transcallosal approaches regarding newly onset seizures, and no significant mortality differences between all three approaches. This study demonstrates that microsurgical approaches are associated with a greater extent of resection compared to endoscopic approaches; however, best results are likely achieved based on the surgeon's expertise, flexibility, and case review.
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Affiliation(s)
- Walid Elshamy
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA.,Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Jake Burkard
- University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Mina Gerges
- Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ufuk Erginoglu
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Abdurahman Aycan
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Burak Ozaydin
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, CSC K8/828, 600 Highland Avenue, Madison, WI, 53792, USA.
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13
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Peciu-Florianu I, Tuleasca C, Legrand V, Reyns N, Lejeune JP. Letter: Colloid Cysts: Evolution of Surgical Approach Preference and Management of Recurrent Cysts. Oper Neurosurg (Hagerstown) 2020; 19:E328-E329. [PMID: 32442311 DOI: 10.1093/ons/opaa154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Constantin Tuleasca
- Neurosurgery Service CHU Lille Roger Salengro Hospital Lille, France.,Department of Clinical Neurosciences Neurosurgery Service and Gamma Knife Center Lausanne University Hospital (CHUV) Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM) University of Lausanne (Unil) Lausanne, Switzerland.,Signal Processing Laboratory (LTS 5) Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, Switzerland
| | - Victor Legrand
- Neurosurgery Service CHU Lille Roger Salengro Hospital Lille, France
| | - Nicolas Reyns
- Neurosurgery Service CHU Lille Roger Salengro Hospital Lille, France
| | - Jean-Paul Lejeune
- Neurosurgery Service CHU Lille Roger Salengro Hospital Lille, France
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14
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Isaacs AM, Bezchlibnyk YB, Dronyk J, Urbaneja G, Yong H, Hamilton MG. Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System. Oper Neurosurg (Hagerstown) 2020; 19:134-142. [DOI: 10.1093/ons/opz409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 11/04/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Endoscopic resection of colloid cysts has gained recent widespread practice. However, reported complication and recurrence rates are variable, possibly, in part, because of a lack of consistency with reporting of the extent of cyst capsule removal.
OBJECTIVE
To present the long-term outcomes of endoscopic resection of third ventricle colloid cysts without complete capsule removal and propose a grading system to allow consistent description of surgical outcomes.
METHODS
A retrospective review of 74 patients who underwent endoscopic resection of symptomatic third ventricle colloid cysts between 1995 and 2018 was performed. Kaplan-Meier analyses were used to assess recurrence-free survival rates.
RESULTS
Median patient age and cyst diameter were 48.0 (13.0-80.0) yr and 12.0 (5.0-27.0) mm, respectively. Complete emptying of cyst contents with capsule coagulation was achieved in 73 (98.6%) patients. All patients improved or remained stable postoperatively, with a median follow-up duration of 10.3 (0.3-23.7) yr. Radiographic recurrence occurred in 6 (8.1%) patients after their initial surgery, 5 (6.8%) of whom underwent redo endoscopic resection. No major complications or mortality was encountered at primary or recurrence surgery.
CONCLUSION
Endoscopic resection of third ventricle colloid cysts without emphasizing complete capsule removal is a viable option for successfully treating colloid cysts of the third ventricle. Long-term follow-up demonstrates that it is associated with low risks of complications, morbidity, mortality, and recurrence. The proposed extent of the resection grading scheme will permit comparison between the different surgical approaches and facilitate the establishment of treatment guidelines for colloid cysts.
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Affiliation(s)
- Albert M Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yarema B Bezchlibnyk
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Jarred Dronyk
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Geberth Urbaneja
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Heather Yong
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark G Hamilton
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
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15
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Sharma M, Ugiliweneza B, Boakye M, Andaluz N, Williams BJ. Feasibility of Bundled Payments in Anterior, Middle, and Posterior Cranial Fossa Skull Base Meningioma Surgery: MarketScan Analysis of Health Care Utilization and Outcomes. World Neurosurg 2019; 131:e116-e127. [PMID: 31323403 DOI: 10.1016/j.wneu.2019.07.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of our study was to compare the health care utilization and outcomes after surgery for anterior cranial fossa skull base meningioma (AFM), middle cranial fossa skull base meningioma (MFM), and posterior cranial fossa skull base meningioma (PFM) across the United States. METHODS We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had at least 24 months of enrollment after the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation after the procedure. RESULTS A cohort of 1191 patients was identified from the database. Less than half of patients (43.66%) were in the AFM cohort, 32.24% were in the MFM cohort, and only 24.1% were in the PFM cohort. Patients who underwent surgery for PFM had longer hospital stay (P = 0.0009), high complication rate (P = 0.0011), and less likely to be discharged home (P = 0.0013) during index hospitalization. There were no differences in overall payments at 12 months and 24 months among the cohorts. There was no significant difference in 90-day median payments among the groups ($66,212 [AFM] vs. $65,602 [MFM] and $71,837 [PFM]; P = 0.198). Male gender, commercial insurance (compared with Medicare), and higher comorbidity scores (score 3 compared with score 0) were associated with higher 90-day payments in the PFM cohort. CONCLUSIONS Overall payments (at 12 months and 24 months) and 90-day payments were not different among the cohorts. Patients with PFM had longer hospital stay and higher complication rate and were less likely to be discharged home with higher utilization of outpatient services at 12 months and 24 months.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Noberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
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16
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Cuoco JA, Rogers CM, Busch CM, Benko MJ, Apfel LS, Elias Z. Postexercise Death Due to Hemorrhagic Colloid Cyst of Third Ventricle: Case Report and Literature Review. World Neurosurg 2019; 123:351-356. [DOI: 10.1016/j.wneu.2018.12.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/06/2023]
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17
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Brunori A, de Falco R, Delitala A, Schaller K, Schonauer C. Tailoring Endoscopic Approach to Colloid Cysts of the Third Ventricle: A Multicenter Experience. World Neurosurg 2018; 117:e457-e464. [DOI: 10.1016/j.wneu.2018.06.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
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18
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Lagman C, Rai K, Chung LK, Nagasawa DT, Beckett JS, Tucker AM, Yang I. Fatal Colloid Cysts: A Systematic Review. World Neurosurg 2017; 107:409-415. [PMID: 28801184 DOI: 10.1016/j.wneu.2017.07.183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To accurately describe patient characteristics and the clinical presentation of fatal colloid cysts. METHODS A systematic literature search of 3 popular databases was performed. Inclusion criteria were individuals with sudden-onset death and colloid cysts identified on imaging and/or autopsy. The cause of death must have been ascribed to the colloid cyst to be eligible for data extraction. Deaths precipitated by lumbar puncture were excluded. Clinical data were extracted and descriptive statistics were ascertained. Subgroup analyses were performed to compare adults with pediatric patients. RESULTS A total of 107 patients were included in the quantitative synthesis. The mean age was 28.5 years (standard deviation 13.3, range 6-79 years). Male and female patients were affected equally. Headache was the most frequent symptom (n = 86, 80%). There were 6 patients (5 adults and 1 child) who reported positional headaches. The mean duration of signs and symptoms was shorter in adults versus pediatric patients (2.1 days vs. 6.5 days, P = 0.02), and more adults presented with signs and symptoms for less than 24 hours than did pediatric patients (38% vs. 6%, P = 0.01). Colloid cyst mean diameter was 2.0 cm (standard deviation 1.1, range 0.5-7.9 cm) and 96% measured 1 cm or larger. CONCLUSIONS Our data suggests that the prodrome preceding sudden death in the setting of a colloid cyst may be shorter in adults. Also, most fatal colloid cysts measured 1 cm or larger.
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Affiliation(s)
- Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Kanwaldeep Rai
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Daniel T Nagasawa
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Joel S Beckett
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Alexander M Tucker
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, USA; Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, California, USA.
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