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Crihfield EG, Uppalapati P, Abittan B, Laibangyang A, Brahmbhatt S, Burlingame M, Goldberg GL, Rabin JM. Development of laparoscopic skills in skills-naïve trainees using self-directed learning with take-home laparoscopic trainer boxes. Surg Open Sci 2023; 16:82-93. [PMID: 37789947 PMCID: PMC10542196 DOI: 10.1016/j.sopen.2023.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/09/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
Background To determine if take home laparoscopic trainer boxes with only self-directed learning can develop laparoscopic skills in surgically naive learners. Methods 74 starting PGY1 OB/Gyn residents and OB/Gyn clerkship medical students volunteered for the study. Learners performed a laparoscopic peg transfer task with only task instructions and no additional training. Initial tasks were recorded and scored. The participants took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the same task for a second/final score. Initial and final scores were compared for improvement. This improvement was compared to practice and variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences. Results Mean peg transfer task scores improved from 287 (SD = 136) seconds to 193 (SD = 79) seconds (p < 0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R2 of 0.134 (p = 0.001). More practice resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R2 of 0.152 (p < 0.001). Interest in a surgical specialty had no impact on final scores or improvement. Playing a musical instrument and having two or more dexterity-based hobbies was associated with a better baseline score (p = 0.032 and p = 0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted scores. Conclusions Our study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.
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Affiliation(s)
- Eric G. Crihfield
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Pooja Uppalapati
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Baruch Abittan
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Anya Laibangyang
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Sonam Brahmbhatt
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Madeleine Burlingame
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Gary L. Goldberg
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Jill M. Rabin
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
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Manning-Geist BL, Kahn R, Nemirovsky D, Girshman J, Laibangyang A, Gordhandas S, Iasonos A, Chui MH, Roche KL, Zivanovic O, Chi DS, Aghajanian C, Grisham RN. Chemotherapy response in low-grade serous ovarian carcinoma at a comprehensive cancer center: Readdressing the roles of platinum and cytotoxic therapies. Cancer 2023; 129:2004-2012. [PMID: 36951509 PMCID: PMC10682957 DOI: 10.1002/cncr.34753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/02/2023] [Accepted: 02/23/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Data on platinum sensitivity of low-grade serous ovarian carcinoma (LGSOC) in the upfront setting is lacking, and there is limited and contradictory information on chemotherapy responses in recurrent disease. METHODS Patients with LGSOC seen at a comprehensive cancer center from January 1, 1998 to September 30, 2021 were identified from institutional databases. Response to neoadjuvant chemotherapy (NACT) or adjuvant platinum-based chemotherapy and to second- to fifth-line regimens was retrospectively characterized by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Wilcoxon rank-sum and two-tailed Fisher exact tests were employed. RESULTS Of 50 patients, 12 received platinum doublets for suboptimal residual disease and 11 as NACT. Of 12 patients with suboptimal residual disease, seven (58%) achieved objective responses (five partial responses [PRs] and two complete responses); of the 11 patients who underwent NACT, one (9%) achieved a PR (p = .027). The 15 remaining patients had stable disease on first-line platinum chemotherapy. Of 44 patients who recurred, 20 had RECIST-evaluable responses to second-line and 27 to third-line chemotherapy. Objective response rates to platinum-based chemotherapy were 22% (two of nine) in the second line and 10% (one of 10) in the third. In second and third lines, highest response rates were observed with nonplatinum chemotherapy with bevacizumab, at 100% (two of two) and 30% (three of 10), respectively. CONCLUSIONS Primary platinum-based chemotherapy has moderate activity in LGSOC and minimal activity in the recurrent setting, suggesting standard definitions of platinum sensitivity may not apply in LGSOC. In the second and third lines, nonplatinum chemotherapy/bevacizumab elicited the highest response rates.
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Affiliation(s)
- Beryl L. Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryan Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Nemirovsky
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey Girshman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anya Laibangyang
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Danbury Hospital, Danbury, CT
| | - Sushmita Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Herman Chui
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Dennis S. Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Rachel N. Grisham
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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3
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Moon AS, Andikyan V, Agarwal R, Stroever S, Misita D, Laibangyang A, Doo D, Chuang LT. Incisional infiltration versus transversus abdominis plane block of liposomal bupivacaine after midline vertical laparotomy for suspected gynecologic malignancy: a pilot study. Gynecol Oncol Rep 2023; 47:101203. [PMID: 37251783 PMCID: PMC10220396 DOI: 10.1016/j.gore.2023.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background To evaluate whether incisional infiltration of liposomal bupivacaine would decrease opioid requirement and pain scores after midline vertical laparotomy for suspected or known gynecologic malignancy compared with transversus abdominis plane (TAP) block with liposomal bupivacaine. Methods A prospective, single blind randomized controlled trial compared incisional infiltration of liposomal bupivacaine plus 0.5% bupivacaine versus TAP block with liposomal bupivacaine plus 0.5% bupivacaine. In the incisional infiltration group, patients received 266 mg free base liposomal bupivacaine with 150 mg bupivacaine hydrochloride. In the TAP block group, 266 mg free base bupivacaine with 150 mg bupivacaine hydrochloride was administered bilaterally. The primary outcome was total opioid use during the first 48-hour postoperative period. Secondary outcomes included pain scores at rest and with exertion at 2, 6, 12, 24 and 48 h after surgery. Results Forty three patients were evaluated. After interim analysis, a three-fold higher sample size than originally calculated was required to detect a statistically significant difference. There was no clinical difference between the two arms in mean opioid requirement (morphine milligram equivalents) for the first 48 h after surgery (59.9 vs. 80.8, p = 0.13). There were no differences in pain scores at rest or with exertion between the two groups at pre-specified time intervals. Conclusion In this pilot study, incisional infiltration of liposomal bupivacaine and TAP block with liposomal bupivacaine demonstrated clinically similar opioid requirement after gynecologic laparotomy for suspected or known gynecologic cancer. Given the underpowered study, these findings cannot support the superiority of either modality after open gynecologic surgery.
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Affiliation(s)
- Ashley S. Moon
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Vaagn Andikyan
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Rakhee Agarwal
- Department of Research and Innovation, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Stephanie Stroever
- Department of Research and Innovation, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - David Misita
- Department of Anesthesiology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Anya Laibangyang
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - David Doo
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Linus T. Chuang
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
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4
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Ferraro A, Laibangyang A, Yazdani A, Hurwitz J, Chuang L. Recurrent cervical cancer after trachelectomy diagnosed by hysteroscopy: A case report. Gynecol Oncol Rep 2023; 45:101134. [PMID: 36683776 PMCID: PMC9853302 DOI: 10.1016/j.gore.2023.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Surveillance for cervical cancer recurrence after radical trachelectomy is challenging and warrants additional research to establish evidence-based screening guidelines. Papanicolaou (Pap smear) with HPV testing, physical exam, and symptom reporting remain the standard of care despite high false positive rates. In this patient with a history of early-stage cervical adenocarcinoma status post radical trachelectomy, a diagnosis of recurrence was made hysteroscopically, prompting evaluation of the utility of this technique for screening and management of patients with suspected recurrent cervical cancer after trachelectomy.
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Affiliation(s)
- Amanda Ferraro
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States,Corresponding author at: 24 Hospital Ave, Department of OBGYN, Danbury, CT 06810, United States.
| | - Anya Laibangyang
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States
| | - Ariella Yazdani
- Larner College of Medicine at the University of Vermont, 89 Beaumont Ave, Burlington, VT 0540, United States
| | - Joshua Hurwitz
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States,Illume Fertility, Reproductive Endocrinology and Infertility, 103 Newtown Rd #1A, Danbury, CT 06810, United States
| | - Linus Chuang
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States,Larner College of Medicine at the University of Vermont, 89 Beaumont Ave, Burlington, VT 0540, United States
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5
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Laibangyang A, Law C, Gupta G, Da Dong X, Chuang L. Parasitic leiomyoma causing small bowel perforation: A case report. Case Rep Womens Health 2021; 32:e00349. [PMID: 34430223 PMCID: PMC8365333 DOI: 10.1016/j.crwh.2021.e00349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background Parasitic leiomyomas are rare extra-uterine tumors that can be seen in patients after myomectomy or morcellation of leiomyomas. Case A 63-year-old woman with a history of abdominal myomectomy 20 years prior presented with worsening abdominal distension and pain for the past eight months. The patient delayed care due to fear of the COVID-19 pandemic and was found to have a 42 cm parasitic leiomyoma attached to the small bowel causing obstruction and perforation. Conclusion Parasitic leiomyomas can cause small bowel obstruction and perforation. Parasitic leiomyomas can range in presentation from asymptomatic to sepsis. Parasitic leiomyomas can cause small bowel obstruction and perforation. Care should not be delayed in the setting of the COVID-19 pandemic.
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Affiliation(s)
- Anya Laibangyang
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
| | - Cassandra Law
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
| | - Gunjan Gupta
- Pathology & Laboratory Medicine, Danbury Hospital, Danbury, CT, United States of America
| | - Xiang Da Dong
- Department of Surgery, Nuvance Health, Danbury, CT, United States of America
| | - Linus Chuang
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
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6
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Laibangyang A, Alter R, Hasan Y, Yamada SD. Superior vena cava syndrome associated with uterine serous carcinoma. Gynecol Oncol Rep 2020; 33:100593. [PMID: 32577490 PMCID: PMC7300129 DOI: 10.1016/j.gore.2020.100593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022] Open
Abstract
Extensive nodal metastases from uterine serous carcinoma can lead to SVC syndrome. Prevention of nodal metastases is an important goals of care discussion. Radiation, steroids and/or chemotherapy must all be considered in this setting.
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Laibangyang A, Rodgers SD, Baron SL, Schaeffer BT, Shikowitz M, Mittler MA, Schneider SJ. Pedicled nasoseptal flap reconstruction for craniopharyngiomas in pediatric patients. Childs Nerv Syst 2020; 36:491-496. [PMID: 31179530 DOI: 10.1007/s00381-019-04238-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Though the use of the pedicled nasoseptal flap (NSF), a reconstructive technique used after endoscopic endonasal approaches (EEA) for resection of craniopharyngiomas, has been shown to reduce the occurrence of post-operative cerebrospinal fluid (CSF) leaks in adults, less is known about its use in pediatric populations, specifically in children under the age of 7. The goal of this retrospective cohort study is to determine the viability of the pedicled NSF for pediatric patients. METHODS Retrospective review of 12 pediatric patients (ages 2-16) undergoing 13 NSF reconstructions after resection of craniopharyngiomas. Radioanatomic analysis of computed tomography (CT) scans was utilized to classify the pneumatization of the sphenoid sinus depending on the thickness of the sphenoid bone margin. Intercarotid distances were measured from magnetic resonance imaging (MRI) scans to assess the feasibility of this reconstruction technique in pediatric patients. RESULTS At the time of surgery, all patients were noted to have adequate NSF length and width. No post-operative high-flow CSF leaks were found within the group. Lack of pneumatization of the sphenoid sinus and narrow intercarotid distances in the youngest of patients did not lead to negative clinical outcomes. CONCLUSIONS Based on our results and experience, the pedicled nasoseptal flap is a viable reconstructive option after EEA in the pediatric population, including even the youngest of patients. In these patients, a narrowed window between the intercarotid arteries and the lack of pneumatization of the sphenoid sinus present a challenge that can be overcome by using stereotactic navigation and advanced endoscopic techniques.
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Affiliation(s)
- Anya Laibangyang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
| | - Shaun D Rodgers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA. .,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, New Hyde Park, NY, 11042, USA.
| | - Shanna L Baron
- Division of Pediatric Neurosurgery, Cohen Children's Medical Center, New Hyde Park, NY, 11042, USA
| | - B Todd Schaeffer
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.,Department of Otolaryngology, Long Island Jewish Medical Center, Queens, NY, 11040, USA
| | - Mark Shikowitz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.,Department of Otolaryngology, Long Island Jewish Medical Center, Queens, NY, 11040, USA
| | - Mark A Mittler
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, New Hyde Park, NY, 11042, USA
| | - Steven J Schneider
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, New Hyde Park, NY, 11042, USA
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8
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Koumas C, Laibangyang A, Barron SL, Mittler MA, Schneider SJ, Rodgers SD. Outcomes following endoscopic endonasal resection of sellar and supresellar lesions in pediatric patients. Childs Nerv Syst 2019; 35:2099-2105. [PMID: 31214816 DOI: 10.1007/s00381-019-04258-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The endoscopic endonasal approach (EEA) is a credible surgical alternative for the resection of sellar and suprasellar lesions such as pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts. However, its application to pediatric patients poses several unique challenges that have not yet been well evaluated. The authors evaluate the safety, efficacy, and outcomes associated with the use of the EEA for treatment of these pathologic entities in pediatric patients. METHODS Retrospective review of 30 patients between the ages of two and 24 who underwent endoscopic endonasal resection of sellar or suprasellar lesions between January 2010 and December 2015. Endocrinological and ophthalmological outcomes, as well as extent of resection and complications were all evaluated. RESULTS Gross total resection was achieved in eight of the nine pituitary adenomas, nine of the 12 craniopharyngiomas, and six of the nine Rathke cleft cysts. Of the 30 patients, 22 remained disease free at last follow-up. A total of six patients developed hypopituitarism and five developed diabetes insipidus. Eleven patients experienced improved vision, sixteen experienced no change, and one patient experienced visual worsening. Postoperative cerebrospinal fluid leak was seen in a single case and later resolved, vasospasm/stroke was experienced by 10% of patients, and new obesity was recorded in 10% of patients. There were no perioperative deaths. CONCLUSIONS Endoscopic endonasal resection is a safe and effective surgical alternative for the management of sellar and suprasellar pathologies in pediatric populations with excellent outcomes, minimal complications, and a low risk of morbidity.
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Affiliation(s)
- Christoforos Koumas
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anya Laibangyang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Shanna L Barron
- Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA
| | - Mark A Mittler
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA
| | - Steven J Schneider
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA
| | - Shaun D Rodgers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA. .,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA.
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