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Lopez F, Agaimy A, Franchi A, Suárez C, Vander Poorten V, Mäkitie AA, Homma A, Eisbruch A, Olsen KD, Saba NF, Nuyts S, Snyderman C, Beitler JJ, Corry J, Hanna E, Hellquist H, Rinaldo A, Ferlito A. Update on olfactory neuroblastoma. Virchows Arch 2024; 484:567-585. [PMID: 38386106 DOI: 10.1007/s00428-024-03758-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
Olfactory neuroblastomas are uncommon malignancies that arise from olfactory receptor cells located high in the nasal cavity. Accurate diagnosis plays a crucial role in determining clinical results and guiding treatment decisions. Diagnosis can be a major challenge for pathologists, especially when dealing with tumours with poor differentiation. The discovery of several molecular and immunohistochemical markers would help to overcome classification difficulties. Due to the paucity of large-scale studies, standardisation of diagnosis, treatment and prediction of outcome remains a challenge. Surgical resection by endoscopic techniques with the addition of postoperative irradiation is the treatment of choice. In addition, it is advisable to consider elective neck irradiation to minimise the risk of nodal recurrence. Molecular characterisation will help not only to make more accurate diagnoses but also to identify specific molecular targets that can be used to develop personalised treatment options tailored to each patient. The present review aims to summarise the current state of knowledge on histopathological diagnosis, the molecular biology and management of this disease.
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Affiliation(s)
- Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Avenida de Roma, S/N, 33011, Oviedo, Asturias, Spain.
| | - Abbas Agaimy
- Institut Für Pathologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alessandro Franchi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, 56126, Pisa, Italy
| | | | - Vincent Vander Poorten
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Oncology, Section of Head and Neck Oncology, KU Leuven, and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Research Program in Systems Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sandra Nuyts
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven-University of Leuven, 3000, Leuven, Belgium
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - June Corry
- Division of Radiation Oncology, GenesisCare Radiation Oncology, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Ehab Hanna
- Department of Head & Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Henrik Hellquist
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Algarve Biomedical Center Research Institute (ABC-RI), 8005-139, Faro, Portugal
- Department of Cellular Pathology, Northern Lincolnshire and Goole NHS Foundation Trust, Lincoln, LN2 5QY, UK
| | | | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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Choby G, Geltzeiler M, Almeida JP, Champagne PO, Chan E, Ciporen J, Chaskes MB, Fernandez-Miranda J, Gardner P, Hwang P, Ji KSY, Kalyvas A, Kong KA, McMillan R, Nayak J, O’Byrne J, Patel C, Patel Z, Peris Celda M, Pinheiro-Neto C, Sanusi O, Snyderman C, Thorp BD, Van Gompel JJ, Young SC, Zenonos G, Zwagerman NT, Wang EW. Multicenter Survival Analysis and Application of an Olfactory Neuroblastoma Staging Modification Incorporating Hyams Grade. JAMA Otolaryngol Head Neck Surg 2023; 149:837-844. [PMID: 37535372 PMCID: PMC10401389 DOI: 10.1001/jamaoto.2023.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/08/2023] [Indexed: 08/04/2023]
Abstract
Importance Current olfactory neuroblastoma (ONB) staging systems inadequately delineate locally advanced tumors, do not incorporate tumor grade, and poorly estimate survival and recurrence. Objective The primary aims of this study were to (1) examine the clinical covariates associated with survival and recurrence of ONB in a modern-era multicenter cohort and (2) incorporate Hyams tumor grade into existing staging systems to assess its ability to estimate survival and recurrence. Design, Setting, and Participants This retrospective, multicenter, case-control study included patients with ONB who underwent treatment between January 1, 2005, and December 31, 2021, at 9 North American academic medical centers. Intervention Standard-of-care ONB treatment. Main Outcome and Measures The main outcomes were overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) as C statistics for model prediction. Results A total of 256 patients with ONB (mean [SD] age, 52.0 [15.6] years; 115 female [44.9%]; 141 male [55.1%]) were included. The 5-year rate for OS was 83.5% (95% CI, 78.3%-89.1%); for DFS, 70.8% (95% CI, 64.3%-78.0%); and for DSS, 94.1% (95% CI, 90.5%-97.8%). On multivariable analysis, age, American Joint Committee on Cancer (AJCC) stage, involvement of bilateral maxillary sinuses, and positive margins were associated with OS. Only AJCC stage was associated with DFS. Only N stage was associated with DSS. When assessing the ability of staging systems to estimate OS, the best-performing model was the novel modification of the Dulguerov system (C statistic, 0.66; 95% CI, 0.59-0.76), and the Kadish system performed most poorly (C statistic, 0.57; 95% CI, 0.50-0.63). Regarding estimation of DFS, the modified Kadish system performed most poorly (C statistic, 0.55; 95% CI, 0.51-0.66), while the novel modification of the AJCC system performed the best (C statistic, 0.70; 95% CI, 0.66-0.80). Regarding estimation of DSS, the modified Kadish system was the best-performing model (C statistic, 0.79; 95% CI, 0.70-0.94), and the unmodified Kadish performed the worst (C statistic, 0.56; 95% CI, 0.51-0.68). The ability for novel ONB staging systems to estimate disease progression across stages was also assessed. In the novel Kadish staging system, patients with stage VI disease were approximately 7 times as likely to experience disease progression as patients with stage I disease (hazard ratio [HR], 6.84; 95% CI, 1.60-29.20). Results were similar for the novel modified Kadish system (HR, 8.99; 95% CI, 1.62-49.85) and the novel Dulguerov system (HR, 6.86; 95% CI, 2.74-17.18). Conclusions and Relevance The study findings indicate that 5-year OS for ONB is favorable and that incorporation of Hyams grade into traditional ONB staging systems is associated with improved estimation of disease progression.
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Affiliation(s)
- Garret Choby
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mathew Geltzeiler
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | | | | | - Erik Chan
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Jeremy Ciporen
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Mark B. Chaskes
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | | | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Hwang
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Keven Seung Yong Ji
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Keonho A. Kong
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Ryan McMillan
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jayakar Nayak
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Jamie O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Chirag Patel
- Department of Otolaryngology–Head and Neck Surgery, Loyola University, Maywood, Illinois
| | - Zara Patel
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Maria Peris Celda
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Carlos Pinheiro-Neto
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Olabisi Sanusi
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Carl Snyderman
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brian D. Thorp
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | | | - Sarah C. Young
- Department of Neurological Surgery, University of Wisconsin, Milwaukee, Wisconsin
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nathan T. Zwagerman
- Department of Neurological Surgery, University of Wisconsin, Milwaukee, Wisconsin
| | - Eric W. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Fields D, McDowell M, Schulien A, Algattas H, Abou-Al-Shaar H, Agarwal N, Alan N, Costacou T, Wang E, Snyderman C, Gardner P, Zenonos G. Low Preoperative Prealbumin Levels Are a Strong Independent Predictor of Postoperative Cerebrospinal Fluid Leak Following Endoscopic Endonasal Skull Base Surgery. World Neurosurg 2022; 167:e110-e116. [PMID: 35961585 DOI: 10.1016/j.wneu.2022.07.102] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prealbumin levels correlate with overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative prealbumin levels predict risk of endoscopic endonasal skull base surgery (EESBS) reconstruction failure, as demonstrated by postoperative cerebrospinal fluid (CSF) leak and/or infection. METHODS Between October 2018 and February 2020, 98 patients with documented preoperative prealbumin levels were prospectively followed. The incidence of CSF leak and infection in patients with low prealbumin levels (≤20 mg/dL) was compared with those with normal prealbumin levels (>20 mg/dL). Numerous factors previously shown to influence CSF leak rates were assessed. Both univariate and multivariable analyses were performed to identify independent predictive factors. RESULTS Within this prospectively gathered patient cohort composed of >95% "high-risk" expanded EESBS, 14 of 98 patients (14.3%) experienced a postoperative CSF leak. Factors univariately associated with postoperative complications at the 0.2 level of significance were used in a multivariable model. Low prealbumin levels (≤20 mg/dL) proved to be a strong independent predictive factor associated with a 5-fold increased risk of postoperative CSF leak (odds ratio 5.01, P = 0.01), and postoperative surgical-site infection (P = 0.0009). These associations remained after controlling for multiple other factors, including body mass index, surgical pathology, previous EESBS, risk assessment index, and high- versus low-flow intraoperative CSF leaks. CONCLUSIONS Preoperative prealbumin levels are an independent predictor of EESBS associated CSF leak and infection. Future studies are needed to investigate the utility of screening and correcting prealbumin levels to limit postoperative complications.
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Affiliation(s)
- Daryl Fields
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Michael McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony Schulien
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hanna Algattas
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Reitz K, Ramos A, Speranza G, Chaer R, Singh M, Snyderman C, Hager E. Non-Functional Carotid Body Tumors in Patients Without Somatic Mutations May Be Considered for Non-Operative Management. Ann Vasc Surg 2022; 85:57-67. [PMID: 35472500 PMCID: PMC9627968 DOI: 10.1016/j.avsg.2022.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/19/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid Body Tumors (CBT) are rare neuroendocrine paragangliomas which are typically asymptomatic and benign, with a low rate of biochemical functionality. Historically, early surgical excision was recommended to prevent development of CBT-related complications. Yet, CBT resection can result in significant cranial nerve and vascular injuries. Recent work has shown successful primary observation without resection of non-carotid body, cranial paragangliomas with slow growth and low rate of neuropathies. We hypothesize that primary observation of CBT is safe and may be considered for majority of CBT. METHODS Retrospective cohort study of patients at a multi-hospital healthcare system with radiologic identification and/or diagnostic or procedural billing codes for CBT (2000-2019). Tumor size (greatest diameter), associated symptoms, and interventions were recorded at the initial evaluation and throughout follow-up. Multivariable logistic regression investigated the risk of initial surgical resection. RESULTS A total of 108 patients (mean age, 59 ± 19 years; 67% female), with 123 CBT (mean diameter 23 ± 12 mm; 52% right) were initially evaluated by otolaryngologists (51%), vascular surgeons (25%), neurosurgeons (8%), or other (16%) medical providers. Fity-five CBT were initially resected, 63 observed, and 5 irradiated. Initial resection was associated with younger age (adjusted odd ratios aOR, 0.95 [95% confidence intervals CI, 0.92-0.97]), male sex (aOR, 4.82 [95% CI, 1.47-15.75]), and evaluation by a vascular surgeon (aOR, 6.17 [95% CI, 2.04-18.63]). Overall median follow-up was 4.7 (IQR, 2.6-9.1) years. Initially observed CBT were on an average stable in size (mean 1 ± 5 mm/year), none became biochemically active, and 2 patients became symptomatic. At the final follow-up, 63 (51%) underwent surgical resection, 54 (44%) observation, and 6 (5%) radiation therapy. Of the 63 surgically resected CBT, 5 (8%) patients had malignant CBT of which 3 (60%) had known somatic mutations (polymerase epsilon [n = 1], succinate dehydrogenase-D gene [n = 2]). Thirty percent of CBT resections had in-hospital postoperative complications, notably including 1 stroke which occurred in an initially observed patient and 16 cranial nerve complications which all occurred in immediately resected patients. Three resected CBT locally recurred, only 1 of which had malignant pathology. CONCLUSIONS Patients with newly diagnosed CBT require biochemical functionality and somatic mutation testing. In the absence of these findings, initial observation of CBTs with annual imaging and symptom monitoring may be considered an alternative to immediate resection which demonstrates a high risk of clinically meaningful postoperative complications.
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Affiliation(s)
- Katherine Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
| | - Anna Ramos
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Rabih Chaer
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Michael Singh
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric Hager
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
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Lechner M, Takahashi Y, Turri-Zanoni M, Ferrari M, Liu J, Counsell N, Mattavelli D, Rampinelli V, Vermi W, Lombardi D, Saade R, Park KW, Schartinger VH, Franchi A, Facco C, Sessa F, Battocchio S, Fenton TR, Vaz FM, O'Flynn P, Howard D, Stimpson P, Wang S, Hannan SA, Unadkat S, Hughes J, Dwivedi R, Forde CT, Randhawa P, Gane S, Joseph J, Andrews PJ, Dave M, Fleming JC, Thomson D, Zhu T, Teschendorff A, Royle G, Steele C, Jimenez JE, Laco J, Wang EW, Snyderman C, Lacy PD, Woods R, O'Neill JP, Saraswathula A, Kaur RP, Zhao T, Ramanathan M, Gallia GL, London NR, Le QT, West RB, Patel ZM, Nayak JV, Hwang PH, Hermsen M, Llorente J, Facchetti F, Nicolai P, Bossi P, Castelnuovo P, Jay A, Carnell D, Forster MD, Bell DM, Lund VJ, Hanna EY. International Multicenter Study of Clinical Outcomes of Sinonasal Melanoma Shows Survival Benefit for Patients Treated with Immune Checkpoint Inhibitors and Potential Improvements to the Current TNM Staging System. J Neurol Surg B Skull Base 2022. [DOI: 10.1055/s-0042-1750178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Objectives Sinonasal mucosal melanoma (SNMM) is an extremely rare and challenging sinonasal malignancy with a poor prognosis. Standard treatment involves complete surgical resection, but the role of adjuvant therapy remains unclear. Crucially, our understanding of its clinical presentation, course, and optimal treatment remains limited, and few advancements in improving its management have been made in the recent past.
Methods We conducted an international multicenter retrospective analysis of 505 SNMM cases from 11 institutions across the United States, United Kingdom, Ireland, and continental Europe. Data on clinical presentation, diagnosis, treatment, and clinical outcomes were assessed.
Results One-, three-, and five-year recurrence-free and overall survival were 61.4, 30.6, and 22.0%, and 77.6, 49.2, and 38.3%, respectively. Compared with disease confined to the nasal cavity, sinus involvement confers significantly worse survival; based on this, further stratifying the T3 stage was highly prognostic (p < 0.001) with implications for a potential modification to the current TNM staging system. There was a statistically significant survival benefit for patients who received adjuvant radiotherapy, compared with those who underwent surgery alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI]: 0.57–0.96, p = 0.021). Immune checkpoint blockade for the management of recurrent or persistent disease, with or without distant metastasis, conferred longer survival (HR = 0.50, 95% CI: 0.25–1.00, p = 0.036).
Conclusions We present findings from the largest cohort of SNMM reported to date. We demonstrate the potential utility of further stratifying the T3 stage by sinus involvement and present promising data on the benefit of immune checkpoint inhibitors for recurrent, persistent, or metastatic disease with implications for future clinical trials in this field.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London, United Kingdom
- UCL Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of ENT, Barts Health NHS Trust, London, United Kingdom
| | - Yoko Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, United Kingdom
| | - Davide Mattavelli
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - William Vermi
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Rami Saade
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Department of Otolaryngology—Head and Neck Surgery, Lebanese American University, Beirut, Lebanon
| | - Ki Wan Park
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Volker H. Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Carla Facco
- Unit of Pathology, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Fausto Sessa
- Unit of Pathology, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Simonetta Battocchio
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Tim R. Fenton
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, United Kingdom
| | - Francis M. Vaz
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Paul O'Flynn
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - David Howard
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Paul Stimpson
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Simon Wang
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S. Alam Hannan
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Samit Unadkat
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Jonathan Hughes
- Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Raghav Dwivedi
- Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Cillian T. Forde
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Premjit Randhawa
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Simon Gane
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Jonathan Joseph
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Peter J. Andrews
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Manas Dave
- Division of Dentistry, University of Manchester, Manchester, United Kingdom
| | - Jason C. Fleming
- Liverpool Head & Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - David Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Liverpool Head & Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Tianyu Zhu
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Andrew Teschendorff
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Gary Royle
- UCL Cancer Institute, University College London, London, United Kingdom
| | | | - Joaquin E. Jimenez
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, United States
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Czech Republic
| | - Eric W. Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, United States
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, United States
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Peter D. Lacy
- Department of Otolaryngology—Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Robbie Woods
- Department of Otolaryngology—Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - James P. O'Neill
- Department of Otolaryngology—Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
- The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anirudh Saraswathula
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
| | - Raman Preet Kaur
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
| | - Tianna Zhao
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Murugappan Ramanathan
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gary L. Gallia
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Nyall R. London
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Sinonasal and Skull Base Tumor Program—Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, United States
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Robert B. West
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Zara M. Patel
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jayakar V. Nayak
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Peter H. Hwang
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Mario Hermsen
- Department of Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Jose Llorente
- Department of Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Amrita Jay
- Department of Histopathology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Dawn Carnell
- Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Martin D. Forster
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Diana M. Bell
- Disease Team Alignment: Head and Neck, City of Hope Medical Center, Duarte, California, United States
| | - Valerie J. Lund
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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6
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Melachuri S, Melachuri M, Vallapil B, Kim S, Snyderman C. The incidence of stroke post neck dissection surgery and perioperative management. Am J Otolaryngol 2022; 43:103360. [PMID: 34972004 DOI: 10.1016/j.amjoto.2021.103360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Head and neck surgery encompasses major vessels, raising the concern of life-threatening complications such as stroke. METHODS Databases at UPMC were queried to identify patients with both neck dissections and stroke from January 1st, 2004, to October 1st, 2020. A retrospective chart review was performed to identify patients who experienced a stroke within 30 days of a neck dissection. RESULTS Search of a UPMC database for carotid artery stenosis (CAS), transient ischemic attack (TIA), and stroke identified 20,527 patients. After matching with the Head and Neck Tumor Registry patients, 41 of 4230 patients with a neck dissection also had a stroke, TIA, or CAS in their lifetime. One patient, with multiple risk factors, despite pre-operative precautions, had a stroke 2 days post neck dissection in the setting of carotid occlusion from hypercoagulability of malignancy and intraoperative vessel injury. The patient subsequently underwent a carotid thrombectomy and vein patch repair and has had no additional cerebrovascular accidents. CONCLUSION Although the incidence of stroke post neck dissection is minimal, patients with multiple risk factors for stroke should be managed carefully to prevent deleterious outcomes.
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7
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Issa M, El-Kouri N, Mater S, Lee JY, Snyderman C, Lee Y. Understanding the Role of the Otolaryngology Hospitalist: Tracheostomies and Tracheostomy Care. Ann Otol Rhinol Laryngol 2021; 131:997-1003. [PMID: 34628934 DOI: 10.1177/00034894211045775] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT). METHODS Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed. RESULTS Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult. CONCLUSION In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.
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Affiliation(s)
- Mohamad Issa
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nadeem El-Kouri
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Sara Mater
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan Y Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Carl Snyderman
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yan Lee
- Division of Otolaryngology, Department of Surgery, Yale Medical Center, New Haven, CT, USA
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8
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Ramos AE, Reitz KM, Speranza G, Singh MJ, Chaer RA, Snyderman C, Hager ES. Safety of Nonoperative Management of Carotid Body Tumors. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Cracolici V, Wang EW, Gardner PA, Snyderman C, Gargano SM, Chiosea S, Singhi AD, Seethala RR. SSTR2 Expression in Olfactory Neuroblastoma: Clinical and Therapeutic Implications. Head Neck Pathol 2021; 15:1185-1191. [PMID: 33929681 PMCID: PMC8633213 DOI: 10.1007/s12105-021-01329-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
Somatostatin receptor 2 (SSTR2) expression has previously been documented in olfactory neuroblastoma (ONB). Here, we fully characterize SSTR2 expression in ONB and correlate staining results with clinicopathologic parameters including Hyams grade. We also assess SSTR2 immunohistochemistry expression in various histologic mimics of ONB to assess its diagnostic functionality. 78 ONBs (51 primary biopsies/excisions and 27 recurrences/metastases) from 58 patients were stained for SSTR2. H-scores based on intensity (0-3 +) and percentage of tumor cells staining were assigned to all cases. 51 histologic mimics were stained and scored in an identical fashion. 77/78 (99%) ONB cases demonstrated SSTR2 staining (mean H-score: 189, range: 0-290). There were no significant differences in staining between primary tumors and recurrences/metastases (mean H-score: 185 vs 198). Primary low-grade ONB had somewhat stronger staining than high-grade tumors (mean H-score: 200 vs 174). SSTR2 expression had no prognostic value when considering disease-free or disease-specific survival. SSTR2 staining is significantly higher in ONB than its histologic mimics (mean H-score: 189 vs 12.9, p < 0.001) suggesting a potential use of the marker in diagnosis of ONB. In conclusion, SSTR2 is consistently expressed in ONB suggesting a role for somatostatin-analog based imaging and therapy in this disease. More generally, SSTR2 may be another marker of neuroendocrine differentiation in ONB.
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Affiliation(s)
- Vincent Cracolici
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- , 9500 Euclid Avenue, L25, Cleveland, OH, USA.
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carl Snyderman
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stacey M Gargano
- Department of Pathology and Laboratory Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Simion Chiosea
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aatur D Singhi
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raja R Seethala
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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10
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Algattas HN, Okonkwo DO, Snyderman C, Gardner PA, Wang EW, Zenonos GA. Staged Repositioning in Endoscopic Endonasal Odontoidectomy Maximizes Decompression While Allowing Preservation of the C1 Anterior Arch: A Technical Note. World Neurosurg 2021; 151:118-123. [PMID: 33940272 DOI: 10.1016/j.wneu.2021.04.105] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preservation of the anterior arch of C1 in endoscopic endonasal odontoidectomy has been proposed as an alternative to complete C1 arch resections, potentially affording less destabilization of the craniocervical junction. Nonetheless, this approach may limit the decompression achieved. In this case, intraoperative repositioning allowed maximal decompression while preserving the anterior arch of C1. METHODS A 79-year-old woman presented with suboccipital pain caused by an expansile and compressive mass centered on the dens. Notably, the mass occluded both vertebral arteries resulting in small cerebellar strokes. An endoscopic endonasal approach for diagnosis and decompression was performed followed by posterior fixation. RESULTS Given the significant compression, the patient was initially positioned in slight cervical extension. After rhinopharyngeal flap harvest, the top half of the anterior arch of C1 was resected, maintaining its structural integrity. The odontoidectomy was completed flush to the superior border of the reduced C1 arch. After an intraoperative computed tomography (CT) scan, performed in a neutral position, the patient was then repositioned with cervical flexion. This maneuver presented the residual odontoid above the C1 arch, but, given the partial removal of the dens, it did not result in any change in neuromonitoring. Further odontoid resection was then completed and follow-up CT scan revealed maximal dens removal, extending below the C1 anterior arch in neutral position. CONCLUSIONS In cases of odontoid/atlantoaxial pathology causing significant neural compression, staged intraoperative repositioning can safely maximize the odontoidectomy, while affording preservation of the structural integrity of the anterior arch of C1.
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Affiliation(s)
- Hanna N Algattas
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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11
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Senthamarai Siddharthan YP, Bata A, Anetakis K, Crammond DJ, Balzer JR, Snyderman C, Gardner P, Thirumala PD. Role of Intraoperative Neurophysiologic Monitoring in Internal Carotid Artery Injury During Endoscopic Endonasal Skull Base Surgery. World Neurosurg 2020; 148:e43-e57. [PMID: 33301995 DOI: 10.1016/j.wneu.2020.11.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In the present study, we investigated the role of intraoperative neuromonitoring (IONM) in internal carotid artery (ICA) injury during endoscopic endonasal skull base surgery (EESBS). METHODS The study group included all 13 patients who had experienced an ICA injury during EESBS with IONM from 2004 to 2017. The medical records were reviewed for the perioperative data. The IONM reports were reviewed to evaluate the baseline somatosensory evoked potentials (SSEP), electroencephalography (EEG), and brainstem auditory evoked potentials (BAEP) and their significant changes related to ICA injury and/or the subsequent surgical/endovascular interventions. RESULTS All 13 patients had undergone SSEP and 7 patients had BAEP monitoring during surgery. EEG was added during emergent angiography following the surgery for 5 patients. Two patients showed significant SSEP changes, and one showed significant SSEP and EEG changes, indicating cerebral hypoperfusion. Of these 3 patients, patient 1 had experienced irreversible SSEP loss with postoperative stroke. Patients 2 and 3 had SSEP and/or EEG changes that had recovered to baseline after interventions without postoperative deficits. Despite ICA injury, 10 patients showed no significant SSEP and/or EEG changes, and all 7 patients with BAEP monitoring showed no significant BAEP changes, indicating adequate cerebral and brainstem perfusion, respectively. The injured ICA was sacrificed in 4 patients, of whom 3 showed stable SSEP and 1 had experienced irreversible SSEP loss. IONM correlated with the postoperative neurologic examination findings in all cases, adequately predicting the neurologic outcomes after ICA injury. CONCLUSION SSEP and EEG monitoring can accurately detect cerebral hypoperfusion and provide real-time feedback during surgery. SSEP and EEG changes predicted for neurologic outcomes and guide surgical decisions regarding the preservation or sacrifice of the ICA. Comprehensive multimodality monitoring according to the surgical risks can serve to detect and guide the management of ICA injury in EESBS.
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Affiliation(s)
| | - Ammar Bata
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Katherine Anetakis
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Donald J Crammond
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey R Balzer
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carl Snyderman
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Parthasarathy D Thirumala
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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12
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Khalafallah A, Fung S, Kozachik S, Valappil B, Shaar HAA, Wang E, Zenonos G, Snyderman C, Gardner P, Gallia G, Rowan N, Mukherjee D. QOLP-15. QUALITATIVE STUDY OF DIFFERENTIAL QUALITY OF LIFE (QOL) IN SUPRASELLAR MENINGIOMA PATIENTS TREATED VIA ENDOSCOPIC ENDONASAL APPROACH VERSUS OPEN CRANIOTOMY. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The optimal surgical treatment of suprasellar meningiomas remains controversial. While successful surgery has historically been measured by extent of tumor resection (EOR), surgeons must also balance tumor- and patient-specific characteristics with quality of life (QoL) outcomes when considering either an open craniotomy or endoscopic endonasal approach (EEA).
METHODS
We conducted 28 in-depth individual interviews with patients diagnosed with suprasellar meningioma and treated via EEA (n=14) or craniotomy (n=14). We used a structured interview script and the transcribed interviews were independently coded by two researchers. Consensus was used to identify themes and domains of interest.
RESULTS
The overall sample (80% between 40-69 years old, 70% female, and 82% white) was largely similar between craniotomy and EEA cohorts. Tumor volumes were not different between both cohorts (p=0.2), with a combined average of 4.4 cm3 (standard error ± 0.7). Suprasellar meningiomas caused a wide range of symptoms with 21 concepts elicited. The most frequently endorsed concepts were “Vision” (n=22), “Headaches” (n=11), “Fatigue” (n=11), “Cognitive Symptoms” (n=10), “Pituitary Dysfunction – including Trouble Sleeping and Frequent Urination” (n=9), “Sinus Problems” (n=7), and “Personality Changes” (5). Both surgical approaches demonstrated improvements in vision (69.2% EEA, 66.7% craniotomy) and headaches (100% EEA, 80% craniotomy). Compared to EEA, craniotomy yielded a longer list of complications (3 vs.14) and surgery-specific symptoms (9 vs.16). More craniotomy patients reported having negative emotions (5 vs.1), new depression and anxiety (6 vs.1), financial difficulties (3 vs.1), and reduced desire/ability to pursue fun activities (12 vs.7) after surgery relative to EEA counterparts.
CONCLUSION
Suprasellar meningiomas can be debilitating with significantly impact on patients’ health and QoL. Our findings demonstrate differential effects upon patients’ post-operative QoL associated with type of surgery. Our findings support the need for measuring patient-centered, disease-specific QoL outcomes in patients undergoing craniotomy versus EEA for suprasellar meningioma resection.
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Affiliation(s)
| | - Shirley Fung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sharon Kozachik
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | - Gary Gallia
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Rowan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Borghei-Razavi H, Truong HQ, Fernandes Cabral DT, Sun X, Celtikci E, Wang E, Snyderman C, Gardner PA, Fernandez-Miranda JC. Endoscopic Endonasal Petrosectomy: Anatomical Investigation, Limitations, and Surgical Relevance. Oper Neurosurg (Hagerstown) 2020; 16:557-570. [PMID: 30982905 DOI: 10.1093/ons/opy195] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The endoscopic endonasal approach (EEA) was recently added to the neurosurgical armamentarium as an alternative approach to the petrous apex (PA) region. However, the maximal extension, anatomical landmarks, and indications of this procedure remain to be established. OBJECTIVE To investigate the limitations and suggest a classification of PA lesions for endoscopic petrosectomy. METHODS Five anatomical specimens were dissected with EEA to the PA. Anatomical landmarks for the surgical steps and maximal limits were noted. Pre- and postprocedural computed tomographic scan and image-guidance were used. Relevant surgical cases were reviewed and presented. RESULTS We defined 3 types of petrosectomy: medial, inferior, and inferomedial. Medial petrosectomy was limited within the paraclival internal carotid artery (ICA) anteriorly, lacerum ICA inferiorly, abducens nerve superiorly, and petrous ICA laterally. Among those, abducens nerve and petrous ICA are surgical limits. Full skeletonization of the paraclival ICA and removal of the lingual process are essential for better access to the medial aspect of PA. Inferior petrosectomy was defined by the lacerum foramen synchondrosis anteriorly, jugular foramen inferiorly, internal acoustic canal posteriorly, and PA superolaterally. Those are surgical limits except for the foramen lacerum synchondrosis. The connective tissue at the pterygosphenoidal fissure was a key landmark for the sublacerum approach. Clinical cases in 3 types of PA lesions were presented. CONCLUSION The EEA provides access to the medial and inferior aspects of the PA. Several technical maneuvers, including paraclival and lacerum ICA skeletonization, sublacerum approach, and lingual process removal, are key to maximize PA drilling.
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Affiliation(s)
- Hamid Borghei-Razavi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Huy Q Truong
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David T Fernandes Cabral
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xicai Sun
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Emrah Celtikci
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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14
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Taylor J, Shuai Y, Robertson L, Normolle DP, Ferris RL, Bear T, Nilsen ML, Johnson JT, Kubik M, Sridharan S, Duvvuri U, Wang E, Skinner HD, Clump DA, Ohr J, Snyderman C, Chiosea SI, Gish-Johnson R, Kim S, Zandberg DP. The effect of locality of residence (LOR) and socioeconomic status (SES) on mortality in patients with squamous cell carcinoma of the head and neck (HNSCC): 20-year experience at the UPMC Hillman Cancer Center. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19043 Background: As cancer centers expand, evaluation of potential disparities in outcomes amongst the catchment area is critically important. We examined the effect of LOR and SES on overall survival (OS) in HNSCC patients treated at HCC, which spans 29 counties in western Pennsylvania with diverse socioeconomic profiles across urban and rural localities. Methods: Retrospective review included patients with primary HNSCC (excluding M1 and recurrent disease) treated at HCC 1997-2018. Using Rural-Urban Commuting Area codes, LOR was classified as urban/suburban or rural according to ZIP code. SES was defined by medium income level (low, moderate (Mod), middle (Mid), Upper) via Federal Financial Institutions Examination Council geocoded census tract data. Kaplan-Meier methods and Cox regression models were used to evaluate OS. Results: 3512 patients were identified. Median age was 61, 72.7% male, 93.2% White, 18% HPV +, 75.5% urban/suburban, and by SES: 4% Low, 21% Mod, 46% Mid, and 19% Upper. Primary site included 35.2% oral cavity, 28.4% oropharynx, 28.1% larynx, 8.3% other, stage was majority III/IVa (61%), 66% had surgery and 54% received multimodality treatment (tx). While median OS differed significantly by race (Black: 5.8 vs. White: 7.3 years, p = 0.0457) and SES (Low: 4.1 vs. Mod: 5.3 vs. Mid: 7.3 vs. Upper: 9.1 years, p < 0.0001), there was no difference by LOR (rural: 7.7 vs. urban/suburban: 7.2 years, p = 0.99). Multivariable Cox Regression showed lower SES was associated with a higher risk of death [(Low vs. Upper, HR: 1.416, 95% CI: 1.023-1.959) (Mod vs. Upper, HR:1.443, 95% CI: 1.214 – 1.716), p = 0.0004], adjusting for LOR and factors associated with OS in univariate analysis (age, smoking status, primary site, staging, tx, HPV status, race, and enrollment on clinical trial). The effect of LOR, race, and enrollment on clinical trial were not significant in multivariate analysis. Conclusions: SES was independently associated with OS in HNSCC patients treated at HCC, while LOR was not associated with OS. The lack of difference by LOR may be partially explained by HCC’s efforts to increase access to care throughout the catchment area by establishing community sites. However, a focus on improving outcomes for lower SES HNSCC patients is needed.
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Affiliation(s)
| | - Yongli Shuai
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | | | - Todd Bear
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | | | - Mark Kubik
- University of Pittsburgh Department of Otolaryngology, Pittsburgh, PA
| | - Shaum Sridharan
- University of Pittsburgh Department of Otolaryngology, Pittsburgh, PA
| | | | - Eric Wang
- University of Pittsburgh Department of Otolaryngology, Pittsburgh, PA
| | | | | | - James Ohr
- University of Pittsburgh Medical Center Cancer Center Pavilion, Pittsburgh, PA
| | - Carl Snyderman
- University of Pittsburgh Department of Otolaryngology, Pittsburgh, PA
| | | | | | - Seungwon Kim
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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15
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Melachuri S, Valappil B, Snyderman C. Variations in Surgical Outcomes of Carotid Body Tumors by Surgical Specialty. Laryngoscope 2020; 131:E190-E195. [PMID: 32311766 DOI: 10.1002/lary.28688] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS A carotid body tumor (CBT) is a rare type of tumor that is divided among multiple surgical specialties. Individual surgeons may have limited experience in treating these tumors. We aim to compare different surgical specialties within a single healthcare system to detect variations in management and outcome. STUDY DESIGN Retrospective chart review. METHODS A chart review of all patients who underwent surgery for CBT at the University of Pittsburgh Medical Center (UPMC) from 2000 to 2019 was carried out. Univariate and multivariate analysis was used for descriptive statistics, comparison of outcomes, and identification of risk factors. RESULTS Fifty-eight CBT resection surgeries were performed at UPMC. Patients with advanced tumor were 6.7 (95% confidence interval [CI]: 1.36-32.7) times more likely to undergo preoperative embolization and 8.53 (95% CI: 2.011-36.19) times more likely to sustain carotid artery injury. Advanced-stage tumor resections were associated with greater blood loss (P = .03) and longer hospitalization (P = .02). Collaborative surgeries were associated with higher rates of carotid artery injury (P = .003), residual tumor (P < .001), and longer hospitalization (P = .003), as these combined cases were generally reserved for advanced-stage tumors (P = .02). There were no differences in outcomes between specialties. Of 22 surgeons, the median number of surgeries per surgeon was one (range = 1-12, 54.5%). CONCLUSIONS Surgeons who completed only one surgery for CBT had a greater rate of hospital readmission and greater length of hospital stay. Collaborative surgeries had worse outcomes due to more advanced tumors requiring more complex surgeries. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E190-E195, 2021.
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Affiliation(s)
- Samyuktha Melachuri
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Benita Valappil
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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16
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Goldschmidt E, Lavigne P, Snyderman C, Gardner PA. Endoscopic endonasal approach for clipping of a PICA aneurysm. Neurosurgical Focus: Video 2020; 2:V14. [PMID: 36284787 PMCID: PMC9542295 DOI: 10.3171/2020.4.focusvid.19901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 11/07/2022]
Abstract
This video depicts the case of a 59-year-old woman that presented to the emergency department with the worst headache of her life. CT showed subarachnoid hemorrhage and digital subtraction angiogram demonstrated a right-side posterior inferior cerebellar artery (PICA) aneurysm. Given the medial and ventral position of the aneurysm, deep to the lower cranial nerves, which obviated distal control from an open approach, and the absence of an endovascular option able to reliably preserve the PICA, an endonasal approach was offered. A far medial approach was performed, and the aneurysm was successfully clipped. The patient developed a postoperative CSF leak with persistent posthemorrhagic hydrocephalus treated with reexploration and an eventual ventriculoperitoneal shunt. The patient was discharged without neurological deficits. The video can be found here: https://youtu.be/_9hsM2CaMow.
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Affiliation(s)
| | - Philippe Lavigne
- Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Goldschmidt E, Schneck M, Gau DM, Carey L, Rasmussen J, Ferreyro B, Ajler P, Snyderman C, Wang E, Fernandez-Miranda J, Gardner PA. Effect of oxidized cellulose on human respiratory mucosa and submucosa and its implications for endoscopic skull-base approaches. Int Forum Allergy Rhinol 2019; 10:282-288. [PMID: 31856397 DOI: 10.1002/alr.22495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Regenerated oxidized cellulose (ROC) sheets have gained popularity as an adjunct to a vascularized nasoseptal flap for closure of dural defects after endoscopic endonasal skull-base approaches (EESBS). However, evidence supporting its impact on the healing process is uncertain. This study was performed to evaluate the impact of ROC on the nasal mucosa and assess its effects on tissue pH, structure, and cell viability. METHODS In 5 patients, a 1-cm2 piece of ROC gauze was placed on the surface of the middle turbinate before it was resected as part of a standard EESBS. Mucosa treated with ROC was separated from untreated mucosa and a histologic examination of structural changes in the respiratory epithelium was performed. To assess the effect of ROC on pH, increasing amounts of ROC were added to culture medium. Nasal fibroblasts viability was assessed in the presence of ROC before and after the pH was neutralized. RESULTS Compared with unexposed controls, treated mucosa exhibited a higher incidence of cell necrosis and epithelial cell detachment. When added to Dulbecco's modified Eagle medium, ROC caused a dose-dependent decrease in pH of the medium. Only 1 ± 0.8% of cultured fibroblasts exposed to the ROC-induced acidic medium were alive, whereas 98.25 ± 0.5% of the cells were viable when the pH was neutralized (p < 0.001). CONCLUSION ROC applied in vivo to nasal mucosa induced epithelial necrosis likely by diminishing the medium pH, because pH neutralization prevents its effect. The ultimate effect of this material on the healing process is yet to be determined.
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Affiliation(s)
- Ezequiel Goldschmidt
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Meghan Schneck
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - David M Gau
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Carey
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - Jorge Rasmussen
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Bruno Ferreyro
- Interdepartmental Division of Critical Care Medicine, Sinai Heath System/University Health Network, Toronto, ON, Canada
| | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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18
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Geltzeiler M, Turner M, Rimmer R, Zenonos G, Hebert A, Snyderman C, Gardner P, Fernandez-Miranda J, Wang EW. Endoscopic Nasopharyngectomy Combined with a Nerve-sparing Transpterygoid Approach. Laryngoscope 2019; 130:2343-2348. [PMID: 31841236 DOI: 10.1002/lary.28479] [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] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/07/2019] [Accepted: 11/17/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Surgical management of nasopharyngeal tumors has evolved in the endoscopic era. Lateral exposure remains difficult especially near the petrous internal carotid artery and bony Eustachian tube (ET). Our study examines the need to sacrifice the vidian and greater palatine nerves in order to successfully perform en bloc endoscopic nasopharyngectomy. METHODS Four cadaveric specimens (eight sides) were dissected bilaterally using a binarial, extended, endoscopic endonasal approach (EEA). Nasopharyngectomy was completed including an extended transptyergoid approach for resection of the cartilaginous ET at its junction with the bony ET. Dissection was attempted without sacrifice of the vidian or palatine nerves. RESULTS Successful en bloc nasopharyngectomy combined with a nerve-sparing transpterygoid approach was achieved in all specimens with successful preservation of the palatine and vidian nerves. The approach provided exposure of foramen lacerum, the petrous carotid, foramen spinosum, and foramen ovale as well as all segments of the cartilaginous Eustachian tube, Meckel's cave and the parapharyngeal carotid. There was no inadvertent exposure or injury of the internal carotid artery. CONCLUSION Endoscopic nasopharyngectomy combined with a nerve-sparing transpterygoid approach allows for en bloc resection of the cartilaginous Eustachian tube and nasopharyngeal contents with broad skull base exposure and preservation of the internal carotid artery, vidian and palatine nerves. LEVEL OF EVIDENCE VI Laryngoscope, 130:2343-2348, 2020.
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Affiliation(s)
- Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Meghan Turner
- the Department of Otolaryngology-Head and Neck Surgery, University of University of West Virginia, Morgantown, West Virginia, U.S.A
| | - Ryan Rimmer
- the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - George Zenonos
- the Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Andrea Hebert
- the Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, U.S.A
| | - Carl Snyderman
- the Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Paul Gardner
- the Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | | | - Eric W Wang
- the Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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Geltzeiler M, Nakassa ACI, Turner M, Setty P, Zenonos G, Hebert A, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Evaluation of Intranasal Flap Perfusion by Intraoperative Indocyanine Green Fluorescence Angiography. Oper Neurosurg (Hagerstown) 2019; 15:672-676. [PMID: 29554360 PMCID: PMC7263840 DOI: 10.1093/ons/opy002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vascularized intranasal flaps are the primary reconstructive option for endoscopic skull base defects. Flap vascularity may be compromised by injury to the pedicle or prior endonasal surgery. There is currently no validated technique for intraoperative evaluation of intranasal flap viability. OBJECTIVE To evaluate the efficacy of indocyanine green (ICG) near-infrared angiography in predicting the viability of pedicled intranasal flaps during endoscopic skull base surgery through a pilot study. METHODS ICG near-infrared fluorescence endoscopy was performed during endoscopic endonasal surgery for skull base tumors. Intraoperative and postoperative data were collected regarding enhancement of the flap body and pedicle. Fluorescence was rated qualitatively. Postoperatively, flap perfusion was evaluated via MRI-contrast enhancement in addition to clinical outcomes (cerebrospinal fluid leak and endoscopic flap appearance). RESULTS Thirty-eight patients underwent ICG fluorescence angiography. Both the body and pedicle enhanced in 20 patients (53%), while the pedicle only enhanced for 12 patients (32%), the body only for 3 (8%), and neither for 3 (8%). When both the pedicle and body enhanced with ICG, the rate of postoperative MRI contrast enhancement was 100% and the rate of flap necrosis was 0%. The sensitivity and specificity of flap pedicle ICG enhancement for predicting postoperative flap MRI enhancement were 97% and 67%, respectively. Two of 3 patients without enhancement developed flap necrosis. CONCLUSION ICG fluorescence angiography of intraoperative flap perfusion is feasible and correlates well with outcomes of postoperative MRI flap enhancement and flap necrosis. Additional study is needed to further refine the imaging technique and optimally characterize the clinical utility.
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Affiliation(s)
- Mathew Geltzeiler
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
- Department of Otolaryn-gology—Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
- Correspondence: Paul Gardner, MD, Department of Neurologic Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 521, Pittsburgh, PA 15213. E-mail:
| | | | - Meghan Turner
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Pradeep Setty
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George Zenonos
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrea Hebert
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Eric Wang
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Juan Fernandez-Miranda
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Paul Gardner
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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20
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Goldschmidt E, Venteicher AS, Nuñez M, Wang E, Snyderman C, Gardner P. Endoscopic endonasal approach for brainstem cavernous malformation. Neurosurgical Focus: Video 2019; 1:V2. [PMID: 36284874 PMCID: PMC9541779 DOI: 10.3171/2019.10.focusvid.19399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/12/2019] [Indexed: 11/21/2022]
Abstract
This 25-year-old woman presented after a second hemorrhage from a mesencephalic cavernous malformation. High-definition fiber tracking demonstrated lateral displacement of the corticospinal tracts, making a midline approach ideal. The lesion appeared to present to the third ventricle, but a transcallosal approach was abandoned due to the posterior third ventricular location and after FIESTA imaging revealed a superior and medial rim of normal parenchyma that would have to be transgressed to access the malformation. An endoscopic endonasal approach with interdural pituitary hemitransposition was performed. The interpeduncular cistern was accessed and the thalamoperforating arteries dissected to access the cavernous malformation that was completely removed in a piecemeal fashion. The patient’s preexisting internuclear ocular palsies and hemiparesis were slightly worsened after surgery as predicted by a drop in anterior tibialis motor evoked potentials. Postoperative MRI showed no infarct, and the hemiparesis was back to baseline at 1-month follow-up. The video can be found here: https://youtu.be/e6203R9HHmk.
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Affiliation(s)
| | | | | | - Eric Wang
- Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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21
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Pacca P, Jhawar SS, Seclen DV, Wang E, Snyderman C, Gardner PA, Aboud E, Fernandez-Miranda JC. "Live Cadaver" Model for Internal Carotid Artery Injury Simulation in Endoscopic Endonasal Skull Base Surgery. Oper Neurosurg (Hagerstown) 2019; 13:732-738. [PMID: 28666364 DOI: 10.1093/ons/opx035] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 06/14/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intraoperative injury of the internal carotid artery (ICA) is the most dreaded complication in endoscopic endonasal surgery (EES) of skull base. Training for ICA injury is practically impossible in live operative settings. OBJECTIVE To evaluate a pulsatile perfusion-based live cadaveric model for ICA injury simulation in a laboratory setting. The major emphasis of the study was to evaluate various means of controlling acute bleeding and evaluating the practical utility of this model for training purposes. METHODS Five embalmed, uninjected cadaveric heads were prepared for study by connecting to a pulsatile perfusion pump system filled with artificial blood solution. EES approaches were used to evaluate different types of ICA injuries similar to operative scenarios. Various methods of managing ICA injuries such as packing, clipping, and trapping, were evaluated. The educational advantages of the live cadaver model were assessed using questionnaires given to participants in a hands-on dissection course. RESULTS The trainee was faced with several scenarios similar to those encountered during an actual intraoperative ICA injury. Packing, clipping, and trapping of the ICA injury were successfully achieved in all segments of the ICA. Clip-based reconstruction techniques were successfully developed. All trainees reported gaining new knowledge, learning new techniques. The responses to the questionnaire confirmed the significant educational value of this model. CONCLUSION The live cadaver model presented here provides real-life experience with major vessel injury during EES in a laboratory setting. This model could significantly improve current training for the management of intraoperative vascular injuries during EES.
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Affiliation(s)
- Paolo Pacca
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Neurosurgical Unit, Department of Neurosciences, University of Torino, Torino, Italy
| | - Sukhdeep S Jhawar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Neurosurgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Daniel V Seclen
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Hospital de Alta Complejidad en Red el Cruce, Buenos Aires, Argentina
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Emad Aboud
- Arkansas Neuroscience Institute, St. Vincent Health System, Little Rock, Arkansas
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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22
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Chou C, Snyderman C, Phillips D, Darby J. The Difficult Airway after Endoscopic Endonasal Skull Base Surgery: A Case Series and Management Algorithm. Otolaryngol Head Neck Surg 2018; 159:927-932. [PMID: 30081764 DOI: 10.1177/0194599818789099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To analyze difficult airway situations affecting patients after endoscopic endonasal surgery (EES) for skull base tumors and to develop an airway management algorithm. STUDY DESIGN Case series with chart review. SETTING Single tertiary care center. SUBJECTS AND METHODS Eleven difficult airway events occurred among patients after EES for skull base tumors, as identified through a retrospective review of our institutional Difficult Airway Management Team registry from January 2008 to March 2016. Data from these events included patient demographics, event characteristics, airway management techniques, and outcomes. Results were used to design a difficult airway protocol. RESULTS The majority of patients were obese (63.6%) and had a dural defect (90.9%), each of which was repaired with a vascularized flap. The most common reasons for the difficult airway call were concern for using mask ventilation in a patient with a dural defect (27.3%) and difficult airway anatomy (27.3%). Two patients did not require airway intervention; 8 were intubated; and 1 underwent cricothyroidotomy. Videolaryngoscopy was the most common first-attempt intubation technique, followed by conventional direct laryngoscopy. Effective adjunctive techniques included intubation through a laryngeal mask airway and bougie-guided intubation. As compared with simple mask ventilation, laryngeal mask airway-assisted ventilation was associated with a decreased incidence of postevent cerebrospinal fluid leak. There were no incidences of postevent pneumocephalus, cardiopulmonary arrest, or mortality. CONCLUSIONS We propose a difficult airway algorithm for patients following EES of the skull base, with sequential recommendations for airway management methods and commentary on adjunctive techniques.
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Affiliation(s)
- Courtney Chou
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carl Snyderman
- 1 Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dennis Phillips
- 2 Department of Anesthesiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,3 Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph Darby
- 3 Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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23
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Ferguson M, Lund V, Howard D, Hellquist H, Petruzzelli G, Snyderman C, Strojan P, Suarez C, Rinaldo A, Lopez F, Ferlito A. Management of sinonasal and skull base nonmesenchymal chondrosarcoma, a narrative review. RHINOL 2018. [DOI: 10.4193/rhinol/18.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Fernandes Cabral DT, Zenonos GA, Nuñez M, Celtikci P, Snyderman C, Wang E, Gardner PA, Fernandez-Miranda JC. Endoscopic Endonasal Transclival Approach for Resection of a Pontine Glioma: Surgical Planning, Surgical Anatomy, and Technique. Oper Neurosurg (Hagerstown) 2018. [DOI: 10.1093/ons/opy005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The endoscopic endonasal approach (EEA) has been proposed as a potential alternative for ventral brainstem lesions. The surgical anatomy, feasibility, and limitations of the EEA for intrinsic brainstem lesions are still poorly understood.
OBJECTIVE
To describe the surgical planning, anatomy, and technique of an intrinsic pontine glioma operated via EEA.
METHODS
Six-human brainstems were prepared for white matter microdissection. Ten healthy subjects were studied with high-definition fiber tractography (HDFT). A 56-yr-old female with right-hemiparesis underwent EEA for an exophytic pontine glioma. Pre- and postoperative HDFTs were implemented.
RESULTS
The corticospinal tracts (CSTs) are the most eloquent fibers in the ventral brainstem. At the pons, CSTs run between the pontine nuclei and the middle cerebellar peduncle (MCP). At the lower medulla, the pyramidal decussation leaves no room for safe ventral access. In our illustrative case, preoperative HDFT showed left-CST displaced posteromedially and partially disrupted, right-CST posteriorly displaced, and MCP severely disrupted. A transclival exposure was performed achieving a complete resection of the exophytic component with residual intra-axial tumor. Immediately postop, patient developed new left-side abducens nerve palsy and worse right-hemiparesis. Ten days postop, her strength returned to baseline. HDFT showed preservation and trajectory restoration of the CSTs.
CONCLUSION
The EEA provides direct access to the ventral brainstem, overcoming the limitations of lateral approaches. For intrinsic pathology, HDFT helps choosing the most appropriate surgical route/boundaries for safer resection. Further experience is needed to determine the indications and limitations of this approach that should be performed by neurosurgeons with high-level expertise in EEA.
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Affiliation(s)
- David T Fernandes Cabral
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maximiliano Nuñez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pinar Celtikci
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Nakassa A, Geltzeiler M, Valappil B, Chang YF, Zenonos G, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Use of Intraoperative Indocyanine Green Endoscopy in the Assessment of Vascularity of Intranasal Flaps. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ana Nakassa
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Benita Valappil
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Yue-Fang Chang
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Lieber S, Wang WH, Nunez M, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. The Dural Architecture of the Cavernous Sinus' Anterior Roof and Clinoid Space: Microsurgical Anatomy and Technical Nuances for Intracavernous and Perisellar Endoscopic Surgery. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stefan Lieber
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Wei-Hsin Wang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Maximiliano Nunez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Hebert A, Mady L, Geltzeiler M, Turner M, Snyderman C, Gardner P, Fernandez-Miranda J, Wang E. Perineural Spread of Squamous Cell Carcinoma to the Skull Base following Treatment of Oropharyngeal P16-Positive Squamous Cell Carcinoma: A Case Series. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Andrea Hebert
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Leila Mady
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Meghan Turner
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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28
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Borghei-Razavi H, Nakassa A, Najera E, Truong H, Wang E, Snyderman C, Gardner P. Bilateral Coagulation of Inferior Hypophyseal Artery in Endoscopic Endonasal Transcavernous Approach: Does It Affect Pituitary Function? Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hamid Borghei-Razavi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Ana Nakassa
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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29
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Sun X, Yu H, Liu Q, Wang D, Fernandez-Miranda J, Gardner P, Wang E, Snyderman C. Temporalis Muscle Flap for Endoscopic Anterior Skull Base Reconstruction: An Anatomic Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Xicai Sun
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Quan Liu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Dehui Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
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Mangussi-Gomes J, Truong H, Belo J, Gardner P, Wang E, Fernandez-Miranda J, Snyderman C. Transmaxillary Endoscopic Approach to the Lateral Recess of the Sphenoid Sinus: An Anatomical Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joao Mangussi-Gomes
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Joao Belo
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Truong H, Najera E, Belo J, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. The Medial Wall of the Cavernous Sinus: Surgical Anatomy, Ligaments, and Surgical Application. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Joao Belo
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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32
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Cohen S, Najera E, Nakassa A, Truong H, Zwagerman N, Snyderman C, Wang E, Gardner P, Fernandez-Miranda J. Selective Surgical Resection of the Medial Wall of the Cavernous Sinus for Invasive Pituitary Adenomas: Surgical Technique and Outcomes in 49 Patients. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Salomon Cohen
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Ana Nakassa
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Nathan Zwagerman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Departments of Otolaryngology and Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Departments of Otolaryngology and Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Departments of Neurological Surgery and Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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33
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Patel V, Gadhoke G, Gardner P, Snyderman C. Lumbar Drainage May Represent A Cost Saving Method for Skull Base Surgeries. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vishaal Patel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Gurpreet Gadhoke
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
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34
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Freiser M, Moore J, Gardner P, Snyderman C, Fernandez-Miranda J, Wang E, Chang YF, Lee S. Analysis of Patient Safety and Outcomes of Live Case Demonstrations in Endoscopic Skull Base Surgery. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Monika Freiser
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - John Moore
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Yue-Fang Chang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Stella Lee
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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35
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Lavigne P, Faden D, Wang E, Gardner P, Fernandez-Miranda J, Snyderman C. Validation of Training Levels in Endoscopic Endonasal Surgery of the Skull Base. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Philippe Lavigne
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Daniel Faden
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Nakassa A, Najera E, Borghei-Razavi H, Truong H, Sun X, Cohen S, Wang E, Snyderman C, Fernandez-Miranda J, Gardner P. Persistent Cerebrospinal Fluid Leak after Endoscopic Endonasal Approach to the Posterior Cranial Fossa. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ana Nakassa
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Hamid Borghei-Razavi
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Xicai Sun
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Salomon Cohen
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Geltzeiler M, Turner M, Zenonos G, Hebert A, Snyderman C, Gardner P, Fernandez-Miranda J, Wang E. Endoscopic Nasopharyngectomy Combined with a Nerve-Sparing Transpterygoid Approach: An Anatomic Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mathew Geltzeiler
- Oregon Health and Science University, Portland, Oregon, United States
| | - Meghan Turner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - George Zenonos
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Andrea Hebert
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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38
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Sen R, Saxena R, Aghdasi N, Li Y, Bly R, Gardner P, Snyderman C, Moe K. Contralateral Transmaxillary Corridor: Surgical Planning and Pathway Analytics. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rajeev Sen
- University of Washington, Seattle, Washington, United States
| | - Rajeev Saxena
- University of Washington, Seattle, Washington, United States
| | - Nava Aghdasi
- University of Washington, Seattle, Washington, United States
| | - Yangming Li
- University of Washington, Seattle, Washington, United States
| | - Randall Bly
- University of Washington, Seattle, Washington, United States
| | - Paul Gardner
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kris Moe
- University of Washington, Seattle, Washington, United States
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39
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Lieber S, Nunez M, Wang WH, Nunes C, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. Pictorial Review of the Microvasculature Arising from the Cavernous Segment of the ICA (C4), and the Venous Connections of the Cavernous Sinus. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stefan Lieber
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Maximiliano Nunez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Wei-Hsin Wang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Cristian Nunes
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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40
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Zwagerman N, Geltzeiler M, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Endonasal Suturing of Nasoseptal Flap to the Nasopharyngeal Fascia Using the V-Loc Wound Closing Device. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nathan Zwagerman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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41
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Mangussi-Gomes J, Nogueira G, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Contralateral Transmaxillary Approach versus Purely Transnasal Approach to the Petroclival Region—An Anatomical and Radiological Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joao Mangussi-Gomes
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Gustavo Nogueira
- Neurological Institute of Curitiba, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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42
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Faden D, Lavigne P, Fernandez-Miranda J, Gardner P, Wang E, Snyderman C. Utilization of the Contralateral Transmaxillary Approach for Chordoma and Chondrosarcoma of the Petrous Apex. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Daniel Faden
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Philippe Lavigne
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Paul Gardner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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43
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Abstract
Developmental anomalies of the skull base may present in childhood or as an adult. The most common pathologies include dermoid, encephalocele, and glioma. Encephaloceles may present as part of a syndrome. Other entities include infantile hemangiomas and teratoma. Endoscopic techniques provide a less invasive and morbid option for treatment. Proper evaluation and treatment is necessary to prevent complications such as meningitis.
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Affiliation(s)
- Meghan Wilson
- Department of Otolaryngology, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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44
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Abstract
Fibro-osseous lesions of the skull base include a variety of lesions with different biologic behavior. The most common lesions include fibrous dysplasia, osteoma, aneurysmal bone cyst, and juvenile ossifying fibroma. The diagnosis can usually be established with radiographic imaging. In the absence of symptoms, slow-growing lesions can often be observed. When surgery is indicated for relief of symptoms, endoscopic endonasal techniques are well suited for all age groups.
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Affiliation(s)
- Meghan Wilson
- Department of Otolaryngology, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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45
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Balakrishnan K, Arjmand EM, Nussenbaum B, Snyderman C. National Multispecialty Survey Results: Comparing Morbidity and Mortality Conference Practices within and outside Otolaryngology. Otolaryngol Head Neck Surg 2017; 158:273-279. [DOI: 10.1177/0194599817737993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective is to describe variations in the otolaryngology morbidity and mortality (M&M) conference and to compare with other specialties. Design Cross-sectional survey. Setting The setting included otolaryngology departments across the United States and nonotolaryngology medical and surgical departments at 4 academic medical centers. Subjects and Methods Participants were members of a national otolaryngology quality/safety network and nonotolaryngology quality leaders at 4 large academic hospitals. Surveys were administered January 2017. Respondents described M&M conference practices, goals, and educational role. Results Twenty-eight of 39 individuals representing 28 institutions completed the otolaryngology survey (72% response rate). Of 197 individuals, 60 (30% response rate) representing 11 surgical and 20 nonsurgical specialties completed the comparison survey. Twenty-seven of 28 otolaryngologists (46 of 60 nonotolaryngologists) worked in academic settings. All otolaryngology programs conducted an M&M conference: 54% discussed all adverse events and errors; 32% used standard case selection processes; 70% used structured discussion, usually root cause analysis (64%); and 32% classified harm level. In comparison with other specialties, otolaryngology programs were more likely to discuss all adverse events and errors ( P = .01). Most conferences led to quality projects and intrainstitutional communication: 22% communicated to patients and families; 73% of respondents thought that M&M conferences should be standardized or use “best practices.” In both surveys, improving patient care was rated the conference’s most important function, followed by trainee education and culture change. Patient care and practice-based learning were rated the most relevant Accreditation Council for Graduate Medical Education Core Competencies in both surveys. Conclusions Academic otolaryngology M&M practices generally align with other specialties, but specifics vary widely, making collaborative quality improvement challenging. Educational and administrative priorities cross specialties. Most respondents thought that standardization and best practices are worthwhile. Nonacademic practice data are needed.
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Affiliation(s)
- Karthik Balakrishnan
- Department of Otorhinolaryngology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ellis M. Arjmand
- Bobby Alford Department of Otolaryngology–Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Brian Nussenbaum
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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46
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Harvey RJ, Nalavenkata S, Sacks R, Adappa ND, Palmer JN, Purkey MT, Schlosser RJ, Snyderman C, Wang EW, Woodworth BA, Smee R, Havas T, Gallagher R. Survival outcomes for stage-matched endoscopic and open resection of olfactory neuroblastoma. Head Neck 2017; 39:2425-2432. [PMID: 28945299 DOI: 10.1002/hed.24912] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 03/28/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Advanced-stage olfactory neuroblastoma requires multimodal therapy for optimal outcomes. Debate exists over endoscopic endonasal surgery in this situation. Stage-matched open and endoscopic surgical therapy were compared. METHODS Patients from 6 cancer institutions were assessed. Stratification included dural involvement, Kadish stage, nodal disease, Hyams' grade, approach, and margin status. At follow-up, local control, nodal status, and evidence of distant metastases were recorded with any subsequent therapy. Statistical analyses to identify risk factors for developing recurrence and survival differences were performed. RESULTS One hundred nine patients were assessed (age 49.2 ± 13.0 years; 46% women) representing Kadish A stage (10%), Kadish B stage (25%), and Kadish C stage (65%). The majority of the patients (61.5%) underwent endoscopic resection, 53.5% within Kadish C stage. Within-stage survival analysis favored endoscopic subgroup for Kadish C stage (log-rank P = .017) nonsignificant for Kadish B stage (log-rank P = .39). CONCLUSION Stage-matched survival was better for the endoscopically treated group compared to the open surgery group, with high negative margin resections obtained.
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Affiliation(s)
- Richard J Harvey
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Department of Otolaryngology - Head and Neck, Skull Base Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Sunny Nalavenkata
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia
| | - Raymond Sacks
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Department of Otolaryngology, Concord General Hospital and Sydney University, Concord, New South Wales, Australia
| | - Nithin D Adappa
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Palmer
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael T Purkey
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Carl Snyderman
- Department of Otolaryngology/ Head & Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Eric W Wang
- Department of Otolaryngology/ Head & Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bradford A Woodworth
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Prince of Wales, Australia
| | - Tom Havas
- Department of Otolaryngology, Head and Neck Surgery, The Prince of Wales Cancer Centre and Hospital, Prince of Wales, Australia
| | - Richard Gallagher
- Department of Otolaryngology - Head and Neck, Skull Base Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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47
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Kubik M, Lee S, Snyderman C, Wang E. Neurologic sequelae associated with delayed identification of iatrogenic skull base injury during endoscopic sinus surgery (ESS). Rhinology 2017; 55:53-58. [PMID: 27665079 DOI: 10.4193/rhin16.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Skull base injury is an infrequent complication during endoscopic sinus surgery (ESS). We hypothesize that late recognition and repair of CSF leaks during ESS is associated with increased neurologic morbidity. METHODOLOGY A retrospective review was performed of patients with skull base injury during ESS at a tertiary center from 1999-2015. The study population was separated into early (less than 72 hrs) and late (more than 72 hrs) intervention groups. Study parameters included time to diagnosis, imaging, site of injury, type of repair, neurologic complications, and clinical outcomes. RESULTS Seventeen patients were studied. The primary surgical interventions included ESS and balloon sinuplasty. Mean latency from primary surgery to presentation to our facility was 11 days. The most common injury site was the cribriform plate and the mean defect size 4.5 mm. Late diagnosis was associated with increased total neurologic complications and increased rates of postoperative meningitis. No neurologic complications occurred in patients diagnosed intraoperatively. All patients underwent successful endoscopic repair. CONCLUSION Skull base injury is a rare but major complication following both balloon sinuplasty and traditional primary ESS. Early diagnosis and endoscopic repair may prevent neurologic morbidity in these patients.
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Affiliation(s)
- M Kubik
- Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Lee
- Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Snyderman
- Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - E Wang
- Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
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48
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Chabot JD, Stefko ST, Snyderman C, Fernandez-Miranda JC. Multicorridor Endoscopic Endonasal and Supraorbital Approach for Orbital Roof Meningioma: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2017; 13:401. [PMID: 28521341 DOI: 10.1093/ons/opw012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joseph D Chabot
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - S Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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49
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Truong H, Sun X, Celtikci E, Borghei-Ravazi H, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. Endoscopic Transmaxillary Trans-Alisphenoid Approach to the Meckel's Cave: An Anatomical Study. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Huy Truong
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Fudan University, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Shanghai, China
| | - Emrah Celtikci
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Hamid Borghei-Ravazi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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50
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Borghei-Razavi H, Truong H, Fernandez-Cabral D, Celtikci E, Sun X, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. Endoscopic Endonasal Maximal Petrosectomy: Anatomical Investigation and Surgical Relevance. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Huy Truong
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | | | - Emrah Celtikci
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Xi Sun
- Department of Otolaryngology-Head and Neck Surgery, Fudan University, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Shanghai, China
| | - Eric Wang
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
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