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Merna C, Lehrich BM, Kshirsagar RS, Eide JG, Diaz-Aguilar LD, Goshtasbi K, Yasaka TM, Sahyouni R, Palmer JN, Adappa ND, Hsu FPK, Kuan EC. Determinants of Survival in Skull Base Chondrosarcoma: A National Cancer Database Study. World Neurosurg 2021; 158:e766-e777. [PMID: 34808412 DOI: 10.1016/j.wneu.2021.11.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/15/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Chondrosarcomas of the skull base are rare tumors most commonly treated surgically with or without adjuvant radiation therapy. Using the National Cancer Database (NCDB), we analyzed overall survival (OS), treatment modalities, and prognosticators. METHODS The NCDB was queried for all cases of histologically confirmed skull base chondrosarcoma treated between 2004 and 2015, excluding patients with more than 1 malignant tumor, on palliative care, receiving unrelated concurrent treatments, or having less than 1 month of follow-up. The χ2 test for categorical variables, Cox proportional hazards models, and Kaplan-Meier log-rank analysis were used to test associations with the use of adjuvant radiation, OS, and survival time. RESULTS A total of 498 patients with skull base chondrosarcoma were identified in the NCDB. Of them, 224 (45.0%) and 198 (39.8%) were treated with either surgery alone or surgery with adjuvant radiation therapy, respectively. Patients more likely to undergo surgery with adjuvant radiation had higher tumor grade (P = 0.008), later year of diagnosis (P = 0.002), positive surgical margins (P < 0.001), and treatment at an academic institution (P = 0.02). Patient, tumor, and socioeconomic factors associated with worse OS on multivariate analysis included the Charlson/Deyo Comorbidity Score ≥2 (P = 0.017), as well as clear cell (P = 0.02) and dedifferentiated (P = 0.006) histology. Age, tumor grade, tumor size, treatment modality, insurance status, facility type, and urban/rural population did not show a statistically significant impact on OS. CONCLUSION The mainstay of treatment for skull base chondrosarcoma is surgery, with consideration of adjuvant radiation. This study demonstrated worse overall survival associated with more frail patients and aggressive histology types. It is important to consider these factors when planning the clinical management of these patients.
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Affiliation(s)
- Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Brandon M Lehrich
- School of Medicine, University of California, Irvine, Orange, California, USA
| | - Rijul S Kshirsagar
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacob G Eide
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Khodayar Goshtasbi
- School of Medicine, University of California, Irvine, Orange, California, USA
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - James N Palmer
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.
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Merna C, Berger MH, Lin HW, Bhattacharyya N. Ambulatory visits for common rhinologic complaints in the United States: A patient-centered perspective. Int Forum Allergy Rhinol 2021; 12:859-862. [PMID: 34779125 DOI: 10.1002/alr.22925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, USA
| | - Michael H Berger
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, USA
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, USA
| | - Neil Bhattacharyya
- Department of Otolaryngology, Massachusetts Eye & Ear and Harvard Medical School, Boston, Massachusetts, USA
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3
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Goshtasbi K, Tsutsumi K, Merna C, Kuan EC, Haidar YM, Tjoa T. Does Medical School Geography and Ranking Influence Residency Match in Otolaryngology? Ann Otol Rhinol Laryngol 2021; 131:485-492. [PMID: 34157902 DOI: 10.1177/00034894211026482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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
OBJECTIVE To elucidate the associations between geographic locations, rankings, and size/funding of medical schools and residency programs among the current otolaryngology residents. METHODS This retrospective cross-sectional study queried otolaryngology residency program websites for relevant publicly accessible information. Location was categorized as Midwest, Northeast, South, and West. Ranking was according to Doximity (residency) and US News and World Report (medical school). Medical school and residency programs were labeled large if they had >704 students or >15 residents, respectively. RESULTS A total of 1413 residents from 98 (89%) otolaryngology residency programs were included. Residents attending their home medical schools (18%) were equally distributed among regions (P = .845). Residents who attended medical schools in the same US regions (54%) were more likely from top-25 (P = .001) or private (P < .001) medical schools. Southern residents were most likely (64%) and Western residents were least likely (39%) from regional medical schools (P < .001), while residents from Midwest and Northeast had similar rates (54%-55%). The percentage of Midwest residents coming from regional medical schools has decreased from the 2013 to 2014 residency cycle (P = .037). Completing undergraduate school, medical school, and residency in the same region (38%) was also highest in the South (45%) and lowest in the West (25%) (P < .001). Residents at top-ranked residency programs were more likely from top-ranked (P < .001), large (P = .025), and private (P = .018) medical schools. CONCLUSION There exist significant associations between otolaryngology residents' medical school location, ranking, size, and funding source and their residency destination. More than half of the current otolaryngology residents attended medical school in the same geographic region, and about one-fifth have attended medical school and residency at the same institution. Future studies are warranted to evaluate how these results change as the match process evolves in the future. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Kotaro Tsutsumi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
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4
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Merna C, Lehrich BM, Diaz-Aguilar LD, Goshtasbi K, Sahyouni R, Hsu FPK, Kuan EC. Determinants of Survival in Skull Base Osteosarcoma: A National Cancer Database Study. World Neurosurg 2021; 151:e828-e838. [PMID: 33974986 DOI: 10.1016/j.wneu.2021.04.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/08/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Skull base osteosarcoma is a rare and aggressive tumor that is most commonly treated with primary surgical resection and adjuvant chemoradiation. Using the National Cancer Database, we analyzed demographic and clinical prognosticators for overall survival (OS). METHODS The National Cancer Database was queried for cases of histologically confirmed skull base osteosarcoma treated between 2004 and 2015, excluding patients receiving palliation or having <1 month of follow-up. A total of 314 patients treated with surgery alone (n = 82), surgery with adjuvant radiotherapy (n = 35), surgery with chemotherapy (n = 114), or trimodality therapy (n = 56) were identified. The χ2 test for categorical variables, Cox proportional hazards models, and Kaplan-Meier log-rank analysis were used to test associations with treatment, OS, and survival time. RESULTS None of the studied demographic characteristics (age, sex, race, overall health) and socioeconomic factors (income and average regional education) were associated with OS (none P < 0.05). Treatment modalities also did not show a significant association with OS (none P < 0.05). Certain tumor characteristics showed an association with OS, with fibroblastic and Paget histologic subtypes (each P = 0.003), poorly differentiated tumor grade (P = 0.03), and tumor size >5 cm (P = 0.045) associated with poorer OS. CONCLUSIONS Tumor histologic subtype, advanced tumor grade, and greater tumor size are predictors of worse OS in skull base osteosarcoma. No significant differences in OS were identified based on treatment modality, which warrants further investigation.
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Affiliation(s)
- Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurological Surgery, University of California San Diego, La Jolla, California, USA
| | - Khodayar Goshtasbi
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California San Diego, La Jolla, California, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA; Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA.
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Hakimi AA, Merna C, Wong BJF. Evaluation of a High-Definition Intraoperative Exoscope in Rhinoplasty Education and Workflow. Facial Plast Surg Aesthet Med 2020; 23:144-145. [PMID: 33155856 DOI: 10.1089/fpsam.2020.0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amir A Hakimi
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, California, USA
| | - Catherine Merna
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California, USA
| | - Brian J-F Wong
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, USA
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6
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Sarna B, Abouzari M, Merna C, Jamshidi S, Saber T, Djalilian HR. Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment. Front Neurol 2020; 11:1046. [PMID: 33041986 PMCID: PMC7522398 DOI: 10.3389/fneur.2020.01046] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022] Open
Abstract
A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and the middle ear cavity, mastoid, or intracranial cavity. A PLF most commonly forms when the integrity of the oval or round window is compromised, and it may be trauma-induced or may occur with no known cause (idiopathic). Controversy regarding the diagnosis of idiopathic PLF has persisted for decades, and the presenting symptoms may be vague. However, potential exists for this condition to be one of the few etiologies of dizziness, tinnitus, and hearing loss that can be treated surgically. The aim of this review is to provide an update on classification, diagnosis, and treatment of PLF. Particular attention will be paid to idiopathic PLF and conditions that may have a similar presentation, with subsequent information on how best to distinguish them. Novel diagnostic criteria for PLF and management strategy for PLF and PLF-like symptoms is presented.
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Affiliation(s)
- Brooke Sarna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Catherine Merna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Shahrnaz Jamshidi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Tina Saber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States.,Department of Biomedical Engineering, University of California, Irvine, CA, United States
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7
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Merna C, Lin HW, Bhattacharyya N. Clinical Characteristics, Complications, and Reasons for Readmission following Lingual Tonsillectomy. Otolaryngol Head Neck Surg 2019; 160:619-621. [DOI: 10.1177/0194599819827820] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This brief communication regards the indications and complications for and rates of readmission following lingual tonsillectomy. The National Readmissions Database (NRD) 2013-2014 was queried for all cases of lingual tonsillectomy occurring from 2013 to 2014. Among 602 lingual tonsillectomies (mean age 36.5 years, 58.2% male), the common indications for surgery were obstructive sleep apnea (58.7%), lingual tonsil hypertrophy/infection (18.8%), and neoplasia (15.9%). Overall, 49 (8.2%) of the cases were readmitted (95% confidence interval, 4.8%-13.5%), with an average readmission duration of 3.0 days and average readmission cost of $25.4K. The most common diagnoses at readmission were bleeding (1.9% of all lingual tonsillectomy cases); dysphagia (1.7%); fever, nausea, vomiting, or diarrhea (1.6%); acute pain (1.6%); and airway obstruction (1.4%). There were no mortalities during primary or subsequent admissions. Lingual tonsillectomy across age groups is relatively free of adverse events, with overall readmission and complication rates similar to those of palatine tonsillectomy.
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Affiliation(s)
- Catherine Merna
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California at Irvine, Orange, California, USA
| | - Harrison W. Lin
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California at Irvine, Orange, California, USA
| | - Neil Bhattacharyya
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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8
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Diaz-Aguilar D, Terterov S, Tucker AM, Sedighim S, Scharnweber R, Wang S, Merna C, Rahman S. Simultaneous cerebrospinal fluid and hematologic metastases in a high-grade ependymoma. Surg Neurol Int 2018; 9:93. [PMID: 29770253 PMCID: PMC5938895 DOI: 10.4103/sni.sni_475_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/16/2018] [Indexed: 01/09/2023] Open
Abstract
Background Ependymomas are relatively uncommon tumors that constitute about 7% of all primary intracranial neoplasms. Among these, high-grade ependymomas are locally aggressive and recur most commonly at the primary site following resection. Ependymomas are also known to be the one glial neoplasm that tends to frequently metastasize inside and outside the central nervous system (CNS) that complicates workup and management. Metastasis due to surgical manipulation is common and neurosurgeons should be well-versed in the most effective methods to remove these tumors in order to avoid such metastases. Case Description Here, we report a case of a 28-year-old female who initially presented with a parenchymal World Health Organization (WHO) grade III anaplastic ependymoma of the occipital lobe without metastasis. After multiple resections, the patient showed no evidence of disease recurrence for 2 years. During follow-up, new metastasis to the frontal lobe as well as to the lung were discovered 2 years after the initial surgery, without recurrence at the tumor's primary site. Conclusions While uncommon, this case demonstrates the possibility for ependymomas to metastasize via cerebrospinal fluid to other locations within the CNS and hematologically to extraneural locations without recurring locally.
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Affiliation(s)
- Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Sergei Terterov
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Alexander M Tucker
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Shaina Sedighim
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA.,Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Rudi Scharnweber
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Stephanie Wang
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Catherine Merna
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Shayan Rahman
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
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Diaz-Aguilar D, Niu T, Terterov S, Scharnweber R, Tucker A, Woodard J, Brara H, Merna C, Shah H, Wang S, Rahman S. Neurenteric cyst of the conus medullaris. Surg Neurol Int 2018. [PMID: 29527391 PMCID: PMC5838830 DOI: 10.4103/sni.sni_315_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Neurenteric cysts (NECs) are rare developmental malformations of the central nervous system (CNS) which originate as benign congenital lesions. They originate from developmental foregut precursors, and are presumed to be the result of abnormal partitioning of the embryonic notochord plate. Such NECs predominantly arise in the cervical region in patients around 6 years of age or in their twenties or thirties. Notably, NECs of the conus medullaris are exceedingly rare, especially in patients of advanced age. Case Description: A 70-year-old male presented with bilateral upper thigh and leg pain of over 20 years duration. His pain worsened over the past 3 years, and he sought surgical management. Although his neurological exam was normal, the lumbar magnetic resonance imaging revealed an intradural, nonenhancing, thin-walled, cystic lesion at L1/conus medullaris. The lesion was successfully resected without any adverse sequelae. Conclusions: NECs are rare congenital legions that involve the spine. Here, an L1 intradural extramedullay neuroenteric cyst of the conus medullaris was resected without complications.
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10
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Terterov S, Diaz-Aguilar D, Scharnweber R, Tucker A, Niu T, Woodard J, Brara H, Poh M, Merna C, Wang S, Rahman S. Surgical nuances of partial sacrectomy for chordoma. Surg Neurol Int 2017; 8:277. [PMID: 29279794 PMCID: PMC5705930 DOI: 10.4103/sni.sni_230_17] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/19/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Sacral chordomas are rare, slow growing, locally aggressive tumors. Unfortunately, aggressive surgical resection is often associated with increased neurological morbidity. Methods: This technical note focuses on the utilization of partial sacrectomy for the resection of complex spinal chordomas. Results: The case presented documents the potential range of postoperative morbidity seen in patients undergoing partial sacrectomy for chordomas. Despite iatrogenic morbidity and tumor recurrence, with the cooperation of medical and surgical spine specialists, majority of patients can achieve good long-term outcomes. Conclusions: Sacral chordomas are rare lesions and pose a therapeutic challenge for spinal surgeons and oncologists. En-bloc surgical resection (e.g., partial sacrectomy) is the treatment of choice for these lesions, and the cooperation between subspecialists can lead to good neurologic outcomes, particularly if gross total resection is achieved.
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Affiliation(s)
- Sergei Terterov
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Daniel Diaz-Aguilar
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Rudi Scharnweber
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Alex Tucker
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Tianyi Niu
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jos'lyn Woodard
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Harsimran Brara
- Department of Neurosurgery, Kaiser Permanente, Los Angeles, California, USA
| | - Melissa Poh
- Department of Plastic Surgery, Kaiser Permanente, Los Angeles, California, USA
| | - Catherine Merna
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Stephanie Wang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Shayan Rahman
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
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11
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Diaz-Aguilar D, Terterov S, Scharnweber R, Merna C, Wang S, Rahman S. Adult sacrococcygeal teratoma with coccygectomy: A case report with a review of the literature. Surg Neurol Int 2017; 8:260. [PMID: 29184711 PMCID: PMC5680643 DOI: 10.4103/sni.sni_224_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Saccrococcygeal teratomas (SCT) are derived from embryonic germ cell layers. They frequently present at the base of the coccyx within the pelvis. While these tumors are common in children, they are exceedingly rare in adults. In adults, a majority of these tumors are intrapelvic and associated with a low risk of malignant transformation. Therefore, this contributes to a good prognosis following resection of mostly benign lesions. Case Description: An adult female with chronic pelvic pain presented with a sacral teratoma. She failed conservative treatment and underwent a coccygectomy with an en-bloc excision of the tumor. Microscopic histological analysis showed no evidence of immature or malignant elements, confirming the diagnosis of a mature, benign, cystic SCT. Conclusions: Mature SCTs in adults are rare malignant lesions. In this case, the patient was cured following primary surgical excision requiring en-bloc coccygectomy.
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Affiliation(s)
- Daniel Diaz-Aguilar
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sergei Terterov
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rudi Scharnweber
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Catherine Merna
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Stephanie Wang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shayan Rahman
- Department of Neurosurgery, Kaiser Permanente Medical Center, Los Angeles, California, USA
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12
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Merna C, Kita A, Wester J, Diaz-Aguilar D, Goldstein JD, Palma Diaz F, Blackwell K, St John MA. Intraosseous mucoepidermoid carcinoma: Outcome review. Laryngoscope 2017; 128:1083-1092. [PMID: 28833169 DOI: 10.1002/lary.26832] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Identify the effect of patient characteristics, disease traits, and treatment modality on patient outcomes in the rare disease process of intraosseous mucoepidermoid carcinoma. STUDY DESIGN Retrospective review of institutional case records and literature. METHODS This study includes one case report, a literature review of the MEDLINE database from 1950 through June 2017 using keywords "intraosseous" and "mucoepidermoid," and a query of the University of California, Los Angeles, Department of Pathology database for all documented cases of intraosseous mucoepidermoid carcinoma of the head and neck. RESULTS Indicators of poorer prognosis were male gender (P = 0.0071) and higher histological grade (P = 0.0095). Lesion site, size, association with odontogenic cyst, and treatment type did not have a statistically significant correlation with patient outcomes. There also was no statistically significant correlation observed between treatment modality and recurrent or progressive disease when stratified by histological grade of the cancer. CONCLUSION This study identified male gender and high histological tumor grade as poor prognostic indicators; however, it did not reveal a statistically significant relationship between treatment modality and patient outcomes. Data regarding patient outcomes following treatment was limited due to loss to follow-up, suggesting that further investigation is required. Based on this review, decisions regarding treatment should be clinically guided and individually tailored to the patient's baseline health, disease severity, and the patient's treatment goals. A multi-disciplinary conference, as was utilized in the presented case report, may be the best approach to treatment planning for these patients at this time. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1083-1092, 2018.
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Affiliation(s)
- Catherine Merna
- David Geffen School of Medicine, University of California Irvine, Irvine.,Department of Head and Neck Surgery, University of California Irvine, Irvine
| | - Ashley Kita
- Department of Head and Neck Surgery, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, Los Angeles, California, U.S.A
| | - Jacob Wester
- Department of Head and Neck Surgery, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, Los Angeles, California, U.S.A
| | | | - Jeffrey D Goldstein
- Head and Neck Cancer Program, Los Angeles, California, U.S.A.,Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Fernando Palma Diaz
- Head and Neck Cancer Program, Los Angeles, California, U.S.A.,Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Keith Blackwell
- Department of Head and Neck Surgery, University of California Irvine, Irvine.,Department of Head and Neck Surgery, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, Los Angeles, California, U.S.A.,Jonsson Comprehensive Cancer Center, Los Angeles, California, U.S.A
| | - Maie A St John
- Department of Head and Neck Surgery, University of California Irvine, Irvine.,Department of Head and Neck Surgery, Los Angeles, California, U.S.A.,Head and Neck Cancer Program, Los Angeles, California, U.S.A.,Jonsson Comprehensive Cancer Center, Los Angeles, California, U.S.A
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Diaz-Aguilar D, Terterov S, Scharnweber R, Brara H, Tucker A, Merna C, Wang S, Rahman S. Surgical nuances of circumferential lumbar spondylectomy: A case report and short literature review. Surg Neurol Int 2017; 8:253. [PMID: 29184704 PMCID: PMC5680665 DOI: 10.4103/sni.sni_225_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/19/2017] [Indexed: 11/04/2022] Open
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Wester JL, Merna C, Peng KA, Lewis R, Sepahdari AR, Ishiyama G, Hosokawa K, Kumakawa K, Ishiyama A. Facial nerve stimulation following cochlear implantation for X-linked stapes gusher syndrome leading to identification of a novel POU3F4 mutation. Int J Pediatr Otorhinolaryngol 2016; 91:121-123. [PMID: 27863625 DOI: 10.1016/j.ijporl.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/16/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
Abstract
We report a case of a nine-year-old male who presented with facial nerve stimulation four years after cochlear implantation. Computed tomography was performed revealing a dilated internal auditory meatus and the cochlear implant electrode was found to be protruding into the fallopian canal at the level of the geniculate ganglion. Subsequent genetic analysis demonstrated X-linked deafness type 2 (DFNX2) caused by a novel c.769C > T nucleotide change in the POU domain, class 3, transcription factor 4 gene (POU3F4). Inactivation of electrodes 1 and 19-21 successfully abated facial nerve stimulation.
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Affiliation(s)
- Jacob L Wester
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catherine Merna
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kevin A Peng
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Rebecca Lewis
- Department of Audiology and Speech Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ali R Sepahdari
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kumiko Hosokawa
- Department of Otolaryngology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kozo Kumakawa
- Department of Otolaryngology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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