1
|
Fitzgerald CW, Hararah M, Mclean T, Woods R, Dogan S, Tabar V, Ganly I, Matros E, Cohen MA. Virtual Surgical Planning and Three-Dimensional Models for Precision Sinonasal and Skull Base Surgery. Cancers (Basel) 2023; 15:4989. [PMID: 37894356 PMCID: PMC10605567 DOI: 10.3390/cancers15204989] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Sinonasal and skull base malignancies represent a rare, heterogenous group of pathologies with an incidence of 0.556 per 100,000 persons in the population. Given the numerous critical anatomic structures located adjacent to the sinonasal cavity and skull base, surgery for tumors in this region requires careful pre-operative planning with the assistance of radiological imaging and intraoperative image guidance technologies to reduce the risk of complications. Virtual surgical planning (VSP) and three-dimensional models (3DMs) are adjunctive technologies which assist clinicians to better visualize patient anatomy using enhanced digital radiological images and physical stereolithographic models based on patients' personal imaging. This review summarizes our institutional experience with VSP and 3DMs in sinonasal and skull base surgical oncology. A clinical case series is used to thematically illustrate the application of VSP and 3DMs in surgical ablation, reconstruction, patient communication, medical education, and interdisciplinary teamwork in sinonasal and skull base surgery.
Collapse
Affiliation(s)
- Conall W. Fitzgerald
- Department of Surgery, Head & Neck Division, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (C.W.F.)
| | - Mohammad Hararah
- Department of Plastic & Microvascular Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Tim Mclean
- Department of Surgery, Head & Neck Division, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (C.W.F.)
| | - Robbie Woods
- Department of Surgery, Head & Neck Division, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (C.W.F.)
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Ian Ganly
- Department of Surgery, Head & Neck Division, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (C.W.F.)
| | - Evan Matros
- Department of Plastic & Microvascular Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marc A. Cohen
- Department of Surgery, Head & Neck Division, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (C.W.F.)
| |
Collapse
|
2
|
Scholfield DW, Fitzgerald CW, Alzumaili B, Eagan A, Xu B, Martinez G, Tuttle RM, Shaha AR, Shah JP, Wong RJ, Patel SG, Ghossein RA, Ganly I. ASO Visual Abstract: Diffuse Sclerosing Papillary Thyroid Carcinoma-Clinicopathological Characteristics and Prognostic Implications in Comparison with Classic and Tall Cell Papillary Thyroid Cancer. Ann Surg Oncol 2023; 30:4771-4772. [PMID: 37219658 DOI: 10.1245/s10434-023-13661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Daniel W Scholfield
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Conall W Fitzgerald
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bayan Alzumaili
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alana Eagan
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - German Martinez
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Ronald A Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA.
| |
Collapse
|
3
|
Scholfield DW, Fitzgerald CW, Alzumaili B, Eagan A, Xu B, Martinez G, Tuttle RM, Shaha AR, Shah JP, Wong RJ, Patel SG, Ghossein RA, Ganly I. Diffuse Sclerosing Papillary Thyroid Carcinoma: Clinicopathological Characteristics and Prognostic Implications Compared with Classic and Tall Cell Papillary Thyroid Cancer. Ann Surg Oncol 2023; 30:4761-4770. [PMID: 37154968 PMCID: PMC10751659 DOI: 10.1245/s10434-023-13589-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/13/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The clinical behaviour and oncologic outcome of diffuse sclerosing papillary thyroid carcinoma (DS-PTC) is poorly understood. The objectives of this study were to compare the clinicopathological characteristics and oncological outcomes of DS-PTC to classic PTC (cPTC) and tall cell PTC (TC-PTC). METHODS After institutional review board approval, 86 DS-PTC, 2,080 cPTC, and 701 TC-PTC patients treated at MSKCC between 1986 and 2021 were identified. Clinicopathological characteristics were compared by using chi-square test. Kaplan-Meier and log rank were used to compare recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). DS-PTC patients were propensity matched to cPTC and TC-PTC patients for further comparison. RESULTS DS-PTC patients were younger with more advanced disease than cPTC and TC-PTC (p < 0.05). Lymphovascular invasion (LVI), extranodal extension, and positive margins were more common in DS-PTC (p < 0.02). Propensity matching confirmed more aggressive histopathological features in DS-PTC. The median number of metastatic lymph nodes was significantly greater and DS-PTC metastases were RAI avid. DS-PTC 5-year RFS was 50.4% compared with 92.4% in cPTC and 88.4% in TC-PTC (p < 0.001). Multivariate analysis confirmed DS-PTC as an independent prognostic factor of recurrence. Ten-year DSS for DS-PTC was 100% compared with 97.1% in cPTC and 91.1% in TC-PTC. Differentiated high-grade, thyroid carcinoma DS had more advanced T-stage and worse 5-year RFS than DS-PTC. CONCLUSIONS DS-PTC presents with more advanced clinicopathological features than cPTC and TC-PTC. Large-volume nodal metastases and LVI are characteristic features. Almost half of patients develop recurrence despite aggressive initial management. Despite this, with successful salvage surgery DSS is excellent.
Collapse
Affiliation(s)
- Daniel W Scholfield
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Conall W Fitzgerald
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bayan Alzumaili
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alana Eagan
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - German Martinez
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snehal G Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald A Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
4
|
Hintze JM, Fitzgerald CW, Lang B, Lennon P, Kinsella JB. Mortality risk in post-operative head and neck cancer patients during the SARS-Cov2 pandemic: early experiences. Eur Arch Otorhinolaryngol 2020; 278:275-278. [PMID: 32572564 PMCID: PMC7307942 DOI: 10.1007/s00405-020-06138-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this report is to outline our early experience with head and neck cancer patients in a tertiary referral center, during the SARS-Cov2 pandemic, and to describe the poor outcomes of patients who acquired the infection. METHODS In this case series from a single-center, national tertiary referral center for head and neck cancer we describe three consecutive head and neck cancer patients who contracted SARS-Cov2 during their inpatient stay. RESULTS Of the three patients described in our case series that contracted SARS-Cov2, two patients died from SARS-Cov2 related illness. CONCLUSION We have demonstrated the significant implications that SARS-Cov2 has on head and neck cancer patients, with 3 patients acquiring SARS-Cov2 in hospital, and 2 deaths in our that cohort. We propose a complete separation in the location of where these patients are being managed, and also dedicated non-SARS-Cov2 staff for their peri-operative management. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Justin M Hintze
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland. .,Trinity College, University of Dublin, Dublin, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Conall W Fitzgerald
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bronagh Lang
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland
| | - John B Kinsella
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland
| |
Collapse
|
5
|
Hintze JM, Geyer L, Fitzgerald CW, Simoes Franklin C, Glynn F, Viani L, Walshe P. The impact of repetitive hyperbaric exposure during SCUBA diving on cochlear implants. Laryngoscope 2019; 129:2760-2764. [PMID: 30810235 DOI: 10.1002/lary.27880] [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: 11/07/2018] [Revised: 12/27/2018] [Accepted: 01/29/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Complications during or after cochlear implantation are relatively rare. They occur more frequently in patients who partake in activities that can potentially lead to local trauma. No formal recommendations exist for participation in self-contained underwater breathing apparatus (SCUBA) activities. We describe three patients with a combined five cochlear implants and extensive diving experience, the largest case series to date, and highlight some of the difficulties faced. We also review the literature on previously described SCUBA-diving patients with cochlear implants. STUDY DESIGN Retrospective case series and literature review. METHODS A review of the known SCUBA divers in the National Hearing Implant and Research Centre in Ireland was conducted, and a review of the literature was carried out using PubMed and Google Scholar. RESULTS Of the three SCUBA divers with cochlear implants, two required reimplantation, the first due to nonauditory stimulation, and the second due to extrusion of the electrode through the tympanic membrane following repetitive SCUBA dives. The third patient remains without complications after 80 dives. CONCLUSIONS Patients with cochlear implants can have complications relating to the implant itself, with device failure a theoretical risk. The cochleostomy can lead to perilymphatic extravasation, as well as inner ear barotrauma, decompression sickness, and formation of air bubbles along the electrode. A combination of deafness, vestibulopathy with abrupt perilymph leak, and loss of proprioception can lead to disorientation and blue dome syndrome. Based on our experience with cochlear implants in SCUBA divers, along with those reported in the literature, we recommend caution in patients with cochlear implants who SCUBA dive regularly and strict adherence to the recommended safety limits. LEVEL OF EVIDENCE 4 129:2760-2764, 2019.
Collapse
Affiliation(s)
- Justin M Hintze
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lina Geyer
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Conall W Fitzgerald
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cristina Simoes Franklin
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,School of Medicine, University of Dublin, Trinity College, Dublin, Ireland
| | - Fergal Glynn
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Laura Viani
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Medicine, University of Dublin, Trinity College, Dublin, Ireland
| | - Peter Walshe
- National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
6
|
Keane E, Fitzgerald CW, Smyth DA, Nataraj MB, Lang E, Skinner LJ, Donnelly MJ. Drain Usage in Head and Neck Surgery: A National Survey of Thirty-five Surgeons across Ten Units. Ir Med J 2018; 111:839. [PMID: 30560635] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction Drain usage is commonplace in head and neck surgery. There is an increasing body of literature disputing their routine placement in certain procedures. The aim of this study is to explore modern-day practice in terms of drain usage and the use of haemostatic agents. Methods A simple questionnaire was devised and sent to 35 ENT Surgeons across 10 units nationally. Results There was an overall response rate of 77.1% (n=27). There was considerable heterogeneity amongst surgeons in terms of indication for insertion, how the decision is made to remove the drain and if any alternative/adjunctive haemostatic agents are being used. Discussion The management of drains is poorly defined and guidelines are lacking. With increased pressure on resources, the risk of infection and discomfort to the patient, further reflection is required to evaluate if careful patient selection rather than habitual drain insertion in every case is more appropriate.
Collapse
Affiliation(s)
- E Keane
- University Hospital Waterford, Dunmore Road, Co. Waterford
| | - C W Fitzgerald
- University Hospital Waterford, Dunmore Road, Co. Waterford
| | - D A Smyth
- University Hospital Waterford, Dunmore Road, Co. Waterford
| | - M B Nataraj
- University Hospital Waterford, Dunmore Road, Co. Waterford
| | - E Lang
- University Hospital Waterford, Dunmore Road, Co. Waterford
| | - L J Skinner
- University Hospital Waterford, Dunmore Road, Co. Waterford
| | - M J Donnelly
- University Hospital Waterford, Dunmore Road, Co. Waterford
| |
Collapse
|
7
|
Baker JF, Fitzgerald CW, O'Neill SC, McCormack D. Cauda equina syndrome secondary to bilateral sacral Tarlov cysts. Spine J 2014; 14:1065-6. [PMID: 24448190 DOI: 10.1016/j.spinee.2013.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/29/2013] [Indexed: 02/03/2023]
Affiliation(s)
- Joseph F Baker
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Conall W Fitzgerald
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Shane C O'Neill
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Damien McCormack
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| |
Collapse
|
8
|
O'Reilly MK, Nason GJ, Liddy S, Fitzgerald CW, Kelly ME, Shields C. DOCSS: doctors on-call smartphone study. Ir J Med Sci 2013; 183:573-7. [PMID: 24338079 DOI: 10.1007/s11845-013-1053-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Smartphones have revolutionised our demands for constant access to information. The usage of smartphones in the clinical setting is becoming widespread. The aim of our study was to assess smartphone ownership and usage across a cohort of interns. METHODS A voluntary novel questionnaire was distributed to interns in two university hospitals. Details regarding smartphone ownership and usage were assessed. Likert scales were utilised for analysis. RESULTS Sixty-one (74.4 %) interns responded to the survey. Sixty (98.4 %) owned a smartphone with iPhone(®) being the most popular (76.7 %). Fifty-five (91.6 %) interns have downloaded medical applications ('apps'), while 29 (52.3 %) reported paying for them. Regarding smartphone use on-call, 30 (50 %) interns agreed it aids diagnoses, 26 (43 %) agree it helped in interpreting laboratory values, 31 (51.7 %) agreed it helped in dosing of medication and 33 (55 %) agreed it was of assistance in medical emergency protocols. Forty-two (70 %), 42 (70 %) and 46 (76.7 %) interns agreed or strongly agreed smartphones have a positive influence on them in terms of levels of stress, confidence and level of knowledge, respectively. CONCLUSION Smartphone usage is widespread among our intern cohort. The introduction of hospital applications with local guidelines would be welcomed; however, this may require informed patient consent regarding their use.
Collapse
Affiliation(s)
- M K O'Reilly
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | | | | | | |
Collapse
|