Hemi-transseptal Approach for Pituitary Surgery: A Follow-Up Study

Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction. Design A retrospective case-control study. Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada. Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology. Main Outcome Measures Operative time, CSF rhinorrhea, and postoperative nasal morbidity. Results A total of 105 patients underwent the Hemi-T approach versus 40 controls. Operative time was shorter using the Hemi-T technique (180.51 ± 56.9 vs. 202.9 ± 62 minutes; p = 0.048). The rates of nasal morbidity (septal perforation [5/102 vs. 6/37; p = 0.029] and mucosal adhesion [11/102 vs. 10/39 p = 0.027]), fascia lata harvest (21/100 vs. 18/39; p = 0.0028), and postoperative CSF leak rates (7/100 vs. 9/38; p = 0.006) were lower in the Hemi-T group. Conclusion Advantages of the Hemi-T approach over traditional exposure techniques include preservation of the nasal vascular pedicle, shorter operative time, reduced fascia lata harvest rates, and decreased nasal morbidity.

Balance Study in Parkinson’s Disease Patients

Objective: 1) To understand the role of vestibular dysfunction in Parkinson’s disease (PD) postural instability. 2) To investigate whether vibrotactile stimulation (VTS) to the trunk can be a tangible form of remediation therapy in patients with postural instability of Parkinson’s disease.

Method: Prospective pilot study; July 2011-ongoing. Postural instability in PD investigated. Clinical study of 10 to 15 mild to moderate PD patients. Vibration therapy (independent variable) applied to the trunk to remediate posture during directional tasks. Rotary chair used to evaluate vestibular function. Data compared to controls with T test and suggested improvement.

Results: Improvements in postural instability with vibration therapy: Patients’ postural performances were compared pre- and posttherapy. Only 1 of 11 of the Parkinson’s patients had a statistically significant improvement of posture after vibration therapy ( P = .0126284). One patient had a statistically lower performance ( P = .0109707), and the remaining had an overall subjective but no statistically significant improvement. Similarly, only 1 control had significant improvement (.0404138) while 5 had statistically decreased performance and the remaining had no statistically significant change. Overall, no statistical significance was seen between PD patients and controls. Rotary chair data: analysis pending.

Conclusion: Preliminarily, no improvements in postural instability have been seen yet. This is inconsistent with case reports. However, patients and controls reported fatigue at the end of testing and this may account for the decreased performance. Rotary chair analysis is pending, thus, no conclusion drawn for this at this time.