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Journal of Neurological Surgery. Part B, Skull Base

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https://www.readbyqxmd.com/read/28321387/free-mucosal-graft-reconstruction-of-the-septum-after-nasoseptal-flap-harvest-a-novel-technique-using-a-posterior-septal-free-mucosal-graft
#1
Frederick Yoo, Edward C Kuan, Marvin Bergsneider, Marilene B Wang
Objectives The nasoseptal flap (NSF) has become the workhorse for reconstruction in endoscopic endonasal skull-base surgery. The NSF, though useful in reconstruction, may lead to significant donor site morbidity. Published techniques to reduce the donor site morbidity, free mucosal grafts, and septal rotational flaps have shown to reduce crusting and remucosalization times. We present a novel technique utilizing posterior septal mucosa as a free mucosal graft for reconstruction of the anterior septal donor site...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321386/computerized-assessment-of-superior-semicircular-canal-dehiscence-size-using-advanced-morphological-imaging-operators
#2
Joel S Beckett, Carlito Lagman, Lawrance K Chung, Timothy T Bui, Seung J Lee, Brittany L Voth, Bilwaj Gaonkar, Quinton Gopen, Isaac Yang
Superior semicircular canal dehiscence (SSCD) describes a pathological aperture at the level of the arcuate eminence. Techniques for quantifying defect size are described with most studies using two-dimensional lengths that underestimate the pathology. The objective of this study is to describe a novel method of measurement that combines manual segmentation of high-resolution computed tomography (HRCT) images of the temporal bone and a morphological skeletonization transform to calculate dehiscence volume. Images were imported into a freely available image segmentation tool: ITK-SNAP (version 3...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321385/the-laparoscopically-harvested-omental-free-flap-a-compelling-option-for-craniofacial-and-cranial-base-reconstruction
#3
Peter D Costantino, David Shamouelian, Tristan Tham, Robert Andrews, Wojciech Dec
Background Management of craniofacial and cranial base tumors is a challenge due to the anatomic intricacies associated with the calvarium, the pathological diversity of lesions that present, and the potential complications. Clinical outcomes in laparoscopically harvested omentum free flaps for cranial base and craniofacial reconstruction are presented in this paper, in the largest case series to date. Methods A retrospective single-center experience for over 10 years with laparoscopically harvested omentum flaps used to reconstruct craniofacial and cranial base defects...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321384/operative-strategies-to-minimize-complications-following-resection-of-pituitary-macroadenomas
#4
Jayesh P Thawani, Ashwin G Ramayya, Jared M Pisapia, Kalil G Abdullah, John Y-K Lee, M Sean Grady
Introduction We sought to identify factors associated with increased length of stay (LOS) and morbidity in patients undergoing resection of pituitary macroadenomas. Methods We reviewed records of 203 consecutive patients who underwent endoscopic endonasal resection of a pituitary macroadenoma (mean age = 55.7 [16-88]) years, volume = 11.3 (1.0-134.3) cm(3). Complete resection was possible in 60/29.6% patients. Mean follow-up was 575 days. Multivariate logistic regression was performed using MATLAB...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321383/direct-endonasal-approach-with-partial-upper-posterior-septectomy-a-rescue-flap-technique-modification
#5
Arturo Sotomayor-González, Armando José Díaz-Martínez, Ramón Radillo-Gil, Everardo García-Estrada, Jesús Alberto Morales-Gómez, Isaac Jair Palacios-Ortiz, Samuel Pérez-Cárdenas, Mauricio Arteaga-Treviño, Ángel Martínez-Ponce De León
Objective Report a modification of the "rescue flap" technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution. Design Prospective study. Setting Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León. Main Outcome Measures Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321382/understanding-the-course-of-vertebral-artery-at-craniovertebral-junction-in-occipital-assimilation-of-atlas-made-simplified-using-conventional-angiography
#6
Anita Jagetia, Tushit Mewda, Ishu Bishnoi, Manoj Bhutte, Hukum Singh, A K Srivastava, Daljit Singh
Introduction Preoperative assessment of vertebral artery (VA) is important to avoid its injury during surgery at craniovertebral junction (CVJ). The main concern is the course of third segment of VA (V3) while performing instrumentation at CVJ, that is, segment of VA from its course through transverse foramen of C2 to its course along the posterior arch of C1. This segment of VA includes its passage through C1 transverse foramen as well. This observational study was done to analyze the course, curvature, and termination of VA in patients with occipital assimilation of atlas at CVJ, a complex congenital anomaly, and compared with the normal course for better understanding especially by young neurosurgeons and spine surgeons...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321381/skull-base-invasion-patterns-and-survival-outcomes-of-nonmelanoma-skin-cancers
#7
Yusuf Dundar, Richard B Cannon, Marcus M Monroe, Luke Oliver Buchmann, Jason Patrick Hunt
Objective Report routes of skull base invasion for head and neck nonmelanoma skin cancers (NMSCs) and their survival outcomes. Design Retrospective. Participants Ninety patients with NMSC with skull base invasion between 2004 and 2014. Major Outcome Measures Demographic, tumor characteristics, and treatments associated with different types of skull base invasion and disease-specific survival (DSS) and overall survival (OS). Results Perineural invasion (PNI) to the skull base occurred in 69% of patients, whereas 38% had direct skull base invasion...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321380/an-evaluation-of-styloidectomy-as-an-adjunct-or-alternative-to-jugular-stenting-in-idiopathic-intracranial-hypertension-and-disturbances-of-cranial-venous-outflow
#8
J Nicholas Higgins, Mathew R Garnett, John D Pickard, Patrick R Axon
Background The extent to which intracranial venous sinus obstruction contributes to idiopathic intracranial hypertension (IIH) is debated. The extent to which extracranial venous obstruction contributes to IIH is virtually unexplored. This article describes an interventional approach to extracranial venous outflow in a group of patients with severe intractable symptoms. Objective To describe our technique and experience of styloidectomy combined with jugular stenting in the treatment of skull base narrowing of the jugular veins...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321379/differentiation-between-posterior-sinuses-using-the-medial-orbital-floor-as-a-landmark
#9
Camila Degen Meotti, Otávio Bejzman Piltcher, Bruno Netto, Jaqueline Lemieszek, Michelle Lavinsky-Wolff, Felipe Marques do Rego Monteiro, Gustavo Rassier Isolan
Objectives This study aims to evaluate the difference in height between the floors of the posterior ethmoid and sphenoid sinuses with respect to the medial orbital floor (MOF) to confirm this difference as a landmark for identification of the posterior sinuses. It also aims to describe this difference regarding the type of pneumatization of the sphenoid sinus (conchal, presellar, and sellar). Design A cross-sectional study was conducted. Study Center The study was conducted at the Department of Radiology of Hospital de Clínicas de Porto Alegre, a tertiary care university hospital in Southern Brazil...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321378/hemi-transseptal-approach-for-pituitary-surgery-a-follow-up-study
#10
Naif Fnais, Salvatore Di Maio, Susan Edionwe, Anthony Zeitouni, Denis Sirhan, Constanza J Valdes, Marc A Tewfik
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...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321377/single-layer-repair-of-large-anterior-skull-base-defects-without-vascularized-mucosal-flap
#11
Frederick Yoo, Marilene B Wang, Marvin Bergsneider, Jeffrey D Suh
Objectives Bilateral anterior skull base (ASB) defects following endoscopic endonasal tumor resection are most commonly repaired utilizing multilayered reconstruction with a vascularized mucosal flap. Single-layer closure of large ASB defects has been described in the literature but this technique has yet to gain a widespread use. We report our experience with a series of patients who underwent reconstruction of large ASB defects using a single-layer intradural graft, without nasoseptal flaps. We also compared the use of acellular dermal matrix (AlloDerm, LifeCell, Branchburg, New Jersey, United States) or collagen matrix xenograft (Duramatrix, Stryker, Kalamazoo, Michigan, United States) as the graft biomaterial...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321376/role-of-glioblastoma-craniotomy-related-to-patient-survival-a-10-year-survey-in-a-tertiary-care-hospital-in-pakistan
#12
Saman Shahid, Kamran Hussain
A total of 270 glioblastoma patients were treated for tumor resection during 2004 to 2014. The following variables were examined: patient age group (PAG) and percent of the extent of resection (EOR) in four types of resections: gross total resection (GTR), subtotal resection (STR), partial resection (PR), and biopsy/decompression (BD). The Karnofsky performance scale (KPS) was used and the average survival time noted. The least survival time (7 months) was noticed in the patient age group 18 to 35 years with biopsy only, whereas, the maximum survival time (14...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321375/cost-effectiveness-analysis-of-surgical-versus-medical-treatment-of-prolactinomas
#13
Corinna C Zygourakis, Brandon S Imber, Rebecca Chen, Seunggu J Han, Lewis Blevins, Annette Molinaro, James G Kahn, Manish K Aghi
Background Few studies address the cost of treating prolactinomas. We performed a cost-utility analysis of surgical versus medical treatment for prolactinomas. Materials and Methods We determined total hospital costs for surgically and medically treated prolactinoma patients. Decision-tree analysis was performed to determine which treatment produced the highest quality-adjusted life years (QALYs). Outcome data were derived from published studies. Results Average total costs for surgical patients were $19,224 ( ± 18,920)...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321374/ectopic-pituitary-adenomas-presenting-as-sphenoid-or-clival-lesions-case-series-and-management-recommendations
#14
Bobby A Tajudeen, Edward C Kuan, Nithin D Adappa, Joseph K Han, Rakesh K Chandra, James N Palmer, David W Kennedy, Marilene B Wang, Jeffrey D Suh
Background An ectopic pituitary adenoma presenting as a clival or sphenoid mass is a rare clinical occurrence that may mislead the clinician and result in unnecessary interventions or potential medicolegal consequences. Here, we present one of the largest multi-institutional case series and review the literature with an emphasis on radiological findings and critical preoperative workup. Methods Retrospective chart review. Results Nine patients were identified with ectopic pituitary adenomas of the sphenoid or clivus...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321373/a-review-of-skull-base-tumor-clinical-trials-past-trends-and-future-opportunities
#15
Anand Devaiah, Charles Murchison
Objective Tumors of the anterior and lateral skull base (TALSB) are relatively rare but can be devastating to patients. By examining trials focused on TALSB, we can characterize the studies that predominate and better understand current directions of study. This gives us a better understanding of future studies to pursue. Study Design This is a retrospective analysis. Settings We set skull base tumor clinical trials in the United States which are listed in ClinicalTrials.gov. Subjects and Methods We used the information available on ClinicalTrials...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321372/treatment-outcomes-of-rathke-s-cleft-cysts-managed-with-marsupialization
#16
Edward C Kuan, Frederick Yoo, Jennifer Chyu, Marvin Bergsneider, Marilene B Wang
Objectives Rathke's cleft cysts (RCC) are benign cystic lesions of the sella resulting from incomplete obliteration of Rathke's cleft. Symptomatic lesions often require surgical decompression, which is often amenable to a transnasal, transsphenoidal (TNTS) approach. We report our experience with marsupialization of RCC and describe a novel technique to promote re-epithelization of the cyst cavity. Design Retrospective review. Setting Tertiary academic medical center. Participants Patients who underwent TNTS for RCC between 2007 and 2015...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321371/anatomic-variations-in-pituitary-endocrinopathies-implications-for-the-surgical-corridor
#17
Edward C Kuan, Frederick Yoo, Won Kim, Karam W Badran, Thomas E Heineman, Ali R Sepahdari, Marvin Bergsneider, Marilene B Wang
Objectives/Hypotheses Functioning pituitary adenomas may produce endocrinopathies such as acromegaly and Cushing syndrome. Both conditions lead to characteristic anatomic variations as a result of hormonally induced abnormal soft tissue deposition. We evaluate the anatomic differences between acromegalics and Cushing disease patients and compare these dimensions to controls. Design Radiographic review of preoperative magnetic resonance images (MRI) of the pituitary gland. Setting Tertiary academic medical center...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28180051/region-specific-objective-signatures-of-endoscopic-surgical-instrument-motion-a-cadaveric-exploratory-analysis
#18
R Alex Harbison, Angelique M Berens, Yangming Li, Randall A Bly, Blake Hannaford, Kris S Moe
Objectives The objective of this study was to evaluate region-specific surgical instrument kinematics among novice and experienced surgeons performing endoscopic endonasal skull base surgery. Design Cadaveric experimental study. Setting Tertiary academic center. Participants Two novice and two experienced surgeons performed eight endoscopic total ethmoidectomies and sphenoidotomies using an optically tracked microdebrider. Main Outcome Measures Time-stamped Euclidian coordinates were recorded. Cumulative instrument travel, mean linear velocity and acceleration, and mean angular velocities were calculated in the anterior ethmoid, posterior ethmoid, and sphenoid sinus regions...
February 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28180050/utility-of-an-ultrasonic-aspirator-in-transcanal-endoscopic-resection-of-temporal-bone-paraganglioma
#19
Brendan P O'Connell, Jacob B Hunter, Matthew L Carlson, Brandon Isaacson, Alejandro Rivas, George B Wanna
The objective of this study was to evaluate the role of removing middle ear paragangliomas using an ultrasonic aspirator (UA) through a transcanal, exclusively endoscopic approach. Three consecutive patients undergoing transcanal endoscopic resection of middle ear paragangliomas using an UA were retrospectively studied. The primary outcome measure was achieving gross total tumor resection. Secondary outcomes included postoperative hearing and early convalescence. Two glomus tympanicum tumors and one small glomus jugulare were included, and complete tumor resection was achieved endoscopically in all cases...
February 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28180049/invasive-aspergillosis-of-anterior-skull-base-in-the-immunocompetent-host-outcomes-with-a-combined-treatment-modality-an-institutional-experience
#20
Saurin R Shah, Amit Keshri, Simple Patadia, Rungmei S K Marak, Sanjay Behari
Objectives To study outcomes with voriconazole therapy in immunocompetent individuals following maximal safe endoscopic resection in invasive aspergillosis of the anterior skull base. Design Retrospective study of patients with chronic invasive aspergillosis including symptomatology, extent of disease, and response to voriconazole following maximal safe resection in immunocompetent individuals. Setting Tertiary care superspeciality referral center. Participants Ten consecutive patients of invasive aspergillosis of anterior skull base managed over a period of 2 years...
February 2017: Journal of Neurological Surgery. Part B, Skull Base
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