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  • 1
    Online Resource
    Online Resource
    Minimally Invasive Transnasal Approach to the Anteromedial Temporal Fossa and Lateral Sphenoid Using a Novel Landmark between Periorbita and Periosteum of the Pterygopalatine Fossa: A Cadaveric Study
    Georg Thieme Verlag KG ; 2023
    In:  Journal of Neurological Surgery Part B: Skull Base
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG
    Abstract: The anteromedial temporal region and the lateral wall of the sphenoid can be the site of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol granuloma of the petrous apex, malignancy, infection, and sellar pathology extending to the lateral cavernous sinus. Approaches to this region are technically challenging and the existing approach requires sacrifice of all of the turbinates including the nasolacrimal duct, which can cause postoperative complications. We describe a novel anatomical landmark between the periorbita and the periosteum of the pterygopalatine fossa (which is located at the inferolateral periorbital periosteal line [ILPPL]). The posterior one-third of the incision line lies between the foramen rotundum and the superior orbital fissure, which is proximal to the maxillary strut. A 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the posterior inferolateral orbital region, anteromedial temporal region, lateral wall of the sphenoid sinus, and lateral wall of the cavernous sinus. A combined multiangled approach to the ILPPL will enable us to preserve all of the turbinates and the septum, and the nasolacrimal duct, allowing for the preservation of the physiological function and pedicled flaps, such as the middle turbinate, inferior turbinate, and septal membrane flap. The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach to the anteromedial temporal fossa.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/a-2101-9910
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2653367-4
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  • 2
    Online Resource
    Online Resource
    Heterogeneity in Outcome Reporting in Endoscopic Endonasal Skull Base Reconstruction: A Systematic Review
    Georg Thieme Verlag KG ; 2021
    In:  Journal of Neurological Surgery Part B: Skull Base Vol. 82, No. 05 ( 2021-10), p. 506-521
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 82, No. 05 ( 2021-10), p. 506-521
    Abstract: Objective Presently, there are no standards for reporting outcomes of endoscopic endonasal skull base reconstruction (ESBR). This is problematic as a lack of consistent reporting makes synthesizing findings in systematic reviews and meta-analysis challenging. Thus, the aim of this study was to systematically review and describe the patterns of reporting outcomes in ESBR as a foundation for developing reporting guidelines. Study Design Present study is a systematic review. Methods Embase, PubMed, CINAHL, Cochrane Library, and Web of Science were searched for all publications with ≥25 patients and a focus on ESBR. The reporting patterns of each study's variables and outcomes were assessed. Results A total of 112 studies were included in the review. The most commonly reported demographic variables were the number of included patients (n = 112, 100%) and types of pathologies treated (n = 104, 92.9%). Meanwhile, the most routinely described preoperative variable was history of prior treatment (n = 48, 42.9%). Type of reconstruction was a commonly reported intraoperative variable (n = 110, 98.2%), though the rate of intraoperative cerebrospinal fluid (CSF) leak was noted in only 76 studies (67.9%). With regard to postoperative outcomes, postoperative CSF leak rate was routinely provided (n = 101, 90.2%), but reporting of other surgical complications was more inconsistent. Ultimately, of the 43 variables and outcomes reviewed, a median of 12 (range: 4–22) was reported in each study. Conclusion There is significant heterogeneity in the outcomes reported in studies relating to ESBR. This highlights the need for the development of standard reporting guidelines to minimize bias and improve interstudy comparability.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/s-0040-1714108
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
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  • 3
    Online Resource
    Online Resource
    Comparative Outcomes by Surgical Approach in Patients with Malignant Sinonasal Disease
    Georg Thieme Verlag KG ; 2022
    In:  Journal of Neurological Surgery Part B: Skull Base Vol. 83, No. S 02 ( 2022-06), p. e353-e359
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 83, No. S 02 ( 2022-06), p. e353-e359
    Abstract: Objective There is a paucity of data on comparative outcomes for open versus endoscopic surgery for patients with malignant sinonasal pathology. Most of the available studies are limited by a sample size 〈 100 patients. Design This is a retrospective cohort study. Setting The findings of this study come from a single-institution tertiary care center from 2008 to 2019. Participants In total, 199 patients who underwent surgery for malignant sinonasal disease participated in this study. Main Outcome Measures The main outcome measures were perioperative complications and reoperation. Results Patients in our sample had a mean age of 59.7 years (SD, 20.4). In total, 62% were male and 72% were white. An endoscopic-only approach was used in 41% of patients and an open or combined approach in 59% of patients. Squamous cell carcinoma was the most common pathology (43.0%), followed by sarcoma (9.5%), skin cancer (6.5%), sinonasal undifferentiated carcinoma (6.5%), and adenocarcinoma (5.5%). The all-cause complication rate was 14.6%. Patients with an open resection had a higher rate of intraoperative complications (5.9 vs. 0%; p = 0.043), postoperative complications (19.5 vs. 3.7%; p = 0.001), and all-cause complications (21.0 vs. 3.7%; p  〈  0.001). The likelihood of early reoperation ( 〈 6 months) or late reoperation ( 〉 6 months) did not significantly differ by surgical approach (p = 1.000 and 0.741, respectively). Conclusion The endoscopic approach for resection of malignant sinonasal disease is viable for select patients and may be associated with a favorable complication rate compared with the open approach.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/s-0041-1729978
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
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  • 4
    Online Resource
    Online Resource
    Postoperative Pain Management and Perceived Patient Outcomes following Endoscopic Pituitary Surgery
    Georg Thieme Verlag KG ; 2022
    In:  Journal of Neurological Surgery Part B: Skull Base Vol. 83, No. 04 ( 2022-08), p. 397-404
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 83, No. 04 ( 2022-08), p. 397-404
    Abstract: Objectives Pain management remains a point of emphasis given the ongoing opioid crisis. There are no studies in the literature interrogating opioid prescribing and use following endoscopic pituitary surgery. This study investigates provider prescribing tendency, patient utilization of analgesics, and patient outcomes regarding pain management after endoscopic pituitary surgery. Methods We identified 100 patients undergoing endoscopic pituitary surgery at one institution from 2016 to 2018 in the electronic medical record (EMR) and state narcotic database to determine postoperative analgesic regimens. A telephone survey was used to characterize postoperative analgesic use and satisfaction with prescribed regimen. Results Fifty-two different pain control regimens were prescribed to the study patients. Also, 93% of study patients were prescribed an opioid postoperatively. The average quantity of opioids prescribed per patient in morphine milligram equivalents (MMEs) was 625 (equivalent 83 oxycodone 5-mg tablets) with an average MME/day of 59 (equivalent 8 oxycodone 5-mg tablets). A total of 71% survey respondents who used opioids reported using 〈 25% of their prescription. The majority of prescription narcotic users consumed 〉 50% of their postoperative opioid intake in the first 24 to 48 hours after discharge. There were no significant differences in pain outcome between opioid users and nonopioid users. Conclusion Vast heterogeneity exists in narcotic prescribing by providers at our institution following endoscopic pituitary surgery. Narcotic prescribing patterns exceeded most patients' analgesic needs. Opioid analgesics were not superior to nonopioids regimens in patient-reported pain outcomes in this study population.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/a-1692-9879
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2653367-4
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  • 5
    Online Resource
    Online Resource
    Outcomes in Pediatric Endoscopic Skull Base Surgery: A Systematic Review
    Georg Thieme Verlag KG ; 2023
    In:  Journal of Neurological Surgery Part B: Skull Base Vol. 84, No. 01 ( 2023-02), p. 024-037
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 84, No. 01 ( 2023-02), p. 024-037
    Abstract: Objectives The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study aims to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents aged 0 to 18 years. Design A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000 to 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Final inclusion criteria included: case series with more than 10 patients with pediatric patients aged ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting This study was conducted at a tertiary care medical center. Participants Children/adolescents aged 0 to 18 years who underwent endoscopic skull base surgery were participated in this study. Main Outcome Measures Patient demographics, pathology, reconstructive technique, intraoperative findings, intraoperative, and postoperative surgical complications were measured through this study. Results Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients aged 0 to 18 years met inclusion criteria for final analysis. Seven of the 12 studies discussed a single pathology. The most common pathology was a skull base defect causing cerebrospinal fluid (CSF) leak. The majority of skull base repairs were made with free tissue grafts. The most common postoperative complication was CSF leak (n = 40). Twelve cases of meningitis occurred postoperatively with two of these episodes resulting in death. Conclusion Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/a-1725-9151
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2653367-4
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