Surgical outcomes in patients with endoscopic versus transcranial approach for skull base malignancies: a 10-year institutional experience

Rutland, John W; Gill, Corey M.; Ladner, Travis R.; Goldrich, David; Villavisanis, Dillan F.; Devarajan, Alex; Pai, Akila; Banihashemi, Amir; Miles, Brett A.; Sharma, Sonam; Balchandani, Priti; Bederson, Joshua B.; Iloreta, Alfred Marc; Shrivastava, Raj

doi:10.1080/02688697.2020.1779659

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…The large proportion of patients who underwent SRPT (54%) as a core of initial therapy can be explained by improvements in perioperative management as well as surgical techniques in children in the last few years. Postoperative morbidity has also been reduced-thanks to the development of combined minimally invasive endoscopic and transcranial or transfacial approaches and free-flap reconstructive possibilities, which limit functional and cosmetic sequelae (34)(35)(36). In the retrospective study of 92 HN-RMS (both ERMS and ARMS) by Dombrowski et al (16), surgery was associated with a reduced risk of mortality after adjusting for TNM staging and location of the tumor (p = 0.05).…”

Section: Survival and Prognostic Factorsmentioning

confidence: 99%

Locoregional Control and Survival in Children, Adolescents, and Young Adults With Localized Head and Neck Alveolar Rhabdomyosarcoma—The French Experience

et al. 2022

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IntroductionThe head and neck (HN) are the most frequent sites of pediatric rhabdomyosarcoma (RMS). Alveolar RMS (ARMS) represents ~20% of all RMS cases and frequently spread to lymph nodes (LNs). The aim was to report locoregional control, event-free survival (EFS), and overall survival (OS), according to clinical and pathological features, LN staging, and treatment modalities.MethodsThe study included all patients prospectively enrolled in EpSSG RMS 2005 study under 21 years of age with localized HN ARMS and diagnosed between 2005 and 2016 in France. Medical data including imaging, surgical report, and radiation therapy planes were analyzed.ResultsForty-eight patients (median age 6 years; range 4 months−21 years), corresponding to 30 parameningeal and 18 non-parameningeal ARMS, were included. There were 33 boys (69%). Tumor locations included the following: orbit (n = 7) among which four cases had bone erosion, paranasal sinuses and nasal cavity (n = 16), deep facial spaces (n = 10), nasolabial fold (n = 8), and other non-parameningeal HN sites (n = 7). A fusion transcript of PAX3-FOXO1 or PAX7-FOXO1 was expressed in 33 of the 45 cases (73%) with molecular analysis. At diagnosis, 10 patients had primary resection of the primary tumor (PRPT) (none with microscopic complete resection) and 9 had LN staging. After induction chemotherapy, 26 patients (54%) had secondary resection of the primary tumor (SRPT) and 13 patients (27%) had cervical LN dissection. A total of 43 patients (90%) were treated with radiation therapy.With a median follow-up of 7 years (range 2–13 years), 5-year OS and EFS were 78% (95% CI, 63–88%) and 66% (95% CI, 51–78%), respectively. We observed 16 events (10 deaths): 4 local, 4 regional, 1 local and regional, and 7 metastatic. In univariate analysis, OS was only superior for patients under 10 years of age (p = 0.002), while FOXO1-negative ARMS, SRPT for parameningeal ARMS, and LN surgery were associated with significantly better EFS.ConclusionOur study confirms a better outcome for fusion-negative ARMS and ARMS in children under 10 years. Moreover, LN surgery and SRPT of parameningeal tumor may improve EFS of ARMS. Larger studies are needed to confirm our findings.

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Section: Survival and Prognostic Factorsmentioning

confidence: 99%

Locoregional Control and Survival in Children, Adolescents, and Young Adults With Localized Head and Neck Alveolar Rhabdomyosarcoma—The French Experience

et al. 2022

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“…Endoscopic approaches to the pituitary did not affect the risk of postoperative DI. Endoscopic approaches have been increasingly employed in pituitary adenoma resection compared to the transcranial and microscope-based approaches for numerous reasons including: shorter operative time, less intraoperative blood loss, and reduced length of stay [20]. They have been shown to have a reduced risk of postoperative complications without signi cant change in gross total resection of the pathology or ability to achieve negative margins [20].…”

Section: Demographic and Clinical Risk Factors For Postoperative Diab...mentioning

confidence: 99%

“…Endoscopic approaches have been increasingly employed in pituitary adenoma resection compared to the transcranial and microscope-based approaches for numerous reasons including: shorter operative time, less intraoperative blood loss, and reduced length of stay [20]. They have been shown to have a reduced risk of postoperative complications without signi cant change in gross total resection of the pathology or ability to achieve negative margins [20]. Endoscopic endonasal approaches are commonly used for a safe trajectory to the pituitary gland and infundibulum for the removal of pituitary tumors.…”

Section: Demographic and Clinical Risk Factors For Postoperative Diab...mentioning

confidence: 99%

Patterns in the Development of Postoperative Diabetes Insipidus after Pituitary Adenoma Resection: A 2016-2019 National Analysis

Vasan

Dullea

Devarajan

et al. 2022

Preprint

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Purpose: Postoperative diabetes insipidus (DI) is a known occurrence after pituitary adenoma (PA) resection. It is reported in up to 30% of procedures with associated postsurgical morbidity and prolonged length of stay. This study aimed to evaluate preoperative factors that may be associated with postoperative DI after pituitary tumor resection. Methods: Data from the 2016-2019 National Inpatient Sample (NIS) was analyzed. Diagnosis related group code was used to identify the hospitalizations for PA resection. Comorbidities were defined by the Elixhauser Comorbidity Index given ICD-10 codes. Univariable and multivariable logistic regression models, accounting for sampling design, were built to determine factors associated with postoperative DI. Results: 61,105 PA patients were included; 55,125 patients did not develop DI, whereas 5,980 patients did. Compared to White patients, Black patients (OR=1.47;p<0.001) and Hispanic patients (OR=1.34;p=0.003) experienced increased odds of postoperative DI. Older age was associated with decreased odds of postoperative DI (OR 1-year increase in age=0.98;p<0.001). Hypertension (OR=0.65;p<0.001) was associated with decreased odds of postoperative DI. Neurological disorders (OR=2.65;p<0.001), paralysis (OR=2.38;p<0.001), and hypothyroidism (OR=2.39;p<0.001) were associated with increased odds of postoperative DI. Endoscopic surgery provided no significant advantage to avoiding postoperative DI (p=0.127). Conclusions: Black and Hispanic patients had significantly increased odds of postoperative DI. Further investigation is needed to uncover the source of these disparities. Hypothyroidism and neurological conditions, likely due to tumor characteristics, increased odds of postoperative DI. Finally, this study contributed to the argument that endoscopic approach does not improve postoperative DI risk in the ongoing debate in the literature.

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“…These sinuses directly connect the nasal cavity and several nearby neurovascular structures within the skull base. Historically, gaining access to pathologies located in the ventral skull base required invasive craniofacial procedures, which could lead to high morbidity and poor outcomes [1,2,3 ▪ ,4]. However, over the years, there has been a transition towards less invasive approaches, aiming to decrease surgical injuries caused by invasive transcranial approaches, optimizing the postoperative course, and clinical outcomes for the patient.…”

Section: Introductionmentioning

confidence: 99%

Neurosurgery for the rhinologist

Nizzola,

Leonel,

Peris-Celda

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. Recent findings The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors. Advances in this field include the development of new surgical techniques and routes that allow better visualization and access to pathologies located in the ventral skull base. Understanding the surgical anatomy related to EEAs is essential not only for neurosurgeons but also for rhinologists. Summary Knowledge of the surgical anatomy of the most common EEAs that utilize paranasal sinuses as a surgical corridor enables more effective management of complex skull base pathologies. Comprehensive anatomical knowledge of these corridors and the surrounding neurovascular structures is crucial to maximize benefits of EEAs and improve outcomes.

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Surgical outcomes in patients with endoscopic versus transcranial approach for skull base malignancies: a 10-year institutional experience

Cited by 8 publications

References 16 publications

Locoregional Control and Survival in Children, Adolescents, and Young Adults With Localized Head and Neck Alveolar Rhabdomyosarcoma—The French Experience

Locoregional Control and Survival in Children, Adolescents, and Young Adults With Localized Head and Neck Alveolar Rhabdomyosarcoma—The French Experience

Patterns in the Development of Postoperative Diabetes Insipidus after Pituitary Adenoma Resection: A 2016-2019 National Analysis

Neurosurgery for the rhinologist

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