Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"Supraorbital Keyhole Approach: Opening of the Frontal Sinus and Cerebrospinal Fluid Rhinorrhea","authors":"Anant Mehrotra, Kuntal Kanti Das, Kamlesh Rangari, Soumen Kanjilal, Pooja Tataskar, Pawan Kumar Verma, Kamlesh S. Bhaisora, Awadhesh Jaiswal, Raj Kumar","doi":"10.1055/a-2297-3768","DOIUrl":"https://doi.org/10.1055/a-2297-3768","url":null,"abstract":"<p>\u0000<b>Introduction:</b> The supraorbital keyhole approach (SOKHA) has been a less invasive alternative for anterior and middle skull base lesions. We aimed to review our data and understand the advantages and limitations of the approach.</p> <p>\u0000<b>Methods:</b> We analyzed our data and reviewed 89 consecutive cases who underwent the SOKHA. We included the clinico-radiological parameters, pathology, use of endoscope, complications, etc. for analysis.</p> <p>\u0000<b>Results:</b> A total of 47 patients were of aneurysm with a total of 48 aneurysms (39 were ruptured and 9 were unruptured) and Acomm artery aneurysm was the most common site. Meningiomas were the second most common pathology encountered (<i>n</i> = 29). Tuberculum sella meningioma being the most common type of meningiomas operated through this approach. Gross total resection was done in all except two cases in which a small part of the tumor was left behind as the tumor was adhered to blood vessels. Among the remaining cases, craniopharyngiomas (<i>n</i> = 7), optic pathway gliomas (<i>n</i> = 2), hypothalamic hamartomas (<i>n</i> = 2), dermoid (<i>n</i> = 1), and arteriovenous malformation (<i>n</i> = 1) were the other pathologies operated upon. Eight patients had opening of the frontal sinus. Four patients had wound bulge and one patient had cerebrospinal fluid (CSF) rhinorrhea. All these cases were managed conservatively.</p> <p>\u0000<b>Conclusion:</b> SOKHA is an excellent approach for anterior cranial fossa lesions especially with properly chosen cases. Incidence of CSF leak in our study is 1.1% and majority can be managed by placement of lumbar drain. Intraoperative obliteration of the frontal sinus can reduce the risk of postoperative CSF leak. A large frontal sinus needs not be a contraindication for SOKHA.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140827480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence of Resected Skull Base Meningiomas during Long-term Follow-up: Incidence and Predisposing Factors","authors":"Joshua Ian Macarthur, Cathal John Hannan, Callum Howard, Jane Halliday, Omar Nathan Pathmanaban, Charlotte Hammerbeck-Ward, Scott A. Rutherford, Andrew T. King","doi":"10.1055/s-0044-1786370","DOIUrl":"https://doi.org/10.1055/s-0044-1786370","url":null,"abstract":"<p>\u0000<b>Introduction</b> Skull base meningiomas (SBMs) are often subtotally resected and there is a paucity of evidence regarding the long-term rates of postoperative tumor progression. We aimed to investigate the factors that influence tumor recurrence in patients with an extended period of follow-up.</p> <p>\u0000<b>Methods</b> Surgically resected tumors with long-term radiological follow-up were included for analysis. Data were collected on patient demographics, anatomical location, Simpson grade, World Health Organization (WHO) grade, modality of reintervention, and functional status. Recurrence was defined as tumor progression requiring intervention. Kaplan–Meier method and log-rank test were used to calculate recurrence-free probability. Cox regression analysis was used to determine factors associated with tumor progression.</p> <p>\u0000<b>Results</b> Sixty-one patients were identified. Median radiological follow-up was 11.25 (IQR 4.3) years. Median age at first surgery was 50 (IQR 17) years. A total of 55/61(90%) tumors were WHO grade I and 6/61(10%) were grade II. Gross total resection (GTR) was achieved in 37/61 (60.7%) patients with subtotal resection (STR) in 24/61 (39.3%). In total, 28/61(45.9%) demonstrated recurrence/regrowth with a median time to recurrence of 2.8 (IQR 5) years. Also, 15/37 (40.5%) and 13/24 (54.2%) patients with GTR and STR, respectively, had tumor recurrence. Of the 28 recurrences, 4/28 (14.3%) underwent reresection, 9/28 (32.1%) were managed with radiotherapy, and 15/28 (53.6%) received both reresection and radiotherapy. Tumor grade was the only significant predictor of tumor recurrence (<i>p</i> = 0.033). Neurological function at last follow-up was significantly worse (modified Rankin scale >2) in patients with recurrence (<i>p</i> = 0.035).</p> <p>\u0000<b>Conclusion</b> Surgically resected SBMs are associated with a significant recurrence rate during prolonged follow-up, irrespective of the extent of resection achieved. We recommend a prolonged period of radiological surveillance for SBM following surgical resection.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140827880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Salvage Microsurgical Resection after Radiation Therapy for Sporadic Vestibular Schwannomas","authors":"Omid Moshtaghi, Patrick Barba, Peter Dixon, Yin Ren, Marc Schwartz, Rick Friedman","doi":"10.1055/a-2297-3849","DOIUrl":"https://doi.org/10.1055/a-2297-3849","url":null,"abstract":"<p>\u0000<b>Background</b> The purpose of this study was to evaluate clinical outcomes after salvage microsurgery for vestibular schwannoma (VS) treated initially with modern radiotherapy techniques as compared to those treated with primary microsurgical resection.</p> <p>\u0000<b>Methods</b> Patients who underwent microsurgical resection of sporadic VS undergoing a translabyrinthine approach at a single academic skull base tertiary referral center were included. Baseline and postoperative dynamic gait index, functional gait assessment, House–Brackmann facial nerve grading, and completeness of resection were prospectively recorded.</p> <p>\u0000<b>Results</b> Of the 265 patients reviewed, 21 (7.9%) patients underwent prior radiation. Median age of the cohort was 55 years (interquartile range: 51–63). The likelihood of achieving a gross total resection was significantly lower for radiated as compared to nonradiated patients (odds ratio: 0.18, 95% confidence interval: 0.05–0.53, <i>p</i> = 0.004) when controlling for tumor size. Radiated patients had better postoperative facial nerve function on the first postoperative day, but this difference was not significant at long-term follow-up. Radiated patients had lower preoperative postural stability scores than nonradiated patients on FGA (26 vs. 23, <i>p</i> = 0.035). Postoperatively, radiated patients had comparable outcomes compared to nonradiated patients when controlling for age and tumor size.</p> <p>\u0000<b>Conclusions</b> Compared to patients with VS treated with surgery alone, previously radiated patients are less likely to achieve gross total resection in the salvage setting. Radiated patients scored better on facial nerve outcomes compared to nonradiated patients in the initial postoperative period but demonstrated similar long-term outcomes.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140800884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Handheld Robot for Endoscopic Endonasal Skull Base Surgery: Updated Preclinical Validation Study (IDEAL Stage 0)","authors":"Joachim Starup-Hansen, Nicola Newall, Emmanouil Dimitrakakis, Danyal Z. Khan, George Dwyer, Keshav Iyengar, Dimitrios Psychogyios, John G. Hanrahan, Siddharth Sinha, James Booker, Danail Stoyanov, Hani J. Marcus","doi":"10.1055/a-2297-3647","DOIUrl":"https://doi.org/10.1055/a-2297-3647","url":null,"abstract":"<p>\u0000<b>Background and Objectives</b> Endoscopic endonasal surgery (EES) has become increasingly popular, yet anatomical constraints posed by the nose and limitations of nonarticulated instruments render EES technically challenging, with a steep associated learning curve. Therefore, we developed a handheld robot to enhance dexterity in endoscopic neurosurgical procedures. A previous trial of the robot demonstrated its potential advantages in endoscopic neurosurgery but also the need for improvements. In this study, we assess the feasibility, acceptability, and comparative performance of the updated robotic prototype (version 0.2) against standard instruments in a preclinical phantom and cadaveric trial.</p> <p>\u0000<b>Methods</b> Ethical approval was received. Participants were stratified according to their neurosurgical experience. In the phantom study, a randomized crossover design compared the robot against standard instruments at a phantom tumor resection task. Statistical analysis was performed using Mann–Whitney U tests and paired <i>t</i>-tests. In the cadaver-based user study, participants evaluated the device's functional domains through a qualitative interview design.</p> <p>\u0000<b>Results</b> In the phantom study, the device demonstrated a learning curve: initial resection attempts favored the traditional instrument (84% vs. 59%, <i>p</i> = 0.055), but parity was achieved by the fifth attempt (80% vs. 83%, <i>p</i> = 0.76). Acceptability was evident, as most clinicians (7/8) preferred the robot for its superior range, ergonomics, and precision. Also, the robot exhibited a diminished cognitive workload. The cadaveric study underscored the robot's clinical feasibility, through sufficient workspace reach and force delivery.</p> <p>\u0000<b>Conclusion</b>: Overall, our robot demonstrates promising acceptability and feasibility for endoscopic neurosurgery, yet further iterative developments are required before proceeding to in-human clinical trials.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140565926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution of Pituitary Surgery in an Australian Health Care Framework","authors":"Nicholas G. Candy, Alistair K. Jukes, Eng H. Ooi, Rowan Valentine, Nick Vrodos, Stephen Santoreneos, Steve Floreani, Peter-John Wormald, Alkis J. Psaltis","doi":"10.1055/s-0044-1786044","DOIUrl":"https://doi.org/10.1055/s-0044-1786044","url":null,"abstract":"<p>\u0000<b>Background</b> The outcomes in pituitary surgery have dramatically changed over the past 130 years. Endoscopic endonasal transsphenoidal approaches are now an accepted method for operating on pituitary tumors, a skillset which takes time to develop. The Australian health care framework provides a unique mixture of public and private care for a geographically dispersed population. In this article, we aim to examine how outcomes for patients in South Australia changed as endoscopic pituitary surgery was adopted and how the Australian health care framework influenced the development of a skull base team.</p> <p>\u0000<b>Methods</b> The case notes of all patients undergoing pituitary surgery between 2006 and 2020 in South Australia. All patients treated by this author group were included.</p> <p>\u0000<b>Results</b> A total of 428 pituitary adenomas were surgically treated. Overall, 182 out of 249 patients (70%) had a complete resection with no recurrence at follow-up, and 49 patients (19%) had a residual that was observed and did not require treatment. Therefore, 89% of patients between the years 2006 and 2020 did not require any further treatment following their pituitary surgery. Upon examination of the 142 patients with functional adenomas, 112 (79%) patients had no recurrence in hormonal dysfunction following surgery, and the remaining 30 (21%) patients required further treatment.</p> <p>\u0000<b>Conclusion</b> We have demonstrated that acceptable outcomes can be achieved in a low-to-moderate volume setting across multiple hospitals when a coordinated effort is made to consolidate these cases within a small group of subspeciality-trained surgeons, as opposed to a more generalist approach.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140565931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usefulness of YouTube Videos Related to Endoscopic Sinus Surgery for Surgical Residents","authors":"Justin Shapiro, Marc Levin, Saud Sunba, Emily Steinberg, Vince Wu, John M. Lee","doi":"10.1055/s-0044-1786045","DOIUrl":"https://doi.org/10.1055/s-0044-1786045","url":null,"abstract":"<p>\u0000<b>Objective</b> The use of online teaching modalities to supplement surgical learning has increased recently, demonstrating promising results. Previous studies have analyzed the value and usefulness of YouTube as an educational source to learners, including teaching surgical skills to Otolaryngology–Head and Neck Surgery (OHNS) trainees. YouTube videos on endoscopic sinus surgery (ESS) still need to be explored as ESS remains a common, yet challenging surgery that OHNS residents encounter regularly. This study aimed to objectively evaluate the usefulness of YouTube videos on ESS for surgical education.</p> <p>\u0000<b>Design</b> YouTube was searched using the following keywords: “uncinectomy,” “maxillary antrostomy,” “anterior ethmoidectomy,” and “ethmoid bulla resection.” These represent the initial ESS steps residents learn. Each video was assessed for eligibility by two independent reviewers.</p> <p>\u0000<b>Outcome Measures</b> The LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS) and ESS-specific criteria were used to assess educational quality. Video popularity index (VPI) was used to calculate video popularity.</p> <p>\u0000<b>Results</b> Of the 38 videos that met inclusion criteria, the average LAP-VEGaS score was 6.59 (± ) 3.23 standard deviation. Most videos were designated low quality. There was a weak positive correlation between whether a video included ESS-specific criteria and LAP-VEGaS score (<i>r</i> = 0.269, <i>p</i> = 0.102). There was a significant positive correlation between VPI and LAP-VEGaS scores (<i>r</i> = 0.497, <i>p</i> = 0.003).</p> <p>\u0000<b>Conclusions</b> Overall, the quality of included videos was poor. OHNS residents should not rely solely or primarily on YouTube videos to learn surgical skills relevant to ESS. To maximize potential of online teaching, high-quality videos should be used to compliment other methods of teaching.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140565832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Endonasal Approach for Residual and Recurrent Craniopharyngioma After Transcranial Approach: A Multi-Institution Experience","authors":"Ronak H. Jani, Sudesh Raju, Miri Kim, Paul A. Gardner, G. Zenonos, C. Snyderman, Eric W Wang, Chirag Patel, Anand V. Germanwala","doi":"10.1055/a-2301-3867","DOIUrl":"https://doi.org/10.1055/a-2301-3867","url":null,"abstract":"Objectives: While the endoscopic endonasal approach (EEA) has become a well-established surgery for resection of craniopharyngiomas (CP), the utility of this procedure following subtotal resection from open transcranial approach (TCA) surgery has yet to be explored. Here we present a multi-institutional case series of patients who underwent EEA for treatment of recurrent CP originally treated by TCA, demonstrating the viability of this approach as salvage surgery.\u0000Design: Retrospective cohort\u0000Setting: Loyola University Medical Center and University of Pittsburgh Medical Center \u0000Participants: Patients who underwent EEA for recurrent CP following an initial TCA between 2003 and 2018.\u0000Main Outcome Measures: GTR rate, surgical complications, visual outcomes, and endocrine outcomes\u0000Results: Patients who underwent EEA for recurrent CP following a prior TCA had a GTR rate of 77%. EEA reoperation was not associated with worsening of visual outcomes as compared to the primary TCA (0% visual worsening after EEA reoperation vs. 40% after primary TCA, p=0.055). While primary TCA resulted in worsening endocrinopathies in 100% of patients (including 7 patients with permanent diabetes insipidus), subsequent EEA for re-resection of CP resulted in stable (30.8%) or improved (69.2%) endocrine function in all patients (p<0.001).\u0000Conclusions: EEA achieves reasonable GTR rates and is an effective, safe surgical option for recurrent CP post initial TCA. This approach demonstrated stable or improved visual and endocrinologic outcomes in all patients within our two-institution series. Thus, EEA should be considered as an efficacious form of re-treatment in cases of progressive and recurrent CP.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140732471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review: Success Rate of Endoscopic Endonasal versus Combined Endonasal and Transorbital Neuroendoscopic Approach for Nontraumatic Cerebrospinal Fluid Leak Repairs in the Lateral Recess of Sphenoid Sinus","authors":"Umnia Nasir Ahmed, Mohammed Saqlain Siddiqui, Haissan Iftikhar, Karan Jolly, Hannah Nieto, Jameel Muzaffar","doi":"10.1055/s-0044-1785486","DOIUrl":"https://doi.org/10.1055/s-0044-1785486","url":null,"abstract":"<p>\u0000<b>Background</b> Cerebrospinal fluid (CSF) leaks from the lateral recess of the sphenoid sinus (LRS) occur due to a skull base defect and are important to treat due to the associated morbidity, e.g., life-threatening meningitis. Nontraumatic CSF leaks have a predilection toward obesity which is a rising phenomenon. LRS is notoriously difficult to access because of its lateral location and its associated neurovascular complications. An alternative surgical corridor has been explored which is the transorbital neuroendoscopic (TONES) approach.</p> <p>\u0000<b>Objective</b> To compare the success rate of the endoscopic endonasal with the TONES approaches.</p> <p>\u0000<b>Rationale</b> This is the first systematic review on the endoscopic endonasal and combined transorbital approaches to treat CSF leaks from the LRS.</p> <p>\u0000<b>Method</b> A PRISMA-concordant systematic review. PubMed, MEDLINE, EMBASE, Web of Science, and SCOPUS were searched. The studies underwent abstract and full-text screening by two reviewers. The data collected included patient demographic, surgical approach, reconstruction method, layers and materials, follow-up period, ROBINS-I bias, complications, and success rate.</p> <p>\u0000<b>Results</b> In total, 26 of 4,385 studies were included for further synthesis. Of these studies, a total of 336 patients were identified from a cohort of 910 patients. The endoscopic endonasal approach showed a repair success rate of 95.24% and the combined TONES and endonasal approach showed a success rate of 100%.</p> <p>\u0000<b>Conclusion</b> Both the endoscopic endonasal and transorbital approach provide a good success rate. However, due to the small TONES sample, large, randomized control trials are needed.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140595517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Clival Leaks and their management","authors":"Katti Blessi Sara, G. Upreti, Habie Thomas, Ajay Philip, R. Sundaresan, E. Gandham, Regi Thomas","doi":"10.1055/a-2300-4130","DOIUrl":"https://doi.org/10.1055/a-2300-4130","url":null,"abstract":"Introduction: Cerebrospinal spinal fluid (CSF) leaks through the nasal cavity occurrence has a rising trend, of which primary spontaneous leak is 6%-40% of all the CSF leaks. The most common site of CSF leak is Ethmoid roof where the bone is thinner in the entire skull base. Clivus being the hard bone, is a rare site for spontaneous leak. We present a case series from a single quaternary care center of this rare occurrence and study its reason and management strategy. \u0000\u0000Materials and Methods: A retrospective surgical audit over a period of 10 years of all patients diagnosed with CSF rhinorrhea was done .A PubMed search was conducted with keywords of CSF leak, CSF rhinorrhea, spontaneous CSF rhinorrhea, clival leak, clivus to identify the literature and these articles were compiled and their management reviewed.\u0000\u0000Results and Analysis: A total of 100 patients underwent surgical management for spontaneous CSF leak of which there were 5 patients who had spontaneous CSF rhinorrhea from the Clivus. There were 4 female patients, 4 patients had high BMI. The most common site of leak was midclivus annd surgical technique employed was multilayer dural plasty with a nasoseptal flap and measures were taken to reduce the intracranial pressure intra operatively and post operatively\u0000\u0000Conclusion: Spontaneous clival leak is a rare entity with mid and lower clivus being the common site. A combined approach by ENT and Neurosurgeons results in best outcome for the patients.\u0000","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140739907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Approaches to Resection of Olfactory Groove Meningiomas: Comparative Meta-Analysis of the Endoscopic Endonasal versus Transcranial and Unilateral versus Bilateral Approaches","authors":"Nolan Brown, Zach Pennington, Saarang Patel, Cathleen C. Kuo, Sachiv Chakravarti, Nicholas E. Bui, Julian Gendreau, Jamie J Van Gompel","doi":"10.1055/a-2297-9055","DOIUrl":"https://doi.org/10.1055/a-2297-9055","url":null,"abstract":"Here we systematically review the extant literature to highlight the advantages of bilateral versus unilateral approaches and endoscopic endonasal (midline) approaches versus transcranial approaches for olfactory groove meningiomas, focusing on complications, extent of resection, and local recurrence rates.\u0000Methods\u0000Three databases were queried to identify all primary prospective trials and retrospective series comparing outcomes following endoscopic endonasal versus transcranial approaches and unilateral versus bilateral craniotomy for surgical resection of olfactory groove meningiomas. All articles were screened by two independent authors and selected for formal analysis according to predefined inclusion/exclusion criteria.\u0000Results:\u0000Seven studies comprising 288 total patients (mean age 55.0 ± 24.6 years) met criteria for inclusion. In the three comparing the endoscopic endonasal (n=21) versus transcranial (n=32) approaches, there was no significant difference between the two with respect to gross total resection (p=0.34) or rates of Simpson Grade 1 resection (p=0.69). EEA demonstrated higher rates of overall complications (p<0.01) including postoperative infection (p=0.03). In the four studies comparing bilateral (n=117) versus unilateral approaches (n=118), overall complication rates (p<0.01) and disease recurrence (p=0.01) were higher with bilateral approaches. All surgery-related mortalities also occurred in the bilateral cohort (n=7, 7.14%). Gross total resection (p=0.63) and Simpson grade (p=0.48) were comparable between approaches. Olfaction preservation was superior for unilateral approaches (p<0.01).\u0000Conclusions\u0000Though the literature is limited, current evidence suggests that the EEA may be favorable over conventional craniotomy for select olfactory groove meningioma patients. Where craniotomy is used, unilateral approaches appear to reduce complications and the risk of olfaction loss","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}