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

{"title":"Burr Hole Endoscopic Mastoidectomy: A Morphometric Cadaveric Study","authors":"Pascal Lavergne, Tawfiq Khoury, KiChang Kang, Anish Sathe, Patrick Kelly, James Evans","doi":"10.1055/s-0043-1777674","DOIUrl":"https://doi.org/10.1055/s-0043-1777674","url":null,"abstract":"<p>\u0000<b>Introduction</b> Traditional open mastoidectomy is performed through a retro-auricular incision to expose the mastoid cortex. Few have addressed the possibility of performing an endoscopic minimally invasive mastoidectomy.</p> <p>\u0000<b>Objective</b> Our objective was to test the feasibility of performing an endoscopic mastoidectomy through a 1 cm incision and burr hole.</p> <p>\u0000<b>Methods</b> Ten cadaver heads (20 mastoids) were used for this morphometric study. We performed an endoscopic mastoidectomy through a 1 cm burr hole located over the antrum. The goals were to reach predetermined landmarks and maximize the drilling of cancellous mastoid bone. Computed tomography (CT) imaging was acquired at baseline, after endoscopic approach and after traditional open mastoidectomy. The scans were then analyzed with volumetric measurements of each mastoid.</p> <p>\u0000<b>Results</b> Endoscopic mastoidectomy facilitated access to most anatomical landmarks. While open mastoidectomy enabled greater extents of mastoidectomy and tegmen exposure, the endoscopic approach exposed 76% of mastoid and 69.9% of the tegmen achievable by the open approach. Additionally, baseline mastoid volume and tegmen surface area positively correlated with the extent of mastoidectomy and tegmen exposure, respectively. Baseline mastoid volume negatively correlated with the percentage of mastoid drilled and tegmen exposed.</p> <p>\u0000<b>Conclusion</b> We demonstrated the feasibility of an endoscopic mastoidectomy through a standardized postauricular burr hole. This approach reduces the incision size and the need for soft tissue dissection. Burr hole mastoidectomy is facilitated using angled scopes which are not reliant on 0-degree line-of-sight. Although the endoscopic approach afforded slightly less exposure, the location and burr hole size can be adjusted depending on the clinical indications.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"63 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105576","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":"Audiometric Outcomes of Auditory Brainstem Implantation During Vestibular Schwannoma Resection in NF2 Patients","authors":"Víctor de Cos, Madeline E. Gibson, Vivienne Li, Olivia A La Monte, Omid Moshtaghi, Peter Dixon, Usman Khan, Rick Friedman, Marc S. Schwartz","doi":"10.1055/a-2236-0113","DOIUrl":"https://doi.org/10.1055/a-2236-0113","url":null,"abstract":"Background: Many patients with neurofibromatosis type II (NF2) suffer from sensorineural hearing loss, and associated cochlear nerve compromise in NF2 patients makes auditory brainstem implant (ABI) an attractive treatment option. The long-term outcomes and benefits of the device are still being explored. Methods: A retrospective review was conducted for 11 ABI recipients at a single institution tertiary center between November 2017 to August 2022. Patients diagnosed with NF2 undergoing resection for concurrent vestibular schwannoma (VS) were included. Pre and post audiometric assessments were reviewed. Evaluation included pure-tone audiometry and speech testing. Results: Our cohort included 11 patients with a median age of 34 years old. All patients underwent a translabyrinthine approach for implant placement with concurrent VS resection. Average tumor size of VS was 2.87 cm. Pre-operatively, 8 patients had pure tone averages (PTA) with no response at 110 dB, 2 were within mild-moderate hearing loss (25-45 dB), and one patient had a PTA of profound loss (92 dB). Post-operatively, 9 (81%) patients had improvement in PTA. In total, 7 patients reported mild side effects upon ABI activation which included dizziness (n=2), tinnitus (n=1), and abdominal and lower extremity tingling sensation (n=3). Of the 7 patients with ESP scores, 5 had a score >75%, indicating the auditory ability to detect pattern perception upon auditory stimulation through the ABI alone. Conclusions: Nine of 11 patients derived benefits from ABI placement. These findings demonstrate that ABI placement during concurrent VS resection can provide a significant hearing benefit for NF2 patients.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"19 s1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150266","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 Comprehensive Analysis of Academic Attributes of the Presidents of the North American Skull Base Society","authors":"Tritan Plute, Othman Bin-Alamer, Arka N. Mallela, Georgios A. Zenonos, Eric W. Wang, Paul A. Gardner, William T. Couldwell, Carl H. Snyderman, Hussam Abou-Al-Shaar","doi":"10.1055/a-2215-0870","DOIUrl":"https://doi.org/10.1055/a-2215-0870","url":null,"abstract":"<p>\u0000<b>Objectives</b> Our objective was to elucidate the demographic, academic, and career attributes of North American Skull Base Society (NASBS) presidents and determine how leadership of this society has changed over time.</p> <p>\u0000<b>Design</b> Thirty-one NASBS presidents have served between 1990 and 2021. Demographic and scholarly variables were recorded from publicly available sources. To determine how trends in NASBS presidents have changed over time, linear and logistic regressions were conducted on continuous and categorical variables, respectively.</p> <p>\u0000<b>Setting</b> Virtual setting was used for this study.</p> <p>\u0000<b>Participants</b> There were no active participants in the study.</p> <p>\u0000<b>Main Outcome Measures</b> Academic metrics of NASBS presidents were the main outcome measure.</p> <p>\u0000<b>Results</b> NASBS presidents had a mean age of 53.3 ± 6.1 years at election and were all male. The most common institution at which former presidents trained (<i>n</i> = 4) and practiced (<i>n</i> = 3) was the University of Pittsburgh. Otolaryngologists comprised 41.9% (<i>n</i> = 13) of the cohort, neurosurgeons made up 38.8% (<i>n</i> = 12), and the remaining 19.3% (<i>n</i> = 6) were from other specialties. NASBS presidents from neurosurgery (<i>p</i> = 0.033) and other specialties (<i>p</i> = 0.014) were more likely to hold the rank of chair compared with those from otolaryngology. Over time, there has been a linear increase in years of research experience at the time of election (<i>p</i> = 0.048). There remains a lack of diversity of gender and race.</p> <p>\u0000<b>Conclusions</b> NASBS presidents have demonstrated increased research activity over time, favoring long-term academic careers. Knowledge of these trends and attributes, which demonstrate an increase in skull base literature, growth of the NASBS, and a need for increased diversity in the field, is important for stewarding the future of the NASBS and promoting equity.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"89 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029655","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":"Outcomes of Extended Middle Fossa Approach for Petroclival Tumors in the Elderly","authors":"Vivian F. Kaul, Micah K. Harris, Masanari Kato, Guilherme Finger, Thomas Gao, Douglas A. Hardesty, Daniel M. Prevedello, Yin Ren, Oliver F. Adunka","doi":"10.1055/a-2219-2551","DOIUrl":"https://doi.org/10.1055/a-2219-2551","url":null,"abstract":"<p>\u0000<b>Objective</b> The aims of the study are (1) to evaluate the extended middle fossa approach (eMCF) for resection of tumors in the petroclivus and anterior cerebellopontine angle (CPA) and (2) to compare surgical outcomes between elderly (≥65 years) and nonelderly patients.</p> <p>\u0000<b>Design</b> Retrospective cohort.</p> <p>\u0000<b>Setting</b> Tertiary referral center.</p> <p>\u0000<b>Participants</b> Adults with petroclival, anterior CPA, or posterior fossa lesions who underwent an eMCF approach from 2012 to 2021 were included in the study.</p> <p>\u0000<b>Main Outcome Measure</b> Demographics, symptoms, cranial nerve (CN) function, and postoperative outcomes.</p> <p>\u0000<b>Results</b> Twenty-nine patients (mean age of 55 years, 59% females) were identified. Eleven (38%) were ≥65 years (65–79 years). The most common pathology was meningioma (<i>n</i> = 13, 45%), followed by vestibular schwannoma (<i>n</i> = 4, 14%) and squamous cell carcinoma (<i>n</i> = 3, 10%). Nineteen tumors (65.5%) were located in the petroclivus, 7 (24%) involved the cavernous sinus, and 10 (34%) were located in the posterior fossa. The mean tumor maximal diameter was 3.4 cm (range: 1.3–7.9 cm). Gross total tumor resection was accomplished in 15 (52%) patients. Most patients (<i>n</i> = 23, 79%) did not develop new CN deficits postoperatively. Of the 13 patients who had complete pre- and postoperative audiometric data, 69% (<i>n</i> = 9) maintained their hearing. Comparing the elderly versus nonelderly patients, there were no significant differences in the development of new CN palsies (<i>p</i> = 0.14), length of stay (<i>p</i> = 0.91), or incidence of postoperative complications (<i>p</i> = 0.30).</p> <p>\u0000<b>Conclusions</b> The eMCF approach provides exposure to the petroclival region, anterior CPA cistern, and posterior fossa for a variety of pathologies. It has a favorable safety profile in the elderly (≥65 years) population with low morbidity.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"38 5 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029543","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":"Diagnostic Accuracy of Contrast-Enhanced MRI for Detection of Perineural Spread in Head and Neck Cancer: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1055/s-0043-1777793","DOIUrl":"https://doi.org/10.1055/s-0043-1777793","url":null,"abstract":"Objectives The aim of this study was to determine the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (CE-MRI) for the detection of perineural spread (PNS) in head and neck cancer patients. Methods A systematic review of PubMed, Embase, Scopus, Web of Science and Cochrane Library databases was performed up to May 20, 2022. We included diagnostic accuracy studies that used CE-MRI for the diagnosis of PNS in patients with head and neck cancer, using histopathology from surgical specimens as the reference standard. Potential bias and applicability of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADUS-2) tool. Pooled joint effect sizes of sensitivity and specificity were calculated by applying bivariate random-effects meta-analysis model. Results Nine studies with 259 patients were included. The pooled sensitivity and specificity of CE-MRI for detecting PNS were 89% (95% confidence interval [CI]: 73–96) and 83% (95% CI: 73–90), respectively. Stratifying by MRI strength, 1.5 T had a higher sensitivity of 97% (95% CI: 47–100) compared with 3 T, which had a sensitivity of 83% (95% CI: 72–90). Both 1.5- and 3-T MRI had a similar specificity in detecting PNS of 85% (95% CI: 63–95) and 84% (95% CI: 75–91), respectively. Conclusions CE-MRI provides good diagnostic test accuracy for the detection of PNS in head and neck cancer. Current evidence suggests 1.5-T MRI provides greater sensitivity compared with 3-T MRI.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"25 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029450","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":"Gender Differences in Quality-of-Life Outcome in Patients Undergoing Endoscopic Endonasal Skull Base Surgery","authors":"Parker Tumlin, Zayd Al-Asadi, Meghan Turner, Hassan H. Ramadan, Chadi A. Makary","doi":"10.1055/a-2215-6027","DOIUrl":"https://doi.org/10.1055/a-2215-6027","url":null,"abstract":"<p>\u0000<b>Background</b> Prior studies showed that female patients with chronic rhinosinusitis (CRS) suffer a worse disease-specific quality of life (QoL).</p> <p>\u0000<b>Goal</b> The aim of this study is to investigate gender differences in sinonasal QoL outcomes in patients requiring endoscopic endonasal skull base surgeries (EESBS).</p> <p>\u0000<b>Methods</b> Cross-sectional analysis of patients presenting to our clinic from August 2020 to December 2022 with skull base tumors, spontaneous cerebrospinal fluid (CSF) rhinorrhea, or Grave's orbitopathy (for orbital decompression) was performed. Baseline and postsurgical QoL were measured using the 22-item Sinonasal Outcome Test (SNOT-22). Patients' demographics and comorbidities were reviewed. Patients with concomitant CRS were excluded.</p> <p>\u0000<b>Results</b> Eighty-six patients were included (54 with skull base tumors, 17 Grave's orbitopathy, and 15 spontaneous CSF rhinorrhea). The mean age of the patients was 52 years (range: 12.4–81.5 years), and 51.6% of the patients were females. There was no age difference between female and male patients. Smoking history, asthma, and allergic rhinitis were also similar between the two groups. Female patients had a significantly higher incidence of depression (58.3 vs. 32.4%, <i>p</i> = 0.018) and migraine (50.0 vs. 21.6%, <i>p</i> = 0.007). Female patients had a significantly worse overall SNOT-22 scores at baseline (33.6 vs. 18.2, <i>p</i> = 0.001), at the 3-month follow-up (29.7 vs. 15.5, <i>p</i> = 0.002), and at the 6-month follow-up (33.5 vs. 14.9, <i>p</i> = 0.005). This worse QoL was seen mainly in the ear/facial, sleep, and psychological domains. Linear regression of the SNOT-22 scores and its subdomains adjusting for comorbidities showed that migraine was found to be the most significant determinant of gender differences in the QoL.</p> <p>\u0000<b>Conclusion</b> Female patients who undergo EESBS show higher overall SNOT-22 scores secondary to higher incidence of migraine.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"22 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629373","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":"Outcome Measures for Medical and Surgical Treatment of Prolactinomas. Is the Role of Surgery Underestimated?","authors":"Andrius Anuzis, Kevin O. Lillehei","doi":"10.1055/a-2212-0504","DOIUrl":"https://doi.org/10.1055/a-2212-0504","url":null,"abstract":"<p>\u0000<b>Introduction</b> The first line treatment for prolactinomas is currently dopamine agonists (DAs). Medical management is prolonged, associated with side effects, financial, and psychological burdens. In dedicated centers, pituitary surgery is a low-risk alternative. We evaluated outcome measures of medical and surgical treatment, to assess, if the role of surgery is underestimated.</p> <p>\u0000<b>Methods</b> We reviewed the charts of 4,660 pituitary patients, managed at the University of Colorado, from 2004 to 2019. The final analysis included 154 patients with prolactinomas, managed medically, and 120 patients, treated surgically. Primary outcome measures were percentage of tumor volume reduction and prolactin level (ng/mL). Mann–Whitney test was used for quantitative variables, contingency tables, and chi-square tests for qualitative variables. Statistical significance was set at <i>p</i> < 0.05.</p> <p>\u0000<b>Results</b> DAs alone were more frequently used for microprolactinomas and Knosp grade 0 adenomas. Surgery was more often performed for macroprolactinomas, giant adenomas, tumors with suprasellar extension, mixed consistency, and sellar floor erosion. Among macroprolactinomas, mean tumor volume reduction after treatment with DAs alone, DAs and surgery, and surgery alone was 53.8, 94.9, and 94.1%, respectively. Prolactin levels after treatment were not significantly different. Continuous DA treatment was required in 94.3% patients in the medical group versus 39.6% in the surgical group.</p> <p>\u0000<b>Conclusions</b> Surgery for macroprolactinomas achieved greater tumor volume reduction and dose reduction or discontinuation of DAs. Prolactin levels achieved did not differ significantly between the groups. Over 60% of patients, undergoing surgery, were able to discontinue DAs. The current treatment paradigm may underestimate the role of surgery in the management of prolactinomas.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"64 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629005","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":"Outcomes after Surgical Resection of Jugular Foramen Schwannomas: Systematic Review and Meta-Analysis","authors":"Haydn Hoffman, Brendan B. Maloney, Dan Y. Draytsel, Harish Babu","doi":"10.1055/a-2215-6209","DOIUrl":"https://doi.org/10.1055/a-2215-6209","url":null,"abstract":"<p>\u0000<b>Objectives</b> We sought to perform a systematic review and meta-analysis of outcomes after surgical resection of jugular foramen schwannomas (JFSs).</p> <p>\u0000<b>Design</b> A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p> <p>\u0000<b>Setting</b> PubMed, Scopus, and Embase databases were searched.</p> <p>\u0000<b>Participants</b> Case series of at least five patients undergoing surgical resection of JFSs were included.</p> <p>\u0000<b>Main Outcome Measures</b> Primary outcomes included gross total resection (GTR) and near total resection (NTR) rates, as well as a composite of the two (GTR + NTR). Additional outcomes included new or worsening cranial nerve (CN) palsies and cerebrospinal fluid (CSF) leak. Random effects models were used to generate pooled outcomes.</p> <p>\u0000<b>Results</b> A total of 25 studies comprising 567 patients were included in the study. The proportions of each tumor grade were the following: grade A (33.1%), grade B (16.1%), grade C (9.2%), and grade D (41.6%). The pooled rate of GTR was 81% (95% confidence interval [CI]: 70–88; <i>I</i>\u0000² = 78.9%) and the composite GTR + NTR rate was 88% (95% CI: 81–93; <i>I</i>\u0000² = 66.4%). Rates of new or worsening CN palsies were the following: 12% hearing loss (95% CI: 7–20; <i>I</i>\u0000² = 69.4%), 27% dysphagia (95% CI: 20–36; <i>I</i>\u0000² = 66%), 20% hoarseness (95% CI: 14–28; <i>I</i>\u0000² = 62.6%), and 19% facial palsy (95% CI: 13–28; <i>I</i>\u0000² = 64.6%). The pooled rate of CSF leak was 9% (95% CI: 6–15; <i>I</i>\u0000² = 43.9%).</p> <p>\u0000<b>Conclusion</b> The literature suggests high GTR rates of JFSs can be achieved. However, new CN deficits are not uncommon.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"6 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629369","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":"Induction Chemotherapy for Locoregionally Advanced Sinonasal Squamous Cell Carcinoma","authors":"A. Abiri, Derek H. Liu, Theodore V Nguyen, Jonathan C. Pang, Sina J. Torabi, Edward C Kuan","doi":"10.1055/a-2226-8414","DOIUrl":"https://doi.org/10.1055/a-2226-8414","url":null,"abstract":"Background: There is emerging evidence to suggest the role of induction chemotherapy (IC) in definitive management of locoregionally advanced sinonasal squamous cell carcinoma (SNSCC). We evaluated the influence of IC on survival and predictors of its use in SNSCC patients.\u0000Methods: The 2004-2017 National Cancer Database was queried for patients with locoregionally advanced SNSCC (T4/M0). Treatments were stratified into 7 groups: definitive chemoradiation (CRT), IC with definitive CRT (IC+CRT), IC+CRT with salvage surgery (IC+CRT+Sx), definitive surgery (Sx), IC with definitive surgery (IC+Sx), definitive surgery with adjuvant radiation or CRT (Sx+ATx), or IC+Sx+ATx. Cox proportional-hazards regression assessed overall survival (OS) and logistic regression identified predictors of IC.\u0000Results: Of 3162 patients, 1088 (34.4%) were female with a mean age of 63.4 ± 13.4 years. The 2- and 5-year OS rates were 58.6% and 42.0%, respectively. Compared to CRT, Sx+ATx (HR: 0.663; p<0.001), IC+Sx (HR: 0.606; p=0.005), or IC+Sx+ATx (HR: 0.468; p=0.001) exhibited reduced mortality. Among patients who were treated with definitive surgery, those receiving IC had additional OS benefit (all p<0.05). Older age (OR: 0.607; p<0.001), female sex (OR: 0.759; p=0.028), black race (OR: 1.650; p<0.001, T4b stage (OR: 1.674; p<0.001), and higher N stage (OR: 1.395; p<0.001) were predictors of IC.\u0000Conclusions: IC prior to definitive surgery with or without adjuvant therapy exhibited the highest OS for locoregionally advanced SNSCC. Age, sex, race, and T/N staging were predictors of IC. Multimodal treatment regimens involving surgery as the primary modality may, therefore, provide the greatest therapeutic response.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"31 2","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008552","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":"Residency Education Practices in Endoscopic Skull Base Surgery","authors":"Rose Dimitroyannis, Sharanya Thodupunoori, Sean Polster, Paramita Das, Christopher R. Roxbury","doi":"10.1055/a-2226-8294","DOIUrl":"https://doi.org/10.1055/a-2226-8294","url":null,"abstract":"Background: There has been increased interest in how residents train in the subspecialty of skull base surgery. Examining which training methods are popular and effective to optimize residency learning is necessary, especially with new training adjuncts available to the modern trainee. In this study, we survey North American Skull Base Society (NASBS) members to analyze endoscopic skull base surgery education methods. \u0000 \u0000Methods: The NASBS membership was surveyed regarding endoscopic skull base surgery teaching and feedback methods using a Likert scale via an anonymized REDCAP form over four months. \u0000 \u0000Results: With a response rate of 10.1%, we found that informal teaching methods and verbal qualitative feedback were rated significantly more effective than other teaching and feedback methods (p<0.01). When comparing the opinions of otolaryngologists and neurosurgeons, otolaryngologists were less likely to believe feedback is most effective with a shared grading scale (p<0.01). Physicians with more than ten years of experience post-training felt model-based and rubric-based teaching were used more frequently (p<0.01). Respondents indicated that standardization and use of simulation, artificial intelligence, and virtual reality should be at the forefront of educational practices used in the field in the coming 5-10 years. \u0000\u0000Conclusion: Despite the current emphasis on informal training, respondents pointed to standardization and simulation as methods of endoscopic skull base surgery education that should be used more in the future. These results indicate an unmet need in skull base education. Future multi-institutional initiatives with NASBS membership participation are warranted.\u0000","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"13 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009769","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}