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

{"title":"Tegmen Dehiscence and Audiologic Outcomes in the Middle Fossa Repair of Superior Semicircular Canal Dehiscence.","authors":"Shravan Patel, Hong-Ho Yang, Isaac Yang, Quinton S Gopen","doi":"10.1055/a-2627-4027","DOIUrl":"10.1055/a-2627-4027","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the audiologic presentation and post-surgical audiologic outcomes of superior semicircular canal dehiscence (SSCD) with concurrent tegmen tympani dehiscence with or without dural-ossicular contact.</p><p><strong>Methods: </strong>We reviewed 358 middle fossa repairs of SSCD at an institution from 2011 to 2022. Primary outcomes were preoperative and pre- to postoperative change in pure-tone average (PTA) and low-frequency air-bone gap (LF-ABG). Tegmen tympani dehiscence and dural-ossicular contact status were assessed on CT imaging and treated as independent variables in multivariable models.</p><p><strong>Results: </strong>Compared with the SSCD-alone cohort, the SSCD + tegmen tympani dehiscence group had significantly higher preoperative PTA (B = 5.40; <i>p</i>  = 0.007) and ABG at 500 Hz (B = 5.08; <i>p</i>  = 0.007) and 1,000 Hz (B = 4.58; <i>p</i>  = 0.003). Similar findings were seen in the SSCD + tegmen tympani dehiscence + combined dural-ossicular contact cohort for PTA (B = 5.32; <i>p</i>  = 0.017) and ABG at 500 Hz (B = 4.50; <i>p</i>  = 0.029) and 1,000 Hz (B = 4.66; <i>p</i>  = 0.006). The SSCD + tegmen tympani dehiscence + unilateral dural-ossicular contact cohort had significantly higher preoperative ABG at 500 Hz (B = 5.11; <i>p</i>  = 0.023) and 1,000 Hz (B = 5.18; <i>p</i>  = 0.005), whereas the bilateral dural-ossicular contact group showed no significant differences. No cohort exhibited significant changes in PTA or LF-ABG postoperatively.</p><p><strong>Conclusion: </strong>Concurrent SSCD and tegmen tympani dehiscence with or without dural-ossicular contact present with greater preoperative PTA and LF-ABG but no significantly different surgical outcomes compared with SSCD alone. Therefore, although tegmen tympani defects may contribute to greater baseline auditory deficits, the MCF approach offers similar levels of improvement in hearing across both groups.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"e75-e82"},"PeriodicalIF":0.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skull Baseline: A Cross-sectional Analysis of Anatomical Curricula in U.S. Neurosurgery Training Programs.","authors":"Beste Gülsuna, Kiana Y Prather, Shannan E Bialek, Helen H Shi, Dorothy He, Andrew M Bauer, Ian F Dunn, Christopher S Graffeo","doi":"10.1055/a-2627-4084","DOIUrl":"10.1055/a-2627-4084","url":null,"abstract":"<p><strong>Introduction: </strong>Assessments of contemporary skull base education as a component of neurosurgery residency programs in the United States are lacking. We sought to conduct and report a novel analysis focusing on access to key educational resources and professional development opportunities.</p><p><strong>Methods: </strong>Cross-sectional survey-based descriptive analysis of skull base education resources across all neurosurgery residency training programs and skull base fellowships in the United States. Program directors of 117 U.S. neurosurgery residency programs were solicited using a standardized questionnaire; 93 (80%) responded.</p><p><strong>Results: </strong>Among responding programs, 19% (18/93) reported having all four key resources: cadaveric dissection laboratories, dedicated skull base rotations, enfolded or postgraduate fellowship program, and fellowship-trained skull base faculty. Cadaveric dissection laboratories were present in 97% of programs with skull base fellowships and 93% without fellowships ( <i>p</i>  > 0.05). Programs with fellowships had significantly more fellowship-trained faculty (mean 2.5 vs. 1.7, <i>p</i>  = 0.004). Of the 34 identified skull base fellowships, 47% were Committee on Advanced Subspecialty Training (CAST)-accredited, and most offered one fellow position annually. The mean annual fellowship caseload was 273 (standard deviation = 104), with no significant difference between CAST-accredited and nonaccredited fellowships ( <i>p</i>  = 0.8). Nearly half of fellowships with a reported founding year were established within the past decade.</p><p><strong>Conclusion: </strong>Skull base education resources are highly variable across neurosurgery residency training programs, apart from the near-universal access to cadaveric dissection laboratories. Further studies are needed to optimize skull base education and professional development opportunities for trainees.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"352-361"},"PeriodicalIF":0.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary Stalk Lesion Sampling by Transsphenoidal Posterior Lobe Biopsy: A Case Series.","authors":"Kyly Hiatt, Zachary A Abecassis, Jessica Eaton, Thomas Hanks, Spencer Raub, Eliza Baird-Daniel, Zirun Zhao, Fatima El-Ghazali, Dominic Nistal, Aria Jamshidi, Kaitlyn Hartl, Dan Child, Amy Lee, Randall Bly, Manuel Ferreira, Jacob Ruzevick, Samuel Emerson","doi":"10.1055/a-2620-3407","DOIUrl":"10.1055/a-2620-3407","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the safety and efficacy of performing posterior lobe pituitary biopsy in patients with pituitary stalk lesions compared with direct stalk biopsy.</p><p><strong>Design: </strong>We performed a single-institution retrospective review of four patients who underwent endoscopic transsphenoidal surgery of the posterior pituitary lobe for a lesion of the pituitary stalk without clear diagnosis, despite noninvasive workup.</p><p><strong>Participants: </strong>Four patients with known pituitary stalk lesions who underwent posterior pituitary biopsy without tumor resection.</p><p><strong>Main outcome measures: </strong>The main outcomes were postprocedural endocrine function across all axes compared with preoperative function, postprocedural morbidities, and ability to obtain an accurate histologic diagnosis from biopsy.</p><p><strong>Results: </strong>A total of 100% (4/4) patients were histologically diagnosed based on tissue from transsphenoidal biopsy of the posterior lobe. There was no worsening of preoperative endocrine function. One patient experienced a cerebrospinal fluid leak. There were no other postoperative complications. None of the patients experienced worsening of vision attributable to biopsy.</p><p><strong>Conclusion: </strong>Transsphenoidal posterior lobe biopsy has a low-risk profile and high diagnostic capacity in patients presenting with a lesion of the pituitary stalk of uncertain etiology.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"308-313"},"PeriodicalIF":0.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy for Vestibular Schwannoma: Retrospective Cohort and Propensity Score Matching Analysis.","authors":"Vinicius de Carvalho Gico, Geovanne Pedro Mauro, Leila Maria Da Roz, Eduardo Weltman, Evandro César De Souza, Rosangela Correa Villar, Eberval Gadelha Figueiredo, Carlos Gilberto Carlotti","doi":"10.1055/a-2620-0288","DOIUrl":"10.1055/a-2620-0288","url":null,"abstract":"<p><strong>Background: </strong>Surgery and stereotactic radiotherapy (SRT) are widely used for treating vestibular schwannomas (VS), but the impact of different SRT regimens remains debated. This study assesses outcomes of various SRT techniques in a large cohort.</p><p><strong>Materials and methods: </strong>Retrospective cohort of consecutive patients treated in a large academic hospital between 2008 and 2024. All patients were treated with LINAC-based SRT. The study compared outcomes between single-dose SRS (12-15 Gy), five-fraction SRS (total of 25 Gy), and conventionally fractionated SRT (50.4 Gy in 28 fractions). The main outcome was progression-free survival (PFS).</p><p><strong>Results: </strong>The cohort included 197 patients, with a median age of 50.2 years, 65.5% of whom were female. The mean lesion size was 2.4 cm, and 61.4% of lesions were classified as high-class Koos (III and IV). Median follow-up was 54.0 months (6-142.1). Overall lesion control was 89.8% by RECIST 1.1 criteria, with no significant difference in PFS between the groups after propensity score matching. New hearing loss occurred in 14.7% of patients, whereas new facial palsy was reported in 3.0%. The presence of type-2 neurofibromatosis (NF2) was associated with poorer PFS (50.4 vs. 46.6 months, <i>p</i>  = 0.002). Propensity score matching analysis was done and all regimens had similar PFS (matched sample size was 193, <i>p</i>  = 0.808).</p><p><strong>Conclusion: </strong>Different SRT regimens showed similar outcomes for lesion control and toxicity in VS patients, including those with NF2. This study supports LINAC-based SRT as a flexible treatment option, although further prospective studies are needed.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"256-263"},"PeriodicalIF":0.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Prophylaxis Antibiotics in the Prevention of Meningitis in Endonasal Anterior Skull Base Surgery: A Systematic Review and Meta-analysis.","authors":"Azfar Javed, Muhammad U Farooq, Abdullah Alburaiki, Hamad Khan, Muhammad S Shahid, Haissan Iftikhar","doi":"10.1055/a-2607-5527","DOIUrl":"10.1055/a-2607-5527","url":null,"abstract":"<p><strong>Objectives: </strong>Anterior skull base surgery is commonly used for the surgical treatment of a variety of skull base lesions. One uncommon, but serious postoperative complication of this procedure is meningitis. Prophylactic antibiotics are widely used but with considerable variability in duration and regimes due to lack of guidelines. This systematic review was carried out to determine the benefit of prophylactic antibiotics in preventing meningitis in patients undergoing endonasal anterior skull base surgery.</p><p><strong>Methods: </strong>The review was undertaken according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Online searches including PubMed, MEDLINE, EMBASE, Cochrane, and gray literature were performed up to May 2, 2024. Articles reporting on patients undergoing endoscopic anterior skull base surgery, the use or not of prophylactic antibiotics, and follow-up outcomes were included for selection. Data extracted included demographics, pathology, prophylactic antibiotic duration/type, nasal pack use, cerebrospinal fluid (CSF) leaks, meningitis rates, sinusitis rates, and other complications.</p><p><strong>Results: </strong>A total of 32 studies were included in this systematic review, totaling 26,477 patients published between 1981 and 2023. The overall rate of developing meningitis with any duration of use of antibiotics was 2%. Patients receiving intraoperative antibiotics alone had a higher rate of subsequent meningitis (3%) compared with patients receiving a postoperative course of 24 hours or a longer course (1%). Patients who had an intraoperative or postoperative CSF leak had a higher rate of meningitis (10%) than those without (0%).</p><p><strong>Conclusion: </strong>This review indicates that postoperative antibiotic course may be more effective in preventing meningitis. Patients who develop a CSF leak have a higher risk of developing meningitis.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"e83-e94"},"PeriodicalIF":0.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiomics for Preoperative Assessment of Pituitary Adenoma Consistency with T2-Weighted MRI: A Multicenter Study.","authors":"Edoardo Agosti, Renato Cuocolo, Marcello Mangili, Vittorio Rampinelli, Pierlorenzo Veiceschi, Martina Cappelletti, Pier Paolo Panciani, Amedeo Piazza, Ilaria Bove, Domenico Solari, Luigi Maria Cavallo, Davide Locatelli, Francesco Doglietto, Alessandro Fiorindi, Marco Maria Fontanella, Lorenzo Ugga","doi":"10.1055/a-2607-0735","DOIUrl":"10.1055/a-2607-0735","url":null,"abstract":"<p><strong>Introduction: </strong>Pituitary adenoma (PA) consistency significantly influences the outcomes of endoscopic endonasal surgery. Radiomics represents a promising tool for objective and quantitative assessment using T2-weighted magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>A multicenter retrospective database was collected (2012-2023), including 394 patients with preoperative T2-weighted MRI and histologically confirmed PAs after endoscopic endonasal surgical removal. Tumor segmentation was performed manually on coronal T2-weighted images using ITK-SNAP software. Radiomic features were extracted with Pyradiomics. A 60:40 dataset split was used to train an Extra Trees classifier, and recursive feature elimination was used to select features. Model performance was assessed using sensitivity, specificity, and the area under the curve of receiver operating characteristic (AUC-ROC) curve metrics.</p><p><strong>Results: </strong>From 1,106 extracted radiomic features, 65 were identified as most predictive following variance and correlation filtering. The sensitivity, specificity, and accuracy of the ET classifier were 74%, 74%, and 63% (±10%), respectively. The AUC-ROC curve was 0.59.</p><p><strong>Conclusion: </strong>Despite its moderate accuracy and AUC-ROC curve, the ET model showed promising performance to predict preoperative PA consistency, underlying the power of radiomics-driven models in PA surgical planning.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"314-321"},"PeriodicalIF":0.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trigeminal Neuralgia in NF2-Related Schwannomatosis.","authors":"Shazia K Afridi, Amoolya Mannava, Duaa Ali Faruqi, Lalani Carlton-Jones","doi":"10.1055/a-2607-6174","DOIUrl":"10.1055/a-2607-6174","url":null,"abstract":"<p><strong>Objectives: </strong>NF2-related schwannomatosis (NF2) is an autosomal dominant syndrome resulting in a predisposition for benign tumors of the nervous system, including schwannomas, meningiomas, and ependymomas. There is a lack of data on the prevalence of trigeminal neuralgia (TN) in NF2 and the relationship between trigeminal schwannomas (TS) and TN in NF2 is also unclear. We sought to investigate the factors predisposing NF2 patients to TN.</p><p><strong>Methods: </strong>We performed a retrospective review of case notes and magnetic resonance imaging (MRI) in our cohort of adult NF2 patients over the age of 16 years meeting the international diagnostic criteria for NF2. We assessed presence and size of TS, size of vestibular schwannoma, clinical findings of neuropathy/pain, history of headache disorder, and intervention. We then looked at the subset of patients with TS and our radiologist reviewed their MRI brain imaging.</p><p><strong>Results: </strong>Fifteen of 189 NF2 patients had TN. Only six had ipsilateral TS. Ipsilateral vestibular schwannomas were significantly larger in the TN subgroup, as was history of ipsilateral radiation and migraine.</p><p><strong>Conclusion: </strong>The majority of TN patients did not have an ipsilateral trigeminal schwannoma. Our data suggest factors associated with TN include size of vestibular schwannoma, history of previous radiotherapy treatment, and migraine.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"264-267"},"PeriodicalIF":0.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Olfactory Bulb Infiltration and Morphological Changes in Olfactory Neuroblastoma Using Magnetic Resonance Imaging.","authors":"Teppei Takeda, Yasine Mirmozaffari, Teru Ebihara, Takeshi Kawasaki, Kazuhiro Omura, Adam J Kimple, Brent A Senior, Nobuyoshi Otori, Charles Ebert, Christine Klatt-Cromwell, Brian D Thorp","doi":"10.1055/a-2607-5757","DOIUrl":"10.1055/a-2607-5757","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate magnetic resonance imaging (MRI)-based changes in olfactory bulb (OB) volume and area to predict the likelihood of OB invasion in olfactory neuroblastoma (ONB).</p><p><strong>Design: </strong>Retrospective review of MRI data.</p><p><strong>Setting: </strong>This study was conducted at the Jikei University, Japan, and the University of North Carolina, United States.</p><p><strong>Participants: </strong>The study included 46 ONB-diagnosed patients undergoing MRI and surgical treatment.</p><p><strong>Main outcome measures: </strong>Preoperative volume and cross-sectional area of the OB were measured, and the surgical pathology of the OB was reviewed.</p><p><strong>Results: </strong>Significant differences in OB metrics were observed between patients with and without OB/tract invasions. Receiver operating characteristic analysis demonstrated high discriminative ability: OB volume (area under the curve [AUC] = 0.971, cutoff 60 mm ³ ) and maximum cross-sectional area (AUC = 0.941, cutoff 9.5 mm ² ) both showed high sensitivity and specificity for predicting OB invasion. The left-right OB difference, with a lesion/nonlesion ratio exceeding 175%, was a strong predictor.</p><p><strong>Conclusion: </strong>Quantitative MRI metrics of the OB are effective in predicting invasion in ONB. These findings may enhance diagnostic accuracy and influence treatment strategies. Further research is warranted to validate these findings in larger cohorts.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"322-329"},"PeriodicalIF":0.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Challenges of Internal Carotid Artery Pseudoaneurysm in Skull Base Osteomyelitis.","authors":"Arun G Karthat, Katti B Sara, Miria Mathews, Nandu Sukumaran, Santhosh B Kannan Bharathy, Aeesha Tasneem, Abi Manesh, Shyamkumar N Keshava, Rajan Sundaresan, Regi Thomas","doi":"10.1055/a-2607-5667","DOIUrl":"10.1055/a-2607-5667","url":null,"abstract":"<p><strong>Background: </strong>Skull base osteomyelitis is a potentially life-threatening infection typically seen in elderly diabetic or immunocompromised patients. Internal carotid artery pseudoaneurysm caused by skull base osteomyelitis is a very rare complication. We present here three such instances to share our clinical experience and insights gained in the management of these cases.</p><p><strong>Methods and results: </strong>A retrospective clinical audit of 142 skull base osteomyelitis patients (January 2010-May 2023) revealed three cases complicated by pseudoaneurysm at the cervicopetrous junction, with <i>Pseudomonas</i> being the primary causative organism. Two patients underwent successful endovascular coiling and survived after prolonged antipseudomonal therapy. A literature review of 12 similar cases also showed <i>Pseudomonas</i> as the dominant pathogen, whereas 1 case each was caused by tuberculosis and fungal infection. Most patients received antimicrobial therapy for more than 3 months. Follow-up data were unavailable for seven patients; among the remaining cases, all survived except one.</p><p><strong>Conclusion: </strong>Internal carotid artery mycotic pseudoaneurysm is a rare yet potentially devastating complication of skull base osteomyelitis. Timely diagnosis and aggressive treatment are crucial to prevent catastrophic outcomes. Endovascular therapy has emerged as the primary modality for the management of these aneurysms. In the absence of surgical debridement for treatment of skull base osteomyelitis, prolonged antimicrobial therapy (at least 3 months) is essential.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"362-371"},"PeriodicalIF":0.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary Apoplexy Precipitated by Non-Cranial Surgeries: An Institutional Experience.","authors":"Sonia Ajmera, Kristen Park, Claudia Hejazi-Garcia, Millie Huang, David Lerner, Alan D Workman, M Sean Grady, Neil Malhotra, Dmitriy Petrov, Daniel Yoshor, Nithin Adappa, James N Palmer, Christina Jackson","doi":"10.1055/a-2607-5957","DOIUrl":"10.1055/a-2607-5957","url":null,"abstract":"<p><strong>Introduction: </strong>Pituitary apoplexy (PA) is a rare, acute condition caused by hemorrhage or infarction within the pituitary gland, primarily associated with preexisting adenomas. Classically, PA presents with severe headache, neuro-ophthalmologic deficits, and/or endocrine disturbances. While the mechanisms of PA are under investigation, vascular changes, blood flow disruptions, and intrasellar pressure are implicated. We report the first 6-year institutional experience of risk factors of PA associated with non-cranial surgeries.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients presenting with PA from July 2017 to January 2024. Patients diagnosed with PA within 1 week of non-cranial surgery were included. Data encompassed medical history, surgical details, presenting symptoms, imaging, and outcomes.</p><p><strong>Results: </strong>Among 56 PA patients, 4 (7.1%) occurred after non-cranial surgeries, including cardiac procedures, mandibulectomy, and toe amputation. Three male patients (one excluded due to incomplete data) presented with oculomotor deficits and endocrine dysfunction. All had lesions greater than 2 cm. Common risk factors included hypertension, significant intraoperative blood pressure fluctuations (systolic range: 60-200 mm Hg), and lengthy anesthesia (average: 9.09 hours). Symptom onset occurred within 24 hours postsurgery.</p><p><strong>Conclusion: </strong>Despite differences in surgical context, several factors seemed to predispose these patients to PA: wide fluctuations in intraoperative blood pressure, preexisting hypertension, and macroadenomas exceeding 2 cm. In patients with known macroadenomas, risk stratification may be helpful based on adenoma size and comorbid conditions affecting vascular health. Sudden intraoperative changes in blood pressure should be avoided. For those with predisposing risk factors undergoing high-risk surgeries, especially cardiac procedures that utilize anticoagulation, obtaining a preoperative computed tomography (CT) head may be warranted.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"293-298"},"PeriodicalIF":0.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}