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

{"title":"Use of Tympanostomy T-Tube for Endoscopic Endonasal Marsupialization of Small Rathke's Cleft Cysts: A Case Series.","authors":"Anna Lazutkin,&nbsp;Ralph Abi Hachem,&nbsp;Patrick J Codd,&nbsp;Ali R Zomorodi,&nbsp;David W Jang","doi":"10.1055/s-0042-1755572","DOIUrl":"https://doi.org/10.1055/s-0042-1755572","url":null,"abstract":"<p><p><b>Objectives</b>  This article describes a novel technique implementing the use of a tympanostomy t-tube to provide long-term marsupialization of small Rathke's cleft cysts (RCCs). <b>Design</b>  A retrospective review of electronic medical records was performed to collect demographic and clinical data on a series of four patients. <b>Setting</b>  Academic medical center. <b>Participants</b>  Four female patients (mean age of 34 years) underwent transsphenoidal endoscopic endonasal surgery for RCC. All four patients presented with headaches. Mean cyst size was 7 mm. Two of the four surgeries were revisions for RCC recurrence. <b>Main Outcome Measures</b>  Symptom resolution after surgery, duration of follow-up, and feasibility of the proposed technique. <b>Results</b>  Tympanostomy t-tube was used to marsupialize small RCCs (< 10 mm) for four patients. Three patients remained symptom-free with endoscopy and imaging showing patent t-tubes at 21 months' (range 20-24 months) follow-up. One patient experienced severe migraines immediately after surgery. Migraines were relieved after t-tube was removed 6 weeks after surgery. <b>Conclusion</b>  Tympanostomy t-tubes placed via an endoscopic endonasal approach can provide long-term marsupialization for small RCCs.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"401-404"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317561/pdf/10-1055-s-0042-1755572.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963511","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 Impact of Delay in Treatment on Survival in Surgically Managed Sinonasal Undifferentiated Carcinoma.","authors":"Anas M Qatanani,&nbsp;Jacob G Eide,&nbsp;Jacob C Harris,&nbsp;Jason A Brant,&nbsp;James N Palmer,&nbsp;Nithin D Adappa,&nbsp;Rijul S Kshirsagar","doi":"10.1055/s-0042-1755601","DOIUrl":"https://doi.org/10.1055/s-0042-1755601","url":null,"abstract":"<p><p><b>Background</b>  Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy with a poor prognosis, and multimodal therapy is the standard of care. We sought to characterize treatment delays in SNUC managed with surgery and adjuvant radiation and to determine the impact on survival using the National Cancer Database (NCDB). <b>Methods</b>  This was a retrospective, population-based cohort study of patients with SNUC between 2004 and 2016 in the NCDB. The intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD) were examined. Recursive partitioning analysis (RPA) was performed to identify the variables with the greatest impact on survival. The association between treatment delay and overall survival (OS) was then assessed using multivariate Cox proportional hazards regression. <b>Results</b>  Of 173 patients who met inclusion criteria, 65.9% were male, average age at diagnosis was 56.6 years, and 5-year OS was 48.1%. Median durations of DTS, SRT, and RTD were 18, 43, and 46 days, respectively. Predictors of treatment delay included Black race, government insurance excluding Medicare/Medicaid, and positive margins. RPA-derived optimal thresholds were 29, 28, and 38 days for DTS, SRT and RTD, respectively. On multivariate analysis, positive margins (hazard ratio [HR]: 4.82; 95% confidence interval [CI]: 2.28-10.2) and DTS less than 29 days (HR: 2.41; 95% CI: 1.23-4.73) were associated with worse OS. <b>Conclusion</b>  Our results likely reflect the aggressive nature of the disease with surgeons taking more invasive disease to the operating room more quickly. Median treatment intervals described may serve as relevant national benchmarks.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"320-328"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317562/pdf/10-1055-s-0042-1755601.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10060779","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":"International Multicenter Study of Clinical Outcomes of Sinonasal Melanoma Shows Survival Benefit for Patients Treated with Immune Checkpoint Inhibitors and Potential Improvements to the Current TNM Staging System.","authors":"Matt Lechner,&nbsp;Yoko Takahashi,&nbsp;Mario Turri-Zanoni,&nbsp;Marco Ferrari,&nbsp;Jacklyn Liu,&nbsp;Nicholas Counsell,&nbsp;Davide Mattavelli,&nbsp;Vittorio Rampinelli,&nbsp;William Vermi,&nbsp;Davide Lombardi,&nbsp;Rami Saade,&nbsp;Ki Wan Park,&nbsp;Volker H Schartinger,&nbsp;Alessandro Franchi,&nbsp;Carla Facco,&nbsp;Fausto Sessa,&nbsp;Simonetta Battocchio,&nbsp;Tim R Fenton,&nbsp;Francis M Vaz,&nbsp;Paul O'Flynn,&nbsp;David Howard,&nbsp;Paul Stimpson,&nbsp;Simon Wang,&nbsp;S Alam Hannan,&nbsp;Samit Unadkat,&nbsp;Jonathan Hughes,&nbsp;Raghav Dwivedi,&nbsp;Cillian T Forde,&nbsp;Premjit Randhawa,&nbsp;Simon Gane,&nbsp;Jonathan Joseph,&nbsp;Peter J Andrews,&nbsp;Manas Dave,&nbsp;Jason C Fleming,&nbsp;David Thomson,&nbsp;Tianyu Zhu,&nbsp;Andrew Teschendorff,&nbsp;Gary Royle,&nbsp;Christopher Steele,&nbsp;Joaquin E Jimenez,&nbsp;Jan Laco,&nbsp;Eric W Wang,&nbsp;Carl Snyderman,&nbsp;Peter D Lacy,&nbsp;Robbie Woods,&nbsp;James P O'Neill,&nbsp;Anirudh Saraswathula,&nbsp;Raman Preet Kaur,&nbsp;Tianna Zhao,&nbsp;Murugappan Ramanathan,&nbsp;Gary L Gallia,&nbsp;Nyall R London,&nbsp;Quynh-Thu Le,&nbsp;Robert B West,&nbsp;Zara M Patel,&nbsp;Jayakar V Nayak,&nbsp;Peter H Hwang,&nbsp;Mario Hermsen,&nbsp;Jose Llorente,&nbsp;Fabio Facchetti,&nbsp;Piero Nicolai,&nbsp;Paolo Bossi,&nbsp;Paolo Castelnuovo,&nbsp;Amrita Jay,&nbsp;Dawn Carnell,&nbsp;Martin D Forster,&nbsp;Diana M Bell,&nbsp;Valerie J Lund,&nbsp;Ehab Y Hanna","doi":"10.1055/s-0042-1750178","DOIUrl":"https://doi.org/10.1055/s-0042-1750178","url":null,"abstract":"<p><p><b>Objectives</b>  Sinonasal mucosal melanoma (SNMM) is an extremely rare and challenging sinonasal malignancy with a poor prognosis. Standard treatment involves complete surgical resection, but the role of adjuvant therapy remains unclear. Crucially, our understanding of its clinical presentation, course, and optimal treatment remains limited, and few advancements in improving its management have been made in the recent past. <b>Methods</b>  We conducted an international multicenter retrospective analysis of 505 SNMM cases from 11 institutions across the United States, United Kingdom, Ireland, and continental Europe. Data on clinical presentation, diagnosis, treatment, and clinical outcomes were assessed. <b>Results</b>  One-, three-, and five-year recurrence-free and overall survival were 61.4, 30.6, and 22.0%, and 77.6, 49.2, and 38.3%, respectively. Compared with disease confined to the nasal cavity, sinus involvement confers significantly worse survival; based on this, further stratifying the T3 stage was highly prognostic ( <i>p</i>  < 0.001) with implications for a potential modification to the current TNM staging system. There was a statistically significant survival benefit for patients who received adjuvant radiotherapy, compared with those who underwent surgery alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI]: 0.57-0.96, <i>p</i>  = 0.021). Immune checkpoint blockade for the management of recurrent or persistent disease, with or without distant metastasis, conferred longer survival (HR = 0.50, 95% CI: 0.25-1.00, <i>p</i>  = 0.036). <b>Conclusions</b>  We present findings from the largest cohort of SNMM reported to date. We demonstrate the potential utility of further stratifying the T3 stage by sinus involvement and present promising data on the benefit of immune checkpoint inhibitors for recurrent, persistent, or metastatic disease with implications for future clinical trials in this field.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"307-319"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317567/pdf/10-1055-s-0042-1750178.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9805964","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":"MELD-Na Score as a Predictor of Postoperative Complications in Ventral Skull Base Surgery.","authors":"Liam S Flanagan,&nbsp;Chris B Choi,&nbsp;Vraj P Shah,&nbsp;Aakash D Shah,&nbsp;Aksha Parray,&nbsp;Jordon G Grube,&nbsp;Christina H Fang,&nbsp;Soly Baredes,&nbsp;Jean Anderson Eloy","doi":"10.1055/a-1842-8668","DOIUrl":"https://doi.org/10.1055/a-1842-8668","url":null,"abstract":"<p><p><b>Objective</b>  The Model for End-stage Liver Disease-Sodium (MELD-Na) score was designed for prognosis of chronic liver disease and has been predictive of outcomes in a variety of procedures. Few studies have investigated its utility in otolaryngology. This study uses the MELD-Na score to investigate the association between liver health and ventral skull base surgical complications. <b>Methods</b>  The National Surgical Quality Improvement Program database was used to identify patients who underwent ventral skull base procedures between 2005 and 2015. Univariate and multivariate analyses were performed to investigate the association between elevated MELD-Na score and postoperative complications. <b>Results</b>  We identified 1,077 patients undergoing ventral skull base surgery with laboratory values required to calculate the MELD-Na score. The mean age was 54.2 years. The mean MELD-Na score was 7.70 (standard deviation = 2.04). Univariate analysis showed that elevated MELD-Na score was significantly associated with increased age (58.6 vs 53.8 years) and male gender (70.8 vs 46.1%). Elevated MELD-Na score was associated with increased rates of postoperative acute renal failure, transfusion, septic shock, surgical complications, and extended length of hospital stay. On multivariate analysis, associations between elevated MELD-Na and increased risk of perioperative transfusions (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.20-2.93; <i>p</i>  = 0.007) and surgical complications (OR, 1.58; 95% CI, 1.25-2.35; <i>p</i>  = 0.009) remained significant. <b>Conclusions</b>  This analysis points to an association between liver health and postoperative complications in ventral skull base surgery. Future research investigating this association is warranted.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"405-412"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317560/pdf/10-1055-a-1842-8668.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9830870","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":"Primary Intracranial Adenoid Cystic Carcinoma: Report of Three Cases.","authors":"Nikolaos Tsetsos,&nbsp;Alexandros Poutoglidis,&nbsp;Dimitrios Terzakis,&nbsp;Ioannis Epitropou,&nbsp;Amanda Oostra,&nbsp;Christos Georgalas","doi":"10.1055/a-1837-6825","DOIUrl":"https://doi.org/10.1055/a-1837-6825","url":null,"abstract":"<p><p><b>Objective</b>  Nasal cavity and paranasal sinuses host a variety of malignant tumors with adenoid cystic carcinoma (ACC) being the most frequent cancer of salivary gland origin. The histological origin of such tumors virtually precludes primarily intracranial localization. The aim of this study is to report cases of primarily intracranial ACC without evidence of other primary lesions at the end of an exhaustive diagnostic workup. <b>Methods</b>  An electronic medical record search complemented by manual searching was conducted to identify prospective and retrospective cases of intracranial ACCs treated in Endoscopic Skull Base Centre Athens at the Hygeia Hospital, Athens from 2010 until 2021 with a mean follow-up time of at least 3 years. Patients were included if after complete diagnostic workup there was no evidence of a nasal or paranasal sinus primary lesion and extension of the ACC. All patients were treated with a combination of endoscopic surgeries performed by the senior author followed by radiotherapy (RT) and/or chemotherapy. <b>Results</b>  Three unique illustrative cases (ACC involving the clivus, cavernous sinus and pterygopalatine fossa, one orbital ACC with pterygopalatine fossa and cavernous sinus involvement and one involving cavernous sinus, and Meckel's cave with extension to the foramen rotundum) were identified. All patients underwent subsequently proton or carbon-ion beam radiation therapy. <b>Conclusions</b>  Primary intracranial ACCs constitute an extremely rare clinical entity with atypical presentation, challenging diagnostic workup and management. The design of an international web-based database with a detailed report of these tumors would be extremely helpful.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"329-335"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317558/pdf/10-1055-a-1837-6825.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799640","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":"Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Sellar and Parasellar Regions.","authors":"Edoardo Agosti,&nbsp;A Yohan Alexander,&nbsp;Luciano C P C Leonel,&nbsp;Jamie J Van Gompel,&nbsp;Michael J Link,&nbsp;Carlos D Pinheiro-Neto,&nbsp;Maria Peris-Celda","doi":"10.1055/a-1869-7532","DOIUrl":"https://doi.org/10.1055/a-1869-7532","url":null,"abstract":"<p><p><b>Introduction</b>  Surgery of the sellar and parasellar regions can be challenging due to the complexity of neurovascular relationships. The main goal of this study is to develop an educational resource to help trainees understand the pertinent anatomy and procedural steps of the endoscopic endonasal approaches (EEAs) to the sellar and parasellar regions. <b>Methods</b>  Ten formalin-fixed latex-injected specimens were dissected. Endoscopic endonasal transsphenoidal transsellar, transtuberculum-transplanum, and transcavernous approaches were performed by a neurosurgery trainee, under supervision from the senior authors and a PhD in anatomy with advanced neuroanatomy experience. Dissections were supplemented with representative case applications. <b>Results</b>  Endoscopic endonasal transsphenoidal approaches afford excellent direct access to sellar and parasellar regions. After a wide sphenoidotomy, a limited sellar osteotomy opens the space to sellar region and medial portion of the cavernous sinus. To reach the suprasellar space (infrachiasmatic and suprachiasmatic corridors), a transplanum-prechiasmatic sulcus-transtuberculum adjunct is needed. The transcavernous approach gains access to the contents of the cavernous sinus and both medial (posterior clinoid and interpeduncular cistern) and lateral structures of the retrosellar region. <b>Conclusion</b>  The anatomical understanding and technical skills required to confidently remove skull base lesions with EEAs are traditionally gained after years of specialized training. We comprehensively describe EEAs to sellar and parasellar regions for trainees to build knowledge and improve familiarity with these approaches and facilitate comprehension and learning in both the surgical anatomy laboratory and the operating room.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"361-374"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317571/pdf/10-1055-a-1869-7532.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10060778","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":"Application of Surface Landmarks Combined with Image-Guided Sinus Location in the Retrosigmoid Approach and Their Clinic-Image Relationship Analysis.","authors":"Weichi Wu,&nbsp;Chang Li,&nbsp;Xiaoyan Zhu,&nbsp;Xiaoyu Guo,&nbsp;Hui Dan Zhu,&nbsp;Zhu Lin,&nbsp;Haibin Liu,&nbsp;Yonggao Mou,&nbsp;Ji Zhang","doi":"10.1055/a-1837-6752","DOIUrl":"https://doi.org/10.1055/a-1837-6752","url":null,"abstract":"<p><p><b>Objectives</b>  During craniotomy for cerebellopontine angle (CPA) lesions, the exact exposure of the margin of the venous sinuses complex remains an essential but risky part of the procedure. Here, we revealed the exact position of the asterion and sinus complex by combining preoperative image information and intraoperative cranial landmarks, and analyzed their clinic-image relationship. <b>Methods</b>  Ninety-four patients who underwent removal of vestibular schwannoma (VS) through retrosigmoid craniotomies were enrolled in the series. To determine the exact location of the sigmoid sinus and the transverse sinus and sigmoid sinus junction (TSSJ), we used preoperative images, such as computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with intraoperative anatomical landmarks. The distance between the asterion and the sigmoid sinus was measured using MRI T1 sequences with gadolinium and/or the CT bone window. <b>Results</b>  In 94 cases of retrosigmoid craniotomies, the asterion lay an average of 12.71 mm on the posterior to the body surface projection to the TSSJ. Intraoperative cranial surface landmarks were used in combination with preoperative image information to identify the distance from the asterion to the sigmoid sinus at the transverse sinus level, allowing for an appropriate initial burr hole (the margin of the TSSJ). <b>Conclusion</b>  By combining intraoperative anatomical landmarks and preoperative image information, the margin of the TSSJ, in particular, the inferior margin of the transverse sinus, can be well and thoroughly identified in the retrosigmoid approach.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"395-400"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317564/pdf/10-1055-a-1837-6752.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9805965","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":"A Low Subfrontal Dural Opening for Operative Management of Anterior Skull Base Lesions.","authors":"Samuel J Cler,&nbsp;Gavin P Dunn,&nbsp;Gregory J Zipfel,&nbsp;Ralph G Dacey,&nbsp;Michael R Chicoine","doi":"10.1055/a-1774-6281","DOIUrl":"https://doi.org/10.1055/a-1774-6281","url":null,"abstract":"<p><p><b>Introduction</b>  A low subfrontal dural opening technique that limits brain manipulation was assessed in patients who underwent frontotemporal approaches for anterior fossa lesions. <b>Methods</b>  A retrospective review was performed for cases using a low subfrontal dural opening including characterization of demographics, lesion size and location, neurological and ophthalmological assessments, clinical course, and imaging findings. <b>Results</b>  A low subfrontal dural opening was performed in 23 patients (17F, 6M), median age of 53 years (range 23-81) with a median follow-up duration of 21.9 months (range 6.2-67.1). Lesions included 22 meningiomas (nine anterior clinoid, 12 tuberculum sellae, and one sphenoid wing), one unruptured internal carotid artery aneurysm clipped during a meningioma resection, and one optic nerve cavernous malformation. Maximal possible resection was achieved in all cases including gross total resection in 16/22 (72.7%), near total in 1/22 (4.5%), and subtotal in 5/22 (22.7%) in which tumor involvement of critical structures limited complete resection. Eighteen patients presented with vision loss; 11 (61%) improved postoperatively, three (17%) were stable, and four (22%) worsened. The mean ICU stay and time to discharge were 1.3 days (range 0-3) and 3.8 days (range 2-8). <b>Conclusion</b>  A low sub-frontal dural opening for approaches to the anterior fossa can be performed with minimal brain exposure, early visualization of the optico-carotid cistern for cerebrospinal fluid release, minimizing need for fixed brain retraction, and Sylvian fissure dissection. This technique can potentially reduce surgical risk and provide excellent exposure for anterior skull base lesions with favorable extent of resection, visual recovery, and complication rates.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"201-209"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171938/pdf/10-1055-a-1774-6281.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10023870","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":"Health Insurance Coverage and Survival Outcomes among Nasopharyngeal Carcinoma Patients: A SEER Retrospective Analysis.","authors":"Ashley Diaz,&nbsp;Daniel Bujnowski,&nbsp;Haobin Chen,&nbsp;Keaton Pendergrast,&nbsp;Peleg Horowitz,&nbsp;Paramita Das,&nbsp;Christopher Roxbury","doi":"10.1055/s-0042-1747962","DOIUrl":"https://doi.org/10.1055/s-0042-1747962","url":null,"abstract":"<p><p><b>Objectives</b>  Insurance coverage plays a critical role in head and neck cancer care. This retrospective study examines how insurance coverage affects nasopharyngeal carcinoma (NPC) survival in the United States using the Surveillance, Epidemiology, and End Results (SEER) program database. <b>Design, Setting, and Participants</b>  A total of 2,278 patients aged 20 to 64 years according to the International Classification of Diseases for Oncology (ICD-O) codes C11.0-C11.9 and ICD-O histology codes 8070-8078 and 8080-8083 between 2007 and 2016 were included and grouped into privately insured, Medicaid, and uninsured groups. Log-rank test and multivariable Cox's proportional hazard model were performed. <b>Main Outcome Measures</b>  Tumor stage, age, sex, race, marital status, disease stage, year of diagnosis, median household county income, and disease-specific survival outcomes including cause of death were analyzed. <b>Results</b>  Across all tumor stages, privately insured patients had a 59.0% lower mortality risk than uninsured patients (hazard ratio [HR]: 0.410, 95% confidence interval [CI]: [0.320, 0.526], <i>p</i>  < 0.01). Medicaid patients were also estimated to have 19.0% lower mortality than uninsured patients (HR: 0.810, 95% CI: [0.626, 1.048], <i>p</i>  = 0.108). Privately insured patients with regional and distant NPC had significantly better survival outcomes compared with uninsured individuals. Localized tumors did not show any association between survival and type of insurance coverage. <b>Conclusion</b>  Privately insured individuals had significantly better survival outcomes than uninsured or Medicaid patients, a trend that was preserved after accounting for tumor grade, demographic and clinicopathologic factors. These results underscore the difference in survival outcomes when comparing privately insured to Medicaid/uninsured populations and warrant further investigation in efforts for health care reform.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"240-247"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171937/pdf/10-1055-s-0042-1747962.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9839051","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":"Endoscopic Endonasal Approach to the Third Ventricle Using the Surgical Corridor of the Reverse Third Ventriculostomy: Anatomo-Surgical Nuances.","authors":"Ali Karadag,&nbsp;Mahmut Camlar,&nbsp;Omer Furkan Turkis,&nbsp;Nijat Bayramli,&nbsp;Erik H Middlebrooks,&nbsp;Necmettin Tanriover","doi":"10.1055/a-1808-1359","DOIUrl":"https://doi.org/10.1055/a-1808-1359","url":null,"abstract":"<p><p><b>Objective</b>  Surgical access to the third ventricle can be achieved through various corridors depending on the location and extent of the lesion; however, traditional transcranial approaches risk damage to multiple critical neural structures. <b>Methods</b>  Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV) was surgically simulated in eight cadaveric heads. Fiber dissections were additionally performed within the third ventricle along the endoscopic route. Additionally, we present a case of ERTV in a patient with craniopharyngioma extending into the third ventricle. <b>Results</b>  The ERTV allowed adequate intraventricular visualization along the third ventricle. The extracranial step of the surgical corridor included a bony window in the sellar floor, tuberculum sella, and the lower part of the planum sphenoidale. ERTV provided an intraventricular surgical field along the foramen of Monro to expose an area bordered by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly, posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius centered posterior inferiorly. <b>Conclusion</b>  The third ventricle can safely be accessed through ERTV either above or below the pituitary gland. ERTV provides a wide exposure of the third ventricle through the tuber cinereum and offers access to the anterior part as far as the anterior commissure and precommissural part of fornix and the whole length of the posterior part. Endoscopic ERTV may be a suitable alternative to transcranial approaches to access the third ventricle in selected patients.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 3","pages":"296-306"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171930/pdf/10-1055-a-1808-1359.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10116536","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}