1
Neuro Oncol
. 2019 Nov 4;21(11):1412-1422. doi: 10.1093/neuonc/noz106.
Automatic Assessment of Glioma Burden: A Deep Learning Algorithm for Fully Automated Volumetric and Bidimensional Measurement
Ken Chang 1, Andrew L Beers 1, Harrison X Bai 2, James M Brown 1, K Ina Ly 3, Xuejun Li 4, Joeky T Senders 5, Vasileios K Kavouridis 5, Alessandro Boaro 5, Chang Su 6, Wenya Linda Bi 7, Otto Rapalino 8, Weihua Liao 9, Qin Shen 10, Hao Zhou 11, Bo Xiao 11, Yinyan Wang 12, Paul J Zhang 13, Marco C Pinho 14, Patrick Y Wen 15, Tracy T Batchelor 16, Jerrold L Boxerman 17, Omar Arnaout 5, Bruce R Rosen 1, Elizabeth R Gerstner 3, Li Yang 18, Raymond Y Huang 19, Jayashree Kalpathy-Cramer 1
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PMID: 31190077 PMCID: PMC6827825 DOI: 10.1093/neuonc/noz106
Free PMC article
Abstract
Background: Longitudinal measurement of glioma burden with MRI is the basis for treatment response assessment. In this study, we developed a deep learning algorithm that automatically segments abnormal fluid attenuated inversion recovery (FLAIR) hyperintensity and contrast-enhancing tumor, quantitating tumor volumes as well as the product of maximum bidimensional diameters according to the Response Assessment in Neuro-Oncology (RANO) criteria (AutoRANO).
Methods: Two cohorts of patients were used for this study. One consisted of 843 preoperative MRIs from 843 patients with low- or high-grade gliomas from 4 institutions and the second consisted of 713 longitudinal postoperative MRI visits from 54 patients with newly diagnosed glioblastomas (each with 2 pretreatment "baseline" MRIs) from 1 institution.
Results: The automatically generated FLAIR hyperintensity volume, contrast-enhancing tumor volume, and AutoRANO were highly repeatable for the double-baseline visits, with an intraclass correlation coefficient (ICC) of 0.986, 0.991, and 0.977, respectively, on the cohort of postoperative GBM patients. Furthermore, there was high agreement between manually and automatically measured tumor volumes, with ICC values of 0.915, 0.924, and 0.965 for preoperative FLAIR hyperintensity, postoperative FLAIR hyperintensity, and postoperative contrast-enhancing tumor volumes, respectively. Lastly, the ICCs for comparing manually and automatically derived longitudinal changes in tumor burden were 0.917, 0.966, and 0.850 for FLAIR hyperintensity volume, contrast-enhancing tumor volume, and RANO measures, respectively.
Conclusions: Our automated algorithm demonstrates potential utility for evaluating tumor burden in complex posttreatment settings, although further validation in multicenter clinical trials will be needed prior to widespread implementation.
Keywords: RANO; deep learning; glioma; longitudinal response assessment; segmentation.
The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.
Comment in
On the promise of artificial intelligence for standardizing radiographic response assessment in gliomas.
Ellingson BM.
Neuro Oncol. 2019 Nov 4;21(11):1346-1347. doi: 10.1093/neuonc/noz162.
PMID: 31504809 No abstract available.
Cited by 5 articles33 references6 figures
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2
Review World Neurosurg
. 2020 Jun 26;S1878-8750(20)31440-6. doi: 10.1016/j.wneu.2020.06.172. Online ahead of print.
The Future of Skull Base Surgery: A View Through Tinted Glasses
Laligam N Sekhar 1, Gordana Juric-Sekhar 2, Zeeshan Qazi 3, Anoop Patel 3, Lynn B McGrath Jr 3, James Pridgeon 3, Niveditha Kalavakonda 4, Blake Hannaford 4
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PMID: 32599213 DOI: 10.1016/j.wneu.2020.06.172
Abstract
This article broadly outlines the potential advances in the field of skull base surgery, which may occur in the next 20 years based on many areas of current research in biology and technology. Many of these advances are also broadly applicable to other areas of neurosurgery. We ground our predictions for future developments in an exploration of what patients and surgeons most desire as outcomes for care. This leads to an examination of recent developments in the field and outlines several promising areas of future improvement in skull base surgery, per se, as well as identifying new hospital support systems needed to accommodate these changes. These include, but are not limited to advances in imaging, Raman Spectroscopy and Microscopy, 3-dimensional printing and rapid prototyping, master-slave and semi-autonomous robots, artificial intelligence applications in all areas of medicine, tele-medicine, and green technologies in hospitals. In addition, we review therapeutic approaches employing nanotechnology, genetic engineering and anti-tumoral antibodies, as well as stem cell technologies to repair damage caused by traumatic injuries, tumors, and iatrogenic injuries to the brain and cranial nerves. Additionally, we discuss the training requirements for future skull- base surgeons and stress the need for adaptability and change. However, the essential requirements for skull base surgeons remain unchanged, namely: knowledge, attention to details, technical skill, innovation, judgement, and compassion. Our conclusion is that active involvement in these rapidly evolving technologies will enable us to shape some of the future of our discipline to address the needs of both patients and our profession.
Copyright © 2020 Elsevier Inc. All rights reserved.
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3
World Neurosurg
. 2020 Jun 26;S1878-8750(20)31425-X. doi: 10.1016/j.wneu.2020.06.157. Online ahead of print.
Efficacy of the Endoscopic Triportal Transmaxillary Approach for Treating Lateral Middle Skull Base Tumors: A Technical Note and Retrospective Case Series
Toru Umehara 1, Manabu Kinoshita 2, Masaki Hayama 3, Takashi Shikina 4, Yasunori Fujimoto 5, Yohei Maeda 3, Hidenori Inohara 3, Haruhiko Kishima 1
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PMID: 32599180 DOI: 10.1016/j.wneu.2020.06.157
Abstract
Background: The endoscopic approach, chiefly via the maxillary sinus, has growing applications for the lateral skull base, and can be classified into the use of "endonasal" or "sublabial" entry. While the "endonasal" transmaxillary approach has been well-accepted, it has a limitation with respect to the lateral exposure. A possible solution is the use of the "sublabial" transmaxillary approach via the canine fossa, which assures lateral accessibility. In clinical practice, we have taken advantage of the concomitant use of the endonasal and sublabial transmaxillary approach for selected patients harboring lateral skull base lesions. In addition to binostril pathways, canine fossa trephination was constructed to facilitate this combined approach, termed the endoscopic triportal transmaxillary approach (ETTA).
Methods: The efficacy of the ETTA was evaluated within a case series. A single-institution retrospective analysis was performed in patients with lateral middle skull base tumors treated via ETTA.
Results: In clinical practice, four patients were eligible for the study, including one receiving a combined endoscopic and transcranial approach. No major complications occurred in patients included in this series. The ETTA facilitated the dynamic manipulation of instruments, which led to rapid hemostasis and the satisfactory surgical resection of tumors. Furthermore, it reduced intraoperative postural stress experienced by the surgeons who performed the procedures.
Conclusions: The concomitant use of the trans-canine fossa approach effectively ameliorated significant technical challenges that tend to occur when using a purely endonasal approach. The ETTA can be an attractive option for treating lateral and middle skull base lesions.
Keywords: Endoscopic transmaxillary approach; Short title: Useful approach for lateral skull base; infratemporal fossa; pterygopalatine fossa.
Copyright © 2020 Elsevier Inc. All rights reserved.
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4
Review World J Otorhinolaryngol Head Neck Surg
. 2020 Apr 8;6(2):118-124. doi: 10.1016/j.wjorl.2020.01.007. eCollection 2020 Jun.
Pediatric Sinonasal and Skull Base Lesions
Charles A Riley 1, Christian P Soneru 1, Jonathan B Overdevest 1, Marc L Otten 2, David A Gudis 1
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PMID: 32596657 PMCID: PMC7296510 DOI: 10.1016/j.wjorl.2020.01.007
Free PMC article
Abstract
Pediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.
Keywords: Chondrosarcoma; Clival chordoma; Craniopharyngioma; Endoscopic sinus surgery; Endoscopic skull base surgery; Juvenile nasopharyngeal angiofibroma; Meningoencephalocele; Pediatrics; Pituitary adenoma.
Conflict of interest statement
None.
65 references1 figure
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5
Review World J Otorhinolaryngol Head Neck Surg
. 2020 Apr 18;6(2):125-131. doi: 10.1016/j.wjorl.2020.01.008. eCollection 2020 Jun.
Skull Base Chordomas Review of Current Treatment Paradigms
Dan Yaniv 1, Ethan Soudry 1, Yulia Strenov 2, Marc A Cohen 3, Aviram Mizrachi 1
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PMID: 32596658 PMCID: PMC7296475 DOI: 10.1016/j.wjorl.2020.01.008
Free PMC article
Abstract
Background: Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation.
Methods: Literature review of current treatment strategies for chordomas of the skull base.
Results: Surgery is the mainstay of treatment and complete resection has paramount importance for prognosis.When complete resection is not achieved recurrent disease is common. The anatomical complexity of the skull base makes resection complex. Endonasal endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be challenging.Evidence suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the disease. Nonetheless, immediate post-operative radiotherapy improves survival. Many strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy, gamma knife surgery, proton beam therapy, and carbon ion radiation therapy.There is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show promise. Several optional molecular targets exist. Brachyury is overexpressed in 95% of chordomas but not in other mesenchymal neoplasms. However, its precise role in chordoma pathogenesis is currently unclear, and its cellular location in the nucleus makes it difficult to target. The inhibition of brachyury in chordoma cell lines induces growth arrest and apoptosis. This does not have clinical application to date. There are retrospective results with different molecular targeted therapies for advanced chordomas with some effectiveness.
Conclusion: Despite improvements made in the past 10 years in our knowledge of chordoma biology, available therapies still offer a limited benefit. There is an unmet need for new therapeutic options for patients with advanced disease. Therefore, patients with advanced disease should be encouraged to participate in clinical trials when and where available.
Keywords: Chordoma; Review; Skull Base; Surgery; Targeted therapy.
© 2020 The Authors.
Conflict of interest statement
None.
52 references4 figures
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6
Review World J Otorhinolaryngol Head Neck Surg
. 2020 Jun 3;6(2):106-114. doi: 10.1016/j.wjorl.2019.11.002. eCollection 2020 Jun.
Surgical Approaches to the Petrous Apex
Kevin L Li 1, Vijay Agarwal 2, Howard S Moskowitz 1, Waleed M Abuzeid 1
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PMID: 32596655 PMCID: PMC7296478 DOI: 10.1016/j.wjorl.2019.11.002
Free PMC article
Abstract
The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures. Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.
Keywords: Anterior approaches; Endoscopic endonasal approach; Lateral approaches; Petrous apex; Surgical approaches.
© 2020 The Authors.
Conflict of interest statement
Waleed Abuzeid, MD is a consultant for Medtronic Inc. and Intersect ENT. Neither of these relationships is pertinent to the contents of this study.
70 references5 figures
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7
Ann Otol Rhinol Laryngol
. 2020 Jun 29;3489420937728. doi: 10.1177/0003489420937728. Online ahead of print.
Allergic Fungal Sinusitis Imitating an Aggressive Skull Base Lesion in the Setting of Pembrolizumab Immunotherapy
Natalie A Krane 1, Daniel M Beswick 1, David Sauer 2, Kara Detwiller 1, Maisie Shindo 1
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PMID: 32597680 DOI: 10.1177/0003489420937728
Abstract
Objectives: We report a case of acutely worsening allergic fungal sinusitis in a patient receiving immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor.
Methods: A 53-year-old man with a history of metastatic melanoma and recent initiation of pembrolizumab therapy presented with acutely worsening headaches, left abducens nerve palsy, and neuroimaging demonstrating an erosive skull base lesion with bilateral cavernous sinus involvement.
Results: Intraoperative findings were consistent with non-invasive allergic fungal sinus disease. Microbiology and histopathologic data ruled out malignancy and demonstrated Aspergillus fumigatus without concern for angioinvasion. After treatment with antifungal therapy, the patient's symptoms and abducens nerve palsy resolved. Symptoms were well-controlled 7 months after his initial presentation.
Conclusions: Inflammatory sinusitis in patients receiving anti-PD-1 therapy may be secondary to T-cell infiltration, a similar pathophysiology as immune-related adverse events, and warrants appreciation by otolaryngologists given our increasing exposure to immunotherapy and its head and neck manifestations.
Keywords: allergic fungal sinusitis; checkpoint inhibitor; immune-related adverse events; immunotherapy; sinusitis.
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8
Review World J Otorhinolaryngol Head Neck Surg
. 2020 Apr 17;6(2):132-136. doi: 10.1016/j.wjorl.2020.01.004. eCollection 2020 Jun.
Free Tissue Reconstruction of the Anterior Skull Base: A Review
Elizabeth Bradford Bell 1, Erin R Cohen 1, Zoukaa Sargi 1, Jason Leibowitz 1
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PMID: 32596659 PMCID: PMC7296482 DOI: 10.1016/j.wjorl.2020.01.004
Free PMC article
Abstract
Objective: There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ablation. However, when open resection is required, free flap reconstruction is often necessary to provide sufficient well-vascularized tissue for optimal wound healing as well as providing adequate tissue bulk for cosmesis. This articleaims to providea focused review of free flaps most commonly used in anterior skull base reconstruction.
Methods: This is a state-of-the-art review based on expert opinion and previously published reviews and journal articles, queried using PubMed and Google Scholar.
Results & conclusion: Anterior skull base reconstruction via free tissue transfer is imperative in limiting complications and promoting healing, particularly with large defects, post-radiation, and in at-risk patients. The type of free flap utilized for a particular anterior skull base reconstruction should be tailored to the patient and nature of the disease. This review offers insight into the numerous reconstructive options for the free flap surgeon.
Keywords: Anterior skull base; Free tissue transfer; Head and neck microvascular; Reconstruction.
© 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
Conflict of interest statement
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
36 references3 figures
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9
Review Hear Res
. 2020 Apr 20;107976. doi: 10.1016/j.heares.2020.107976. Online ahead of print.
Regulation of Auditory Plasticity During Critical Periods and Following Hearing Loss
Dora Persic 1, Maryse E Thomas 2, Vassilis Pelekanos 3, David K Ryugo 4, Anne E Takesian 2, Katrin Krumbholz 3, Sonja J Pyott 5
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PMID: 32591097 DOI: 10.1016/j.heares.2020.107976
Abstract
Sensory input has profound effects on neuronal organization and sensory maps in the brain. The mechanisms regulating plasticity of the auditory pathway have been revealed by examining the consequences of altered auditory input during both developmental critical periods-when plasticity facilitates the optimization of neural circuits in concert with the external environment-and in adulthood-when hearing loss is linked to the generation of tinnitus. In this review, we summarize research identifying the molecular, cellular, and circuit-level mechanisms regulating neuronal organization and tonotopic map plasticity during developmental critical periods and in adulthood. These mechanisms are shared in both the juvenile and adult brain and along the length of the auditory pathway, where they serve to regulate disinhibitory networks, synaptic structure and function, as well as structural barriers to plasticity. Regulation of plasticity also involves both neuromodulatory circuits, which link plasticity with learning and attention, as well as ascending and descending auditory circuits, which link the auditory cortex and lower structures. Further work identifying the interplay of molecular and cellular mechanisms associating hearing loss-induced plasticity with tinnitus will continue to advance our understanding of this disorder and lead to new approaches to its treatment.
Keywords: Aging; Auditory brainstem; Auditory cortex; Developmental critical periods; Hearing loss; Hidden hearing loss; Neuronal reorganization; Sensory deprivation; Synaptopathy; Tinnitus.
Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.
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10
Childs Nerv Syst
. 2020 Jun 27. doi: 10.1007/s00381-020-04759-4. Online ahead of print.
Preoperative Planning With a 3D Model and Repair of Sphenoid Dysplasia: A Technical Note
Peter Spazzapan 1, Miha Verdenik 2, Andreja Eberlinc 2
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PMID: 32594237 DOI: 10.1007/s00381-020-04759-4
Abstract
Introduction: Sphenoid dysplasia is a distinctive marker of neurofibromatosis 1. It is a malformation of the sphenoid bone characterized by an enlargement of the superior orbital fissure, through which the intracranial content herniates, leading to a facial disfigurement and exophthalmos and to a potential visual deterioration. Surgical treatment has the aim of separating the intracranial from the intraorbital space.
Methods and results: We present a new technique for the repair of sphenoid dysplasia, based on the preoperative planning on a 3D print of the skull base.
Conclusions: The use of a 3D skull base model allows an effective surgical planning and a precise modelling of the titanium mesh, which is implanted to separate the intracranial from the intraorbital space.
Keywords: Exophthalmos; Neurofibromatosis; Skull base; Sphenoid dysplasia.
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11
Laryngoscope Investig Otolaryngol
. 2020 Feb 26;5(3):344-347. doi: 10.1002/lio2.335. eCollection 2020 Jun.
Effect of Endoscopic Endonasal Skull Base Surgery on Snoring
Do Hyun Kim 1, Min Hyeong Lee 1, Jaeyoon Lee 1, Sung Won Kim 1
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PMID: 32596475 PMCID: PMC7314477 DOI: 10.1002/lio2.335
Free PMC article
Abstract
Background: As the number of endoscopic skull base surgeries has increased, postoperative changes in quality of life require attention, including evaluation of whether snoring symptoms change.
Objective: To investigate the effect of endoscopic endonasal skull base surgery on snoring and nasal symptom scores.
Methods: Between February 2009 and September 2018, 510 patients underwent skull base tumor resection via an endoscopic endonasal approach and were included in this study. Nasal symptoms were scored using the Nasal Obstruction Symptoms Evaluation (NOSE) scale and snoring symptoms were subjectively scored from 0 to 10 by partners using a visual analog scale (VAS). Computational fluid dynamics (CFD) was employed for pilot patient analysis.
Results: A pituitary adenoma was the most common surgical pathology encountered over the past 10 years (81.6% of all tumors). The NOSE scores increased significantly after surgery (pre-surgery, 3.28 ± 3.18; post-surgery, 4.09 ± 3.61; P < .001). The snoring VAS score decreased significantly postoperatively (pre-surgery, 2.91 ± 2.74; post-surgery, 2.43 ± 2.45; P < .001). A positive correlation was apparent between the NOSE and snoring score changes (r = 0.374; P < .001).
Conclusions: Snoring improved after endoscopic endonasal skull base surgery, associated with changes in nasal symptoms.
Level of evidence: 4.
Keywords: endonasal; endoscopic; skull base; snoring.
© 2019 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.
Conflict of interest statement
The authors declare no potential conflict of interest.
25 references2 figures
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12
Iran J Otorhinolaryngol
. 2020 May;32(110):169-173. doi: 10.22038/ijorl.2019.37340.2220.
Variations of Ethmoid Roof in the Iranian Population- A Cross Sectional Study
Maryam Moradi 1, Bahare Dalili 2
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PMID: 32596176 PMCID: PMC7302525 DOI: 10.22038/ijorl.2019.37340.2220
Free PMC article
Abstract
Introduction: This study aimed to investigate the distribution of ethmoid roof variation and symmetry according to Keros classification.
Materials and methods: This cross-sectional study assessed the paranasal CT scans of 600 patients over 18 years of age with no history of surgery, trauma, or localized fracture in the ethmoid, nose, and anterior skull base. The lateral lamella of the cribriform plate (LLCP) sizes were measured and classified as Keros type I (1-3 mm), II (4-7mm), and III (8-16mm). Moreover, the symmetry was surveyed in accordance with the LLCP measurements on both sides of the ethmoid roof. These variations were analyzed regarding gender and age.
Results: In total, 600 patients participated in this study out of whom 311 cases were male. According to the results, the mean age of the participants was 37.50±16.63 years. Furthermore, the mean values of the LLCP height for the right and left sides were 4.17±1.69 and 4.93±1.97 mm, respectively. Moreover, the asymmetry was observed in 38.3% of the cases, and they were classified as 36.7% Keros type I, 50.5% Keros type II, and 12.8% Keros type III.
Conclusion: Keros type II and symmetry were the most common variations in this study. In addition, these variations were independent of age and gender.
Keywords: Anatomy; Classification; Ethmoid sinus.
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13
Eur Arch Otorhinolaryngol
. 2020 Jun 26. doi: 10.1007/s00405-020-06169-3. Online ahead of print.
The Effect of Superior Canal Dehiscence Size and Location on Audiometric Measurements, Vestibular-Evoked Myogenic Potentials and Video-Head Impulse Testing
Andrea Castellucci 1 2, Gianluca Piras 3 4, Valeria Del Vecchio 3 5, Francesco Maria Crocetta 3 6, Vincenzo Maiolo 7, Gian Gaetano Ferri 3, Angelo Ghidini 6, Cristina Brandolini 3
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PMID: 32592013 DOI: 10.1007/s00405-020-06169-3
Abstract
Purpose: To correlate objective measures of audio-vestibular function with superior canal dehiscence (SCD) size and location in ears with SCD and compare results with literature.
Methods: We retrospectively evaluated 242 patients exhibiting SCD and/or extremely thinned bone overlying superior canals (SC) on CT scans and selected 73 SCD patients (95 ears with SCD). Data concerning audiometry, impedance audiometry, video-head impulse test (vHIT), cervical vestibular-evoked myogenic potentials (cVEMPs) and ocular VEMPs (oVEMPs) to air- (AC) and bone-conducted (BC) stimuli were collected for each pathologic ear and correlated with dehiscence size and location.
Results: AC pure-tone average (PTA) (p = 0.013), low-frequency air-bone gap (ABG) (p < 0.001), AC cVEMPs amplitude (p = 0.002), BC cVEMPs amplitude (p < 0.001) and both AC and BC oVEMPs amplitude (p < 0.001) positively correlated with increasing SCD size. An inverse relationship between dehiscence length and both AC cVEMPs and oVEMPs thresholds (p < 0.001) and SC vestibulo-ocular reflex (VOR) gain (p < 0.001) was observed. Dehiscences at the arcuate eminence (AE) exhibited lower SC VOR gains compared to SCD along the ampullary arm (p = 0.008) and less impaired BC thresholds than dehiscences at the superior petrosal sinus (p = 0.04).
Conclusion: We confirmed that SCD size affects AC PTA, ABG and both amplitudes and thresholds of cVEMPs and oVEMPs. We also described a tendency for SC function to impair with increasing SCD size and when dehiscence is located at the AE. The latter data may be explained either by a spontaneous canal plugging exerted by middle fossa dura or by a dissipation through the dehiscence of mechanical energy conveyed to the endolymph during high-frequency impulses.
Keywords: Air–bone gap; Dehiscence size; Superior canal dehiscence; Superior petrosal sinus; Vestibular evoked myogenic potentials; Video head impulse test.
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14
J Histochem Cytochem
. 2020 Jun 30;22155420939833. doi: 10.1369/0022155420939833. Online ahead of print.
Immunocytochemical Localization of Olfactory-signaling Molecules in Human and Rat Spermatozoa
Yuliya Makeyeva 1 2, Christopher Nicol 3, William L Ledger 4, David K Ryugo 1 5 6
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PMID: 32603211 DOI: 10.1369/0022155420939833
Abstract
Expression of olfactory receptors (ORs) in non-olfactory tissues has been widely reported over the last 20 years. Olfactory marker protein (OMP) is highly expressed in mature olfactory sensory neurons (mOSNs) of the olfactory epithelium. It is involved in the olfactory signal transduction pathway, which is mediated by well-conserved components, including ORs, olfactory G protein (Golf), and adenylyl cyclase 3 (AC3). OMP is widely expressed in non-olfactory tissues with an apparent preference for motile cells. We hypothesized that OMP is expressed in compartment-specific locations and co-localize with an OR, Golf, and AC3 in rat epididymal and human-ejaculated spermatozoa. We used immunocytochemistry to examine the expression patterns of OMP and OR6B2 (human OR, served as positive olfactory control) in experimentally induced modes of activation and determine whether there are any observable differences in proteins expression during the post-ejaculatory stages of spermatozoal functional maturation. We found that OMP was expressed in compartment-specific locations in human and rat spermatozoa. OMP was co-expressed with Golf and AC3 in rat spermatozoa and with OR6B2 in all three modes of activation (control, activated, and hyperactivated), and the mode of activation changed the co-expression pattern in acrosomal-reacted human spermatozoa. These observations suggest that OMP expression is a reliable indicator of OR-mediated chemoreception, may be used to identify ectopically expressed ORs, and could participate in second messenger signaling cascades that mediate fertility.
Keywords: chemoreception; fluorescence microscopy; interstitial tissue; olfactory epithelium; olfactory marker protein; reproduction; sperm.
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15
Iran J Otorhinolaryngol
. 2020 May;32(110):133-138. doi: 10.22038/ijorl.2019.36294.2194.
Results of End-To-Side Hypoglossal-Facial Nerve Anastomosis in Facial Paralysis After Skull Base Surgery
Sasan Dabiri 1, Mohammadtaghi Khorsandi Ashtiani 1, Melorina Moharreri 1, Zahra Mahvi Khomami 1, Ali Kouhi 1, Nasrin Yazdani 1, Pedram Borghei 1, Kayvan Aghazadeh 1
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PMID: 32596171 PMCID: PMC7302531 DOI: 10.22038/ijorl.2019.36294.2194
Free PMC article
Abstract
Introduction: The primary aim of facial reanimation surgery is to restore tone, symmetry, and movement to the paralyzed face. Hypoglossal-facial end-to-side anastomosis provides satisfactory facial reanimation in the irreversible proximal injury of the facial nerve. This study discussed the facial function results of end-to-side anastomosing of hypoglossal nerve to facial nerve when the injury occurred during skull base surgery.
Materials and methods: The present study enrolled a total of 10 patients who underwent end-to-side hypoglossal-facial nerve anastomosis after facial nerve paralysis due to skull base surgery. The data of the patients were gathered from hospital records, pictures, and movies during the 18 months of follow-up.
Results: At the 18 months of follow-up, seven (70%) and three (30%) patients were reported with grades III and IV of the House-Brackmann scoring system, respectively. In total, out of the seven grade III patients, six subjects underwent early anastomosis (within the first year of the paralysis). On the other hand, among patients with grade IV, two subjects had late anastomosis.
Conclusion: It seems that early end-to-side hypoglossal-facial anastomosis can be a favorable surgical option with good facial function results for reanimating the facial function of patients with facial paralysis following skull base surgery.
Keywords: Facial nerve paralysis; Hypoglossal-facial nerve anastomosis; Rehabilitation.
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16
Laryngoscope
. 2020 Jan;130(1):E1-E10. doi: 10.1002/lary.28052. Epub 2019 May 13.
Survival in Low-Grade and High-Grade Sinonasal Adenocarcinoma: A National Cancer Database Analysis
Aryan Shay 1, Ashwin Ganti 1, Anish Raman 1, Hannah N Kuhar 1, Samuel R Auger 1, Michael Eggerstedt 2, Tirth Patel 2, Edward C Kuan 3, Pete S Batra 2, Bobby A Tajudeen 2
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PMID: 31081940 DOI: 10.1002/lary.28052
Abstract
Objectives/hypothesis: The purpose of this study was to investigate survival differences between low-grade and high-grade sinonasal adenocarcinoma (SNAC) by examining demographics, tumor characteristics, and treatment modalities.
Study design: Retrospective database analysis.
Methods: The National Cancer Database was queried for patients with SNAC between 2004 and 2015. Univariate and multivariate analyses were performed for all cases of SNAC. Subsequent analysis focused on low-grade (grade 1 and grade 2) and high-grade (grade 3 and grade 4) SNAC.
Results: A total of 1,288 patients with SNAC were included in the main cohort and divided into low grade (n = 601) and high grade (n = 370). The 5-year overall survival for all patients, low-grade, and high-grade was 54%, 64%, and 38%, respectively. Prognostic factors associated with decreased survival for the main cohort include advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.03-1.06), Charlson-Deyo score (HR: 1.37; 95% CI: 1.05-1.78), grade 2 (HR: 2.21; 95% CI: 1.26-3.86], grade 3 (HR: 3.67; 95% CI: 2.09-6.45), and grade 4 (HR: 3.31; 95% CI: 1.38-7.91). Radiotherapy was associated with improved overall survival for high-grade SNAC (HR: 0.41; 95% CI: 0.24-0.70) but not for low-grade SNAC (HR: 1.05; 95% CI: 0.59-1.85).
Conclusions: This investigation is the largest to date analyzing the association of treatment modalities with overall survival in SNAC. Surgery remains paramount to treatment, with radiotherapy offering additional survival benefit for high-grade SNAC. Administration of chemotherapy was not associated with improved survival.
Level of evidence: 4 Laryngoscope, 130:E1-E10, 2020.
Keywords: Adenocarcinoma; National Cancer Database; grade; malignancy; overall survival; sinonasal.
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
22 references
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17
Clin Auton Res
. 2020 Jun 27. doi: 10.1007/s10286-020-00706-0. Online ahead of print.
Somatic and Autonomic Findings in Cancer-Related Base of the Skull Syndromes
Alexandru Barboi 1, Sylwia Pocica 2
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PMID: 32594278 DOI: 10.1007/s10286-020-00706-0
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18
J Allergy Clin Immunol
. 2020 Jun 24;S0091-6749(20)30677-1. doi: 10.1016/j.jaci.2020.04.048. Online ahead of print.
Reply
Joaquim Mullol 1, Franklin Mariño 2, Meritxell Valls 3, Isam Alobid 4, Concepció Marin 5
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PMID: 32593492 DOI: 10.1016/j.jaci.2020.04.048
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19
J Craniofac Surg
. 2020 Jun 24. doi: 10.1097/SCS.0000000000006686. Online ahead of print.
Chondroma in the Area of the Spheno-Ethmoid Junction
Jinfeng Liu 1, Qingqing Hao, Wei Wu, Ningyu Wang
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PMID: 32604309 DOI: 10.1097/SCS.0000000000006686
Abstract
Chondroma in the area of the spheno-ethmoidal junction is very rare. A 29-year-old male patient with chronic rhinosinusitis with nasal polyps was arranged for a preoperative computed tomography scan, and a lesion was accidentally found in his spheno-ethmoidal junction and involved the skull base. Combined with MRI, the lesion was misdiagnosed as fungal sinusitis. However, no fungal lesions were found during the operation, and cartilage tissue was confirmed only after some bone was ground away under the guidance of a surgical navigation system. Our case indicates that chondroma is easily misdiagnosed as fungal sinusitis when it appears in the sinuses and should be carefully distinguished from fungal sinusitis. Moreover, when lesions involve the skull base, surgical navigation systems are useful in accurately locating lesions.
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20
World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 16;6(2):94-99. doi: 10.1016/j.wjorl.2020.01.001. eCollection 2020 Jun.
Endoscopic Endonasal Approaches to the Craniovertebral Junction: The Otolaryngologist's Perspective
Qasim Husain 1, Matthew H Kim 2, Ibrahim Hussain 3, Vijay K Anand 2, Jeffrey P Greenfield 3, Theodore H Schwartz 2 3, Ashutosh Kacker 2
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PMID: 32596653 PMCID: PMC7296474 DOI: 10.1016/j.wjorl.2020.01.001
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Abstract
Objective: To review indications and techniques for the endoscopic endonasal approach to the craniovertebral junction (CVJ), analyze postoperative outcomes, and discuss important technical considerations.
Methods: A retrospective analysis was performed on all patients undergoing endonasal endoscopic approaches to the CVJ from May 2007 to June 2017. Demographic information, presenting symptoms, imaging results, treatment course, postoperative functional status, and follow-up were recorded.
Results: There was a total of 30 patients in this series, with a mean follow-up of 11.7 months. The average age was 33.6 years (range, 5-75 years), with 18 females and 12 males. The majority of patients (n = 22, 73.3%) had Chiari malformation type 1 with basilar invagination and symptomatic cervicomedullary compression as the indication for surgery. Intraoperative cerebrospinal fluid leak (CSF) was noted in 3 cases of odontoid resection and a single case of skull base resection. There were no postoperative CSF leaks. Overall, 81% of patients resumed regular diet by post-operative day 2 (range, 0-8 days). Severe postoperative dysphagia occurred in two cases with one requiring gastrostomy tube placement and another utilizing total parenteral nutrition for support prior to eventual gastrostomy. On average, patients were extubated by postoperative day 0.93 (range 0-3 days), with 85% extubated by postoperative day 1. A tracheotomy was required in one patient.
Conclusion: The endonasal endoscopic approach is a valuable technique for access to the CVJ with minimal disruption of respiratory and alimentary function.
Keywords: Craniovertebral junction; Endoscopic skull base surgery; Odontoidectomy.
© 2020 The Authors.
Conflict of interest statement
None.
16 references3 figures
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Clin Neurol Neurosurg
. 2020 Jun 24;196:106041. doi: 10.1016/j.clineuro.2020.106041. Online ahead of print.
TRANS-FRONTAL SINUS APPROACH FOR OLFACTORY GROOVE MENINGIOMAS: A 19 YEAR EXPERIENCE
Francesco Zenga 1, Federica Penner 2, Fabio Cofano 1, Andrea Lavorato 1, Valentina Tardivo 1, Marco Maria Fontanella 3, Diego Garbossa 1, Roberto Stefini 4
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PMID: 32604034 DOI: 10.1016/j.clineuro.2020.106041
Abstract
Introduction: Olfactory groove meningiomas (OGMs) account for 8-13 % of all intracranial meningiomas. The gold standard of treatment is generally surgery, however various approaches have been used and the literature is still uncertain about the superiority of one treatment over the others. The most debated techniques are traditional microscopic open approaches versus the endoscopic endonasal ones. The aim of this paper is to prove a valid surgical route that gathers the benefits of both endoscopic and transcranial routes.
Methods: Fifty consecutive patients underwent trans-frontal sinus surgical removal of an OGM between January 2000 and January 2019 at the Neurosurgical Departments in Torino, Brescia and Legnano (Italy). The clinical features were collected in a database and compared with neuroimaging and outcomes. All patients were investigated with neuroimaging techniques. Clinical evaluations were performed 3-4 months and 1 year after surgery, together with neuroradiological follow-up.
Results: All patients with OGM underwent Simpson grade I resection. The most common neurological symptom leading to neuroradiological evaluations were headaches (36 %), followed by behavioural changes (30 %), hyposmia/anosmia (12 %), visual impairments (6%) and focal deficits (6%). At 3-4 months follow-up 48 patients underwent a brain MRI (2 patients underwent a brain CT), and a complete resection was confirmed in 45 patients (94 %).
Conclusions: Despite different techniques and studies supported by good evidence, there is no consensus on the best surgical approach for OGMs. The data shown in this article suggests that the trans-frontal sinus approach is a valid alternative to an endoscopic approach and the classical transcranial routes, collecting benefits from both approaches.
Keywords: Anterior cranial fossa; Olfactory groove meningioma; Skull base surgery; Trans frontal sinus approach.
Copyright © 2020 Elsevier B.V. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest There are no conflicts of interest associated with this publication to the writers knowledge and there has been no significant financial support that contributed to this work that could have influenced its outcome. The authors confirm that the manuscript has been read and approved for submission by all the named authors.
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Review World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 20;6(2):84-93. doi: 10.1016/j.wjorl.2020.01.005. eCollection 2020 Jun.
Perioperative Management of Endoscopic Transsphenoidal Pituitary Surgery
Martin Hanson 1, Hao Li 1, Eliza Geer 1, Sasan Karimi 1, Viviane Tabar 1, Marc A Cohen 1
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PMID: 32596652 PMCID: PMC7296486 DOI: 10.1016/j.wjorl.2020.01.005
Free PMC article
Abstract
The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.
Keywords: Endoscopic skull base surgery; Perioperative management; Pituitary; Pituitary surgery.
© 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
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None.
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23
Laryngoscope Investig Otolaryngol
. 2020 May 26;5(3):546-551. doi: 10.1002/lio2.403. eCollection 2020 Jun.
New Marsupialization Technique in Endolymphatic Sac Surgery
Ahmad Daneshi 1, Farideh Hosseinzadeh 1, Saleh Mohebbi 2, Mohammad Mohseni 1, S Saeed Mohammadi 3, Alimohamad Asghari 2
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PMID: 32596499 PMCID: PMC7314464 DOI: 10.1002/lio2.403
Free PMC article
Abstract
Objectives: The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery.
Methods: Forty-three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border.
Results: Mean duration of the follow-up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated.
Conclusion: The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss.
Level of evidence: 3.
Keywords: Meniere's disease; endolymphatic sac decompression; marsupialization technique.
© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.
Conflict of interest statement
The authors declare no potential conflict of interest.
22 references4 figures
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Laryngoscope Investig Otolaryngol
. 2020 May 11;5(3):529-535. doi: 10.1002/lio2.394. eCollection 2020 Jun.
Balance Function After Cochlear Implant and Inner Ear Anomaly: Comparison of Dynamic Posturography
Farideh Hosseinzadeh 1, Alimohamad Asghari 2, Maziar Moradi-Lakeh 3, Mohammad Farhadi 1, Ahmad Daneshi 1, Mohammad Mohseni 1, S Saeed Mohammadi 4
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PMID: 32596497 PMCID: PMC7314490 DOI: 10.1002/lio2.394
Free PMC article
Abstract
Introduction: Patients with sensorineural hearing loss suffer concomitant vestibular dysfunction that is more prevalent in patients with inner ear anomaly and could be aggravated with cochlear implantation. To assess the vestibular dysfunction in patients with cochlear implantation, we compared their results with those of patients with and without inner ear anomaly.
Materials and methods: This is a historical cohort study lasting for 20 years on 50 patients with cochlear implantation. All patients underwent dynamic posturography and Bruininks-Oseretsky Test.
Results: Twenty-two (44%) of the participants showed some types of inner ear anomaly. The frequency of abnormal Bruininks-Oseretsky Test was 45.5% and 10.7% (P = .005, odds ratio [OR] = 6.9). Abnormal composite was seen in 77.3% and 21.4%, respectively (P < .001; OR = 12.5). The mean strategy score in the fifth condition of the sensory organization test was 25.0 ± 20.4 in patients with inner ear anomaly, whereas it was 44.1 ± 18.9 in those without it (P = .001).
Conclusion: Balance capability in cochlear implantation patients with inner ear anomaly compared to those without inner ear anomaly was worse. More vestibular rehabilitation treatment plans are suggested for these patients.
Keywords: Bruininks‐Oseretsky Test; cochlear implantation; inner ear anomaly; posturography; vestibular function tests.
© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.
Conflict of interest statement
All authors acknowledge that they have no affiliations with or involvement in any organization or entity with any financial interest, or nonfinancial interest in the subject matter or materials discussed in this manuscript.
14 references
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25
Ann Otol Rhinol Laryngol
. 2020 Jun 30;3489420937731. doi: 10.1177/0003489420937731. Online ahead of print.
The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology
Geoffrey Casazza 1, Matthew L Carlson 2, Clough Shelton 3, Richard K Gurgel 3
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PMID: 32602346 DOI: 10.1177/0003489420937731
Abstract
Objective: Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base.
Study design: Retrospective case series.
Setting: Two tertiary care academic centers.
Patients: Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017.
Interventions: Surgical management of medially-invasive cholesteatomas.
Main outcome measures: The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed.
Results: Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence.
Conclusions: The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.
Keywords: cholesteatoma; chronic ear disease; skull base surgery; transcochlear; translabyrinthine.
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26
World Neurosurg
. 2020 Jun 27;S1878-8750(20)31460-1. doi: 10.1016/j.wneu.2020.06.192. Online ahead of print.
Temporal Bone Chondroblastoma: Systematic Review of Clinical Features and Outcomes
Abdelsimar T Omar 2nd 1, Jeric L Arbizo 2, Kimberly Mae C Ong 2, Christine Mae G Olivar 3, Jonathan P Rivera 3, Charlotte M Chiong 4, Arsenio Claro A Cabungcal 2, Kathleen Joy O Khu 1
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PMID: 32603862 DOI: 10.1016/j.wneu.2020.06.192
Abstract
Objectives: Chondroblastoma is an uncommon benign neoplasm of cartilaginous origin usually involving the long bones. The temporal bone is a rare location for this tumor. As such, the clinical profile, optimal medical and surgical management, and outcomes of treatment for temporal bone chondroblastoma remain unknown.
Materials and methods: We performed a systematic review of the SCOPUS, PubMed, and CENTRAL databases for case reports and case series on patients with histopathologically proven temporal bone chondroblastoma. Data on demographics, clinical manifestation, surgical management, adjuvant treatment, and outcome on last follow-up were collected.
Results: A total of 100 cases were reported in the literature, including one described in the current study. The mean age of patients was 42.3 years (2 - 85 years), with a slight male predilection (1.3:1). The most common clinical manifestations were otologic complaints such as hearing loss (65%), tinnitus, and otalgia, and a palpable mass. Surgical excision was done in all cases, with gross total excision achieved in 58%. Radiation therapy was performed in 18% of cases, mostly as adjuvant treatment after subtotal excision. There were no deaths at a median follow-up of 2 years. Among the patients with detailed status on follow-up, 58% had complete neurologic recovery, 38% had partial recovery, while 4% had progression of symptoms due to tumor recurrence.
Conclusion: Temporal bone chondroblastoma has a distinct clinical profile from chondroblastoma of long bones. Surgery is the mainstay of treatment, and radiation therapy may be given after subtotal excision. Outcomes are generally favorable after treatment.
Keywords: Chondroblastoma; skull base surgery; temporal bone.
Copyright © 2020 Elsevier Inc. All rights reserved.
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27
Editorial World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 22;6(2):83. doi: 10.1016/j.wjorl.2019.12.002. eCollection 2020 Jun.
Evolution in Surgery for the Anterior Skull Base
Marc A Cohen 1
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PMID: 32596651 PMCID: PMC7296507 DOI: 10.1016/j.wjorl.2019.12.002
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28
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935395. doi: 10.1177/0194599820935395. Online ahead of print.
Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High-Volume Center Confer Survival Benefit?
Jordan I Teitelbaum 1, Khalil Issa 1, Ian R Barak 2, Feras Y Ackall 1, Sin-Ho Jung 2, David W Jang 1, Ralph Abi Hachem 1
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PMID: 32600116 DOI: 10.1177/0194599820935395
Abstract
Objective: To determine whether treatment of sinonasal squamous cell carcinoma (SCC) at a high-volume facility affects survival.
Study design: Retrospective database analysis.
Setting: National Cancer Database (2004-2014).
Subjects and methods: The National Cancer Database was queried for sinonasal SCC from 2004 to 2014. Patient demographics, tumor characteristics and classification, resection margins, treatment regimen, and facility case-specific volume-averaged per year and grouped in tertiles as low (0%-33%), medium (34%-66%), and high (67%-100%)-were compared. Overall survival was compared with Cox proportional hazards regression analysis.
Results: A total of 3835 patients treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. Patients who underwent surgery with adjuvant RT had better overall survival (hazard ratio [HR], 0.74; P < .001; 95% CI, 0.63-0.86). As for treatment volume per facility, 7.4% of patients were treated at a low-volume center, 17.5% at a medium-volume center, and 75.1% at a high-volume center. Univariate analysis showed that treatment at a high-volume facility conferred a significantly better overall survival (HR, 0.77; P = .002). Multivariable Cox proportional hazards regression analysis, adjusting for age, sex, tumor classification, and treatment regimen, demonstrated that patients who underwent treatment at a high-volume facility (HR, 0.81; P < .001) had significantly improved survival.
Conclusion: This study shows a better overall survival for sinonasal SCC treated at high-volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.
Keywords: facility volume; oncologic outcome; sinonasal squamous cell carcinoma; sinonasal tumors; treatment center.
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29
Case Reports World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 18;6(2):115-117. doi: 10.1016/j.wjorl.2020.01.003. eCollection 2020 Jun.
Endoscopic Trans-Pterygoid Resection of a Low-Grade Cribriform Cystadenocarcinoma of the Infratemporal Fossa
Vikram G Ramjee 1, Landon J Massoth 1 2, John P Richards 2nd 3, Kibwei A McKinney 1
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PMID: 32596656 PMCID: PMC7296483 DOI: 10.1016/j.wjorl.2020.01.003
Free PMC article
Abstract
This article presents a case of low-grade cribriform cystadenocarcinomas (LGCCC), a rare salivary gland tumor manifesting in the infratemporal fossa (ITF). The lesion in this case is unique in its location, histopathology, and management in that the tumor resection was performed using an exclusively endoscopic, endonasal approach. This case highlights the expanding application of endoscopic skull base techniques to address an indolent, slow-growing malignancy of the ITF.
Keywords: Cribriform cystadenocarcinoma; Endoscopic; Infratemporal fossa; Intraductal carcinoma; Low-grade; Salivary gland neoplasm.
© 2020 The Authors.
Conflict of interest statement
Kibwei A. McKinney is a part of the Speakers Bureau for Intersect ENT.
10 references2 figures
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30
J Laryngol Otol
. 2020 May;134(5):377-378. doi: 10.1017/S0022215120000663.
The World Health Organization's World Report on Hearing: A Call to Action for Hearing Care Providers
C L Nieman 1 2, C M McMahon 3
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PMID: 32597386 DOI: 10.1017/S0022215120000663
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Neuro Oncol
. 2019 Nov 4;21(11):1412-1422. doi: 10.1093/neuonc/noz106.
Automatic Assessment of Glioma Burden: A Deep Learning Algorithm for Fully Automated Volumetric and Bidimensional Measurement
Ken Chang 1, Andrew L Beers 1, Harrison X Bai 2, James M Brown 1, K Ina Ly 3, Xuejun Li 4, Joeky T Senders 5, Vasileios K Kavouridis 5, Alessandro Boaro 5, Chang Su 6, Wenya Linda Bi 7, Otto Rapalino 8, Weihua Liao 9, Qin Shen 10, Hao Zhou 11, Bo Xiao 11, Yinyan Wang 12, Paul J Zhang 13, Marco C Pinho 14, Patrick Y Wen 15, Tracy T Batchelor 16, Jerrold L Boxerman 17, Omar Arnaout 5, Bruce R Rosen 1, Elizabeth R Gerstner 3, Li Yang 18, Raymond Y Huang 19, Jayashree Kalpathy-Cramer 1
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PMID: 31190077 PMCID: PMC6827825 DOI: 10.1093/neuonc/noz106
Free PMC article
Abstract
Background: Longitudinal measurement of glioma burden with MRI is the basis for treatment response assessment. In this study, we developed a deep learning algorithm that automatically segments abnormal fluid attenuated inversion recovery (FLAIR) hyperintensity and contrast-enhancing tumor, quantitating tumor volumes as well as the product of maximum bidimensional diameters according to the Response Assessment in Neuro-Oncology (RANO) criteria (AutoRANO).
Methods: Two cohorts of patients were used for this study. One consisted of 843 preoperative MRIs from 843 patients with low- or high-grade gliomas from 4 institutions and the second consisted of 713 longitudinal postoperative MRI visits from 54 patients with newly diagnosed glioblastomas (each with 2 pretreatment "baseline" MRIs) from 1 institution.
Results: The automatically generated FLAIR hyperintensity volume, contrast-enhancing tumor volume, and AutoRANO were highly repeatable for the double-baseline visits, with an intraclass correlation coefficient (ICC) of 0.986, 0.991, and 0.977, respectively, on the cohort of postoperative GBM patients. Furthermore, there was high agreement between manually and automatically measured tumor volumes, with ICC values of 0.915, 0.924, and 0.965 for preoperative FLAIR hyperintensity, postoperative FLAIR hyperintensity, and postoperative contrast-enhancing tumor volumes, respectively. Lastly, the ICCs for comparing manually and automatically derived longitudinal changes in tumor burden were 0.917, 0.966, and 0.850 for FLAIR hyperintensity volume, contrast-enhancing tumor volume, and RANO measures, respectively.
Conclusions: Our automated algorithm demonstrates potential utility for evaluating tumor burden in complex posttreatment settings, although further validation in multicenter clinical trials will be needed prior to widespread implementation.
Keywords: RANO; deep learning; glioma; longitudinal response assessment; segmentation.
The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.
Comment in
On the promise of artificial intelligence for standardizing radiographic response assessment in gliomas.
Ellingson BM.
Neuro Oncol. 2019 Nov 4;21(11):1346-1347. doi: 10.1093/neuonc/noz162.
PMID: 31504809 No abstract available.
Cited by 5 articles33 references6 figures
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Review World Neurosurg
. 2020 Jun 26;S1878-8750(20)31440-6. doi: 10.1016/j.wneu.2020.06.172. Online ahead of print.
The Future of Skull Base Surgery: A View Through Tinted Glasses
Laligam N Sekhar 1, Gordana Juric-Sekhar 2, Zeeshan Qazi 3, Anoop Patel 3, Lynn B McGrath Jr 3, James Pridgeon 3, Niveditha Kalavakonda 4, Blake Hannaford 4
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PMID: 32599213 DOI: 10.1016/j.wneu.2020.06.172
Abstract
This article broadly outlines the potential advances in the field of skull base surgery, which may occur in the next 20 years based on many areas of current research in biology and technology. Many of these advances are also broadly applicable to other areas of neurosurgery. We ground our predictions for future developments in an exploration of what patients and surgeons most desire as outcomes for care. This leads to an examination of recent developments in the field and outlines several promising areas of future improvement in skull base surgery, per se, as well as identifying new hospital support systems needed to accommodate these changes. These include, but are not limited to advances in imaging, Raman Spectroscopy and Microscopy, 3-dimensional printing and rapid prototyping, master-slave and semi-autonomous robots, artificial intelligence applications in all areas of medicine, tele-medicine, and green technologies in hospitals. In addition, we review therapeutic approaches employing nanotechnology, genetic engineering and anti-tumoral antibodies, as well as stem cell technologies to repair damage caused by traumatic injuries, tumors, and iatrogenic injuries to the brain and cranial nerves. Additionally, we discuss the training requirements for future skull- base surgeons and stress the need for adaptability and change. However, the essential requirements for skull base surgeons remain unchanged, namely: knowledge, attention to details, technical skill, innovation, judgement, and compassion. Our conclusion is that active involvement in these rapidly evolving technologies will enable us to shape some of the future of our discipline to address the needs of both patients and our profession.
Copyright © 2020 Elsevier Inc. All rights reserved.
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World Neurosurg
. 2020 Jun 26;S1878-8750(20)31425-X. doi: 10.1016/j.wneu.2020.06.157. Online ahead of print.
Efficacy of the Endoscopic Triportal Transmaxillary Approach for Treating Lateral Middle Skull Base Tumors: A Technical Note and Retrospective Case Series
Toru Umehara 1, Manabu Kinoshita 2, Masaki Hayama 3, Takashi Shikina 4, Yasunori Fujimoto 5, Yohei Maeda 3, Hidenori Inohara 3, Haruhiko Kishima 1
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PMID: 32599180 DOI: 10.1016/j.wneu.2020.06.157
Abstract
Background: The endoscopic approach, chiefly via the maxillary sinus, has growing applications for the lateral skull base, and can be classified into the use of "endonasal" or "sublabial" entry. While the "endonasal" transmaxillary approach has been well-accepted, it has a limitation with respect to the lateral exposure. A possible solution is the use of the "sublabial" transmaxillary approach via the canine fossa, which assures lateral accessibility. In clinical practice, we have taken advantage of the concomitant use of the endonasal and sublabial transmaxillary approach for selected patients harboring lateral skull base lesions. In addition to binostril pathways, canine fossa trephination was constructed to facilitate this combined approach, termed the endoscopic triportal transmaxillary approach (ETTA).
Methods: The efficacy of the ETTA was evaluated within a case series. A single-institution retrospective analysis was performed in patients with lateral middle skull base tumors treated via ETTA.
Results: In clinical practice, four patients were eligible for the study, including one receiving a combined endoscopic and transcranial approach. No major complications occurred in patients included in this series. The ETTA facilitated the dynamic manipulation of instruments, which led to rapid hemostasis and the satisfactory surgical resection of tumors. Furthermore, it reduced intraoperative postural stress experienced by the surgeons who performed the procedures.
Conclusions: The concomitant use of the trans-canine fossa approach effectively ameliorated significant technical challenges that tend to occur when using a purely endonasal approach. The ETTA can be an attractive option for treating lateral and middle skull base lesions.
Keywords: Endoscopic transmaxillary approach; Short title: Useful approach for lateral skull base; infratemporal fossa; pterygopalatine fossa.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Review World J Otorhinolaryngol Head Neck Surg
. 2020 Apr 8;6(2):118-124. doi: 10.1016/j.wjorl.2020.01.007. eCollection 2020 Jun.
Pediatric Sinonasal and Skull Base Lesions
Charles A Riley 1, Christian P Soneru 1, Jonathan B Overdevest 1, Marc L Otten 2, David A Gudis 1
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PMID: 32596657 PMCID: PMC7296510 DOI: 10.1016/j.wjorl.2020.01.007
Free PMC article
Abstract
Pediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.
Keywords: Chondrosarcoma; Clival chordoma; Craniopharyngioma; Endoscopic sinus surgery; Endoscopic skull base surgery; Juvenile nasopharyngeal angiofibroma; Meningoencephalocele; Pediatrics; Pituitary adenoma.
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None.
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5
Review World J Otorhinolaryngol Head Neck Surg
. 2020 Apr 18;6(2):125-131. doi: 10.1016/j.wjorl.2020.01.008. eCollection 2020 Jun.
Skull Base Chordomas Review of Current Treatment Paradigms
Dan Yaniv 1, Ethan Soudry 1, Yulia Strenov 2, Marc A Cohen 3, Aviram Mizrachi 1
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PMID: 32596658 PMCID: PMC7296475 DOI: 10.1016/j.wjorl.2020.01.008
Free PMC article
Abstract
Background: Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation.
Methods: Literature review of current treatment strategies for chordomas of the skull base.
Results: Surgery is the mainstay of treatment and complete resection has paramount importance for prognosis.When complete resection is not achieved recurrent disease is common. The anatomical complexity of the skull base makes resection complex. Endonasal endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be challenging.Evidence suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the disease. Nonetheless, immediate post-operative radiotherapy improves survival. Many strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy, gamma knife surgery, proton beam therapy, and carbon ion radiation therapy.There is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show promise. Several optional molecular targets exist. Brachyury is overexpressed in 95% of chordomas but not in other mesenchymal neoplasms. However, its precise role in chordoma pathogenesis is currently unclear, and its cellular location in the nucleus makes it difficult to target. The inhibition of brachyury in chordoma cell lines induces growth arrest and apoptosis. This does not have clinical application to date. There are retrospective results with different molecular targeted therapies for advanced chordomas with some effectiveness.
Conclusion: Despite improvements made in the past 10 years in our knowledge of chordoma biology, available therapies still offer a limited benefit. There is an unmet need for new therapeutic options for patients with advanced disease. Therefore, patients with advanced disease should be encouraged to participate in clinical trials when and where available.
Keywords: Chordoma; Review; Skull Base; Surgery; Targeted therapy.
© 2020 The Authors.
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None.
52 references4 figures
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6
Review World J Otorhinolaryngol Head Neck Surg
. 2020 Jun 3;6(2):106-114. doi: 10.1016/j.wjorl.2019.11.002. eCollection 2020 Jun.
Surgical Approaches to the Petrous Apex
Kevin L Li 1, Vijay Agarwal 2, Howard S Moskowitz 1, Waleed M Abuzeid 1
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PMID: 32596655 PMCID: PMC7296478 DOI: 10.1016/j.wjorl.2019.11.002
Free PMC article
Abstract
The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures. Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.
Keywords: Anterior approaches; Endoscopic endonasal approach; Lateral approaches; Petrous apex; Surgical approaches.
© 2020 The Authors.
Conflict of interest statement
Waleed Abuzeid, MD is a consultant for Medtronic Inc. and Intersect ENT. Neither of these relationships is pertinent to the contents of this study.
70 references5 figures
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7
Ann Otol Rhinol Laryngol
. 2020 Jun 29;3489420937728. doi: 10.1177/0003489420937728. Online ahead of print.
Allergic Fungal Sinusitis Imitating an Aggressive Skull Base Lesion in the Setting of Pembrolizumab Immunotherapy
Natalie A Krane 1, Daniel M Beswick 1, David Sauer 2, Kara Detwiller 1, Maisie Shindo 1
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PMID: 32597680 DOI: 10.1177/0003489420937728
Abstract
Objectives: We report a case of acutely worsening allergic fungal sinusitis in a patient receiving immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor.
Methods: A 53-year-old man with a history of metastatic melanoma and recent initiation of pembrolizumab therapy presented with acutely worsening headaches, left abducens nerve palsy, and neuroimaging demonstrating an erosive skull base lesion with bilateral cavernous sinus involvement.
Results: Intraoperative findings were consistent with non-invasive allergic fungal sinus disease. Microbiology and histopathologic data ruled out malignancy and demonstrated Aspergillus fumigatus without concern for angioinvasion. After treatment with antifungal therapy, the patient's symptoms and abducens nerve palsy resolved. Symptoms were well-controlled 7 months after his initial presentation.
Conclusions: Inflammatory sinusitis in patients receiving anti-PD-1 therapy may be secondary to T-cell infiltration, a similar pathophysiology as immune-related adverse events, and warrants appreciation by otolaryngologists given our increasing exposure to immunotherapy and its head and neck manifestations.
Keywords: allergic fungal sinusitis; checkpoint inhibitor; immune-related adverse events; immunotherapy; sinusitis.
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Review World J Otorhinolaryngol Head Neck Surg
. 2020 Apr 17;6(2):132-136. doi: 10.1016/j.wjorl.2020.01.004. eCollection 2020 Jun.
Free Tissue Reconstruction of the Anterior Skull Base: A Review
Elizabeth Bradford Bell 1, Erin R Cohen 1, Zoukaa Sargi 1, Jason Leibowitz 1
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PMID: 32596659 PMCID: PMC7296482 DOI: 10.1016/j.wjorl.2020.01.004
Free PMC article
Abstract
Objective: There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ablation. However, when open resection is required, free flap reconstruction is often necessary to provide sufficient well-vascularized tissue for optimal wound healing as well as providing adequate tissue bulk for cosmesis. This articleaims to providea focused review of free flaps most commonly used in anterior skull base reconstruction.
Methods: This is a state-of-the-art review based on expert opinion and previously published reviews and journal articles, queried using PubMed and Google Scholar.
Results & conclusion: Anterior skull base reconstruction via free tissue transfer is imperative in limiting complications and promoting healing, particularly with large defects, post-radiation, and in at-risk patients. The type of free flap utilized for a particular anterior skull base reconstruction should be tailored to the patient and nature of the disease. This review offers insight into the numerous reconstructive options for the free flap surgeon.
Keywords: Anterior skull base; Free tissue transfer; Head and neck microvascular; Reconstruction.
© 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
Conflict of interest statement
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
36 references3 figures
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9
Review Hear Res
. 2020 Apr 20;107976. doi: 10.1016/j.heares.2020.107976. Online ahead of print.
Regulation of Auditory Plasticity During Critical Periods and Following Hearing Loss
Dora Persic 1, Maryse E Thomas 2, Vassilis Pelekanos 3, David K Ryugo 4, Anne E Takesian 2, Katrin Krumbholz 3, Sonja J Pyott 5
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PMID: 32591097 DOI: 10.1016/j.heares.2020.107976
Abstract
Sensory input has profound effects on neuronal organization and sensory maps in the brain. The mechanisms regulating plasticity of the auditory pathway have been revealed by examining the consequences of altered auditory input during both developmental critical periods-when plasticity facilitates the optimization of neural circuits in concert with the external environment-and in adulthood-when hearing loss is linked to the generation of tinnitus. In this review, we summarize research identifying the molecular, cellular, and circuit-level mechanisms regulating neuronal organization and tonotopic map plasticity during developmental critical periods and in adulthood. These mechanisms are shared in both the juvenile and adult brain and along the length of the auditory pathway, where they serve to regulate disinhibitory networks, synaptic structure and function, as well as structural barriers to plasticity. Regulation of plasticity also involves both neuromodulatory circuits, which link plasticity with learning and attention, as well as ascending and descending auditory circuits, which link the auditory cortex and lower structures. Further work identifying the interplay of molecular and cellular mechanisms associating hearing loss-induced plasticity with tinnitus will continue to advance our understanding of this disorder and lead to new approaches to its treatment.
Keywords: Aging; Auditory brainstem; Auditory cortex; Developmental critical periods; Hearing loss; Hidden hearing loss; Neuronal reorganization; Sensory deprivation; Synaptopathy; Tinnitus.
Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.
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10
Childs Nerv Syst
. 2020 Jun 27. doi: 10.1007/s00381-020-04759-4. Online ahead of print.
Preoperative Planning With a 3D Model and Repair of Sphenoid Dysplasia: A Technical Note
Peter Spazzapan 1, Miha Verdenik 2, Andreja Eberlinc 2
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PMID: 32594237 DOI: 10.1007/s00381-020-04759-4
Abstract
Introduction: Sphenoid dysplasia is a distinctive marker of neurofibromatosis 1. It is a malformation of the sphenoid bone characterized by an enlargement of the superior orbital fissure, through which the intracranial content herniates, leading to a facial disfigurement and exophthalmos and to a potential visual deterioration. Surgical treatment has the aim of separating the intracranial from the intraorbital space.
Methods and results: We present a new technique for the repair of sphenoid dysplasia, based on the preoperative planning on a 3D print of the skull base.
Conclusions: The use of a 3D skull base model allows an effective surgical planning and a precise modelling of the titanium mesh, which is implanted to separate the intracranial from the intraorbital space.
Keywords: Exophthalmos; Neurofibromatosis; Skull base; Sphenoid dysplasia.
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11
Laryngoscope Investig Otolaryngol
. 2020 Feb 26;5(3):344-347. doi: 10.1002/lio2.335. eCollection 2020 Jun.
Effect of Endoscopic Endonasal Skull Base Surgery on Snoring
Do Hyun Kim 1, Min Hyeong Lee 1, Jaeyoon Lee 1, Sung Won Kim 1
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PMID: 32596475 PMCID: PMC7314477 DOI: 10.1002/lio2.335
Free PMC article
Abstract
Background: As the number of endoscopic skull base surgeries has increased, postoperative changes in quality of life require attention, including evaluation of whether snoring symptoms change.
Objective: To investigate the effect of endoscopic endonasal skull base surgery on snoring and nasal symptom scores.
Methods: Between February 2009 and September 2018, 510 patients underwent skull base tumor resection via an endoscopic endonasal approach and were included in this study. Nasal symptoms were scored using the Nasal Obstruction Symptoms Evaluation (NOSE) scale and snoring symptoms were subjectively scored from 0 to 10 by partners using a visual analog scale (VAS). Computational fluid dynamics (CFD) was employed for pilot patient analysis.
Results: A pituitary adenoma was the most common surgical pathology encountered over the past 10 years (81.6% of all tumors). The NOSE scores increased significantly after surgery (pre-surgery, 3.28 ± 3.18; post-surgery, 4.09 ± 3.61; P < .001). The snoring VAS score decreased significantly postoperatively (pre-surgery, 2.91 ± 2.74; post-surgery, 2.43 ± 2.45; P < .001). A positive correlation was apparent between the NOSE and snoring score changes (r = 0.374; P < .001).
Conclusions: Snoring improved after endoscopic endonasal skull base surgery, associated with changes in nasal symptoms.
Level of evidence: 4.
Keywords: endonasal; endoscopic; skull base; snoring.
© 2019 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.
Conflict of interest statement
The authors declare no potential conflict of interest.
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12
Iran J Otorhinolaryngol
. 2020 May;32(110):169-173. doi: 10.22038/ijorl.2019.37340.2220.
Variations of Ethmoid Roof in the Iranian Population- A Cross Sectional Study
Maryam Moradi 1, Bahare Dalili 2
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PMID: 32596176 PMCID: PMC7302525 DOI: 10.22038/ijorl.2019.37340.2220
Free PMC article
Abstract
Introduction: This study aimed to investigate the distribution of ethmoid roof variation and symmetry according to Keros classification.
Materials and methods: This cross-sectional study assessed the paranasal CT scans of 600 patients over 18 years of age with no history of surgery, trauma, or localized fracture in the ethmoid, nose, and anterior skull base. The lateral lamella of the cribriform plate (LLCP) sizes were measured and classified as Keros type I (1-3 mm), II (4-7mm), and III (8-16mm). Moreover, the symmetry was surveyed in accordance with the LLCP measurements on both sides of the ethmoid roof. These variations were analyzed regarding gender and age.
Results: In total, 600 patients participated in this study out of whom 311 cases were male. According to the results, the mean age of the participants was 37.50±16.63 years. Furthermore, the mean values of the LLCP height for the right and left sides were 4.17±1.69 and 4.93±1.97 mm, respectively. Moreover, the asymmetry was observed in 38.3% of the cases, and they were classified as 36.7% Keros type I, 50.5% Keros type II, and 12.8% Keros type III.
Conclusion: Keros type II and symmetry were the most common variations in this study. In addition, these variations were independent of age and gender.
Keywords: Anatomy; Classification; Ethmoid sinus.
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13
Eur Arch Otorhinolaryngol
. 2020 Jun 26. doi: 10.1007/s00405-020-06169-3. Online ahead of print.
The Effect of Superior Canal Dehiscence Size and Location on Audiometric Measurements, Vestibular-Evoked Myogenic Potentials and Video-Head Impulse Testing
Andrea Castellucci 1 2, Gianluca Piras 3 4, Valeria Del Vecchio 3 5, Francesco Maria Crocetta 3 6, Vincenzo Maiolo 7, Gian Gaetano Ferri 3, Angelo Ghidini 6, Cristina Brandolini 3
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PMID: 32592013 DOI: 10.1007/s00405-020-06169-3
Abstract
Purpose: To correlate objective measures of audio-vestibular function with superior canal dehiscence (SCD) size and location in ears with SCD and compare results with literature.
Methods: We retrospectively evaluated 242 patients exhibiting SCD and/or extremely thinned bone overlying superior canals (SC) on CT scans and selected 73 SCD patients (95 ears with SCD). Data concerning audiometry, impedance audiometry, video-head impulse test (vHIT), cervical vestibular-evoked myogenic potentials (cVEMPs) and ocular VEMPs (oVEMPs) to air- (AC) and bone-conducted (BC) stimuli were collected for each pathologic ear and correlated with dehiscence size and location.
Results: AC pure-tone average (PTA) (p = 0.013), low-frequency air-bone gap (ABG) (p < 0.001), AC cVEMPs amplitude (p = 0.002), BC cVEMPs amplitude (p < 0.001) and both AC and BC oVEMPs amplitude (p < 0.001) positively correlated with increasing SCD size. An inverse relationship between dehiscence length and both AC cVEMPs and oVEMPs thresholds (p < 0.001) and SC vestibulo-ocular reflex (VOR) gain (p < 0.001) was observed. Dehiscences at the arcuate eminence (AE) exhibited lower SC VOR gains compared to SCD along the ampullary arm (p = 0.008) and less impaired BC thresholds than dehiscences at the superior petrosal sinus (p = 0.04).
Conclusion: We confirmed that SCD size affects AC PTA, ABG and both amplitudes and thresholds of cVEMPs and oVEMPs. We also described a tendency for SC function to impair with increasing SCD size and when dehiscence is located at the AE. The latter data may be explained either by a spontaneous canal plugging exerted by middle fossa dura or by a dissipation through the dehiscence of mechanical energy conveyed to the endolymph during high-frequency impulses.
Keywords: Air–bone gap; Dehiscence size; Superior canal dehiscence; Superior petrosal sinus; Vestibular evoked myogenic potentials; Video head impulse test.
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14
J Histochem Cytochem
. 2020 Jun 30;22155420939833. doi: 10.1369/0022155420939833. Online ahead of print.
Immunocytochemical Localization of Olfactory-signaling Molecules in Human and Rat Spermatozoa
Yuliya Makeyeva 1 2, Christopher Nicol 3, William L Ledger 4, David K Ryugo 1 5 6
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PMID: 32603211 DOI: 10.1369/0022155420939833
Abstract
Expression of olfactory receptors (ORs) in non-olfactory tissues has been widely reported over the last 20 years. Olfactory marker protein (OMP) is highly expressed in mature olfactory sensory neurons (mOSNs) of the olfactory epithelium. It is involved in the olfactory signal transduction pathway, which is mediated by well-conserved components, including ORs, olfactory G protein (Golf), and adenylyl cyclase 3 (AC3). OMP is widely expressed in non-olfactory tissues with an apparent preference for motile cells. We hypothesized that OMP is expressed in compartment-specific locations and co-localize with an OR, Golf, and AC3 in rat epididymal and human-ejaculated spermatozoa. We used immunocytochemistry to examine the expression patterns of OMP and OR6B2 (human OR, served as positive olfactory control) in experimentally induced modes of activation and determine whether there are any observable differences in proteins expression during the post-ejaculatory stages of spermatozoal functional maturation. We found that OMP was expressed in compartment-specific locations in human and rat spermatozoa. OMP was co-expressed with Golf and AC3 in rat spermatozoa and with OR6B2 in all three modes of activation (control, activated, and hyperactivated), and the mode of activation changed the co-expression pattern in acrosomal-reacted human spermatozoa. These observations suggest that OMP expression is a reliable indicator of OR-mediated chemoreception, may be used to identify ectopically expressed ORs, and could participate in second messenger signaling cascades that mediate fertility.
Keywords: chemoreception; fluorescence microscopy; interstitial tissue; olfactory epithelium; olfactory marker protein; reproduction; sperm.
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15
Iran J Otorhinolaryngol
. 2020 May;32(110):133-138. doi: 10.22038/ijorl.2019.36294.2194.
Results of End-To-Side Hypoglossal-Facial Nerve Anastomosis in Facial Paralysis After Skull Base Surgery
Sasan Dabiri 1, Mohammadtaghi Khorsandi Ashtiani 1, Melorina Moharreri 1, Zahra Mahvi Khomami 1, Ali Kouhi 1, Nasrin Yazdani 1, Pedram Borghei 1, Kayvan Aghazadeh 1
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PMID: 32596171 PMCID: PMC7302531 DOI: 10.22038/ijorl.2019.36294.2194
Free PMC article
Abstract
Introduction: The primary aim of facial reanimation surgery is to restore tone, symmetry, and movement to the paralyzed face. Hypoglossal-facial end-to-side anastomosis provides satisfactory facial reanimation in the irreversible proximal injury of the facial nerve. This study discussed the facial function results of end-to-side anastomosing of hypoglossal nerve to facial nerve when the injury occurred during skull base surgery.
Materials and methods: The present study enrolled a total of 10 patients who underwent end-to-side hypoglossal-facial nerve anastomosis after facial nerve paralysis due to skull base surgery. The data of the patients were gathered from hospital records, pictures, and movies during the 18 months of follow-up.
Results: At the 18 months of follow-up, seven (70%) and three (30%) patients were reported with grades III and IV of the House-Brackmann scoring system, respectively. In total, out of the seven grade III patients, six subjects underwent early anastomosis (within the first year of the paralysis). On the other hand, among patients with grade IV, two subjects had late anastomosis.
Conclusion: It seems that early end-to-side hypoglossal-facial anastomosis can be a favorable surgical option with good facial function results for reanimating the facial function of patients with facial paralysis following skull base surgery.
Keywords: Facial nerve paralysis; Hypoglossal-facial nerve anastomosis; Rehabilitation.
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16
Laryngoscope
. 2020 Jan;130(1):E1-E10. doi: 10.1002/lary.28052. Epub 2019 May 13.
Survival in Low-Grade and High-Grade Sinonasal Adenocarcinoma: A National Cancer Database Analysis
Aryan Shay 1, Ashwin Ganti 1, Anish Raman 1, Hannah N Kuhar 1, Samuel R Auger 1, Michael Eggerstedt 2, Tirth Patel 2, Edward C Kuan 3, Pete S Batra 2, Bobby A Tajudeen 2
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PMID: 31081940 DOI: 10.1002/lary.28052
Abstract
Objectives/hypothesis: The purpose of this study was to investigate survival differences between low-grade and high-grade sinonasal adenocarcinoma (SNAC) by examining demographics, tumor characteristics, and treatment modalities.
Study design: Retrospective database analysis.
Methods: The National Cancer Database was queried for patients with SNAC between 2004 and 2015. Univariate and multivariate analyses were performed for all cases of SNAC. Subsequent analysis focused on low-grade (grade 1 and grade 2) and high-grade (grade 3 and grade 4) SNAC.
Results: A total of 1,288 patients with SNAC were included in the main cohort and divided into low grade (n = 601) and high grade (n = 370). The 5-year overall survival for all patients, low-grade, and high-grade was 54%, 64%, and 38%, respectively. Prognostic factors associated with decreased survival for the main cohort include advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.03-1.06), Charlson-Deyo score (HR: 1.37; 95% CI: 1.05-1.78), grade 2 (HR: 2.21; 95% CI: 1.26-3.86], grade 3 (HR: 3.67; 95% CI: 2.09-6.45), and grade 4 (HR: 3.31; 95% CI: 1.38-7.91). Radiotherapy was associated with improved overall survival for high-grade SNAC (HR: 0.41; 95% CI: 0.24-0.70) but not for low-grade SNAC (HR: 1.05; 95% CI: 0.59-1.85).
Conclusions: This investigation is the largest to date analyzing the association of treatment modalities with overall survival in SNAC. Surgery remains paramount to treatment, with radiotherapy offering additional survival benefit for high-grade SNAC. Administration of chemotherapy was not associated with improved survival.
Level of evidence: 4 Laryngoscope, 130:E1-E10, 2020.
Keywords: Adenocarcinoma; National Cancer Database; grade; malignancy; overall survival; sinonasal.
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
22 references
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17
Clin Auton Res
. 2020 Jun 27. doi: 10.1007/s10286-020-00706-0. Online ahead of print.
Somatic and Autonomic Findings in Cancer-Related Base of the Skull Syndromes
Alexandru Barboi 1, Sylwia Pocica 2
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PMID: 32594278 DOI: 10.1007/s10286-020-00706-0
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18
J Allergy Clin Immunol
. 2020 Jun 24;S0091-6749(20)30677-1. doi: 10.1016/j.jaci.2020.04.048. Online ahead of print.
Reply
Joaquim Mullol 1, Franklin Mariño 2, Meritxell Valls 3, Isam Alobid 4, Concepció Marin 5
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PMID: 32593492 DOI: 10.1016/j.jaci.2020.04.048
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19
J Craniofac Surg
. 2020 Jun 24. doi: 10.1097/SCS.0000000000006686. Online ahead of print.
Chondroma in the Area of the Spheno-Ethmoid Junction
Jinfeng Liu 1, Qingqing Hao, Wei Wu, Ningyu Wang
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PMID: 32604309 DOI: 10.1097/SCS.0000000000006686
Abstract
Chondroma in the area of the spheno-ethmoidal junction is very rare. A 29-year-old male patient with chronic rhinosinusitis with nasal polyps was arranged for a preoperative computed tomography scan, and a lesion was accidentally found in his spheno-ethmoidal junction and involved the skull base. Combined with MRI, the lesion was misdiagnosed as fungal sinusitis. However, no fungal lesions were found during the operation, and cartilage tissue was confirmed only after some bone was ground away under the guidance of a surgical navigation system. Our case indicates that chondroma is easily misdiagnosed as fungal sinusitis when it appears in the sinuses and should be carefully distinguished from fungal sinusitis. Moreover, when lesions involve the skull base, surgical navigation systems are useful in accurately locating lesions.
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20
World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 16;6(2):94-99. doi: 10.1016/j.wjorl.2020.01.001. eCollection 2020 Jun.
Endoscopic Endonasal Approaches to the Craniovertebral Junction: The Otolaryngologist's Perspective
Qasim Husain 1, Matthew H Kim 2, Ibrahim Hussain 3, Vijay K Anand 2, Jeffrey P Greenfield 3, Theodore H Schwartz 2 3, Ashutosh Kacker 2
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PMID: 32596653 PMCID: PMC7296474 DOI: 10.1016/j.wjorl.2020.01.001
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Abstract
Objective: To review indications and techniques for the endoscopic endonasal approach to the craniovertebral junction (CVJ), analyze postoperative outcomes, and discuss important technical considerations.
Methods: A retrospective analysis was performed on all patients undergoing endonasal endoscopic approaches to the CVJ from May 2007 to June 2017. Demographic information, presenting symptoms, imaging results, treatment course, postoperative functional status, and follow-up were recorded.
Results: There was a total of 30 patients in this series, with a mean follow-up of 11.7 months. The average age was 33.6 years (range, 5-75 years), with 18 females and 12 males. The majority of patients (n = 22, 73.3%) had Chiari malformation type 1 with basilar invagination and symptomatic cervicomedullary compression as the indication for surgery. Intraoperative cerebrospinal fluid leak (CSF) was noted in 3 cases of odontoid resection and a single case of skull base resection. There were no postoperative CSF leaks. Overall, 81% of patients resumed regular diet by post-operative day 2 (range, 0-8 days). Severe postoperative dysphagia occurred in two cases with one requiring gastrostomy tube placement and another utilizing total parenteral nutrition for support prior to eventual gastrostomy. On average, patients were extubated by postoperative day 0.93 (range 0-3 days), with 85% extubated by postoperative day 1. A tracheotomy was required in one patient.
Conclusion: The endonasal endoscopic approach is a valuable technique for access to the CVJ with minimal disruption of respiratory and alimentary function.
Keywords: Craniovertebral junction; Endoscopic skull base surgery; Odontoidectomy.
© 2020 The Authors.
Conflict of interest statement
None.
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21
Clin Neurol Neurosurg
. 2020 Jun 24;196:106041. doi: 10.1016/j.clineuro.2020.106041. Online ahead of print.
TRANS-FRONTAL SINUS APPROACH FOR OLFACTORY GROOVE MENINGIOMAS: A 19 YEAR EXPERIENCE
Francesco Zenga 1, Federica Penner 2, Fabio Cofano 1, Andrea Lavorato 1, Valentina Tardivo 1, Marco Maria Fontanella 3, Diego Garbossa 1, Roberto Stefini 4
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PMID: 32604034 DOI: 10.1016/j.clineuro.2020.106041
Abstract
Introduction: Olfactory groove meningiomas (OGMs) account for 8-13 % of all intracranial meningiomas. The gold standard of treatment is generally surgery, however various approaches have been used and the literature is still uncertain about the superiority of one treatment over the others. The most debated techniques are traditional microscopic open approaches versus the endoscopic endonasal ones. The aim of this paper is to prove a valid surgical route that gathers the benefits of both endoscopic and transcranial routes.
Methods: Fifty consecutive patients underwent trans-frontal sinus surgical removal of an OGM between January 2000 and January 2019 at the Neurosurgical Departments in Torino, Brescia and Legnano (Italy). The clinical features were collected in a database and compared with neuroimaging and outcomes. All patients were investigated with neuroimaging techniques. Clinical evaluations were performed 3-4 months and 1 year after surgery, together with neuroradiological follow-up.
Results: All patients with OGM underwent Simpson grade I resection. The most common neurological symptom leading to neuroradiological evaluations were headaches (36 %), followed by behavioural changes (30 %), hyposmia/anosmia (12 %), visual impairments (6%) and focal deficits (6%). At 3-4 months follow-up 48 patients underwent a brain MRI (2 patients underwent a brain CT), and a complete resection was confirmed in 45 patients (94 %).
Conclusions: Despite different techniques and studies supported by good evidence, there is no consensus on the best surgical approach for OGMs. The data shown in this article suggests that the trans-frontal sinus approach is a valid alternative to an endoscopic approach and the classical transcranial routes, collecting benefits from both approaches.
Keywords: Anterior cranial fossa; Olfactory groove meningioma; Skull base surgery; Trans frontal sinus approach.
Copyright © 2020 Elsevier B.V. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest There are no conflicts of interest associated with this publication to the writers knowledge and there has been no significant financial support that contributed to this work that could have influenced its outcome. The authors confirm that the manuscript has been read and approved for submission by all the named authors.
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22
Review World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 20;6(2):84-93. doi: 10.1016/j.wjorl.2020.01.005. eCollection 2020 Jun.
Perioperative Management of Endoscopic Transsphenoidal Pituitary Surgery
Martin Hanson 1, Hao Li 1, Eliza Geer 1, Sasan Karimi 1, Viviane Tabar 1, Marc A Cohen 1
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PMID: 32596652 PMCID: PMC7296486 DOI: 10.1016/j.wjorl.2020.01.005
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Abstract
The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.
Keywords: Endoscopic skull base surgery; Perioperative management; Pituitary; Pituitary surgery.
© 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
Conflict of interest statement
None.
98 references
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23
Laryngoscope Investig Otolaryngol
. 2020 May 26;5(3):546-551. doi: 10.1002/lio2.403. eCollection 2020 Jun.
New Marsupialization Technique in Endolymphatic Sac Surgery
Ahmad Daneshi 1, Farideh Hosseinzadeh 1, Saleh Mohebbi 2, Mohammad Mohseni 1, S Saeed Mohammadi 3, Alimohamad Asghari 2
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PMID: 32596499 PMCID: PMC7314464 DOI: 10.1002/lio2.403
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Abstract
Objectives: The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery.
Methods: Forty-three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border.
Results: Mean duration of the follow-up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated.
Conclusion: The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss.
Level of evidence: 3.
Keywords: Meniere's disease; endolymphatic sac decompression; marsupialization technique.
© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.
Conflict of interest statement
The authors declare no potential conflict of interest.
22 references4 figures
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Laryngoscope Investig Otolaryngol
. 2020 May 11;5(3):529-535. doi: 10.1002/lio2.394. eCollection 2020 Jun.
Balance Function After Cochlear Implant and Inner Ear Anomaly: Comparison of Dynamic Posturography
Farideh Hosseinzadeh 1, Alimohamad Asghari 2, Maziar Moradi-Lakeh 3, Mohammad Farhadi 1, Ahmad Daneshi 1, Mohammad Mohseni 1, S Saeed Mohammadi 4
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PMID: 32596497 PMCID: PMC7314490 DOI: 10.1002/lio2.394
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Abstract
Introduction: Patients with sensorineural hearing loss suffer concomitant vestibular dysfunction that is more prevalent in patients with inner ear anomaly and could be aggravated with cochlear implantation. To assess the vestibular dysfunction in patients with cochlear implantation, we compared their results with those of patients with and without inner ear anomaly.
Materials and methods: This is a historical cohort study lasting for 20 years on 50 patients with cochlear implantation. All patients underwent dynamic posturography and Bruininks-Oseretsky Test.
Results: Twenty-two (44%) of the participants showed some types of inner ear anomaly. The frequency of abnormal Bruininks-Oseretsky Test was 45.5% and 10.7% (P = .005, odds ratio [OR] = 6.9). Abnormal composite was seen in 77.3% and 21.4%, respectively (P < .001; OR = 12.5). The mean strategy score in the fifth condition of the sensory organization test was 25.0 ± 20.4 in patients with inner ear anomaly, whereas it was 44.1 ± 18.9 in those without it (P = .001).
Conclusion: Balance capability in cochlear implantation patients with inner ear anomaly compared to those without inner ear anomaly was worse. More vestibular rehabilitation treatment plans are suggested for these patients.
Keywords: Bruininks‐Oseretsky Test; cochlear implantation; inner ear anomaly; posturography; vestibular function tests.
© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.
Conflict of interest statement
All authors acknowledge that they have no affiliations with or involvement in any organization or entity with any financial interest, or nonfinancial interest in the subject matter or materials discussed in this manuscript.
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25
Ann Otol Rhinol Laryngol
. 2020 Jun 30;3489420937731. doi: 10.1177/0003489420937731. Online ahead of print.
The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology
Geoffrey Casazza 1, Matthew L Carlson 2, Clough Shelton 3, Richard K Gurgel 3
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PMID: 32602346 DOI: 10.1177/0003489420937731
Abstract
Objective: Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base.
Study design: Retrospective case series.
Setting: Two tertiary care academic centers.
Patients: Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017.
Interventions: Surgical management of medially-invasive cholesteatomas.
Main outcome measures: The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed.
Results: Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence.
Conclusions: The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.
Keywords: cholesteatoma; chronic ear disease; skull base surgery; transcochlear; translabyrinthine.
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26
World Neurosurg
. 2020 Jun 27;S1878-8750(20)31460-1. doi: 10.1016/j.wneu.2020.06.192. Online ahead of print.
Temporal Bone Chondroblastoma: Systematic Review of Clinical Features and Outcomes
Abdelsimar T Omar 2nd 1, Jeric L Arbizo 2, Kimberly Mae C Ong 2, Christine Mae G Olivar 3, Jonathan P Rivera 3, Charlotte M Chiong 4, Arsenio Claro A Cabungcal 2, Kathleen Joy O Khu 1
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PMID: 32603862 DOI: 10.1016/j.wneu.2020.06.192
Abstract
Objectives: Chondroblastoma is an uncommon benign neoplasm of cartilaginous origin usually involving the long bones. The temporal bone is a rare location for this tumor. As such, the clinical profile, optimal medical and surgical management, and outcomes of treatment for temporal bone chondroblastoma remain unknown.
Materials and methods: We performed a systematic review of the SCOPUS, PubMed, and CENTRAL databases for case reports and case series on patients with histopathologically proven temporal bone chondroblastoma. Data on demographics, clinical manifestation, surgical management, adjuvant treatment, and outcome on last follow-up were collected.
Results: A total of 100 cases were reported in the literature, including one described in the current study. The mean age of patients was 42.3 years (2 - 85 years), with a slight male predilection (1.3:1). The most common clinical manifestations were otologic complaints such as hearing loss (65%), tinnitus, and otalgia, and a palpable mass. Surgical excision was done in all cases, with gross total excision achieved in 58%. Radiation therapy was performed in 18% of cases, mostly as adjuvant treatment after subtotal excision. There were no deaths at a median follow-up of 2 years. Among the patients with detailed status on follow-up, 58% had complete neurologic recovery, 38% had partial recovery, while 4% had progression of symptoms due to tumor recurrence.
Conclusion: Temporal bone chondroblastoma has a distinct clinical profile from chondroblastoma of long bones. Surgery is the mainstay of treatment, and radiation therapy may be given after subtotal excision. Outcomes are generally favorable after treatment.
Keywords: Chondroblastoma; skull base surgery; temporal bone.
Copyright © 2020 Elsevier Inc. All rights reserved.
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27
Editorial World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 22;6(2):83. doi: 10.1016/j.wjorl.2019.12.002. eCollection 2020 Jun.
Evolution in Surgery for the Anterior Skull Base
Marc A Cohen 1
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PMID: 32596651 PMCID: PMC7296507 DOI: 10.1016/j.wjorl.2019.12.002
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28
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935395. doi: 10.1177/0194599820935395. Online ahead of print.
Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High-Volume Center Confer Survival Benefit?
Jordan I Teitelbaum 1, Khalil Issa 1, Ian R Barak 2, Feras Y Ackall 1, Sin-Ho Jung 2, David W Jang 1, Ralph Abi Hachem 1
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PMID: 32600116 DOI: 10.1177/0194599820935395
Abstract
Objective: To determine whether treatment of sinonasal squamous cell carcinoma (SCC) at a high-volume facility affects survival.
Study design: Retrospective database analysis.
Setting: National Cancer Database (2004-2014).
Subjects and methods: The National Cancer Database was queried for sinonasal SCC from 2004 to 2014. Patient demographics, tumor characteristics and classification, resection margins, treatment regimen, and facility case-specific volume-averaged per year and grouped in tertiles as low (0%-33%), medium (34%-66%), and high (67%-100%)-were compared. Overall survival was compared with Cox proportional hazards regression analysis.
Results: A total of 3835 patients treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. Patients who underwent surgery with adjuvant RT had better overall survival (hazard ratio [HR], 0.74; P < .001; 95% CI, 0.63-0.86). As for treatment volume per facility, 7.4% of patients were treated at a low-volume center, 17.5% at a medium-volume center, and 75.1% at a high-volume center. Univariate analysis showed that treatment at a high-volume facility conferred a significantly better overall survival (HR, 0.77; P = .002). Multivariable Cox proportional hazards regression analysis, adjusting for age, sex, tumor classification, and treatment regimen, demonstrated that patients who underwent treatment at a high-volume facility (HR, 0.81; P < .001) had significantly improved survival.
Conclusion: This study shows a better overall survival for sinonasal SCC treated at high-volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.
Keywords: facility volume; oncologic outcome; sinonasal squamous cell carcinoma; sinonasal tumors; treatment center.
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29
Case Reports World J Otorhinolaryngol Head Neck Surg
. 2020 Mar 18;6(2):115-117. doi: 10.1016/j.wjorl.2020.01.003. eCollection 2020 Jun.
Endoscopic Trans-Pterygoid Resection of a Low-Grade Cribriform Cystadenocarcinoma of the Infratemporal Fossa
Vikram G Ramjee 1, Landon J Massoth 1 2, John P Richards 2nd 3, Kibwei A McKinney 1
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PMID: 32596656 PMCID: PMC7296483 DOI: 10.1016/j.wjorl.2020.01.003
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Abstract
This article presents a case of low-grade cribriform cystadenocarcinomas (LGCCC), a rare salivary gland tumor manifesting in the infratemporal fossa (ITF). The lesion in this case is unique in its location, histopathology, and management in that the tumor resection was performed using an exclusively endoscopic, endonasal approach. This case highlights the expanding application of endoscopic skull base techniques to address an indolent, slow-growing malignancy of the ITF.
Keywords: Cribriform cystadenocarcinoma; Endoscopic; Infratemporal fossa; Intraductal carcinoma; Low-grade; Salivary gland neoplasm.
© 2020 The Authors.
Conflict of interest statement
Kibwei A. McKinney is a part of the Speakers Bureau for Intersect ENT.
10 references2 figures
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30
J Laryngol Otol
. 2020 May;134(5):377-378. doi: 10.1017/S0022215120000663.
The World Health Organization's World Report on Hearing: A Call to Action for Hearing Care Providers
C L Nieman 1 2, C M McMahon 3
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PMID: 32597386 DOI: 10.1017/S0022215120000663
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