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Philips R, Martin D, Eskander A, Schord J, Brown N, Zhao S, Brock G, Kumar B, Carrau R, Ozer E, Agrawal A, Kang SY, Rocco JW, Schuller D, Ali S, Blakaj D, Bhatt A, Grecula J, Teknos T, Diavolitsis V, Old M. Effect of adjuvant radiotherapy treatment center volume on overall survival. Oral Oncol 2018; 78:46-51. [PMID: 29496057 DOI: 10.1016/j.oraloncology.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES to examine the impact of radiotherapy center volume on overall survival in patients with oral cavity and oropharyngeal squamous cell carcinoma getting adjuvant radiation therapy after receiving surgery at a high-volume center. MATERIALS AND METHODS a retrospective study was conducted on patients with oral cavity squamous cell carcinoma or oropharyngeal squamous cell carcinoma treated surgically at a tertiary institution from 2000 to 2012 who received adjuvant radiotherapy. The outcome variable was overall survival and the independent variable was location of adjuvant radiation therapy: high-volume center (HVC) versus low-volume center (LVC). Cox proportional hazards models were used to assess associations between predictors of death. Variables that were found to be significant at the α = 0.10 were included in a multivariable model. RESULTS 336 patients met inclusion criteria. One-hundred thirty-nine patients received adjuvant radiation therapy at HVC and 197 patients received adjuvant radiation therapy at LVC. A univariate Cox proportional hazards model identified the variables location, age, marital status, subsite, T stage, extracapsular extension, and smoking status to include in a multivariable model. Age, subsite, T stage, and extracapsular extension were independent predictors of overall survival (p < .05). Location (p = .55), marital status (p = .29), and smoking status (p = .22) were not statistically significant predictors of survival. CONCLUSION After surgery at a HVC, the volume of adjuvant radiation therapy center was not significantly associated with overall survival. Significant predictors of survival included age, subsite, T stage, and extracapsular extension.
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Eskander A, Kang SY, Tweel B, Sitapara J, Old M, Ozer E, Agrawal A, Carrau R, Rocco J, Teknos TN. Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients. Otolaryngol Head Neck Surg 2018; 158:265-272. [DOI: 10.1177/0194599817742373] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To determine the predictors of length of stay (LOS), readmission within 30 days, and unplanned return to the operating room (OR) within 30 days in head and neck free flap patients. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (OSU, 2006-2012) were assessed. Multivariable logistic regression to assess the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results In total, 515 patients were identified, of whom 66% had oral cavity cancers, 33% had recurrent tumors, and 28% underwent primary radiotherapy. Of the patients, 31.5% had a LOS greater than 9 days, predicted by longer operative time, oral cavity and pharyngeal tumor sites, blood transfusion, diabetes mellitus, and any complication. A total of 12.6% of patients were readmitted within 30 days predicted by absent OSU preoperative assessment clinic attendance and any complication, and 14.8% of patients had an unplanned OR return predicted by advanced age. Conclusions When assessing quality metrics, adjustment for the complexity involved in managing patients with head and neck cancer with a high comorbidity index, clean contaminated wounds, and a high degree of primary radiotherapy is important. Patients seen in a preoperative assessment clinic had a lower risk of readmission postoperatively, and this should be recommended for all head and neck free flap patients. Quality improvement projects should focus on predictors and prevention of complications as this was the number one predictor of both increased length of stay and readmission.
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Santamaría A, Langdon C, López-Chacon M, Cordero A, Enseñat J, Carrau R, Bernal-Sprekelsen M, Alobid I. Radio-anatomical analysis of the pericranial flap "money box approach" for ventral skull base reconstruction. Laryngoscope 2017; 127:2482-2489. [PMID: 28322453 DOI: 10.1002/lary.26574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/27/2017] [Accepted: 02/09/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the versatility of the pericranial flap (PCF) to reconstruct the ventral skull base, using the frontal sinus as a gate for its passage into the sinonasal corridor "money box approach." STUDY DESIGN Anatomic-radiological study and case series. METHODS Various approaches and their respective defects (cribriform, transtuberculum, clival, and craniovertebral junction) were completed in 10 injected specimens. The PCF was introduced into the nose through the uppermost portion of the frontal sinus (money box approach). Computed tomography (CT) scans (n = 50) were used to measure the dimensions of the PCF and the skull base defects. The vertical projection of the external ear canal was used as the reference point to standardize the incisions for the PCF. RESULTS The surface area and maximum length of the PCF were 121.5 ± 19.4 cm2 and 18.3 ± 1.3 cm, respectively. Using CT scans, we determined that to reconstruct defects secondary to transcribriform, transtuberculum, clival, and craniovertebral approaches, the PCF distal incision must be placed respectively at -3.7 ± 2.0 cm (angle -17.4 ± 8.5°), -0.2 ± 2.0 cm (angle -1.0 ± 9.3°), +5.5 ± 2.3 cm (angle +24.4 ± 9.7°), +8.4 ± 2.4 cm (angle +36.6 ± 11.5°), as related to the reference point. Skull base defects in our clinical cohort (n = 6) were completely reconstructed uneventfully with the PCF. CONCLUSIONS The PCF renders enough surface area to reconstruct all possible defects in the ventral and median skull base. Using the uppermost frontal sinus as a gateway into the nose (money box approach) is feasible and simple. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2482-2489, 2017.
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Somma T, Solari D, Beer-Furlan A, Guida L, Otto B, Prevedello D, Cavallo LM, Carrau R, Cappabianca P. Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature. World Neurosurg 2017; 100:369-380. [DOI: 10.1016/j.wneu.2016.11.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 12/28/2022]
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Priddy BH, Nunes CF, Beer-Furlan A, Carrau R, Dallan I, Prevedello DMS. A Side Door to Meckel's Cave: Anatomic Feasibility Study for the Lateral Transorbital Approach. Oper Neurosurg (Hagerstown) 2017; 13:614-621. [DOI: 10.1093/ons/opx042] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: In the last decade, endoscopic skull base surgery has significantly developed and generated a plethora of techniques and approaches for access to the cranial ventral floor. However, the exploration for the least-aggressive, maximally efficient approach continues.
OBJECTIVE: To describe in detail an anatomical study, along with the technical nuances of a novel endoscopic approach to Meckel's Cave (MC) using a lateral transorbital (LTO) route.
METHODS: Eighteen orbits of injected cadaveric specimens were operated on, using an endoscopic LTO approach to MC, middle cranial fossa, and paramedian skull base preserving the orbital rim. Surgical navigation and an after-the-fact infratemporal craniectomy were utilized to identify the limits of the approach.
RESULTS: Following a transorbital approach opening a trapezoid window at the superolateral aspect (average 166.7 mm2), a middle fossa “peeling” and full visualization of MC was accomplished with no difficulties in all specimens. The entire approach was performed extradurally without the need to expose the temporal lobe.
CONCLUSION: In a cadaveric model, the endoscopic LTO approach affords a direct route to access MC. Its main advantage is that it is minimally disruptive in nature, less brain retraction is required, and it reaches the middle fossa in an anterolateral perspective. It also requires no manipulation of the temporalis muscle, limited cosmetic incision, and rapid recovery. It seems a viable alternative to traditional approaches for lesions lateral to the cranial nerves at the cavernous sinus and MC, that is, schwannomas. Clinical utilization of this approach will challenge its efficacy and identify limitations.
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Lima L, Servian D, Gomez M, Montaser A, Vasconcelos V, Furlan A, El-Khatib A, Otto B, Carrau R, Prevedello D. Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gomez M, Carrau R, Prevedello D, Otto B, Lima L, Servian D, Montaser A, de Vasconcelos V, Naudy C. Olfactory Grove Meningiomas: Endoscopic Endonasal Corridors Based on Anatomical Landmarks for Olfaction Revised. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hardesty D, Beer-Furlan A, Jamshidi A, Carrau R, Prevedello D. A Proposed Algorithm for the Management of Large Third Ventricular Craniopharyngiomas. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Montaser A, Furlan A, Gomez M, Lima L, Servian D, Vasconcelos V, Prevedello D, Carrau R, Otto B. Retrospective Review of Complications Related to Extended Endoscopic Endonasal Skull Base Surgery. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oyama K, Ishii Y, Tahara S, Watanabe T, Hirohata T, Katsuno M, Prevedello D, Carrau R, Froelich S, Morita A, Matsuno A. Surgical Anatomy for Endoscopic Endonasal Approach to the Ventrolateral Skull Base Lesions. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gomez M, Carrau R, Prevedello D, Otto B, Montaser A, Servian D, Lima L, de Vasconcelos V, Naudy C. Olfactory Anatomy and Surgical Implications for the Preservation of Its Function. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1598635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Montaser A, Lima L, Gomez M, Servian D, Vasconcelos V, Furlan A, Prevedello D, Carrau R, Otto B. Extended Endoscopic Endonasal Clipping of Intracranial Aneurysms: An Anatomical Feasibility Study. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hollingsworth B, Senter L, Zhang X, Brock GN, Jarjour W, Nagy R, Brock P, Coombes KR, Kloos RT, Ringel MD, Sipos J, Lattimer I, Carrau R, Jhiang SM. Risk Factors of 131I-Induced Salivary Gland Damage in Thyroid Cancer Patients. J Clin Endocrinol Metab 2016; 101:4085-4093. [PMID: 27533304 PMCID: PMC5095242 DOI: 10.1210/jc.2016-1605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Sialadenitis and xerostomia are major adverse effects of 131I therapy in thyroid cancer patients. The risk factors for these adverse effects, other than administered activity of 131I, have not been investigated. OBJECTIVE The aim of this study is to identify risk factors for 131I-induced salivary gland damage among follicular cell-derived thyroid cancer patients. DESIGN We enrolled 216 thyroid cancer patients who visited The Ohio State University Wexner Medical Center between April 2013 and April 2014. Symptoms of xerostomia and sialadenitis were identified via questionnaire and medical record search. To validate the findings in a large cohort, we retrospectively searched for ICD-9/10 codes for sialadenitis, xerostomia, and autoimmune disease associated with Sjögren's syndrome (AID-SS) in our existing database (n = 1507). Demographic and clinical information was extracted from medical records. Multivariate analyses were performed to identify independent predictors for salivary gland damage. RESULTS 131I treatment associated with higher incidence of xerostomia and sialadenitis. Patients with xerostomia had 46 mCi higher mean cumulative 131I activity and 21 mCi higher mean first-administered 131I activity than patients without xerostomia. Increased age associated with higher incidence of xerostomia, and females had a higher incidence of sialadenitis. Patients who experienced sialadenitis before 131I therapy had higher sialadenitis incidence after 131I therapy. 131I-treated patients diagnosed with AID-SS, whether before or after 131I treatment, had a higher incidence of xerostomia and sialadenitis among 131I-treated patients. CONCLUSION Risk factors for 131I-induced salivary gland damage include administered 131I activity, age, gender, history of sialadenitis before 131I treatment, and AID-SS diagnosis.
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Hachem RA, Beer-Furlan A, Elkhatib A, Rangarajan S, Prevedello D, Blakaj D, Bhatt A, Carrau R. Modern Treatment Outcomes in Sinonasal Malignancies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Arrese LC, Carrau R, Plowman EK. Relationship Between the Eating Assessment Tool-10 and Objective Clinical Ratings of Swallowing Function in Individuals with Head and Neck Cancer. Dysphagia 2016. [PMID: 27538876 DOI: 10.1007/s00455-016-9741-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Eating Assessment Tool-10 (EAT-10) represents a validated, easy to administer patient report dysphagia severity scale. Although its ability to detect swallowing impairment has been investigated in other patient populations, the utility of this instrument in individuals with head and neck cancer (HNC) has not been studied. The aim of the current investigation was to determine the relationship between patient ratings of swallowing impairment (EAT-10) and objective clinical ratings of swallow physiology in individuals with HNC. Forty-four HNC participants completed the EAT-10 and a standardized videofluoroscopy swallow study. Blinded raters determined airway safety using the penetration-aspiration scale (PAS) and swallowing function using the modified barium swallow impairment profile (MBSImP™©). Participants were stratified into three groups (pre-treatment through 1 year post-treatment, 1-5 years post-treatment, and >5 years post-treatment). Independent t tests, Pearson's and Spearman's Rho correlations, and a Bonferroni correction for multiple comparisons were performed. EAT-10 scores were significantly higher in HNC patients with unsafe swallowing (M 24.45, SD 8.32) compared to those with safe swallowing (M 16.20, SD 12.14), t(21) = -2.36, p < 0.04. Significant correlations were revealed between EAT-10 scores and the MBSImP™© (pharyngeal composite), and PAS scores (p < 0.05) for the pre-treatment to within 1 year post-treatment group. No associations, however, were observed for HNC patients in the time groups representing greater than 1-year post cancer treatment.
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Arrese LC, Carrau R, Plowman EK. Relationship Between the Eating Assessment Tool-10 and Objective Clinical Ratings of Swallowing Function in Individuals with Head and Neck Cancer. Dysphagia 2016; 32:83-89. [PMID: 27538876 DOI: 10.1007/s00455-016-9741-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/05/2016] [Indexed: 12/12/2022]
Abstract
The Eating Assessment Tool-10 (EAT-10) represents a validated, easy to administer patient report dysphagia severity scale. Although its ability to detect swallowing impairment has been investigated in other patient populations, the utility of this instrument in individuals with head and neck cancer (HNC) has not been studied. The aim of the current investigation was to determine the relationship between patient ratings of swallowing impairment (EAT-10) and objective clinical ratings of swallow physiology in individuals with HNC. Forty-four HNC participants completed the EAT-10 and a standardized videofluoroscopy swallow study. Blinded raters determined airway safety using the penetration-aspiration scale (PAS) and swallowing function using the modified barium swallow impairment profile (MBSImP™©). Participants were stratified into three groups (pre-treatment through 1 year post-treatment, 1-5 years post-treatment, and >5 years post-treatment). Independent t tests, Pearson's and Spearman's Rho correlations, and a Bonferroni correction for multiple comparisons were performed. EAT-10 scores were significantly higher in HNC patients with unsafe swallowing (M 24.45, SD 8.32) compared to those with safe swallowing (M 16.20, SD 12.14), t(21) = -2.36, p < 0.04. Significant correlations were revealed between EAT-10 scores and the MBSImP™© (pharyngeal composite), and PAS scores (p < 0.05) for the pre-treatment to within 1 year post-treatment group. No associations, however, were observed for HNC patients in the time groups representing greater than 1-year post cancer treatment.
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Teknos TN, Old MO, Grecula JC, Agrawal A, Ozer E, Carrau R, Kang S, Rocco JW, Blakaj D, Diavolitsis V, Baiocchi RA, Kumar B, Savvides P. A phase 1 trial of vorinostat in combination with concurrent chemoradiation therapy in the treatment of advanced stage head and neck squamous cell carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Beer-Furlan A, Jamshidi A, Abi-Hachem R, Otto B, Carrau R, Prevedello D. Endoscopic Endonasal Management for Ventral Skull Base Metastatic Tumors. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vivas A, Díaz J, Slijepcevic A, Wuesthoff C, Prevedello D, Otto B, Carrau R. Anatomic Guidelines for the Repair of CSF Leaks in the Lateral Recess of the Sphenoid Sinus. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tanjararak K, Upadhyay S, Thiensri T, Rianmanee S, Muto J, Prevedello D, Otto B, Carrau R. Parapharyngeal Internal Carotid Artery: A Comparative Analysis of Surgical Exposure and Vascular Control via Endoscopic Endonasal, Transoral and Transcervical Approaches. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Soldatova L, Campbell R, Carrau R, Prevedello D, Ditzel Filho L, Otto B. Sinonasal Neuroendocrine Neoplasms: Histopathologic Differentiation and Treatment Outcomes. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Oyama K, Prevedello D, S. L, Filho D, Muto J, Gun R, Kerr E, Otto B, Carrau R. Anatomic Comparison of the Endonasal and Transpetrosal Approaches for Interpeduncular Fossa Access. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Soldatova L, Campbell R, Schmidt T, Pinto J, Prevedello D, ElKhatib A, Filho L, Otto B, Carrau R. Role of Leukocyte Platelet Rich Fibrin in Endoscopic Endonasal Skull Base Surgery Defect Reconstruction. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1580038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Goulart C, Upadhyay S, Ditzel L, Otto B, Carrau R, Prevedello L, Prevedello D. Newly Diagnosed Sellar Tumors in Patients with Cancer. Advantages of Surgical Intervention Over Empiric Radiotherapy. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Upadhyay S, Buohliqah L, Otto B, Prevedello D, Carrau R. Olfactory Assessment in Patients Undergoing Endoscopic Skull Base Surgery- Lessons Learnt. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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