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Jacquesson T, Djarouf I, Simon É, Haegelen C, Mertens P, Picart T, Fernandez-Miranda J. Educational stereoscopic representation of a step-by-step brain white fiber dissection according to Klingler's method. Surg Radiol Anat 2024; 46:303-311. [PMID: 38376527 DOI: 10.1007/s00276-024-03305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/14/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Understanding and teaching the three-dimensional architecture of the brain remains difficult because of the intricate arrangement of grey nuclei within white matter tracts. Although cortical area functions have been well studied, educational and three-dimensional descriptions of the organization of deep nuclei and white matter tracts are still missing. OBJECTIVE We propose herein a detailed step-by-step dissection of the lateral aspect of a left hemisphere using the Klingler method and provide high-quality stereoscopic views with the aim to help teach medical students or surgeons the three-dimensional anatomy of the brain. METHODS Three left hemispheres were extracted and prepared. Then, according to the Klingler method, dissections were carried out from the lateral aspect. Photographs were taken at each step and were modified to provide stereoscopic three-dimensional views. RESULTS Gray and white structures were described: cortex, claustrum, putamen, pallidum, caudate nucleus, amygdala; U-fibers, external and internal capsules, superior longitudinal fasciculus, frontal aslant fasciculus, uncinate fasciculus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, corticospinal fasciculus, corona radiata, anterior commissure, and optic radiations. CONCLUSION This educational stereoscopic presentation of an expert dissection of brain white fibers and basal ganglia would be of value for theoretical or hands-on teaching of brain anatomy; labeling and stereoscopy could, moreover, improve the teaching, understanding, and memorizing of brain anatomy. In addition, this could be also used for the creation of a mental map by neurosurgeons for the preoperative planning of brain tumor surgery.
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Affiliation(s)
- Timothée Jacquesson
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France.
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Idriss Djarouf
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Émile Simon
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Claire Haegelen
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patrick Mertens
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thiébaud Picart
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
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Geltzeiler M, Choby GW, Ji KSY, JessMace C, Almeida JP, de Almeida J, Champagne PO, Chan E, Ciporen JN, Chaskes MB, Cornell S, Drozdowski V, Fernandez-Miranda J, Gardner PA, Hwang PH, Kalyvas A, Kong KA, McMillan RA, Nayak JV, Patel C, Patel ZM, Celda MP, Pinheiro-Neto C, Sanusi OR, Snyderman CH, Thorp BD, Van Gompel JJ, Zadeh G, Zenonos G, Zwagerman NT, Wang EW. Radiographic predictors of occult intracranial involvement in olfactory neuroblastoma patients. Int Forum Allergy Rhinol 2023; 13:1876-1888. [PMID: 36841933 DOI: 10.1002/alr.23145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Traditional management of olfactory neuroblastoma (ONB) includes margin-negative resection with removal of cribriform plate, dura, and olfactory bulb, regardless of intracranial disease. This approach may be overtreating certain patients. Our investigation examines risk factors associated with occult intracranial disease to optimize therapeutic outcomes. METHODS This retrospective, multi-institutional cohort study examined clinical covariates associated with occult intracranial involvement. Patient demographics, staging, Hyam's grade, and pathologic involvement of dura, olfactory bulb/tract, and brain were collected. Diagnostic imaging was reviewed. Positive and negative predictive value (NPV) were estimated along with effect size estimates. Cox hazard regression examined associations with overall survival (OS) and disease-free survival (DFS). RESULTS A total of 224 subjects with new diagnoses of ONB (2005-2021) were identified. Skull base bone involvement on computed tomography (CT) had the highest NPV for pathologic dura (88.0%), olfactory bulb (88%), and brain involvement (97.3%). Hyam's grade category was significantly associated with dural involvement (φC = 0.26; 95% confidence interval [CI]: 0.16, 0.42). Subjects without radiologic skull base involvement (n = 66) had pathologic positivity of 12.1%. Within this subgroup, Hyam's grade was clinically significant for dural positivity (φ = 0.34; 95% CI: -0.12, 0.71) with 28.6% involvement in high grade tumors. Neither clinical nor pathologic positivity of intracranial structures were associated with significantly different OS or DFS. CONCLUSIONS Both CT and magnetic resonance imaging (MRI) had reasonably good NPV for involvement of dura and olfactory bulb. Higher Hyam's grade was associated with dural involvement. Patients with low-grade tumors not involving the skull base may be suitable for avoiding skull base resection; however, further investigation is warranted.
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Affiliation(s)
- Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Garret W Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Keven Seung Yong Ji
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - C JessMace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - John de Almeida
- Department of Surgery, University of Toronto, Ontario, Canada
| | | | - Erik Chan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Jeremy N Ciporen
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark B Chaskes
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah Cornell
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Veronica Drozdowski
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | | | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | | | - Keonho A Kong
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan A McMillan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Chirag Patel
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Maria Peris Celda
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Olabisi R Sanusi
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gelareh Zadeh
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nathan T Zwagerman
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Choby G, Geltzeiler M, Almeida JP, Champagne PO, Chan E, Ciporen J, Chaskes MB, Fernandez-Miranda J, Gardner P, Hwang P, Ji KSY, Kalyvas A, Kong KA, McMillan R, Nayak J, O’Byrne J, Patel C, Patel Z, Peris Celda M, Pinheiro-Neto C, Sanusi O, Snyderman C, Thorp BD, Van Gompel JJ, Young SC, Zenonos G, Zwagerman NT, Wang EW. Multicenter Survival Analysis and Application of an Olfactory Neuroblastoma Staging Modification Incorporating Hyams Grade. JAMA Otolaryngol Head Neck Surg 2023; 149:837-844. [PMID: 37535372 PMCID: PMC10401389 DOI: 10.1001/jamaoto.2023.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/08/2023] [Indexed: 08/04/2023]
Abstract
Importance Current olfactory neuroblastoma (ONB) staging systems inadequately delineate locally advanced tumors, do not incorporate tumor grade, and poorly estimate survival and recurrence. Objective The primary aims of this study were to (1) examine the clinical covariates associated with survival and recurrence of ONB in a modern-era multicenter cohort and (2) incorporate Hyams tumor grade into existing staging systems to assess its ability to estimate survival and recurrence. Design, Setting, and Participants This retrospective, multicenter, case-control study included patients with ONB who underwent treatment between January 1, 2005, and December 31, 2021, at 9 North American academic medical centers. Intervention Standard-of-care ONB treatment. Main Outcome and Measures The main outcomes were overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) as C statistics for model prediction. Results A total of 256 patients with ONB (mean [SD] age, 52.0 [15.6] years; 115 female [44.9%]; 141 male [55.1%]) were included. The 5-year rate for OS was 83.5% (95% CI, 78.3%-89.1%); for DFS, 70.8% (95% CI, 64.3%-78.0%); and for DSS, 94.1% (95% CI, 90.5%-97.8%). On multivariable analysis, age, American Joint Committee on Cancer (AJCC) stage, involvement of bilateral maxillary sinuses, and positive margins were associated with OS. Only AJCC stage was associated with DFS. Only N stage was associated with DSS. When assessing the ability of staging systems to estimate OS, the best-performing model was the novel modification of the Dulguerov system (C statistic, 0.66; 95% CI, 0.59-0.76), and the Kadish system performed most poorly (C statistic, 0.57; 95% CI, 0.50-0.63). Regarding estimation of DFS, the modified Kadish system performed most poorly (C statistic, 0.55; 95% CI, 0.51-0.66), while the novel modification of the AJCC system performed the best (C statistic, 0.70; 95% CI, 0.66-0.80). Regarding estimation of DSS, the modified Kadish system was the best-performing model (C statistic, 0.79; 95% CI, 0.70-0.94), and the unmodified Kadish performed the worst (C statistic, 0.56; 95% CI, 0.51-0.68). The ability for novel ONB staging systems to estimate disease progression across stages was also assessed. In the novel Kadish staging system, patients with stage VI disease were approximately 7 times as likely to experience disease progression as patients with stage I disease (hazard ratio [HR], 6.84; 95% CI, 1.60-29.20). Results were similar for the novel modified Kadish system (HR, 8.99; 95% CI, 1.62-49.85) and the novel Dulguerov system (HR, 6.86; 95% CI, 2.74-17.18). Conclusions and Relevance The study findings indicate that 5-year OS for ONB is favorable and that incorporation of Hyams grade into traditional ONB staging systems is associated with improved estimation of disease progression.
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Affiliation(s)
- Garret Choby
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mathew Geltzeiler
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | | | | | - Erik Chan
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Jeremy Ciporen
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Mark B. Chaskes
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | | | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Hwang
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Keven Seung Yong Ji
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Keonho A. Kong
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Ryan McMillan
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jayakar Nayak
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Jamie O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Chirag Patel
- Department of Otolaryngology–Head and Neck Surgery, Loyola University, Maywood, Illinois
| | - Zara Patel
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Maria Peris Celda
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Carlos Pinheiro-Neto
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Olabisi Sanusi
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Carl Snyderman
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brian D. Thorp
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | | | - Sarah C. Young
- Department of Neurological Surgery, University of Wisconsin, Milwaukee, Wisconsin
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nathan T. Zwagerman
- Department of Neurological Surgery, University of Wisconsin, Milwaukee, Wisconsin
| | - Eric W. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Dauleac C, Frindel C, Pélissou-Guyotat I, Nicolas C, Yeh FC, Fernandez-Miranda J, Cotton F, Jacquesson T. Full cervical cord tractography: A new method for clinical use. Front Neuroanat 2022; 16:993464. [PMID: 36237419 PMCID: PMC9550930 DOI: 10.3389/fnana.2022.993464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
Despite recent improvements in diffusion-weighted imaging, spinal cord tractography is not used in routine clinical practice because of difficulties in reconstructing tractograms, with a pertinent tri-dimensional-rendering, in a long post-processing time. We propose a new full tractography approach to the cervical spinal cord without extensive manual filtering or multiple regions of interest seeding that could help neurosurgeons manage various spinal cord disorders. Four healthy volunteers and two patients with either cervical intramedullary tumors or spinal cord injuries were included. Diffusion-weighted images of the cervical spinal cord were acquired using a Philips 3 Tesla machine, 32 diffusion directions, 1,000 s/mm2b-value, 2 × 2 × 2 mm voxel size, reduced field-of-view (ZOOM), with two opposing phase-encoding directions. Distortion corrections were then achieved using the FSL software package, and tracking of the full cervical spinal cord was performed using the DSI Studio software (quantitative anisotropy-based deterministic algorithm). A unique region of avoidance was used to exclude everything that is not of the nervous system. Fiber tracking parameters used adaptative fractional anisotropy from 0.015 to 0.045, fiber length from 10 to 1,000 mm, and angular threshold of 90°. In all participants, a full cervical cord tractography was performed from the medulla to the C7 spine level. On a ventral view, the junction between the medulla and spinal cord was identified with its pyramidal bulging, and by an invagination corresponding to the median ventral sulcus. On a dorsal view, the fourth ventricle—superior, middle, and inferior cerebellar peduncles—was seen, as well as its floor and the obex; and gracile and cuneate tracts were recognized on each side of the dorsal median sulcus. In the case of the intramedullary tumor or spinal cord injury, the spinal tracts were seen to be displaced, and this helped to adjust the neurosurgical strategy. This new full tractography approach simplifies the tractography pipeline and provides a reliable 3D-rendering of the spinal cord that could help to adjust the neurosurgical strategy.
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Affiliation(s)
- Corentin Dauleac
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
- *Correspondence: Corentin Dauleac
| | - Carole Frindel
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
| | - Isabelle Pélissou-Guyotat
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Célia Nicolas
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Radiologie, Lyon, France
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - François Cotton
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Radiologie, Lyon, France
| | - Timothée Jacquesson
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
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Ng S, Lima Maldonado I, Destrieux C, Yeh FC, Fernandez-Miranda J, Duffau H, Jacquesson T. Magnetic Resonance Diffusion Tractography of Brain White Matter tracts-An Educational 3-Dimensional Stereoscopic Overview for Operative Planning and Mapping in Brain Tumor Surgery: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e177. [PMID: 35972103 DOI: 10.1227/ons.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | | | | | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Timothée Jacquesson
- Department of Anatomy, University of Lyon 1, Lyon, France.,Multidisciplinary Skull Base Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Lechner M, Takahashi Y, Turri-Zanoni M, Liu J, Counsell N, Hermsen M, Kaur RP, Zhao T, Ramanathan M, Schartinger VH, Emanuel O, Helman S, Varghese J, Dudas J, Riechelmann H, Sprung S, Haybaeck J, Howard D, Engel NW, Stewart S, Brooks L, Pickles JC, Jacques TS, Fenton TR, Williams L, Vaz FM, O'Flynn P, Stimpson P, Wang S, Hannan SA, Unadkat S, Hughes J, Dwivedi R, Forde CT, Randhawa P, Gane S, Joseph J, Andrews PJ, Royle G, Franchi A, Maragliano R, Battocchio S, Bewicke-Copley H, Pipinikas C, Webster A, Thirlwell C, Ho D, Teschendorff A, Zhu T, Steele CD, Pillay N, Vanhaesebroeck B, Mohyeldin A, Fernandez-Miranda J, Park KW, Le QT, West RB, Saade R, Manes RP, Omay SB, Vining EM, Judson BL, Yarbrough WG, Sansovini M, Silvia N, Grassi I, Bongiovanni A, Capper D, Schüller U, Thavaraj S, Sandison A, Surda P, Hopkins C, Ferrari M, Mattavelli D, Rampinelli V, Facchetti F, Nicolai P, Bossi P, Henriquez OA, Magliocca K, Solares CA, Wise SK, Llorente JL, Patel ZM, Nayak JV, Hwang PH, Lacy PD, Woods R, O'Neill JP, Jay A, Carnell D, Forster MD, Ishii M, London NR, Bell DM, Gallia GL, Castelnuovo P, Severi S, Lund VJ, Hanna EY. Clinical outcomes, Kadish-INSICA staging and therapeutic targeting of somatostatin receptor 2 in olfactory neuroblastoma. Eur J Cancer 2022; 162:221-236. [PMID: 34980502 PMCID: PMC9554673 DOI: 10.1016/j.ejca.2021.09.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Olfactory neuroblastoma (ONB) is a rare cancer of the sinonasal region. We provide a comprehensive analysis of this malignancy with molecular and clinical trial data on a subset of our cohort to report on the potential efficacy of somatostatin receptor 2 (SSTR2)-targeting imaging and therapy. METHODS We conducted a retrospective analysis of 404 primary, locally recurrent, and metastatic olfactory neuroblastoma (ONB) patients from 12 institutions in the United States of America, United Kingdom and Europe. Clinicopathological characteristics and treatment approach were evaluated. SSTR2 expression, SSTR2-targeted imaging and the efficacy of peptide receptor radionuclide therapy [PRRT](177Lu-DOTATATE) were reported in a subset of our cohort (LUTHREE trial; NCT03454763). RESULTS Dural infiltration at presentation was a significant predictor of overall survival (OS) and disease-free survival (DFS) in primary cases (n = 278). Kadish-Morita staging and Dulguerov T-stage both had limitations regarding their prognostic value. Multivariable survival analysis demonstrated improved outcomes with lower stage and receipt of adjuvant radiotherapy. Prophylactic neck irradiation significantly reduces the rate of nodal recurrence. 82.4% of the cohort were positive for SSTR2; treatment of three metastatic cases with SSTR2-targeted peptide-radionuclide receptor therapy (PRRT) in the LUTHREE trial was well-tolerated and resulted in stable disease (SD). CONCLUSIONS This study presents pertinent clinical data from the largest dataset, to date, on ONB. We identify key prognostic markers and integrate these into an updated staging system, highlight the importance of adjuvant radiotherapy across all disease stages, the utility of prophylactic neck irradiation and the potential efficacy of targeting SSTR2 to manage disease.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London, UK; Academic Head and Neck Centre, UCL Division of Surgery and Interventional Science, University College London, London, UK; ENT Department, Barts Health NHS Trust, London, United Kingdom; Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA.
| | - Yoko Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Mario Hermsen
- Department of Head and Neck Oncology, Instituto de Investigacio´n Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncologı´a Del Principado de Asturias (IUOPA), Centro de Investigacio´n Biome´dica en Red (CIBER-ONC), Oviedo, Spain
| | - Raman Preet Kaur
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Tianna Zhao
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Volker H Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Oscar Emanuel
- UCL Cancer Institute, University College London, London, UK
| | - Sam Helman
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jordan Varghese
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jozsef Dudas
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Susanne Sprung
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Haybaeck
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria; Diagnostic & Research Center for Molecular BioMedicine, Institute of Pathology, Medical University Graz, Graz, Austria
| | - David Howard
- Head and Neck Cancer Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Nils Wolfgang Engel
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Stewart
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Laura Brooks
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Jessica C Pickles
- Department of Developmental Biology and Cancer & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Department of Developmental Biology and Cancer & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tim R Fenton
- School of Biosciences, University of Kent, Canterbury, UK; School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Luke Williams
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Francis M Vaz
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Paul O'Flynn
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Paul Stimpson
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Simon Wang
- Institute of Nuclear Medicine, University College London, London, UK
| | - S Alam Hannan
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Samit Unadkat
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Jonathan Hughes
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Raghav Dwivedi
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Cillian T Forde
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Premjit Randhawa
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Simon Gane
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Jonathan Joseph
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Peter J Andrews
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Gary Royle
- UCL Cancer Institute, University College London, London, UK
| | | | - Roberta Maragliano
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Simonetta Battocchio
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | | | | | - Amy Webster
- UCL Cancer Institute, University College London, London, UK
| | - Chrissie Thirlwell
- UCL Cancer Institute, University College London, London, UK; College of Medicine and Health and Institute of Biomedical and Clinical Science, University of Exeter, Exeter, UK
| | - Debbie Ho
- Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Andrew Teschendorff
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, China
| | - Tianyu Zhu
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, China
| | - Christopher D Steele
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | | | - Ahmed Mohyeldin
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, USA
| | | | - Ki Wan Park
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, USA
| | - Robert B West
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, USA
| | - Rami Saade
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Peter Manes
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
| | | | - Eugenia M Vining
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
| | | | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Maddalena Sansovini
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Nicolini Silvia
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Ilaria Grassi
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - David Capper
- Department of Neuropathology, Charite - Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany; German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, Institute of Neuropathology, And Research Institute Children's Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Selvam Thavaraj
- Centre for Clinical, Oral & Translational Science, King's College London, Department of Head and Neck Pathology, Guy's Hospital, London, UK
| | - Ann Sandison
- Department of Head and Neck Pathology, Guy's Hospital, London, UK
| | | | | | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Oswaldo A Henriquez
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Kelly Magliocca
- Department of Pathology, Emory University School of Medicine, Atlanta, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jose L Llorente
- Dept Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Zara M Patel
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Jayakar V Nayak
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Peter H Hwang
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Peter D Lacy
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Robbie Woods
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - James P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland; The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amrita Jay
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - Dawn Carnell
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Martin D Forster
- UCL Cancer Institute, University College London, London, UK; Academic Head and Neck Centre, UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Masaru Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Nyall R London
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Sinonasal and Skull Base Tumor Program, Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Diana M Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, USA; Division of Anatomic Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Gary L Gallia
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Stefano Severi
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Valerie J Lund
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK.
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Simon E, Beuriat PA, Delabar V, Jouanneau E, Fernandez-Miranda J, Jacquesson T. Cranial and Cerebral Anatomic Key Points for Neurosurgery: A New Educational Insight. Oper Neurosurg (Hagerstown) 2022; 22:e18-e27. [PMID: 34982906 DOI: 10.1227/ons.0000000000000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The anatomy of both the skull and the brain offers many landmarks that could lead surgery. Cranial "craniometric" key points were described many years ago, and then, cerebral key points-along sulci and gyri-were detailed more recently for microneurosurgical approaches that can reach deep structures while sparing the brain. Nonetheless, this anatomic knowledge is progressively competed by new digital devices, such as imaging guidance systems, although they can be misleading. OBJECTIVE To summarize cranial and sulcal key points and their related anatomic structures to renew their interest in modern neurosurgery and help surgical anatomy teaching. METHODS After a literature review collecting anatomic key points of skull and brain, specimens were prepared and images were taken to expose skull and brain from lateral, superior, posterior, and oblique views. A high-definition camera was used, and images obtained were modified, superimposing both key points and underlying anatomic structures. RESULTS From 4 views, 16 cranial key points were depicted: anterior and superior squamous point, precoronal and retrocoronal point, superior sagittal point, intraparietal point, temporoparietal point, preauricular point, nasion, bregma, stephanion, euryon, lambda, asterion, opisthocranion, and inion. These corresponded to underlying cerebral key points and relative brain parts: anterior and posterior sylvian point, superior and inferior rolandic point, supramarginal and angular gyri, parieto-occipital sulcus, and various meeting points between identifiable sulci. Stereoscopic views were also provided to help learning these key points. CONCLUSION This comprehensive overview of the cranial and sulcal key points could be a useful tool for any neurosurgeon who wants to check her/his surgical route and make the surgery more "gentle, safe, and accurate."
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Affiliation(s)
- Emile Simon
- Department of Anatomy, University of Lyon 1, Lyon, France
| | | | - Violaine Delabar
- Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Timothée Jacquesson
- Department of Anatomy, University of Lyon 1, Lyon, France.,Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,CREATIS Laboratory, CNRS UMR5220, Inserm U1044, INSA-Lyon, University of Lyon 1, Lyon, France
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8
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Mohyeldin A, Katznelson L, Fernandez-Miranda J. Somatotroph Adenomas have a Predilection to Invade the Cavernous Sinus and Resection of the Medial Wall of the Cavernous Sinus Offers the Highest Potential for Biochemical Remission in Acromegaly. J Endocr Soc 2021. [PMCID: PMC8090634 DOI: 10.1210/jendso/bvab048.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Recurrence and remission rates vary widely among different histological subtypes of pituitary adenoma. Invasion of the medial wall of the cavernous sinus is a known mechanism that may account for such failed clinical outcomes as its removal has long been considered unattainable. The use of modern endoscopic techniques allows for direct intraoperative evaluation of invasion and resection of the medial wall of the cavernous sinus with low morbidity when performed by highly experienced surgeons. In this retrospective study we evaluated 105 consecutive primary pituitary adenomas operated by a single surgeon including 28 corticotroph, 27 gonadotroph, 24 somatotroph, 15 lactotroph, 5 null-cell, 5 plurihormonal, and 1 dual adenoma; 53 caused hypersecretory syndromes, specifically acromegaly (30), hyperprolactinemia (15) and Cushing’s disease (8). In each case, we performed meticulous intraoperative inspection of the medial wall with its surgical removal when invasion was suspected, regardless of functional status. Medial wall resection was performed in 46% of pituitary adenomas, and 38/48 walls confirmed pathologic evidence of invasion rendering a positive predictive value of intraoperative evaluation of medial wall invasion of 79%. Furthermore, we show for the first time that the rate of medial wall invasion among pathological subtypes is dramatically different. Somatotroph tumors invaded the medial wall much more often than other adenoma subtypes, 83% intraoperatively and 71% histologically, followed by plurihormonal tumors (40%) and gonadotrophs (33%), both with intraoperative positive predictive value of 100%. The least likely to invade were corticotroph, at a rate of 32% intraoperatively and 21% histologically, and null-cell adenomas at 0%. Removal of the medial wall caused no permanent morbidity with no carotid artery injuries and 2 patients with transient diplopia. We report that resecting the medial wall of the cavernous sinus in acromegaly offers the highest potential for biochemical remission with average postoperative day 1 GH levels at 0.96 ug/l and early surgical remission rates at 90% (100% with adjuvant therapy) based on normalization of IGF-1 levels 3 to 6 months after surgery; these results are significantly better than previously reported but longer follow-up is required for definitive conclusions. Our findings may explain the failed biochemical remission rates seen in acromegaly and illustrate the relevance of advanced surgical techniques for successful outcomes in pituitary surgery.
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Azad AD, Sears CM, Hwang PH, Mohyeldin A, Fernandez-Miranda J, Kossler AL. Multi-compartment skull base orbital cavernous venous malformation: A rare presentation of a common orbital mass. Am J Ophthalmol Case Rep 2021; 21:101020. [PMID: 33598587 PMCID: PMC7868709 DOI: 10.1016/j.ajoc.2021.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/09/2020] [Accepted: 01/14/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose We present a unique case of an orbital intraconal cavernous venous malformation that extended along the trigeminal nerve to the pterygopalatine and middle cranial fossa. Our aim is to describe an atypical presentation of this common orbital vascular mass. Observations A 57-year-old female presented with right eye proptosis. Orbital magnetic resonance imaging demonstrated a lobulated contrast-enhancing mass involving the right intraconal orbital space, pterygopalatine fossa, and right middle cranial fossa, radiographically presumed to be a schwannoma. Intraoperative and histopathologic evaluation confirmed a cavernous venous malformation that extended along the trigeminal nerve. The mass, including its attachments to the cranial nerves and dura, was successfully removed via a combined transorbital and endoscopic endonasal approach. The patient recovered well with 20/20 vision, full extraocular movements, and resolution of proptosis. Conclusions This a rare presentation of an orbital cavernous venous malformation not previously described. Cavernous venous malformations typically present as ovoid well-circumscribed lesions; however, they can also extend outside the orbit along the path of cranial nerves, as was observed in this case. These types of lesions should be included in the differential diagnosis of masses arising from or extending along cranial nerves, even when involving the orbit.
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Affiliation(s)
- Amee D Azad
- Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Connie M Sears
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Ahmed Mohyeldin
- Department of Neurosurgery, Stanford Neuroscience Health Center, Stanford University, Palo Alto, CA, USA
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford Neuroscience Health Center, Stanford University, Palo Alto, CA, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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10
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Panesar SS, Kliot M, Parrish R, Fernandez-Miranda J, Cagle Y, Britz GW. Promises and Perils of Artificial Intelligence in Neurosurgery. Neurosurgery 2020; 87:33-44. [PMID: 31748800 DOI: 10.1093/neuros/nyz471] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/28/2019] [Indexed: 11/13/2022] Open
Abstract
Artificial intelligence (AI)-facilitated clinical automation is expected to become increasingly prevalent in the near future. AI techniques may permit rapid and detailed analysis of the large quantities of clinical data generated in modern healthcare settings, at a level that is otherwise impossible by humans. Subsequently, AI may enhance clinical practice by pushing the limits of diagnostics, clinical decision making, and prognostication. Moreover, if combined with surgical robotics and other surgical adjuncts such as image guidance, AI may find its way into the operating room and permit more accurate interventions, with fewer errors. Despite the considerable hype surrounding the impending medical AI revolution, little has been written about potential downsides to increasing clinical automation. These may include both direct and indirect consequences. Directly, faulty, inadequately trained, or poorly understood algorithms may produce erroneous results, which may have wide-scale impact. Indirectly, increasing use of automation may exacerbate de-skilling of human physicians due to over-reliance, poor understanding, overconfidence, and lack of necessary vigilance of an automated clinical workflow. Many of these negative phenomena have already been witnessed in other industries that have already undergone, or are undergoing "automation revolutions," namely commercial aviation and the automotive industry. This narrative review explores the potential benefits and consequences of the anticipated medical AI revolution from a neurosurgical perspective.
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Affiliation(s)
- Sandip S Panesar
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Michel Kliot
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Rob Parrish
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | | | - Yvonne Cagle
- NASA Ames Research Center, Mountain View, California
| | - Gavin W Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
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11
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Najera E, Truong HQ, Belo JTA, Borghei-Razavi H, Gardner PA, Fernandez-Miranda J. Proximal Branches of the Anterior Cerebral Artery: Anatomic Study and Applications to Endoscopic Endonasal Surgery. Oper Neurosurg (Hagerstown) 2020; 16:734-742. [PMID: 30649510 DOI: 10.1093/ons/opy308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/03/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The endoscopic endonasal approach is a surgical alternative for midline anterior skull base tumors. A detailed understanding of the proximal anterior cerebral artery (ACA) branches' anatomy from an endonasal perspective is essential for avoiding vascular complications. OBJECTIVE To evaluate, from an endonasal perspective, the anatomic variations of the ACA and its proximal branches, specifically the recurrent artery of Heubner (RAH), and the fronto-orbital (FOA) and frontopolar (FPA) arteries. METHODS We study the origin, course, branching pattern, diameter, and relationship between the proximal ACA branches and the optic apparatus and olfactory tract in 25 head specimens. RESULTS The RAH was present in all hemispheres and originated within 3 ± 1.5 mm of the AcomA, with a 0.4 ± 0.1 mm diameter. Based on its relationship with the A1 segment, we observed three RAH courses: anterior (40%), superior (22%), and posterior (38%). The FOA was present in all cases, a mean of 6 ± 4 mm from the AcomA, with a 0.7 ± 0.4 mm diameter. The FOA arose mainly from the A2 (70%), with three courses in relation to the olfactory tract: crossing its proximal third (54%), crossing its middle third (31%), and running parallel to it along the gyrus rectus (15%). The FPA was present in 92% of the hemispheres, a mean of 10 ± 5 mm from the AcomA, always arising from the A2 and coursing anteriorly within the interhemispheric fissure towards the frontal pole. CONCLUSION The RAH, FOA, and FPA can be differentiated by origin, course, and destination using the A1 segment, olfactory tract, and interhemispheric fissure, respectively, as surgical landmarks.
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Affiliation(s)
- Edinson Najera
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Huy Q Truong
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joao T Alves Belo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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12
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Patel ZM, Fernandez-Miranda J, Hwang PH, Nayak JV, Dodd RL, Sajjadi H, Jackler RK. In Reply: Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic. Neurosurgery 2020; 87:E162-E163. [PMID: 32323725 PMCID: PMC7188177 DOI: 10.1093/neuros/nyaa156] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zara M Patel
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Juan Fernandez-Miranda
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Peter H Hwang
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Jayakar V Nayak
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Robert L Dodd
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Hamed Sajjadi
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Robert K Jackler
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
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13
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Patel ZM, Fernandez-Miranda J, Hwang PH, Nayak JV, Dodd R, Sajjadi H, Jackler RK. Letter: Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic. Neurosurgery 2020; 87:E66-E67. [PMID: 32293678 PMCID: PMC7184431 DOI: 10.1093/neuros/nyaa125] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Zara M Patel
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Juan Fernandez-Miranda
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Peter H Hwang
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Jayakar V Nayak
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Robert Dodd
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Hamed Sajjadi
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
| | - Robert K Jackler
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery Stanford University School of Medicine Stanford, California
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14
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Goldschmidt E, Schneck M, Gau DM, Carey L, Rasmussen J, Ferreyro B, Ajler P, Snyderman C, Wang E, Fernandez-Miranda J, Gardner PA. Effect of oxidized cellulose on human respiratory mucosa and submucosa and its implications for endoscopic skull-base approaches. Int Forum Allergy Rhinol 2019; 10:282-288. [PMID: 31856397 DOI: 10.1002/alr.22495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Regenerated oxidized cellulose (ROC) sheets have gained popularity as an adjunct to a vascularized nasoseptal flap for closure of dural defects after endoscopic endonasal skull-base approaches (EESBS). However, evidence supporting its impact on the healing process is uncertain. This study was performed to evaluate the impact of ROC on the nasal mucosa and assess its effects on tissue pH, structure, and cell viability. METHODS In 5 patients, a 1-cm2 piece of ROC gauze was placed on the surface of the middle turbinate before it was resected as part of a standard EESBS. Mucosa treated with ROC was separated from untreated mucosa and a histologic examination of structural changes in the respiratory epithelium was performed. To assess the effect of ROC on pH, increasing amounts of ROC were added to culture medium. Nasal fibroblasts viability was assessed in the presence of ROC before and after the pH was neutralized. RESULTS Compared with unexposed controls, treated mucosa exhibited a higher incidence of cell necrosis and epithelial cell detachment. When added to Dulbecco's modified Eagle medium, ROC caused a dose-dependent decrease in pH of the medium. Only 1 ± 0.8% of cultured fibroblasts exposed to the ROC-induced acidic medium were alive, whereas 98.25 ± 0.5% of the cells were viable when the pH was neutralized (p < 0.001). CONCLUSION ROC applied in vivo to nasal mucosa induced epithelial necrosis likely by diminishing the medium pH, because pH neutralization prevents its effect. The ultimate effect of this material on the healing process is yet to be determined.
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Affiliation(s)
- Ezequiel Goldschmidt
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Meghan Schneck
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - David M Gau
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Carey
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - Jorge Rasmussen
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Bruno Ferreyro
- Interdepartmental Division of Critical Care Medicine, Sinai Heath System/University Health Network, Toronto, ON, Canada
| | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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15
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Geltzeiler M, Turner M, Rimmer R, Zenonos G, Hebert A, Snyderman C, Gardner P, Fernandez-Miranda J, Wang EW. Endoscopic Nasopharyngectomy Combined with a Nerve-sparing Transpterygoid Approach. Laryngoscope 2019; 130:2343-2348. [PMID: 31841236 DOI: 10.1002/lary.28479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/07/2019] [Accepted: 11/17/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Surgical management of nasopharyngeal tumors has evolved in the endoscopic era. Lateral exposure remains difficult especially near the petrous internal carotid artery and bony Eustachian tube (ET). Our study examines the need to sacrifice the vidian and greater palatine nerves in order to successfully perform en bloc endoscopic nasopharyngectomy. METHODS Four cadaveric specimens (eight sides) were dissected bilaterally using a binarial, extended, endoscopic endonasal approach (EEA). Nasopharyngectomy was completed including an extended transptyergoid approach for resection of the cartilaginous ET at its junction with the bony ET. Dissection was attempted without sacrifice of the vidian or palatine nerves. RESULTS Successful en bloc nasopharyngectomy combined with a nerve-sparing transpterygoid approach was achieved in all specimens with successful preservation of the palatine and vidian nerves. The approach provided exposure of foramen lacerum, the petrous carotid, foramen spinosum, and foramen ovale as well as all segments of the cartilaginous Eustachian tube, Meckel's cave and the parapharyngeal carotid. There was no inadvertent exposure or injury of the internal carotid artery. CONCLUSION Endoscopic nasopharyngectomy combined with a nerve-sparing transpterygoid approach allows for en bloc resection of the cartilaginous Eustachian tube and nasopharyngeal contents with broad skull base exposure and preservation of the internal carotid artery, vidian and palatine nerves. LEVEL OF EVIDENCE VI Laryngoscope, 130:2343-2348, 2020.
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Affiliation(s)
- Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Meghan Turner
- the Department of Otolaryngology-Head and Neck Surgery, University of University of West Virginia, Morgantown, West Virginia, U.S.A
| | - Ryan Rimmer
- the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - George Zenonos
- the Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Andrea Hebert
- the Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, U.S.A
| | - Carl Snyderman
- the Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Paul Gardner
- the Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | | | - Eric W Wang
- the Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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16
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Geltzeiler M, Nakassa ACI, Turner M, Setty P, Zenonos G, Hebert A, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Evaluation of Intranasal Flap Perfusion by Intraoperative Indocyanine Green Fluorescence Angiography. Oper Neurosurg (Hagerstown) 2019; 15:672-676. [PMID: 29554360 PMCID: PMC7263840 DOI: 10.1093/ons/opy002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vascularized intranasal flaps are the primary reconstructive option for endoscopic skull base defects. Flap vascularity may be compromised by injury to the pedicle or prior endonasal surgery. There is currently no validated technique for intraoperative evaluation of intranasal flap viability. OBJECTIVE To evaluate the efficacy of indocyanine green (ICG) near-infrared angiography in predicting the viability of pedicled intranasal flaps during endoscopic skull base surgery through a pilot study. METHODS ICG near-infrared fluorescence endoscopy was performed during endoscopic endonasal surgery for skull base tumors. Intraoperative and postoperative data were collected regarding enhancement of the flap body and pedicle. Fluorescence was rated qualitatively. Postoperatively, flap perfusion was evaluated via MRI-contrast enhancement in addition to clinical outcomes (cerebrospinal fluid leak and endoscopic flap appearance). RESULTS Thirty-eight patients underwent ICG fluorescence angiography. Both the body and pedicle enhanced in 20 patients (53%), while the pedicle only enhanced for 12 patients (32%), the body only for 3 (8%), and neither for 3 (8%). When both the pedicle and body enhanced with ICG, the rate of postoperative MRI contrast enhancement was 100% and the rate of flap necrosis was 0%. The sensitivity and specificity of flap pedicle ICG enhancement for predicting postoperative flap MRI enhancement were 97% and 67%, respectively. Two of 3 patients without enhancement developed flap necrosis. CONCLUSION ICG fluorescence angiography of intraoperative flap perfusion is feasible and correlates well with outcomes of postoperative MRI flap enhancement and flap necrosis. Additional study is needed to further refine the imaging technique and optimally characterize the clinical utility.
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Affiliation(s)
- Mathew Geltzeiler
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
- Department of Otolaryn-gology—Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
- Correspondence: Paul Gardner, MD, Department of Neurologic Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 521, Pittsburgh, PA 15213. E-mail:
| | | | - Meghan Turner
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Pradeep Setty
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George Zenonos
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrea Hebert
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Eric Wang
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Juan Fernandez-Miranda
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Department of Otolaryngology—Head and Neck Surgery, University of Pitts-burgh Medical Center, Pittsburgh, Penns-ylvania
| | - Paul Gardner
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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17
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Panesar SS, Fernandez-Miranda J. Commentary: The Nomenclature of Human White Matter Association Pathways: Proposal for a Systematic Taxonomic Anatomical Classification. Front Neuroanat 2019; 13:61. [PMID: 31244620 PMCID: PMC6580230 DOI: 10.3389/fnana.2019.00061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/24/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Sandip S Panesar
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
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18
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Little A, Yuen K, Chicoine M, Kelly D, Gardner P, Fernandez-Miranda J, Barkhoudarian G, Chandler J, Prevedello D, Mayberg M. MON-439 Evaluation of Surgical Resection Goal and Its Relationship to the Extent of Resection and Patient Outcomes in 221 Patients following Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas: Data from the TRANSSPHER Study. J Endocr Soc 2019. [PMCID: PMC6551158 DOI: 10.1210/js.2019-mon-439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Prospective data of the influence of the neurosurgeon’s preoperative goal regarding the extent of tumor resection and patient outcomes are scarce in patients with pituitary adenomas who have undergone transsphenoidal pituitary surgery using modern gland-sparing surgical techniques. Objective: We analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study of patients with nonfunctioning pituitary adenomas (ClinicalTrials.gov NCT02357498). Methods: Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. Results: A total of 221 patients were treated with transsphenoidal surgery at 7 pituitary centers in the United States from February 2015 to June 2017. GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = 0.001). Sensitivity, specificity, positive predictive value, and negative predictive values of GTR goal were 82.2%, 43.9%, 86.5%, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced neurosurgeon were associated with neurosurgeons choosing GTR as the goal (P < 0.01). However, there was no association between surgical goal and the presence of pituitary hormone deficiencies 6 months after surgery (P = 0.31). There was a trend towards a higher rate of major neurological complications in the STR goal cohort (4/50 patients, 8.0%) compared to the GTR cohort (4/171, 2.3%) (p=0.079). Tumor Knosp grade (P = 0.004) and size (P = 0.001) were stronger predictors of GTR than was surgical goal (P = 0.014). The most common site of detecting residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). Conclusion: This is the first prospective multi-center pituitary surgery study that examined surgical goal regarding extent of tumor resection and associated patient outcomes. We found that surgical goal is not a reliable predictor of actual tumor resection, and a more aggressive surgical goal does not correlate with pituitary gland dysfunction or major neurological complications 6 months after surgery. A better understanding of the ability of neurosurgeons to meet their expectations and of the factors associated with surgical result could improve prognostication and preoperative counseling of the extent of tumor resection, and postoperative functionality of pituitary hormone secretion.
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Affiliation(s)
- Andrew Little
- Barrow Neurological Institute, Phoenix, AZ, United States
| | - Kevin Yuen
- Barrow Neurological Institute, Scottsdale, AZ, United States
| | - Michael Chicoine
- Washington University School of Medicine, St Louis, MO, United States
| | - Daniel Kelly
- Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Inst, Santa Monica, CA, United States
| | - Paul Gardner
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | | | - Marc Mayberg
- University of Washington Medical Center, Seattle, WA, United States
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19
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Panesar SS, Abhinav K, Yeh FC, Jacquesson T, Collins M, Fernandez-Miranda J. Tractography for Surgical Neuro-Oncology Planning: Towards a Gold Standard. Neurotherapeutics 2019; 16:36-51. [PMID: 30542904 PMCID: PMC6361069 DOI: 10.1007/s13311-018-00697-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging tractography permits in vivo visualization of white matter structures. Aside from its academic value, tractography has been proven particularly useful to neurosurgeons for preoperative planning. Preoperative tractography permits both qualitative and quantitative analyses of tumor effects upon surrounding white matter, allowing the surgeon to specifically tailor their operative approach. Despite its benefits, there is controversy pertaining to methodology, implementation, and interpretation of results in this context. High-definition fiber tractography (HDFT) is one of several non-tensor tractography approaches permitting visualization of crossing white matter trajectories at high resolutions, dispensing with the well-known shortcomings of diffusion tensor imaging (DTI) tractography. In this article, we provide an overview of the advantages of HDFT in a neurosurgical context, derived from our considerable experience implementing the technique for academic and clinical purposes. We highlight nuances of qualitative and quantitative approaches to using HDFT for brain tumor surgery planning, and integration of tractography with complementary operative adjuncts, and consider areas requiring further research.
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Affiliation(s)
- Sandip S Panesar
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Kumar Abhinav
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothée Jacquesson
- CHU de Lyon - Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | - Malie Collins
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA.
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20
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Swiderski A, Dresang H, Hula W, Dickey M, Yeh FC, Fernandez-Miranda J, Doyle P. Structural fragmentation of linguistic brain networks predicts aphasia severity, but not response to treatment. Front Hum Neurosci 2019. [DOI: 10.3389/conf.fnhum.2019.01.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Nakassa A, Geltzeiler M, Valappil B, Chang YF, Zenonos G, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Use of Intraoperative Indocyanine Green Endoscopy in the Assessment of Vascularity of Intranasal Flaps. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ana Nakassa
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Benita Valappil
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Yue-Fang Chang
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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22
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Lieber S, Wang WH, Nunez M, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. The Dural Architecture of the Cavernous Sinus' Anterior Roof and Clinoid Space: Microsurgical Anatomy and Technical Nuances for Intracavernous and Perisellar Endoscopic Surgery. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stefan Lieber
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Wei-Hsin Wang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Maximiliano Nunez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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23
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Hebert A, Mady L, Geltzeiler M, Turner M, Snyderman C, Gardner P, Fernandez-Miranda J, Wang E. Perineural Spread of Squamous Cell Carcinoma to the Skull Base following Treatment of Oropharyngeal P16-Positive Squamous Cell Carcinoma: A Case Series. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Andrea Hebert
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Leila Mady
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Meghan Turner
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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24
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Sun X, Yu H, Liu Q, Wang D, Fernandez-Miranda J, Gardner P, Wang E, Snyderman C. Temporalis Muscle Flap for Endoscopic Anterior Skull Base Reconstruction: An Anatomic Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Xicai Sun
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Quan Liu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Dehui Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai Shi, China
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Neurological Surgery, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
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25
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Belo J, Truong H, Mangussi-Gomes J, Wang E, Fernandez-Miranda J. Lateral Transorbital versus Endonasal Transpterygoid Approach to the Lateral Recess of the Sphenoid Sinus: A Comparative Anatomical Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joao Belo
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Joao Mangussi-Gomes
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, United States
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26
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Truong H, Zanabria R, Najera E, Celtikci E, Sun X, Borghei-Razavi H, Gardner P, Fernandez-Miranda J. The Superior Hypophyseal Artery from the Endoscopic Endonasal Perspective: Anatomical Variations and Surgical Nuances for Its Mobilization and Preservation. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Huy Truong
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Robert Zanabria
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Emrah Celtikci
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Xicai Sun
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | | | - Paul Gardner
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
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27
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Mangussi-Gomes J, Truong H, Belo J, Gardner P, Wang E, Fernandez-Miranda J, Snyderman C. Transmaxillary Endoscopic Approach to the Lateral Recess of the Sphenoid Sinus: An Anatomical Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joao Mangussi-Gomes
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Joao Belo
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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28
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Truong H, Najera E, Belo J, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. The Medial Wall of the Cavernous Sinus: Surgical Anatomy, Ligaments, and Surgical Application. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Joao Belo
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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29
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Cohen S, Najera E, Nakassa A, Truong H, Zwagerman N, Snyderman C, Wang E, Gardner P, Fernandez-Miranda J. Selective Surgical Resection of the Medial Wall of the Cavernous Sinus for Invasive Pituitary Adenomas: Surgical Technique and Outcomes in 49 Patients. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Salomon Cohen
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Ana Nakassa
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Nathan Zwagerman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Departments of Otolaryngology and Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Departments of Otolaryngology and Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Departments of Neurological Surgery and Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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30
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Freiser M, Moore J, Gardner P, Snyderman C, Fernandez-Miranda J, Wang E, Chang YF, Lee S. Analysis of Patient Safety and Outcomes of Live Case Demonstrations in Endoscopic Skull Base Surgery. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Monika Freiser
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - John Moore
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Yue-Fang Chang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Stella Lee
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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31
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Lavigne P, Faden D, Wang E, Gardner P, Fernandez-Miranda J, Snyderman C. Validation of Training Levels in Endoscopic Endonasal Surgery of the Skull Base. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Philippe Lavigne
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Daniel Faden
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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32
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Nakassa A, Najera E, Borghei-Razavi H, Truong H, Sun X, Cohen S, Wang E, Snyderman C, Fernandez-Miranda J, Gardner P. Persistent Cerebrospinal Fluid Leak after Endoscopic Endonasal Approach to the Posterior Cranial Fossa. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ana Nakassa
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Hamid Borghei-Razavi
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Xicai Sun
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Salomon Cohen
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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33
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Geltzeiler M, Turner M, Zenonos G, Hebert A, Snyderman C, Gardner P, Fernandez-Miranda J, Wang E. Endoscopic Nasopharyngectomy Combined with a Nerve-Sparing Transpterygoid Approach: An Anatomic Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mathew Geltzeiler
- Oregon Health and Science University, Portland, Oregon, United States
| | - Meghan Turner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - George Zenonos
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Andrea Hebert
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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34
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Zenonos G, Chu A, Niranjan A, Gardner P, Fernandez-Miranda J, Flickinger J, III E, Lunsford L. Predictors of Recurrence after Gamma Knife Radiosurgery for Cavernous Sinus Meningiomas. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Georgios Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - A. Chu
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - A. Niranjan
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - P. Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - J. Fernandez-Miranda
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - J. Flickinger
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Edward III
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - L. Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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35
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Najera E, Truong H, Belo J, Cohen S, Nakassa A, Gardner P, Fernandez-Miranda J. Basal Perforating Arteries of the Anterior Communicating Artery: Anatomical Study and Implications for Suprachiasmatic Region Surgery. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Joao Belo
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Salomon Cohen
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Ana Nakassa
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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36
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Lieber S, Nunez M, Wang WH, Nunes C, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. Pictorial Review of the Microvasculature Arising from the Cavernous Segment of the ICA (C4), and the Venous Connections of the Cavernous Sinus. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stefan Lieber
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Maximiliano Nunez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Wei-Hsin Wang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Cristian Nunes
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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37
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Borghei-Razavi H, Wenping X, Truong H, Cabral D, Stefko S, Fernandez-Miranda J, Gardner P. Surgical Limitations of the Supraorbital “Eyebrow” Approach: From the Anterior Fossa to the Middle Fossa. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hamid Borghei-Razavi
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Xiong Wenping
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - David Cabral
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - S. Stefko
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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38
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Zwagerman N, Geltzeiler M, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Endonasal Suturing of Nasoseptal Flap to the Nasopharyngeal Fascia Using the V-Loc Wound Closing Device. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nathan Zwagerman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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39
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Mangussi-Gomes J, Nogueira G, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P. Contralateral Transmaxillary Approach versus Purely Transnasal Approach to the Petroclival Region—An Anatomical and Radiological Study. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joao Mangussi-Gomes
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Gustavo Nogueira
- Neurological Institute of Curitiba, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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40
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Najera E, Nakassa A, Cohen S, Truong H, Borghei-Razavi H, Gardner P, Fernandez-Miranda J. Proximal Branches of the Anterior Cerebral Artery: Anatomical Study and Applications to Endoscopic Endonasal Surgery. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Edinson Najera
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Ana Nakassa
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Salomon Cohen
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Huy Truong
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Hamid Borghei-Razavi
- Surgical Neuroanatomy Lab, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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41
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Faden D, Lavigne P, Fernandez-Miranda J, Gardner P, Wang E, Snyderman C. Utilization of the Contralateral Transmaxillary Approach for Chordoma and Chondrosarcoma of the Petrous Apex. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Daniel Faden
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Philippe Lavigne
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Paul Gardner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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42
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Truong H, Sun X, Celtikci E, Borghei-Ravazi H, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. Endoscopic Transmaxillary Trans-Alisphenoid Approach to the Meckel's Cave: An Anatomical Study. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Huy Truong
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Xicai Sun
- Department of Otolaryngology-Head and Neck Surgery, Fudan University, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Shanghai, China
| | - Emrah Celtikci
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Hamid Borghei-Ravazi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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43
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Lieber S, Zenonos G, Zwagerman N, Chabot J, Stefko T, Fernandez-Miranda J, Gardner P. Pushing the Boundaries of the Lateral Orbitotomy through a Lateral Canthotomy Approach: Successful Resection of Two Middle Cranial Fossa Pathologies with Extension into the Posterior Cranial Fossa—An Anatomical and Technical Note. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stefan Lieber
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Nathan Zwagerman
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Joseph Chabot
- Department of Neurosciences, St. Cloud Hospital, St. Cloud, Minnesota, United States
| | - Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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44
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Borghei-Razavi H, Truong H, Fernandez-Cabral D, Celtikci E, Sun X, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. Endoscopic Endonasal Maximal Petrosectomy: Anatomical Investigation and Surgical Relevance. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Huy Truong
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | | | - Emrah Celtikci
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Xi Sun
- Department of Otolaryngology-Head and Neck Surgery, Fudan University, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Shanghai, China
| | - Eric Wang
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
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45
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Duncan K, Wang E, Fernandez-Miranda J, Yu J. The Utility of Image Guidance in Developing Minimally Invasive Periorbital Approaches to the Skull Base. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katherine Duncan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Jenny Yu
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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46
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Setty P, Zenonos G, Geltzeiler M, Hebert A, Wang E, Snyderman C, Fernandez-Miranda J, Gardner P. Residual and Recurrent Disease after Endoscopic Endonasal Approach to Midline Anterior Skull Base Meningiomas. J Neurol Surg B Skull Base 2017. [DOI: 10.1055/s-0037-1600629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Pradeep Setty
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Georgios Zenonos
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Andrea Hebert
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Paul Gardner
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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47
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Borghei-Razavi H, Fernandez-Cabral D, Truong H, Chabot J, Celtikci E, Wang E, Stefko S, Snyderman C, Gardner P, Fernandez-Miranda J. Minimally Invasive Approaches for Anterior Skull Base Meningiomas: Supraorbital Eyebrow, Endoscopic Endonasal, or a Combination of Both? Anatomical Study and Surgical Application. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Huy Truong
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Josef Chabot
- Department of Neurosciences, St. Cloud Hospital, St. Cloud, Minnesota, United States
| | - Emrah Celtikci
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - S. Stefko
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
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48
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Lieber S, Nunez M, Nunes C, Wang E, Snyderman C, Gardner P, Fernandez-Miranda J. Surgical Anatomy of the Medial Wall of the Cavernous Sinus and Technical Nuances for its Surgical Resection. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stefan Lieber
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Maximiliano Nunez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Cristian Nunes
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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49
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Rowan N, Turner M, Wang E, Fernandez-Miranda J, Gardner P, Snyderman C. A Skull Base Course Participants' Experience with Endoscopic Endonasal Carotid Artery Injuries. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nicholas Rowan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Meghan Turner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | | | - Paul Gardner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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50
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Setty P, Geltzeiler M, Hebert A, Zenonos G, Wang E, Snyderman C, Fernandez-Miranda J, Gardner P. The Role of Staging in Endoscopic Endonasal Approaches for Large and Giant Anterior Skull Base Meningiomas. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pradeep Setty
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Andrea Hebert
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Georgios Zenonos
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eric Wang
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Paul Gardner
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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