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Nguyen TV, Bitner BF, Hong EM, Pang JC, Meller LLT, Nguyen C, Kuan EC. Severe unilateral refractory epistaxis arising from the septal branch of the anterior ethmoid artery. Int Forum Allergy Rhinol 2024. [PMID: 38353285 DOI: 10.1002/alr.23330] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/23/2024]
Abstract
KEY POINTS The septal branch of the anterior ethmoid artery (sbAEA) is an underrecognized source of severe refractory epistaxis. Herein, we describe the presentation, predisposing factors, treatment strategies, and outcomes of a series of patients with this condition.
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Affiliation(s)
- Theodore V Nguyen
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Benjamin F Bitner
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Ellen M Hong
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Jonathan C Pang
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Leo Li Tang Meller
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Cecilia Nguyen
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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Du AT, Pang JC, Victor R, Tang Meller LL, Torabi SJ, Goshtasbi K, Kim MG, Hsu FPK, Kuan EC. The Influence of Facility Volume and Type on Skull Base Chordoma Treatment and Outcomes. World Neurosurg 2022; 166:e561-e567. [PMID: 35868508 DOI: 10.1016/j.wneu.2022.07.064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the influence of facility case volume and type on skull base chordoma treatment and overall survival (OS). METHODS The 2004-2016 National Cancer Database was queried for skull base chordoma patients receiving definitive treatment. Facilities were categorized into 2 cohorts by calculating the mean number of patients treated per facility and using cutoff numbers that were 0.5 SD above and below the computed mean to separate the groups. As, by definition of the inclusion criteria, all included facilities treated at least 1 patient, low-volume facilities were defined as treating 1 patient, and high-volume facilities were defined as treating ≥7 patients; mid-volume facilities (facilities treating ≥2 but ≤6 patients) were excluded. Differences in treatment course, outcomes, and OS by facility type were assessed. RESULTS The study included 658 patients (44.8% female, 79.5% White). The 187 unique facilities were categorized into 95 low-volume facilities (treating 1 patient during timeline) and 26 high-volume facilities (treating ≥7 patients during timeline). Kaplan-Meier log-rank analysis demonstrated a significant positive association between facility volume and OS (P < 0.001) and an improvement in OS in patients at academic facilities (P = 0.018). On Cox proportional hazards multivariate regression after adjusting for sex, age, Charlson-Deyo comorbidity index, and insurance type, high-volume facilities and academic facilities were associated with a lower mortality risk than low-volume facilities and nonacademic facilities (P < 0.001 and P = 0.03, respectively). CONCLUSIONS Higher facility case volume and academic facility type appear to be associated with improved survival outcomes in treatment of skull base chordomas.
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Affiliation(s)
- Amy T Du
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Robert Victor
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Leo Li Tang Meller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Michael G Kim
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.
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