Idiopathic Subglottic Stenosis: An Institutional Review of Outcomes With a Multimodality Surgical Approach

2020 ◽  
pp. 019459982096697
Author(s):  
Christopher D. Dwyer ◽  
Mehdi Qiabi ◽  
Dalilah Fortin ◽  
Richard I. Inculet ◽  
Anthony C. Nichols ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Tertiary Care ◽  
Subglottic Stenosis ◽  
Tube Placement ◽  
Surgical Approaches ◽  
Patient Decision Making ◽  
Airway Patency ◽  
Airway Intervention ◽  
Surgical Workflow ◽  
Surgical Airway

Objectives This article reports on a unique cohort of patients with idiopathic subglottic stenosis spilt fairly equally between endoscopic and open surgical approaches. Patients’ sequence of operations and reinterventions over time are outlined, offering insight to improve surgical counseling and allow for informative, autonomous patient decision making. Study Design Retrospective cohort study. Setting Tertiary care academic center. Methods Cases of consecutive adults with idiopathic subglottic stenosis managed surgically over a 12-year period (January 2006–December 2017) were retrospectively reviewed. Surgical workflow, complications, and outcomes, including reinterventions and tracheotomy dependence, are reported. Results Seventy-two patients (71 women; mean age, 50.4 years) with idiopathic subglottic stenosis requiring surgical airway intervention were identified. Six patients underwent tracheotomy prior to attempt at airway stenosis surgery. Initial surgical approach thereafter included endoscopic (73.5%, n = 53) and open (26.4%, n = 19) procedures. Thirty-one patients underwent cricotracheal resection; the reintervention rate was 22.5%. Sixty patients underwent 147 endoscopic procedures; the reintervention rate was 75.5%, and the mean time between dilations was 83 weeks (range, 5-402). Two (2.8%) patients remain tracheotomy dependent. Adverse events were significantly higher in the cricotracheal group, especially with respect to dysphonia and temporary gastrostomy tube placement ( P < .01). Conclusions Endoscopic and open surgical airway intervention can be employed successfully to avoid tracheotomy dependence and maintain airway patency; however, multiple procedures are usually required, regardless of surgical approach. Cricotracheal reintervention rates are lower than endoscopic dilation but with increased morbidity. Quality-of-life outcomes should be clearly discussed with patients before deciding on a surgical management strategy.

Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

2020 ◽  
Author(s):  
Ravi Sankar Manogaran ◽  
Raj Kumar ◽  
Arulalan Mathialagan ◽  
Anant Mehrotra ◽  
Amit Keshri ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Tertiary Care ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Complete Excision ◽  
Lateral Skull Base ◽  
The Individual ◽  
Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

Endoscopic Transpterygoid Approach to the Lateral Sphenoid Recess: Surgical Approach and Clinical Experience

2005 ◽  
Vol 133 (1) ◽  
pp. 20-26 ◽  
Author(s):  
William E. Bolger
Keyword(s):  
Clinical Experience ◽  
Surgical Approach ◽  
Care Center ◽  
Tertiary Care ◽  
The Body ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Fungal Sinusitis ◽  
Skull Base Defect ◽  
Invasive Techniques

OBJECTIVE: Pathology within a lateral recess of a widely pneumatized sphenoid sinus is difficult to access with the use of traditional open and current endoscopic surgical approaches. A new surgical procedure, the endoscopic transpterygoid approach, directly accesses this region. A clinical experience over several year with this approach is reported as well as a refined and updated description of the technique. SETTING: Tertiary care center. METHODS: Retrospective review of medical records of patients treated with the endoscopic transpterygoid approach to the lateral sphenoid recess. RESULTS: An endoscopic transpterygoid approach was performed in 9 patients, 6 to resect a middle fossa meningoencephalocele and repair the CSF leak and associated skull base defect, 2 for possible invasive fungal sinusitis, and 1 to marsupialize a symptomatic epidermoid cyst. Patients tolerated the approach well and no significant complications occurred. CONCLUSIONS AND SIGNIFICANCE: In selected cases, the endoscopic transpterygoid approach enables the otolaryngologist to meet modern demands to treat conditions in the lateral sphenoid using minimally invasive techniques that are well-tolerated by patients. The surgical approach and the initial experience described herein is presented in the hopes that it can aid fellow otolaryngologists to help patients with challenging conditions in this region of the body.

scholarly journals The Effect of the COVID-19 Pandemic on Pediatric Tympanostomy Tube Placement

2021 ◽  
pp. 019459982110089
Author(s):  
Gillian R. Diercks ◽  
Michael S. Cohen
Keyword(s):  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Community Setting ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Care Providers ◽  
Billing Data ◽  
Patient Age ◽  
Patient Âgé ◽  
Tympanostomy Tubes

Objective To evaluate how the coronavirus disease 2019 (COVID-19) pandemic has affected tympanostomy tube placement and practice patterns. Study Design A retrospective review of billing data. Setting A large-volume practice with both community and tertiary care providers. Methods As part of a quality initiative, billing data were queried to identify children <18 years of age who underwent tympanostomy tube placement between January 2019 and December 2020. Patient age, practice location, and case numbers were gathered. Results The study included data from 2652 patients. Prior to state-mandated clinic and operating room restrictions, there were no significant differences in the number of tympanostomy tubes placed ( P = .64), including month-to-month comparisons, the distribution of patients being cared for at community vs tertiary care sites ( P = .63), or patient age at the time of surgery ( P = .97) between 2019 and 2020. After resumption of outpatient clinical and elective surgical activities, the number of tympanostomy tubes placed decreased significantly between 2019 and 2020 (831 vs 303 cases, P = .003), with a persistent month-to-month difference. In addition, patients undergoing tube placement were older (4.5 vs 3.2 years, P < .001). The distribution of cases performed in the community setting decreased during this time period as well ( P < .001). Conclusion During the COVID-19 pandemic, the rate of pediatric tympanostomy tube placement has significantly decreased. The age of patients undergoing surgery has increased, and more children are being cared for in a tertiary setting. These findings may reflect changes in the prevalence of acute and chronic otitis media as the result of the pandemic.

scholarly journals Surgical Approach to Anorectal Melanoma with PET-CT Staging: A Case Report

2017 ◽  
Vol 03 (04) ◽  
pp. e177-e180 ◽  
Author(s):  
Nilufer Bulut ◽  
Sevinc Dagıstanlı ◽  
Burcak Yılmaz ◽  
O. Atay
Keyword(s):  
Surgical Approach ◽  
Early Stage ◽  
Wide Spectrum ◽  
Surgical Approaches ◽  
Histopathological Diagnosis ◽  
Imaging Method ◽  
Medical Treatments ◽  
Good Imaging ◽  
Rectal Melanoma ◽  
Pet Ct

AbstractRectal hemorrhage should be evaluated within a wide spectrum ranging from benign diseases to a malignant process. Especially, the melanomas of rectum are detected at an advanced stage when diagnosed since the present symptoms of rectal melanomas are similar. The question of what will be the surgical approach with MR, CT, and PET-CT imaging methods performed after histopathological diagnosis still conserves its topicality. PET-CT is a good imaging method for determination of distant metastasis and lymphatic involvement. In the present case, a patient with early-stage rectal melanoma was treated with APR. No relapse/metastasis was detected during the 18-month follow-up. The aggressive course of the disease and its low response rates to medical treatments may cause the surgical approaches to be more extensive.

scholarly journals Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center

2021 ◽  
Author(s):  
Rahul Singh ◽  
Ravi Shankar Prasad ◽  
Ashvamedh Singh ◽  
Kulwant Singh ◽  
Anurag Sahu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Sagittal Plane ◽  
Care Center ◽  
Tertiary Care ◽  
International Standards ◽  
Surgical Approaches ◽  
Severity Of Injury ◽  
Cord Injury

Abstract Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.

Comparison of Outcomes following Primary and Repeat Resection of Craniopharyngioma

2021 ◽  
Author(s):  
Alexander A. Aabedi ◽  
Jacob S. Young ◽  
Ryan R. L. Phelps ◽  
Ethan A. Winkler ◽  
Michael W. McDermott ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Primary Resection ◽  
Endocrine Function ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Limited Data ◽  
Time To Recurrence ◽  
Skull Base Lesions

Abstract Introduction The management of recurrent craniopharyngioma is complex with limited data to guide decision-making. Some reports suggest reoperation should be avoided due to an increased complication profile, while others have demonstrated that safe reoperation can be performed. For other types of skull base lesions, maximal safe resection followed by adjuvant therapy has replaced radical gross total resection due to the favorable morbidity profiles. Methods Seventy-one patients underwent resection over a 9-year period for craniopharyngioma and were retrospectively reviewed. Patients were separated into primary resection and reoperation cohorts and stratified by surgical approach (endonasal vs. cranial) and survival analyses were performed based on cohort and surgical approach. Results Fifty patients underwent primary resection, while 21 underwent reoperation for recurrence. Fifty endonasal transsphenoidal surgeries and 21 craniotomies were performed. Surgical approaches were similarly distributed across cohorts. Subtotal resection was achieved in 83% of all cases. There were no differences in extent of resection, visual outcomes, subsequent neuroendocrine function, and complications across cohorts and surgical approaches. The median time to recurrence was 87 months overall, and there were no differences by cohort and approach. The 5-year survival rate was 81.1% after reoperation versus 93.2% after primary resection. Conclusion Compared with primary resection, reoperation for craniopharyngioma recurrence is associated with similar functional and survival outcomes in light of individualized surgical approaches. Maximal safe resection followed by adjuvant radiotherapy for residual tumor likely preserves vision and endocrine function without sacrificing overall patient survival.

Surgery of pituitary tumours

2011 ◽  
pp. 165-176
Author(s):  
Ian F. Dunn ◽  
Edward R. Laws
Keyword(s):  
Technological Innovation ◽  
Surgical Approach ◽  
Transsphenoidal Surgery ◽  
Transsphenoidal Approach ◽  
Surgical Approaches ◽  
Pituitary Tumours ◽  
Full Spectrum ◽  
Clinical Syndromes ◽  
Surgical History ◽  
Surgical Options

Pituitary tumours have both endocrine and neuro-oncologic sequelae. Secretory tumours may liberate physiological hormones to pathological excess, generating a full spectrum of metabolic aberrations and hallmark clinical syndromes. Other pituitary tumours are endocrinologically inactive and generate instead a variety of compressive phenomena such as pituitary hypofunction and neurological compromise. Although advances continue to be made in the pharmacological and radiotherapeutic management of pituitary tumours, surgery remains the treatment of choice for most of these lesions. Of the available surgical options, the transsphenoidal route is the dominant surgical approach to these tumours. Shaped by the brilliant insight of individual surgeons and technological innovation, transsphenoidal surgery for the sellar and parasellar regions is a fascinating chronicle in surgical history whose evolution continues unabated. We herein review surgical approaches to pituitary tumours, emphasizing the transsphenoidal approach.

Safety and Efficacy of Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes versus Standard Placement

2017 ◽  
Vol 83 (10) ◽  
pp. 1184-1187
Author(s):  
Husam Shadid ◽  
Maureen Keckeisen ◽  
Ali Zarrinpar
Keyword(s):  
Enteral Feeding ◽  
Care Center ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Tube Placement ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Feeding Tubes ◽  
Electromagnetic Guidance ◽  
Nasoenteral Feeding

Although enteral feeding in critically ill patients has been shown to be beneficial, reliable postpyloric placement of feeding tubes remains a challenge. The standard of care involves blind placement, frequently requiring multiple attempts, and radiographs. To evaluate the effect of electromagnetic-guided bedside placement in reducing time to establishment of feeding, lung placement, use of radiography, and cost, we initiated a prospective trial using electromagnetic-guided bedside placement and compared them to a retrospective cohort. Fifty-three consecutive placements of nasoenteral feeding tubes were made using electromagnetic-guidance on patients requiring enteral nutrition in a surgical intensive care unit at a tertiary care center. Sixty-three placement attempts in the preceding seven months served as controls. There were no significant differences between the two groups in terms of age, sex, weight, body mass index, hiatal or ventral hernias, or previous esophageal/gastric operations. The number of radiographs needed per patient, need for fluoroscopy, radiology charge per patient for the tube placement, and time from first attempt at placement to confirmation of postpyloric location were lower for the electromagnetic-guided group. Use of electromagnetic guidance allows reliable and cost-effective postpyloric enteral feeding tube placement compared with blind insertion.

scholarly journals Otitis Media Middle Ear Effusion Identification and Characterization Using an Optical Coherence Tomography Otoscope

2020 ◽  
Vol 162 (3) ◽  
pp. 367-374 ◽  
Author(s):  
Diego Preciado ◽  
Ryan M. Nolan ◽  
Radhika Joshi ◽  
Gina M. Krakovsky ◽  
Anqi Zhang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Middle Ear ◽  
Tertiary Care ◽  
Image Data ◽  
Tube Placement ◽  
Secondary Outcome ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Interreader Agreement ◽  
Blinded Reader

Objective To determine the feasibility of detecting and differentiating middle ear effusions (MEEs) using an optical coherence tomography (OCT) otoscope. Study Design Cross-sectional study. Setting US tertiary care children’s hospital. Subjects and Methods Seventy pediatric patients undergoing tympanostomy tube placement were preoperatively imaged using an OCT otoscope. A blinded reader quiz was conducted using 24 readers from 4 groups of tiered medical expertise. The primary outcome assessed was reader ability to detect presence/absence of MEE. A secondary outcome assessed was reader ability to differentiate serous vs nonserous MEE. Results OCT image data sets were analyzed from 45 of 70 total subjects. Blinded reader analysis of an OCT data subset for detection of MEE resulted in 90.6% accuracy, 90.9% sensitivity, 90.2% specificity, and intra/interreader agreement of 92.9% and 87.1%, respectively. Differentiating MEE type, reader identification of nonserous MEE had 70.8% accuracy, 53.6% sensitivity, 80.1% specificity, and intra/interreader agreement of 82.9% and 75.1%, respectively. Multivariate analysis revealed that age was the strongest predictor of OCT quality. The mean age of subjects with quality OCT was 5.01 years (n = 45), compared to 2.54 years (n = 25) in the remaining subjects imaged ( P = .0028). The ability to capture quality images improved over time, from 50% to 69.4% over the study period. Conclusion OCT otoscopy shows promise for facilitating accurate MEE detection. The imageability with the prototype device was affected by age, with older children being easier to image, similar to current ear diagnostic technologies.

scholarly journals Familial Aggregation in Idiopathic Subglottic Stenosis

2020 ◽  
Vol 163 (5) ◽  
pp. 1011-1017
Author(s):  
Virginia E. Drake ◽  
Alexander Gelbard ◽  
Nara Sobriera ◽  
Elizabeth Wohler ◽  
Lynne L. Berry ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Familial Aggregation ◽  
Tertiary Care ◽  
Positive Family History ◽  
Disease Onset ◽  
Subglottic Stenosis ◽  
Patient Demographics ◽  
The North ◽  
Familial Clustering ◽  
Tertiary Care Centers

Objective To evaluate inheritance patterns and define the familial clustering rate of idiopathic subglottic stenosis (iSGS). Study Design Retrospective observational study. Setting International multicenter collaborative of >30 tertiary care centers. Methods Patients with a clinically confirmed iSGS diagnosis within the North American Airway Collaborative’s iSGS1000 cohort consented between 2014 and 2018 were eligible for enrollment. Patient demographics and disease severity were abstracted from the collaborative’s iSGS longitudinal registry. Pedigrees of affected families were created. Results A total of 810 patients with iSGS were identified. Positive family history for iSGS was reported in 44 patients in 20 families. The rate of familial clustering in iSGS is 2.5%. Mean age of disease onset is 42.6 years. Of the 44 patients with familial aggregation of iSGS, 42 were female and 2 were male; 13 were mother-daughter pairs and 2 were father-daughter pairs. There were 3 sister-sister pairs. There was 1 niece-aunt pair and 2 groups of 3 family members. One pedigree demonstrated 2 affected mother-daughter pairs, with the mothers being first-degree paternal cousins. Inheritance is non-Mendelian, and anticipation is present in 11 of 13 (84%) parent-offspring pairs. The mean age of onset between parents (48.4 years) and offspring (36.1 years) was significantly different ( P = .016). Conclusion This study quantifies the rate of familial clustering of iSGS at 2.5%. Inheritance is non-Mendelian, and disease demonstrates anticipation. These data suggest that there may be a genetic contribution in iSGS.

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