Machine learning–based prediction of outcomes of the endoscopic endonasal approach in Cushing disease: is the future coming?

OBJECTIVEMachine learning (ML) is an innovative method to analyze large and complex data sets. The aim of this study was to evaluate the use of ML to identify predictors of early postsurgical and long-term outcomes in patients treated for Cushing disease (CD).METHODSAll consecutive patients in our center who underwent surgery for CD through the endoscopic endonasal approach were retrospectively reviewed. Study endpoints were gross-tumor removal (GTR), postsurgical remission, and long-term control of disease. Several demographic, radiological, and histological factors were assessed as potential predictors. For ML-based modeling, data were randomly divided into 2 sets with an 80% to 20% ratio for bootstrapped training and testing, respectively. Several algorithms were tested and tuned for the area under the curve (AUC).RESULTSThe study included 151 patients. GTR was achieved in 137 patients (91%), and postsurgical hypersecretion remission was achieved in 133 patients (88%). At last follow-up, 116 patients (77%) were still in remission after surgery and in 21 patients (14%), CD was controlled with complementary treatment (overall, of 131 cases, 87% were under control at follow-up). At internal validation, the endpoints were predicted with AUCs of 0.81–1.00, accuracy of 81%–100%, and Brier scores of 0.035–0.151. Tumor size and invasiveness and histological confirmation of adrenocorticotropic hormone (ACTH)–secreting cells were the main predictors for the 3 endpoints of interest.CONCLUSIONSML algorithms were used to train and internally validate robust models for all the endpoints, giving accurate outcome predictions in CD cases. This analytical method seems promising for potentially improving future patient care and counseling; however, careful clinical interpretation of the results remains necessary before any clinical adoption of ML. Moreover, further studies and increased sample sizes are definitely required before the widespread adoption of ML to the study of CD.

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Endoscopic Endonasal Approach for Craniopharyngiomas with Intraventricular Extension: Long-Term Outcomes and Meta-analysis

10.1055/s-0040-1702331 ◽

2020 ◽

Author(s):

Hanna Algattas ◽

Pradeep Setty ◽

Ezequiel Goldschmidt ◽

Eric W. Wang ◽

Elizabeth Tyler-Kabara ◽

...

Keyword(s):

Meta Analysis ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Long Term Outcomes ◽

Endoscopic Endonasal

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Excision of Greater Superficial Petrosal Nerve Schwannoma Via a Pure Endoscopic Endonasal Approach

Ear Nose & Throat Journal ◽

10.1177/01455613211026397 ◽

2021 ◽

pp. 014556132110263

Author(s):

Zhenlin Wang ◽

Siyuan Zhang ◽

Yan Qi ◽

Lianjie Cao ◽

Pu Li ◽

...

Keyword(s):

Hearing Loss ◽

Clinical Features ◽

Middle Cranial Fossa ◽

Nerve Sheath Tumor ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Greater Superficial Petrosal Nerve ◽

Clinical Records

Greater superficial petrosal nerve (GSPN) schwannomas are an exceedingly rare nerve sheath tumor. The current literature search was conducted using Medline and Embase database by key search terms. Only 31 cases have been reported in the literature so far. Facial palsy, hearing loss, and xerophthalmia accounted for 48.4% (15), 41.9% (13), and 29% (9) of all cases, respectively. The middle cranial fossa approach was used in all previous reports. A retrospective review of 2 GSPN schwannomas patients treated by endoscopic endonasal approach (EEA) in our center was collected. Clinical records, including clinical features, pre- and postoperative images, surgery, and follow-up information, were reviewed. In all cases, clinical features including facial numbness and headache were found, with tinnitus in case 1, hearing loss, xerophthalmia in case 2. Imaging studies showed a solid mass that originated in the anterior of the petrous bone. Two patients were treated by EEA. Furthermore, no recurrence was found during the follow-up period (15-29 months) in both of the 2 cases after the operation. Complete resection of GSPN schwannomas can be achieved via the pure EEA. Endoscopic endonasal approach for radical removal of tumors is safe and feasible.

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Endoscopic Endonasal Approach for Craniopharyngiomas with Intraventricular Extension: Case Series, Long-Term Outcomes, and Review

World Neurosurgery ◽

10.1016/j.wneu.2020.08.184 ◽

2020 ◽

Vol 144 ◽

pp. e447-e459

Author(s):

Hanna Algattas ◽

Pradeep Setty ◽

Ezequiel Goldschmidt ◽

Eric W. Wang ◽

Elizabeth C. Tyler-Kabara ◽

...

Keyword(s):

Case Series ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Long Term Outcomes ◽

Endoscopic Endonasal

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Endoscopic Surgery of a Sinonasal Inverted Papilloma: Surgical Strategy, Follow-up, and Recurrence Rate

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4387 ◽

2017 ◽

Vol 31 (1) ◽

pp. 51-55 ◽

Cited By ~ 10

Author(s):

Xiao-Dan Jiang ◽

Qing-Zhe Dong ◽

Shen-Ling Li ◽

Tian-Qiao Huang ◽

Nian-Kai Zhang

Keyword(s):

Recurrence Rate ◽

Endoscopic Surgery ◽

Inverted Papilloma ◽

Surgical Strategy ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Sinonasal Inverted Papilloma ◽

Significant Difference

Background Sinonasal inverted papilloma (SNIP) is noted for its high rate of recurrence and malignant transformation. Although many clinical studies have demonstrated the effectiveness of the endoscopic approach for SNIP, the surgical strategy has been the subject of much debate. Objective To evaluate the effectiveness of the endoscopic endonasal approach in SNIP. Methods A systematic review of patients with a diagnosis of SNIP and who had surgery at our institution from June 2005 to March 2013 was performed. All the patients who had postoperative follow-up for >2 years were enrolled. Each case was categorized into one of four stages as reported by Krouse. Demographic and tumor date, operative approach, complications, and recurrence rates were collected. Results A total of 125 patients were included in this study. There were 17 patients in stage 1, 40 in stage 2, 57 in stage 3, and 11 in stage 4. The overall recurrence rate was 8.0%. There was no significant difference in recurrence among the stages (all p > 0.05). Recurrence after endoscopic endonasal approach (8.4%) and a combined endoscopic and open exposure procedure (5.6%) were not significantly different (p > 0.05). The recurrence rate was significantly (p < 0.05) higher in patients with revision (15.6%) than in patients in the primary cases (3.8%). A common site of tumor origin was recorded to be from the maxillary sinus (40.2%). Twenty percent of recurrences were observed up to 5 years after surgery. Conclusion Endoscopic surgery may be preferred for treating SNIP. The elevated recurrence rate after revision emphasized the significance of the first surgery. We encourage a follow-up period of at least 5 years.

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The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

Scientific Reports ◽

10.1038/s41598-021-83905-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Peng Yu ◽

Tutu Xu ◽

Xinyu Wu ◽

Zhitong Liu ◽

Yong Wang ◽

...

Keyword(s):

Anterior Cerebral Artery ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Tuberculum Sellae Meningioma ◽

Csf Leakage ◽

Invasive Method ◽

Tuberculum Sellae

AbstractCompared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.

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Expanding indications for the extended endoscopic endonasal approach to hypothalamic gliomas: preliminary report

Neurosurgical FOCUS ◽

10.3171/2014.7.focus14317 ◽

2014 ◽

Vol 37 (4) ◽

pp. E11 ◽

Cited By ~ 11

Author(s):

Matteo Zoli ◽

Diego Mazzatenta ◽

Adelaide Valluzzi ◽

Gianluca Marucci ◽

Nicola Acciarri ◽

...

Keyword(s):

Quality Of Life ◽

Tumor Resection ◽

Small Sample ◽

Anterior Communicating Artery ◽

Moderate Increase ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

Object In the last decade the indications for the endoscopic endonasal approach have been progressively expanded to include lesions that have not been traditionally considered amenable to resection through the transsphenoidal route. In this study, the authors analyze their experience with hypothalamic gliomas treated via the endoscopic endonasal approach. Methods Consecutive cases of hypothalamic gliomas treated since 2007 via an endoscopic endonasal approach were reviewed. Preoperative and postoperative neuroimaging as well as endocrinological, neurological, and visual symptoms were analyzed to assess the surgical outcome. Signs and symptoms of hypothalamic dysfunction including body mass index (BMI), memory, sleep-wake rhythm, and polyphagia were prospectively collected pre- and postoperatively to assess hypothalamic function. Quality of life was evaluated using the Katz scale. Results In the initial phase the endoscopic endonasal approach was adopted in 3 cases with a palliative intent, to obtain a biopsy sample or for debulking of the mass followed by radio- or chemotherapy. In 2 later cases it was successfully adopted to achieve gross-total tumor resection. Complications consisted of 2 postoperative CSF leaks, which required an endoscopic endonasal reintervention. Visual deficit improved in 3 cases and normalized in the other 2. Four patients developed diabetes insipidus, and 3 an anterior panhypopituitarism. All patients had a moderate increase in BMI. No patients presented with any other signs of hypothalamic damage, and their quality of life at follow-up is normal. Conclusions Despite the limitations of a short follow-up and small sample, the authors’ early experience with the endoscopic endonasal approach has revealed it to be a direct, straightforward, and safe approach to third ventricle astrocytomas. It allowed the authors to perform tumor resection with the same microsurgical technique: dissecting the tumor with 2 hands, performing a central debulking, and controlling the bleeding with bipolar coagulation. The main limitations were represented by some anatomical conditions, such as the position of the chiasm and the anterior communicating artery complex and, finally, by the challenge of watertight plastic repair. To definitively evaluate the role of this approach in hypothalamic gliomas, a comparison with transcranial series would be necessary, but due to the rarity of these cases such a study is still lacking. The authors observed that more aggressive surgery is associated with a worse endocrinological outcome; thus they consider it to be an open question (in particular in prepubertal patients) whether radical removal is an advisable goal for hypothalamic gliomas.

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Pseudocapsule-Based Resection for Pituitary Adenomas via the Endoscopic Endonasal Approach

Frontiers in Oncology ◽

10.3389/fonc.2021.812468 ◽

2022 ◽

Vol 11 ◽

Author(s):

Yuefei Zhou ◽

Jialiang Wei ◽

Feng Feng ◽

Jianguo Wang ◽

Pengfei Jia ◽

...

Keyword(s):

Pituitary Adenomas ◽

Tumor Resection ◽

Csf Leak ◽

Safe Procedure ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Extracapsular Resection

IntroductionThe endoscopic endonasal approach (EEA) is a safe and effective treatment for pituitary adenomas (PAs). Since extracapsular resection (ER) of PAs improves tumor resection and endocrine remission rates, the interface between the pseudocapsule and gland draws increasing attention. However, it is difficult to precisely dissect the tumor along the exact boundary, and complete removal of the tumor increases the risks of normal tissue damage and cerebrospinal fluid (CSF) leakage. In this study, we investigated the extracapsular resection as well as the pseudocapsule histology to evaluate the effectiveness and safety of pseudocapsule-related surgical interventions.MethodsFrom December 2017 to December 2019, 189 patients of PAs via EEA in our single center were analyzed retrospectively. The images, operative details, and clinical follow-up of patients were collected. Sixty-four patients underwent pseudocapsule-based ER, and 125 patients also underwent traditional intracapsular resection (IR) with or without intensive excision for FPAs. The clinical characteristics, tumor resection, endocrinological outcomes, and postoperative morbidities of the two groups were compared. Informed consent for publication of our article was obtained from each patient. Histological examination of pseudocapsule was performed using hematoxylin and eosin and reticulin staining.ResultsThe gross total recession was 62 (96.9%) in the ER group and 107 (85.6%) cases in the IR group, whereas the endocrine remission rate was 29/31 (93.5%) and 40/53 (75.5%) cases, respectively. Anterior pituitary functions were not aggravated postoperatively in any patient, but transient diabetes insipidus (DI) occurred more in the IR group (64.0%) than in ER (48.4%). Pseudocapsule specimens were obtained in 93 patients, and clusters of small cell aggregation were detected in 11 pseudocapsule specimens (11.8%) whereas other patients showed no remarkable developed pseudocapsule. Intraoperative CSF leak occurred more in the ER group (28.1%) than in the IR group (13.6%), but no difference was seen between two groups postoperatively. No case of intracranial hematoma or pituitary crisis occurred in both groups. After a mean follow-up of 22.8 months, tumor recurrence was observed in 4 (2.1%) cases.ConclusionPseudocapsule-based extracapsular resection of PAs via EEA is an effective and safe procedure to achieve complete resection with high and sustained endocrine remission and without deteriorating pituitary function.

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Long Term Follow-up after Endoscopic Endonasal Approach for the Treatment of Cushing's Disease

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669956 ◽

2018 ◽

Vol 80 (03) ◽

pp. 306-309

Author(s):

Alexandre Bossi Todeschini ◽

Américo Rubens Leite dos Santos ◽

Ricardo Landini Lutaif Dolci ◽

José Viana Lima Junior ◽

Nilza Maria Scalissi ◽

...

Keyword(s):

Cushing’S Disease ◽

Early Years ◽

Neurological Deficits ◽

Cushing's Disease ◽

Csf Leak ◽

Sustained Remission ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

Introduction Surgery has been the standard treatment for Cushing's disease. Currently, the endoscopic endonasal approach (EEA) is the most widely used technique. However, among some endocrinologists and neurosurgeons used to the microscope assisted technique, there are still questions about the effectiveness and safety of transitioning to the EEA. We aim to show our initial experience with such transition. Method Retrospective review of medical records of patients, who underwent EEA in our center as a first treatment for Cushing's disease, and with a minimum 18 months of follow-up, from March 2004 to March 2014 Results Our cohort had 16 patients (14 females and 2 males), with a mean age of 33.7 years. The mean follow-up was 52.0 months. Magnetic resonance imaging (MRI) identified an adenoma in 93.8% of the patients (56.2% microadenomas and 37.5% macroadenomas). Postoperative cerebrospinal fluid (CSF) leak was observed in two patients (12.5%). No new neurological deficits were present after surgery. The early remission and sustained remission rates after a single procedure were 87.5 and 68.75%, respectively. Weight reduction, improved control of blood pressure, and lower serum glucose levels were documented in 68.75, 60, and 55.5% of patients, respectively, after remission. Conclusion Despite the need for specialized training, equipment and team building by ENT (Ear, Nose and Throat) and neurosurgery, the transition from microscope assisted pituitary surgery to endoscopic endonasal approach is possible and safe. The clinical outcomes, even in the early years, are similar to the previous microscope assisted treatment, and over time, with greater experience and knowledge, there is a tendency for improvement.

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P.053 Expanded endoscopic endonasal approach for petrous apex lesions: our clinical experience and surgical techniques

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.155 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S29-S29

Author(s):

F Alkherayf ◽

S Kilty

Keyword(s):

Cranial Nerve ◽

Surgical Techniques ◽

Csf Leak ◽

Petrous Apex ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Invasive Approach ◽

Brain Retraction

Background: Traditionally petrous apex lesions surgical approach is associated with multiple complications including brain injury secondary to brain retraction. Expanded endoscopic endonasal trans-clival (EEET) can be used in selected patients with minimal complications. Methods: We are presenting our experience over the last three years in patients who underwent EEET resection of petrous apex lesions: 8 patients underwent such procedure. All patients underwent extensive workup including MRI and CTA to identify the relation of the carotid to the lesion. All surgeries were done with neuro-physiological monitoring. Intraoperative neuronavigation and endoscopic Doppler were used to identify the petrous segment of the internal carotid artery. Our follow up ranged from 6 months to 2.5 years. Results: All patients presented with severe neurologic symptoms related to either fifth cranial nerve, sixth cranial nerve or brain stem compression. Pathologies included chondrosarcoma, cholesterol granulomas and lymphangioma. All patients demonstrated improvement in their symptoms. None of our patients had intra-operative vascular injury. There was no post-operative CSF leak or infection. Postoperative imaging demonstrated excellent resection with no clear residual. Three patient required adjuvant stereotactic radiosurgery because of their underlying pathology. Conclusions: The expanded endoscopic endonasal approach for petrous apex lesion should be considered as a minimally invasive approach in selected cases.

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