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Transorbital approach for endoscopic repair of encephalocele

Sarris, Christina E; Santarelli, Griffin D; Little, Andrew S
This video demonstrates the transorbital approach for endoscopic repair of an anterior skull base encephalocele. The patient is a 77-year-old man with morbid obesity and a 2-year history of left-sided cerebrospinal fluid (CSF) rhinorrhea and radiographic evidence of an anterior skull base defect with an encephalocele. An endoscopic transorbital approach was chosen for repair because of its minimally invasive access to the anterolateral skull base. The patient had an excellent clinical outcome with resolution of the CSF rhinorrhea and preservation of full vision and extraocular muscle function. The video can be found here: https://youtu.be/oDhZgnaiZ00.
PMCID:9542374
PMID: 36284788
ISSN: 2643-5217
CID: 5475082

Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement and Reduction in Operative Time and Total Hospital Charges

Catapano, Joshua S; Mezher, Andrew W; Wang, Derrick J; Whiting, Alexander C; Mooney, Michael A; Bohl, Michael A; Sheehy, John P; DiDomenico, Joseph D; Sarris, Christina E; Smith, Kris A; Lawton, Michael T; Zabramski, Joseph M
OBJECTIVE:In ventriculoperitoneal shunt (VPS) placement, distal placement of the peritoneal catheter will typically be performed by a neurosurgeon. More recently, laparoscopic-assisted (LA) placement of the distal peritoneal catheter by general surgeons has become common. The present study examined whether LA placement of a VPS (LAVPS) is associated with a reduced operative time, lower hospital costs, and fewer distal revisions. METHODS:A retrospective review was performed of the data from all patients who had received a new VPS at our institution from 2013 to 2016. Age, sex, diagnosis, previous abdominal surgery, operative time, anesthesia grade, incidence of 30-day shunt failure, and total hospital charges were analyzed. RESULTS:A total of 680 patients had undergone first-time VPS placement, including 199 with LAVPS and 481 with non-LAVPS placement (non-LAVPS). The mean age of the LAVPS patients was significantly older than that of the non-LAVPS patients (64.1 vs. 59.3 years; P = 0.002). The mean operative time was shorter in the LAVPS group than in the non-LAVPS group (55 vs. 75 minutes; P < 0.001). Distal shunt revision within 30 days occurred more often for the non-LAVPS patients (6 of 481 [1.2%]) than for the LAVPS patients (0 of 199 [0%]). A subset analysis of patients with normal-pressure hydrocephalus found decreased total hospital charges in the LAVPS group ($67,124 vs. $80,890; P = 0.009). CONCLUSIONS:Compared with non-LAVPS, LAVPS was associated with significantly shorter operative times and fewer distal shunt revisions within 30 days. The findings from a subset analysis supported a decrease in total hospital charges. Additional studies are needed; however, these data suggest that LAVPS is a safer, less-expensive alternative to non-LAVPS.
PMID: 31874294
ISSN: 1878-8769
CID: 5474992

Evaluation of Surgical Resection Goal and Its Relationship to Extent of Resection and Patient Outcomes in a Multicenter Prospective Study of Patients With Surgically Treated, Nonfunctioning Pituitary Adenomas: A Case Series [Case Report]

Little, Andrew S; Chicoine, Michael R; Kelly, Daniel F; Sarris, Christina E; Mooney, Michael A; White, William L; Gardner, Paul A; Fernandez-Miranda, Juan C; Barkhoudarian, Garni; Chandler, James P; Prevedello, Daniel M; Liebelt, Brandon D; Sfondouris, John; Mayberg, Marc R
BACKGROUND:The influence of the surgeon's preoperative goal regarding the extent of tumor resection on patient outcomes has not been carefully studied among patients with nonfunctioning pituitary adenomas. OBJECTIVE:To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. 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:GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = .001). Sensitivity, specificity, positive predictive value, and negative predictive value of GTR goal were 82.2, 43.9, 86.5, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced surgeon were associated with surgeons choosing GTR as the goal (P < .01). There was no association between surgical goal and presence of pituitary deficiency at 6 mo (P = .31). Tumor Knosp grade (P = .004) and size (P = .001) were stronger predictors of GTR than was surgical goal (P = .014). The most common site of residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). CONCLUSION:This is the first pituitary surgery study to examine surgical goal regarding extent of tumor resection and associated patient outcomes. Surgical goal is a poor predictor of actual tumor resection. A more aggressive surgical goal does not correlate with pituitary gland dysfunction. A better understanding of the ability of surgeons to meet their expectations and of the factors associated with surgical result should improve prognostication and preoperative counseling.
PMID: 31079156
ISSN: 2332-4260
CID: 5474982

Convexity meningioma resection in the modern neurosurgical era

Sarris, Christina; Sanai, Nader
Convexity meningiomas are among the most common extra-axial tumors encountered in neurosurgery. Advances in diagnostic imaging, intraoperative technology, and nonsurgical treatment modalities have changed the face of neurosurgical oncology. In this chapter we describe the modern neurosurgeon's approach to convexity meningiomas in terms of diagnosis, treatment, and follow-up care.
PMID: 32586511
ISSN: 0072-9752
CID: 5475002

Proposal and Validation of a Simple Grading Scale (TRANSSPHER Grade) for Predicting Gross Total Resection of Nonfunctioning Pituitary Macroadenomas After Transsphenoidal Surgery

Mooney, Michael A; Sarris, Christina E; Zhou, James J; Barkhoudarian, Garni; Chicoine, Michael R; Fernandez-Miranda, Juan C; Gardner, Paul A; Hardesty, Douglas A; Jahnke, Heidi; Kelly, Daniel F; Liebelt, Brandon D; Mayberg, Marc R; Prevedello, Daniel M; Sfondouris, John; Sheehy, John P; Chandler, James P; Yuen, Kevin C J; White, William L; Little, Andrew S
BACKGROUND:A simple, reliable grading scale to better characterize nonfunctioning pituitary adenomas (NFPAs) preoperatively has potential for research and clinical applications. OBJECTIVE:To develop a grading scale from a prospective multicenter cohort of patients that accurately and reliably predicts the likelihood of gross total resection (GTR) after transsphenoidal NFPA surgery. METHODS:Extent-of-resection (EOR) data from a prospective multicenter study in transsphenoidal NFPA surgery were analyzed (TRANSSPHER study; ClinicalTrials.gov NCT02357498). Sixteen preoperative radiographic magnetic resonance imaging (MRI) tumor characteristics (eg, tumor size, invasion measures, tumor signal characteristics, and parameters impacting surgical access) were evaluated to determine EOR predictors, to calculate receiver-operating characteristic curves, and to develop a grading scale. A separate validation cohort (n = 165) was examined to assess the scale's performance and inter-rater reliability. RESULTS:Data for 222 patients from 7 centers treated by 15 surgeons were analyzed. Approximately one-fifth of patients (18.5%; 41 of 222) underwent subtotal resection (STR). Maximum tumor diameter > 40 mm; nodular tumor extension through the diaphragma into the frontal lobe, temporal lobe, posterior fossa, or ventricle; and Knosp grades 3 to 4 were identified as independent STR predictors. A grading scale (TRANSSPHER grade) based on a combination of these 3 features outperformed individual variables in predicting GTR (AUC, 0.732). In a validation cohort, the scale exhibited high sensitivity and specificity (AUC, 0.779) and strong inter-rater reliability (kappa coefficient, 0.617). CONCLUSION:This simple, reliable grading scale based on preoperative MRI characteristics can be used to better characterize NFPAs for clinical and research purposes and to predict the likelihood of achieving GTR.
PMID: 30649445
ISSN: 2332-4260
CID: 5474972

Rare Thyroid Transcription Factor 1-Positive Tumors of the Sellar Region: Barrow Neurological Institute Retrospective Case Series

Cole, Tyler S; Potla, Subodh; Sarris, Christina E; Przybylowski, Colin J; Baranoski, Jacob F; Mooney, Michael A; Barranco, F David; White, William L; Eschbacher, Jennifer M; Little, Andrew S
OBJECTIVE:Granular cell tumors (GCTs), pituicytomas, and spindle cell oncocytomas are rare, nonfunctioning pituitary tumors sharing positive staining of thyroid transcription factor 1. We present our series, the first single-institutional report with long-term surgical follow-up of all 3 tumor types. METHODS:Our institutional pathology database was queried for these 3 pathologic diagnoses. Clinical records were assessed for clinical presentation, preoperative and postoperative endocrine status, tumor location on imaging, surgical characteristics, pathology results, and tumor recurrence. RESULTS:Data were analyzed for 4 patients with GCTs, 4 with pituicytomas, and 3 with spindle cell oncocytomas. The most common symptoms at presentation were vision changes (64%), headache (55%), endocrine abnormalities (55%), and fatigue (46%). GCTs were the only subtype to present exclusively in the infundibulum and the only subtype in our series to be treated with a transcranial transsylvian approach to resection (n = 2). In our study, in contrast to other reports, estimated blood loss was less than 300 mL in all patients. Imaging confirmed gross total resection in all 11 cases with no known recurrences at a mean (standard deviation) follow-up of 4.7 (3.7) years. CONCLUSIONS:We present a single-institution series of rare thyroid transcription factor 1-staining posterior pituitary tumors of the sellar region. Key novel findings include gross total resection with no tumor recurrence at nearly 5 years of mean follow-up and no cases of excess or uncontrolled blood loss. Our findings reinforce the observation that GCTs present in the suprasellar space.
PMID: 31132506
ISSN: 1878-8769
CID: 5472762

Hemorrhagic Complications of External Ventriculostomy in the Aspirin and P2Y12 Response Assay Era

Majmundar, Neil; Sarris, Christina; Shastri, Darshan; Doran, Joseph; Gandhi, Chirag; Assina, Rachid
OBJECTIVE:Hemorrhagic complications reported from external ventricular drain (EVD) placement range from 10% to 44%. There remains limited literature investigating the incidence, risk factors, and mechanisms to prevent its occurrence, especially in the setting of antiplatelet agent use. We investigated EVD-related hemorrhagic complications after the implementation of VerifyNow platelet inhibition assays at our institution. METHODS:Medical records from 445 patients requiring EVD placement during a 2-year period during which our institution used the assays were reviewed. In total 345 patients were included, and 208 of them underwent assay testing. Indications for EVD included complications of cerebrovascular disease (n = 215), traumatic brain injury (n = 74), primary hydrocephalus (n = 23), and tumor (n = 33). Hemorrhage was defined as any new area of hyperdensity adjacent to or immediately along the catheter trajectory on computed tomography. RESULTS:There was no significant decrease in catheter-induced hemorrhage (CIH) between patients who underwent the VerifyNow assay and those who did not. Platelet transfusion did not significantly decrease the risk of CIH. CIH occurred in 17.7% of patients, significantly decreased when compared with our previously published incidence of 33% before platelet inhibition assay use (P < 0.05). Patients with cerebrovascular disease complications exhibited a significant decrease in CIH, 20% versus 39%, before assay use (P < 0.01). CONCLUSIONS:The incidence of hemorrhage is lower in our new cohort when compared with that of our previously published cohort. Despite the overall decreased rate of hemorrhage, there was no significant difference in hemorrhage rates between patients who did or did not undergo the assay. Platelet transfusion did not decrease the incidence of hemorrhage in patients with inhibited platelet function.
PMID: 30439521
ISSN: 1878-8769
CID: 5474962

Pediatric Lumbar Puncture Pressures do not Correlate with Intracranial Pressures Measured via Intraparenchymal Wire [Meeting Abstract]

Sarris, Christina; Cole, Tyler; Bristol, Ruth
ISI:000475838400195
ISSN: 0022-3085
CID: 5475102

Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy

Mooney, Michael A; Hendricks, Benjamin; Sarris, Christina E; Spetzler, Robert F; Almefty, Kaith K; Porter, Randall W
PMCID:5951693
PMID: 29765830
ISSN: 2193-6331
CID: 5474952

Intracranial Pressure Measurement Under General Anesthesia Is Not Reliable [Meeting Abstract]

Bristol, Ruth E.; Sarris, Christina E.; Singh, Davinder; Hooft, Nicole
ISI:000515151400044
ISSN: 0148-396x
CID: 5475112