Faculty Bibliography

INTRODUCTION/BACKGROUND:Differentiated thyroid cancer is the most common endocrine malignancy and has an excellent 5-year survival rate after appropriate management. Current management guidelines state that thyroid lobectomy is adequate resection for papillary thyroid cancer (PTC) without preoperative evidence of high-risk features. However, the extent of surgery for PTC in the thyroid isthmus remains controversial, given the unclear lymphatic drainage and retrospective studies suggesting higher rates of lymphatic metastasis. The aim of this study was to examine the surgical management and outcomes of patients with isthmus PTC. METHODS:A retrospective review was performed at two high-volume centers of 138 patients who underwent thyroidectomy between 2013 and 2021 with isthmus PTC on final pathology. Preoperative tumor characteristics, surgical pathology, and postoperative outcomes were compared. RESULTS:There were 138 patients treated for isthmus PTC. Total thyroidectomy (TT) was most frequently performed (70.0 ​%), followed by lobectomy (TL, 17.1 ​%) and isthmusectomy (TI, 12.9 ​%). Among the 106 patients with Bethesda V/VI nodules, most underwent TT (75.5 ​%), followed by TL (13.2 ​%), and TI (11.3 ​%). Patients with Bethesda III/IV nodules most frequently had TI (44.4 ​%) or TL (44.4 ​%), then followed by TT (11.1 ​%). Patients who underwent TT more frequently had suspicious lymph nodes on preoperative imaging (n ​= ​30, n ​= ​1, n ​= ​0, p ​< ​0.001) and/or multiple nodules than TL and TI respectively (73.5 ​%, 70.8 ​%, 16.7 ​%, p ​< ​0.001). Of TT patients, 48 had central neck dissections (29 prophylactic and 19 therapeutic) and 20 had both therapeutic CND and lateral neck dissections. TT patients had larger median tumor size (1.5 ​cm; TL 1.1 ​cm; TI 1.0 ​cm; p ​= ​0.008). PTC variants were identified in 26.1 ​% of patients. Completion thyroidectomy was performed in 4 patients (TL, n ​= ​2; TI, n ​= ​2, p ​= ​0.41). Of 99 patients with lymph nodes sampled, 62 patients had metastatic lymph nodes (TT 58.2 ​%; TL, 16.7 ​%; TI: 11.1 ​%; p ​= ​0.02). At the last follow-up, 10 patients had persistent/recurrent disease (TT: 8, TI: 2, TL: 0). At one year, among patients who did not undergo TT, 10 patients required thyroid hormone replacement (TL: 56 ​%; TI: 10 ​%; p ​= ​0.018). CONCLUSION/CONCLUSIONS:Isthmus PTC may present with high-risk pathologic variants and positive nodes in 2 out of 3 patients. TI may be an appropriate management strategy in small, low-risk tumors, with similar reoperation rates as TL and lower rates of needing thyroid hormone replacement.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Neurosurgical clinical research depends on medical data collection and evaluation that is often laborious, time consuming, and inefficient. The goal of this work was to implement and evaluate a novel departmental data infrastructure (Neuro Data Hub) designed to provide specialized data services for neurosurgical research. Data acquisition would become available purely by request. METHODS:through collaboration between Department Leadership and Medical Center Information Technology, integrating it with Institutional Review Board workflows and an existing Epic electronic health record Datalake infrastructure. The system implementation included monthly departmental meetings and an asynchronous Research Electronic Data Capture-based request system. Data requests submitted between August 2023 and November 2024 were analyzed and categorized as basic, complex, or Natural Language Processing (NLP)-augmented, with optional visualization and database creation services. Request volumes, types, and execution times were assessed. RESULTS:The Hub processed 39 research data requests (2.6/month), comprising 3 basic, 22 complex, and 14 NLP-augmented requests. Two complex requests included visualization services, and one NLP request included database creation. Average request execution time was 36.5 days, with NLP-augmented requests showing increasing adoption over time. CONCLUSION/CONCLUSIONS:The Neuro Data Hub represents a paradigm shift from centralized to department-level data services, providing specialized support for neurosurgical research and democratizing access to institutional data. While effective, implementation may be limited by institutional information technology infrastructure requirements. This model could serve as a template for any form of medical-clinical research program seeking to improve data accessibility and research capabilities.

OBJECTIVE:To characterize patient outcomes after primary stereotactic radiosurgery (SRS) for the management of sporadic facial nerve schwannoma. STUDY DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Six tertiary referral centers across the United States and United Kingdom. PATIENTS/METHODS:Adults undergoing SRS from 2000 through 2023 for sporadic facial nerve schwannoma along any segment of the facial nerve were included. Patients with NF2-related schwannomatosis were excluded. INTERVENTION/METHODS:Stereotactic radiosurgery. MAIN OUTCOME MEASURE/METHODS:Long-term tumor control. RESULTS:Among 60 patients meeting inclusion, the median age at SRS was 52 years (IQR: 41 to 64) with a median tumor size of 19.5 mm (IQR: 14.7 to 22.8). Tumors commonly involved the internal auditory canal (73%), cisternal (49%), geniculate/labyrinthine (47%), and tympanic segments (22%). Two patients experienced SRS failure and underwent salvage treatment; salvage-free survival rates (95% CI; number still at risk) at 1, 3, 5, and 10 years after SRS were 100% (100 to 100; 55), 100% (100 to 100; 36), 100% (100 to 100; 18), and 87% (72 to 100; 9), respectively. Among 31 (52%) patients with House-Brackmann (HB) grade I facial function at presentation, only 6 demonstrated worse facial function at a median of 3.2 years (IQR: 1.7 to 6.6) after SRS. Of 18 patients with serviceable hearing (AAO-HNS class A/B) at SRS, 13 maintained serviceable hearing at a median of 1.0 years (IQR: 0.5 to 4.9) of post-SRS audiometric follow-up. CONCLUSIONS:Durable tumor control after primary SRS for sporadic facial nerve schwannoma is achieved in most patients. Among those with HB grade I facial function at presentation, treatment with SRS harbors limited additional risk of facial paresis beyond observation alone.

PURPOSE/UNASSIGNED:Primary muscle tension dysphonia (pMTD) is a form of vocal hyperfunction with no preexisting tissue trauma to the vocal folds. There are no known structural or neurological causes of pMTD, and there is rarely obvious, confirmatory evidence to reliably diagnose individuals accurately. Furthermore, acoustic and aerodynamic measurements taken during voice assessments vary widely within this population. The purpose of this study was to find subgroups within a sample of pMTD patients based on acoustic and aerodynamic measurements. We use a computational approach to elucidate what has largely been observational in the past. METHOD/UNASSIGNED:-means clustering analysis was conducted. RESULTS/UNASSIGNED:The exploratory factor analysis grouped together variables across patients, which resulted in three principal axes. These three principal axes separately consisted of aperiodicity, fundamental frequency, and aerodynamic measurements. These principal axes explained 44.7% of the total variance. Four clusters of patients were identified across the three principal axes. These were characterized by (a) a high amount of aperiodicity in the voice, (b) lower fundamental frequency values, (c) higher fundamental frequency values, and (d) high aerodynamic values. CONCLUSIONS/UNASSIGNED:The clusters identified in the current study are reliable and moderately separated. Furthermore, these clusters align with previously identified subgroups in related work. The analysis presented here lays the groundwork for additional clustering analyses with new pMTD samples, as well as future work establishing subtype classifications of pMTD.

INTRODUCTION/BACKGROUND:Foreign bodies in the aerodigestive tract pose a clinical challenge that must be addressed both swiftly and judiciously. Characteristics specific to both individual patients and to individual types of foreign bodies must be taken into consideration when planning for foreign body removal. OBJECTIVE:To discuss a scenario in which multidisciplinary decision-making was employed to remove a foreign body both quickly and safely. CASE SUMMARY/METHODS:We present a case of an adolescent girl who presented with throat pain and inability to manage her secretions after unintentionally swallowing a fork, which became lodged in her proximal esophagus. The position of the tines of the fork made intubation impossible. The fork was removed using direct laryngoscopy while the patient maintained spontaneous respirations. DISCUSSION/CONCLUSIONS:Complex decision-making, involving clinicians with expertise in various specialties, is often necessary to ensure a safe outcome. Careful planning and consideration of various details, specific to both foreign body characteristics and to patients themselves, are necessary to provide safe and efficient care for patients with foreign body ingestion.

OBJECTIVE:Bilateral cochlear implantation (CI) is not routinely recommended in patients of advanced age due to concerns regarding cost-effectiveness and the medical risks of multiple operations in this population. This study seeks to evaluate outcomes of bilateral CI in post-lingually deafened adults over 65 years old. STUDY DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Tertiary referral center. PATIENTS/METHODS:Thirty-five post-lingually deafened adults over 65 years at the time of second implantation (CI2) and 11 post-lingually deafened adults over 65 years at the time of simultaneous implantation. INTERVENTIONS/METHODS:Bilateral cochlear implantation. MAIN OUTCOME MEASURES/METHODS:Bilateral CNC word scores at 1 year postoperatively. RESULTS:Bilateral CNC scores were significantly improved compared with preoperative scores 1 year postoperatively in both sequentially implanted patients (d=9.2%, P<0.001) and simultaneously implanted patients (d=44%, P=0.028). No significant correlations were observed between changes in bilateral CNC word scores at 1 year and age at the time of CI1 (r=0.095, P=0.665), age at the time of CI2 (r=0.034, P=0.879), or length of time between implantations (r=0.164, P=0.453) in sequentially implanted patients, nor was age at implantation correlated with changes in bilateral CNC scores at 1 year in simultaneously implanted patients (r=0.548, P=0.452). Finally, bilateral CNC scores of sequentially and simultaneously implanted patients were not found to be different at 1 year (d=4.5%, P=0.8905). CONCLUSIONS:Patients older than 65 years who underwent both sequential and simultaneous bilateral cochlear implantation showed similar and significant improvements in speech perception scores compared with preoperative scores. These outcomes were not correlated with age at the time of implantation or time between implantations in the case of sequentially implanted patients. This suggests that significant benefit can be seen even with advanced age at the time of implantation and longer time between implantations.