Anthony Del Signore

The presentation and outcomes of mucosal melanoma in 695 patients

Most data on sinonasal mucosal melanoma come from small institutional studies, and therefore optimal treatment methods are not well understood. The purpose of this study was to analyze the association between treatment and survival in sinonasal mucosal melanoma.

Complications and Failures of Office-Based Endoscopic Angiolytic Laser Surgery Treatment

OBJECTIVES/HYPOTHESIS Although office-based laser surgery applications for benign and premalignant lesions of the larynx are appealing, there are scant data on their complications and failures. We review office-based angiolytic laser surgery in patients with benign laryngeal pathology for rates of complication and failure. STUDY DESIGN Retrospective chart review. METHODS Two hundred fifty-five patients who underwent in-office angiolytic laser surgery treatment over 4 years were reviewed. The criteria for complications and failures were based on postprocedure stroboscopy and clinical findings. RESULTS The majority of patients had unilateral disease, which included polyps (46%), leukoplakia (14%), papilloma (13%), scar (12%), and varix (11%). There were 382 laser treatments, of which 56% were by pulsed potassium titanyl phosphate laser. Average energy delivery was lesion specific, with papilloma receiving the most (mean 351 J) and varices receiving the least (mean 53 J) energy. Most in-office treatments were tolerated well. Four percent of patients had complications including stiffness, atrophy, and transient but prolonged hyperemia. Twenty-seven percent of patients required multiple laser treatments. Multiple treatments were more likely in papilloma and leukoplakia. CONCLUSIONS While in-office laser therapy for benign vocal fold lesions is appealing, repeated treatment due to incomplete resolution may be needed. Risks of transient and long-term complications are low but real. Patient selection and standardized laser energy parameters may help in decreasing complications and need for repeat procedures.

Primary Intraosseous Cavernous Hemangioma of the Clivus: Case Report and Review of the Literature

Primary intraosseous hemangiomas are benign, vascular malformations that account for approximately 1% of all primary bone neoplasms. These tumors are mostly found in vertebral bodies and are rarely seen in the calvarium, where they represent 0.2% of bony neoplasms. When found in the skull, they tend to present with vague symptoms and do not have the typical radiological findings suggestive of hemangiomas. Because of this, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. Involvement of the skull base is exceedingly rare, and presentation with cranial nerve unilateral polyneuropathies has not been reported. We report a patient case with review of recent pertinent literature.

Immersive virtual reality as a teaching tool for neuroanatomy

Three‐dimensional (3D) computer modeling and interactive virtual reality (VR) simulation are validated teaching techniques used throughout medical disciplines. Little objective data exists supporting its use in teaching clinical anatomy. Learner motivation is thought to limit the rate of utilization of such novel technologies. The purpose of this study is to evaluate the effectiveness, satisfaction, and motivation associated with immersive VR simulation in teaching medical students neuroanatomy.

Improved delivery of sinus irrigations after middle turbinate resection during endoscopic sinus surgery: Sinus irrigation and middle turbinate resection

Improvement in topical delivery to nasal mucosa is a fundamental goal of endoscopic sinus surgery (ESS). This study compares the penetration of irrigation before and after middle turbinate resection (MTR) to assess the efficacy of topical delivery.

Thyroid and Parathyroid Surgery

Multiple staging systems employed, stage affected by age (45). Cervical metastatic disease very common in papillary thyroid cancer, does not usually affect prognosis. Thyroid malignancy is usually treated surgically. Key to successful parathyroid adenoma is accurate preoperative localization. Intraoperative parathyroid hormone (PTH) assay used at most centers to verify adequate treatment

Prevalence of severe obstructive sleep apnea in pediatric adenotonsillectomy patients

To determine the prevalence of severe obstructive sleep apnea (OSA) in a pediatric population who underwent indicated surgery for sleep disordered breathing (SDB).

Outcomes in Adult Sinonasal Rhabdomyosarcoma

Objective To describe patient demographics, histology, treatment modalities, and survival associated with adult sinonasal rhabdomyosarcoma. Study Design Retrospective review of a national database. Setting Tertiary medical center. Subjects and Methods Patient demographics, tumor histology, treatment modalities, and survival trends were examined for patients aged ≥18 years who were diagnosed with sinonasal rhabdomyosarcoma between 2004 and 2013 with the National Cancer Database. Kaplan-Meier analysis and the log-rank tests were performed to determine the unadjusted association between overall survival and various patient and disease characteristics. Results A total of 186 patients were identified; 5-year overall survival was 28.4%. Over half of patients were between 18 and 35 years old at diagnosis (53.8%), which was associated with improved 5-year overall survival over patients >35 years old (31.9% vs 24.4%, P = .014). Alveolar sinonasal rhabdomyosarcoma was most common (66.7%). There was no statistical difference in 5-year overall survival between alveolar and embryonal subtypes (30.5% vs 41.6%, P > .05). Metastatic disease was present in 27.7% of patients and was associated with worse 5-year overall survival (14.7% vs 33.9%, P < .0001). The majority of patients were treated with chemotherapy with adjuvant radiation (49.5%). A quarter of patients were treated with surgery plus chemoradiation (25.8%). Conclusion We present the largest analysis of adult sinonasal rhabdomyosarcoma using a standardized national based database. Adult sinonasal rhabdomyosarcoma has a very poor prognosis independent of histologic subtype. The small number of surgical cases limits the ability of the analysis to accurately compare treatment with chemoradiation with and without surgery.

A systematic review of secondary cerebrospinal fluid leaks

Background Secondary cerebrospinal leaks (CSF) are leaks that recur after an initial endoscopic repair of CSF leaks. Identification of characteristics that could predict secondary leaks may allow surgeons to plan repairs with the knowledge that these defects are more likely to fail. Objective To identify characteristics that could predict secondary CSF leaks. Methods A search of all studies that reported outcomes after endoscopic repair of CSF leaks was conducted by using medical literature data bases. Studies with the following criteria were included: written in the English language, secondary CSF leaks after primary repair, and assessment of success of fistula repair. Data extracted included the etiology of the leak, site of the leak, reconstructive materials used, and success of the repair. Results Ninety-four studies, from 1988 to 2015, with a total of 3149 primary CSF leaks were included. Sixty-three studies (67%) had a success rate of ≥80%; 77 studies (82%) had secondary leak rates of <40%. For 88 of the 94 studies (94%), the success rate after secondary repair improved to 81.0–100%. Of 48 studies that included leaks of more than one site, the sphenoid was the most common site of leak in 26 studies (55%), the ethmoid was the most common site in 16 studies (34%), and the cribriform was the most common site in 11 studies (23%). Conclusion The rate of secondary CSF leaks was low due to advances in endoscopic repair techniques. Spontaneous and iatrogenic CSF leaks were more likely to recur, especially without adequate control of underlying factors, such as increased intracranial pressure and obesity. Further studies with consistent reporting are required for more definitive conclusions about secondary CSF leaks.

Costs in Pituitary Surgery: Racial, Socioeconomic, and Hospital Factors

Abstract Objective To investigate the influence of patient demographic factors and hospital factors on cost and length of stay in patients undergoing pituitary surgery. Design/Setting A retrospective cross‐sectional study of the 2008 to 2012 Nationwide/National Inpatient Sample. Participants Patient demographics and hospital characteristics for patients undergoing pituitary surgery were compared between white, black, and Hispanic patients. Main Outcome Measures Variables associated with increased cost and increased length of hospital stay were ascertained and compared against each racial and ethnic group via multiple linear regression analysis. Results Of 8,812 patients who underwent pituitary surgery, 5,924 (67.2%) patients were white, 1,590 (18.0%) were black, and 1,296 (14.7%) were Hispanic. Patient variables found to be significantly different between racial groups via univariate analysis were age, chronic conditions, gender, income, and primary payer. Hospital variables found to be significantly different were location/teaching status, region, and ownership. Hospitalization cost was significantly lower for whites (−