Puya Alikhani

Surgical management of trigeminal neuralgia: use and cost-effectiveness from an analysis of the Medicare Claims Database.

BACKGROUND Trigeminal neuralgia is a relatively common neurosurgical pathology with multiple management options. Microvascular decompression (MVD) is nonablative and is considered the gold standard. However, stereotaxic radiosurgery (SRS) and percutaneous stereotaxic rhizotomy (PSR) are 2 noninvasive but ablative options that have rapidly gained support. OBJECTIVE To use Medicare claims data in conjunction with a literature review to assess the usage, effectiveness, and cost-effectiveness of the 3 different invasive treatments for trigeminal neuralgia. METHODS All of the claims of trigeminal neuralgia treatment were extracted from the 2011 5% Inpatient and Outpatient Limited Data Set. Current Procedural Terminology, 4th Edition/International Classification of Diseases, Ninth Revision codes for the 3 different surgical treatment modalities were used to further classify these claims. Kaplan-Meier survival curves in key articles were used to calculate quality-adjusted life years and cost-effectiveness for each procedure. RESULTS A total of 1582 claims of trigeminal neuralgia were collected. Ninety-four (6%) patients underwent surgical intervention. Forty-eight (51.1%) surgical patients underwent MVD, 39 (41.5%) underwent SRS, and 7 (7.4%) underwent PSR. The average weighted costs for MVD, SRS, and PSR were

Anterior Petrosectomy: Consecutive Series of 46 Patients with Attention to Approach-Related Complications.

40 434.95,

Drainage of a ventral epidural atlantoaxial abscess via the transoral approach

38 062.27, and

Endoscopic endonasal resection of a medullary cavernoma: a novel case

3910.64, respectively. The quality-adjusted life years were 8.2 for MVD, 4.9 for SRS, and 6.5 for PSR. The cost per quality-adjusted life year was calculated as

Surgical Exposure of the Cranial Nerves

4931.1,

Anterior inferior petrosectomy: defining the role of endonasal endoscopic techniques for petrous apex approaches

7767.8, and

Paraclival or Cavernous Internal Carotid Artery: One Segment but Two Names

601.64 for MVD, SRS, and PSR, respectively. CONCLUSION This study shows that the most frequently used surgical management of trigeminal neuralgia is MVD, followed closely by SRS. PSR, despite being the most cost-effective, is by far the least utilized treatment modality.

Endoscopic Transnasal Coagulation of Anterior and Posterior Ethmoidal Arteries before Open Resection of Large Anterior Skull Base Meningiomas: A Novel Combined Approach and Review of Two Illustrative Cases

Objective Anterior petrosectomy(AP) was popularized in the 1980s and 1990s as micro-neurosurgery proliferated. Original reports concentrated on the anatomy of the approach and small case series. Recently, with the advent of additional endonasal approaches to the petrous apex, the morbidity of AP remains unclear. This report details approach-related morbidity around and under the temporal lobe. Methods A total of 46 consecutive patients identified from our surgical database were reviewed retrospectively. Results Of the 46 patients, 61% were women. Median age of the patients was 50 years (mean: 48 ± 2 years). Median follow-up of this cohort was 66 months. Most procedures dealt with intradural pathology (n = 40 [87%]). Approach-related morbidity consisted of only two patients (4%) with new postoperative seizures. There were only two significant postoperative hemorrhages (4%). Cerebrospinal fluid leakage occurred in two patients (4%) requiring reoperation. Conclusion Approach-related complications such as seizures and hematoma were infrequent in this series, < 4%. This report describes a contemporary group of patients treated with open AP and should serve as a comparison for approach-related morbidity of endoscopic approaches. Given the pathologies treated with this approach, the morbidity appears acceptable.

Anterior Inferior Petrosectomy: Defining the Role of Endonasal Endoscopic Techniques for Petrous Apex Approaches

We present a 28-year-old man with neck pain, fevers, elevated acute-phase reactant levels and progressive quadraparesis. He had a history of intravenous drug abuse. Contrast-enhanced cervical spine MRI revealed a heterogeneously enhancing mass in the anterior atlantoaxial region with spinal cord compression. The patient was taken emergently to the operating room for decompression. Although the transoral approach for access to the ventral atlantoaxial complex for resection of compressive inflammatory and neoplastic lesions is well described, reports of evacuation of infectious lesions via this route are limited. Thus, we report drainage of a ventral high cervical abscess via the transoral approach.

Merging the Paraclival ICA with the Bouthillier Classification

Abstract Brainstem cavernomas can present very challenging operative problems. Endoscopic endonasal approaches to these lesions in the mesencephalon and pons have been described. In this article the authors present the first case of a medullary cavernoma resected by an endoscopic transclival approach. A 26 year-old woman with a 1.5 cm medullary cavernoma presented with imbalance, swallowing difficulty, and right hemibody weakness. She was taken to the operating room for endoscopic endonasal transclival resection. Her pre-existing neurologic deficits worsened initially after surgery, but at three-month follow-up she had made a full neurologic recovery.