Effect of Extent of Resection and Adjuvant Radiation on Recurrence of BRAF versus β-Catenin-Mutated Craniopharyngioma: A Single Institutional Case Series.

Objectives: The two histologic subtypes of craniopharyngiomas (CPs), papillary and adamantinomatous, harbor mutually exclusive mutations of BRAF V600E and CTNNB1, respectively. Studies suggest that subtotal resection (STR) plus adjuvant radiation therapy (XRT) may result in similar progression-free survival (PFS) as gross total resection (GTR). We hypothesized that STR ± XRT and GTR result in similar PFS for both BRAF and β-catenin-mutated CPs.

A Multicenter Study of Unplanned Hospital Readmissions after Transsphenoidal Surgery for Cushing's Disease.

Objectives: Patients undergoing surgery for Cushing's disease may be more likely to be readmitted to the hospital than other patients with pituitary disorders. We investigated rates, causes, and predictors of unplanned readmission following transsphenoidal surgery for Cushing's disease to identify areas for clinical, financial, and administrative improvements.

Design: Retrospective cohort study.

Secondary Malignancies in Patients with Meningioma: A Surveillance, Epidemiology, and End Results Data Analysis.

Background: The risk of secondary primary malignancies (SPMs) in meningioma patients is not well understood. In this unidirectional analysis, we evaluated the risk of SPMs occurring following a primary diagnosis of meningioma.

Methods: The Surveillance, Epidemiology, and End Results (SEER-17) database (2000-2020) was used to identify 124,769 meningioma patients from a total of 9,208,295 cancer cases.

Awake Versus Asleep Craniotomy for Glioma: A Comparison of Survival and Costs Using Time-Driven Activity-Based Costing.

Background And Objectives: Gliomas are among the most common primary brain tumors. Based on proximity to eloquent structures, surgeons may perform an awake craniotomy (AC) or an asleep craniotomy under general anesthesia (GA). To date, no study has used time-driven activity-based costing to compare costs of these procedures.

Outcome metrics for primary endoscopic endonasal surgery for low-risk patients with Cushing's disease: an evidence-based position statement from the Registry of Adenomas of the Pituitary and Related Disorders consortium.

Objective: Reports of surgical outcomes for Cushing's disease are mostly limited to single-center experiences by expert surgeons. Therefore, no generalizable surgical outcome metrics for endoscopic endonasal Cushing's disease surgery are available for practitioners to guide quality-improvement efforts. This is potentially problematic, given the high morbidity and excess mortality observed in patients who do not achieve remission.

Expert Strategies: Skull Base Reconstruction-Global Perspectives, Insights, and Algorithms through a Mixed Methods Approach.

Objective: There is limited consensus on endoscopic skull base surgery (ESBS) reconstruction principles. This study aims to generate comprehensive themes regarding ESBS reconstruction by pooling the experiences of ESBS experts, with comparison to a literature review of current published evidence.

Methods: Structured qualitative interviews of ESBS experts regarding postoperative management and reconstruction of various defect locations were conducted.

Introducing the operative value index for glioma surgery: an integration of quality-adjusted life years with time-driven activity-based costing.

Background: Although many studies have examined outcomes after glioma surgery, few have explored the factors driving variation in the cost-effectiveness of surgical care. In this study, we integrate granular time-driven activity-based costing (TDABC) methodology with quality-adjusted life years (QALYs) to measure the true "value" (outcomes achieved per dollar spent) of glioma surgery.

Methods: 176 glioma surgeries performed at a single institution were reviewed.

Specialty Neurosurgery Hospitalists: Neurosurgeons' Perspectives.

Neurosurgery is increasingly performed on patients with significant medical co-morbidities. These could both delay surgery and can lead to postoperative complications. This situation highlights the role played by internal medicine-trained physicians, which include both outpatient providers and hospitalists.

Drivers of Intraoperative Costs for Transsphenoidal Endoscopic Surgery for Sellar Lesions: A Time-Driven Activity-Based Cost Analysis.

Background: Neurosurgeons lack precise insights into the true costs of transsphenoidal endoscopic surgery for sellar and suprasellar lesions (TESS), including pituitary adenomas, craniopharyngiomas, and apoplexy. To address this critical knowledge gap, we employ time-driven activity-based costing (TDABC) for TESS.

Methods: We analyzed 221 TESS procedures performed between 2017 and 2022 at a large academic medical center.

Impact of Frailty on Surgical Outcomes of Patients With Cushing Disease Using the Multicenter Registry of Adenomas of the Pituitary and Related Disorders Registry.

Background And Objectives: Despite growing interest in how patient frailty affects outcomes (eg, in neuro-oncology), its role after transsphenoidal surgery for Cushing disease (CD) remains unclear. We evaluated the effect of frailty on CD outcomes using the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) data set from a collaboration of US academic pituitary centers.

Methods: Data on consecutive surgically treated patients with CD (2011-2023) were compiled using the 11-factor modified frailty index.

Cushing Disease Clinical Phenotype and Tumor Behavior Vary With Age: Diagnostic and Perioperative Implications.

Context: Little is known about presenting clinical characteristics, tumor biology, and surgical morbidity of Cushing disease (CD) with aging.

Objective: Using a large multi-institutional data set, we assessed diagnostic and prognostic significance of age in CD through differences in presentation, laboratory results, tumor characteristics, and postoperative outcomes.

Methods: Data from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) were reviewed for patients with CD treated with transsphenoidal tumor resection at 11 centers between 2003 and 2023.

Improvement in cranial neuropathies following stereotactic radiotherapy as primary treatment for skull base meningiomas.

Purpose: Many patients with skull base meningiomas (SBMs) develop cranial neuropathies, though there is a paucity in literature regarding cranial neuropathy improvement following treatment. This is even more profound when isolating for patients who received stereotactic radiotherapy (SRT) as their primary treatment without additional open surgery. Our goal was to investigate the effect of SRT on cranial neuropathies secondary to SBMs and identify predictors of favourable treatment response.

The Presence of Pigment Incontinence in Sinonasal Mucosal Melanoma.

Background: Regression is an immunological phenomenon described in cutaneous melanoma whereby tumor is replaced with tumor-infiltrating lymphocytes, granulation tissue, and mature fibroblasts often accompanied by pigment incontinence (accumulation of melanin in the upper dermis). Pigment incontinence results in grossly pigmented lesions that may be mistaken for viable tumor and has not been described in sinonasal mucosal melanoma (SNMM). This study investigates the presence of regression and pigment incontinence in patients with SNMM.

Multicenter Registry of Adenomas of the Pituitary and Related Disorders: Initial Description of Cushing Disease Cohort, Surgical Outcomes, and Surgeon Characteristics.

Background And Objectives: To address the lack of a multicenter pituitary surgery research consortium in the United States, we established the Registry of Adenomas of the Pituitary and Related Disorders (RAPID). The goals of RAPID are to examine surgical outcomes, improve patient care, disseminate best practices, and facilitate multicenter surgery research at scale. Our initial focus is Cushing disease (CD).

Health Disparities in the Neurosurgical Care of Patients with Trigeminal Neuralgia.

Background: There has been limited investigation into how social determinants of health impact treatment outcomes in patients with trigeminal neuralgia (TN). We aimed to investigate how social determinants of health may alter the course of clinical care for patients with TN.

Methods: The electronic medical record was queried for patients with a diagnosis of TN comanaged by neurosurgeons and other facial pain specialists at our medical center.

Long-Term Outcomes of Surgery and Radiation Treatment for Adult Patients with Craniopharyngioma.

Objective: Treatment of craniopharyngioma typically entails gross total resection (GTR) or subtotal resection with adjuvant radiation (STR-RT). We analyzed outcomes in adults with craniopharyngioma undergoing GTR versus STR-RT.

Methods: This retrospective study enrolled 115 patients with craniopharyngioma in 5 institutions.

Predictors of Subjective Olfactory Dysfunction and Sinonasal Quality-of-Life After Endoscopic Transsphenoidal Pituitary Surgery.

Background: This is the largest study in North America investigating olfactory outcomes after pituitary surgery to date.

Objective: Characterize factors associated with subjective olfactory dysfunction (OD) and worsened sinonasal quality-of-life (QOL) after endoscopic TSA.

Methods: Patients undergoing primary TSA for secreting and non-secreting pituitary adenomas between 2017 and 2021 with pre- and post-operative SNOT-22 scores were included.

Multifocal Ectopic Recurrence of a C2 Chordoma.

 Chordomas are histologically benign but locally aggressive tumors with a high propensity to recur. Our case highlights the importance of long-term vigilance in patients who have undergone chordoma resection.  We report the case of a 47-year-old man with a cervical chordoma who developed multiple musculoskeletal ectopic recurrences in the left supraclavicular region, the proximal right bicep, and the left submandibular region without recurrence in the primary tumor site.

Predictors of recurrence after surgical resection of parafalcine and parasagittal meningiomas.

Purpose: Owing to their vicinity near the superior sagittal sinus, parasagittal and parafalcine meningiomas are challenging tumors to surgically resect. In this study, we investigate key factors that portend increased risk of recurrence after surgery.

Methods: This is a retrospective study of patients who underwent resection of parasagittal and parafalcine meningiomas at our institution between 2012 and 2018.