Small Ruptured Anterior Communicating Artery Aneurysms in the Endovascular Right-of-First-Refusal Era: Intraprocedural Rupture Risk and Retreatment at Follow-up.

Background: Ruptured small anterior communicating artery (ACoA) aneurysms can pose a technical challenge for endovascular therapy. We sought to explore treatment and follow-up results in the modern endovascular right of first refusal era.

Methods: Smaller (≤ 7mm) ruptured aneurysms of the ACoA undergoing treatment were compared with non-ACoA counterparts, and further dichotomized by size (≤3mm and 3-7mm).

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.

Institutional experience using the endoscopic endonasal approach for the treatment of 40 intracranial aneurysms: indications, outcomes, and technical considerations.

Objective: The endoscopic endonasal approach (EEA) provides a ventral surgical corridor, which can be advantageous in the management of carefully selected cerebral aneurysms. The literature lacks large series to better delineate the indications and limitations of this technique. The aim of this study was to elucidate the technique's safety, indications, advantages, and limitations, as well as its evolution over time.

Occipitocervical surgery rescue: The "" technique.

Instability of the occipitocervical junction may compress neural elements, resulting in progressive disability. After the technique was developed to correct for thoracolumbar scoliosis, the construct was developed for chin-on-chest deformity at the cervicothoracic junction as a similar three-rod approach. Demonstrated is a four-rod iteration utilized to stabilize the occipitocervical junction and correct condylar instability, termed the technique.

Impact of adjuvant radiation therapy on outcomes in grade 2 conventional chondrosarcoma.

Objective: While histological subtype and grade are important for guiding treatment of skull base chondrosarcomas, the role of adjuvant radiation therapy (RT) and the optimal radiation modality for grade 2 conventional chondrosarcoma (cCS) are not well defined. The aim of this study was to further elucidate optimal treatment strategies for grade 2 cCS.

Methods: Multi-institutional data from the Skull Base Chondrosarcoma Consortium, including patient demographics, radiological features, and outcomes, were analyzed retrospectively.

Supraorbital craniotomy for microvascular decompression of optic nerve due to neurovascular conflict with anterior cerebral artery: 2-Dimensional operative video.

Optic neuropathy due to vascular compression is a rare and poorly understood phenomenon. While contact between the optic nerve and nearby arteries is not uncommon, in most cases, it is an incidental finding in asymptomatic patients. Vascular compression has previously been suggested to be associated with optic neuropathy and visual dysfunction, with a plausible role for surgical decompression in appropriately selected patients.

Refinement of Hyams Grading Criteria for Olfactory Neuroblastoma in an Endoscopic Sinus Surgery Predominant Cohort with Extended Follow-up: Worth the Effort?

Background: Hyams grading is considered prognostic in olfactory neuroblastoma (ONB), but grading criteria are subjective and predate modern classification and surgical approach. We evaluate the application of granular grading criteria to an endoscopic surgery predominant cohort with extended follow-up.

Methods: 78 ONB patients were identified (1994-2019) with original diagnoses dating to 1979.

Prolactinoma Resection in a Transgender Woman on Gender-affirming Hormone Therapy.

The management of prolactinoma in the setting of gender-affirming hormone therapy (GAHT) is lacking in the literature. We present the case of a transgender woman who was found to have prolactinoma prior to initiating GAHT. Initially, medication effectively managed prolactin levels; however, upon starting GAHT, maintaining control of these levels became challenging.

Radiogenomics and Radiomics of Skull Base Chordoma: Classification of Novel Radiomic Subgroups and Prediction of Genetic Signatures and Clinical Outcomes.

Background: Chordomas are rare, aggressive tumors of notochordal origin, commonly affecting the spine and skull base. Skull Base Chordomas (SBCs) comprise approximately 39% of cases, with an incidence of less than 1 per million annually in the U.S.

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.

Exploring perspectives on skull base chordoma management: a modified Delphi approach to consensus.

Objective: Current treatment for skull base chordomas utilizes both surgical resection and adjuvant radiation, but recent studies have demonstrated evidence that has brought the use of adjuvant radiotherapy into question. Chordomas differ greatly in molecular makeup and proliferation. These factors have led to significant variation in management across providers.

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.

Transorbital neuroendoscopic approach for recurrent sinonasal inverted papilloma.

This surgical video demonstrates the case of a 38-year-old male with recurrent inverted papilloma involving the lamina papyracea and frontal sinus outflow tract. The frontal sinus was diminutive on the side of the tumor, and as such a combined endoscopic endonasal with endoscopic transorbital via transcaruncular route was advised for resection of the anterolateral tumor and contralateral margin. After endonasal resection, a transorbital approach was utilized to traverse the lamina papyracea from lateral to medial and resect tumor along the ethmoid roof and posterior table of the frontal sinus.

Combined transorbital neuroendoscopic and endoscopic endonasal resection of orbital hemangioma.

Orbital cavernous hemangiomas are the most common benign primary neoplasm of the orbit in adults and can lead to proptosis and optic neuropathy. Resection is the primary treatment for symptomatic cases. Choice of surgical approach depends on the lesion's size, location, and relation to intraorbital structures.

Clinical comparison of flow diversion and microsurgery for retreatment of intracranial aneurysms.

Background: The goal of aneurysm retreatment is effective, durable obliteration. Flow diversion (FD) and microsurgical clipping generally represent two aneurysm treatment options with high obliteration rates. However, their relative efficacy in aneurysm retreatment has been infrequently evaluated.

Factors Associated With a Higher 30-Day Hospitalization Period for Pituitary Adenoma Patients: Introducing a Novel Outcome Metric.

Background And Objectives: A novel metric that incorporates both length of stay (LOS) and readmission in 1 metric, the 30-day hospitalization ratio (HR) (total number of days of hospitalization/30 days) was applied to patients undergoing endonasal surgery for pituitary adenoma. The objectives of this study were to determine predictive factors associated with prolonged hospitalization and economic burden and to demonstrate the utility of 30-day HR as a novel outcome metric compared with LOS and readmission.

Methods: A retrospective chart review of 492 patients who underwent an endoscopic endonasal approach for pituitary adenoma at a Pituitary Tumor Center of Excellence between January 2015 and September 2022.

Characterizing Disparities in Access to Surgery for Pituitary Adenomas: A National Cancer Database Analysis.

Context: Although there is an established improved postoperative outcome for pituitary adenomas (PA) surgically resected at high-volume facilities (HVFs), access to these centers may not be equitable.

Objective: To investigate the racial and socioeconomic differences that lead to unequal distribution of access for PAs at HVFs in the United States.

Design And Patients: Retrospective analysis of data from the National Cancer Database (NCDB) from 2004 to 2019 on 57,807 patients with PA.

Skull base chordomas presenting with abducens nerve deficits: clinical characteristics and predictive factors for deficit improvement or resolution.

Objective: Skull base chordomas (SBCs) often present with cranial nerve (CN) VI deficits. Studies have not assessed the prognosis and predictive factors for CN VI recovery among patients presenting with CN VI deficits.

Methods: The medical records of patients who underwent resection for primary chordoma from 2001 to 2020 were reviewed.

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.

The Connective Tissue Architecture of the Cavernous Sinus: An Anatomical Study and Unifying Conceptualization.

Objective: The aim of this study was to synthesize existing knowledge regarding the anatomy of the cavernous sinus (CS), critically evaluate the current anatomical hypotheses concerning its walls, to conduct anatomical dissections, and develop a comprehensive understanding of the connective tissue structure of the CS.

Methods: We performed systematic dissections on 15 fresh adult cadavers. Specifically, 5 specimens were approached laterally, 5 were sectioned in the axial plane, and 5 were dissected using endoscopic endonasal techniques.

A Comprehensive Analysis of Academic Attributes of the Presidents of the North American Skull Base Society.

 Our objective was to elucidate the demographic, academic, and career attributes of North American Skull Base Society (NASBS) presidents and determine how leadership of this society has changed over time.  Thirty-one NASBS presidents have served between 1990 and 2021. Demographic and scholarly variables were recorded from publicly available sources.