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Papers by vijay anand

Research paper thumbnail of Office-Based Digital Video Endoscopy in Otolaryngology

Laryngoscope, 2006

... Email: Vijay K. Anand MD (vijayanandmd@aol.com). *Correspondence: Vijay K. Anand MD, VijayAna... more ... Email: Vijay K. Anand MD (vijayanandmd@aol.com). *Correspondence: Vijay K. Anand MD, VijayAnand, MD, 772 Park Avenue, New York, NY 10021, USA. † Dr. Vijay Anand is a paid consultant and a member of Medical Digital Developers, LLC. Publication History. ...

Research paper thumbnail of Endoscopic Transsphenoidal Pituitary Surgery with Intraoperative Magnetic Resonance Imaging

Neurosurgery, 2006

BACKGROUND: The use of the fiberoptic endoscope is a recent innovation in pituitary surgery. OBJE... more BACKGROUND: The use of the fiberoptic endoscope is a recent innovation in pituitary surgery. OBJECTIVE: To investigate the evidence of an operative learning curve after the introduction of endoscopic transsphenoidal surgery in our unit. METHODS: The first 125 patients who underwent endoscopic transnasal transsphenoidal surgery for pituitary fossa lesions between 2005 and 2007 performed by 1 surgeon were studied. Changes in a number of parameters were assessed between 2 equal 15-month time periods: period 1 (53 patients) and period 2 (72 patients). RESULTS: There were 67 patients (54%) with nonfunctioning adenomas, 22 (18%) with acromegaly, and 10 (8%) with Cushing's disease. Between study periods 1 and 2, there was a decrease in the mean duration of surgery for nonfunctioning adenomas (from 120 minutes to 91 minutes; P , .01). This learning effect was not apparent for functioning adenomas, the surgery for which also took longer to perform. The proportion of patients with an improvement in their preoperative visual field deficits increased over the study period (from 80% to 93%; P , .05). There were nonsignificant trends toward improved endocrine remission rates for patients with Cushing's disease (from 50% to 83%), but operative complications, notably the rates of hypopituitarism, did not change. Overall length of hospital stay decreased between time periods 1 and 2 (from 7 to 4 days median; P , .01). CONCLUSION: The improvements in the duration of surgery and visual outcome noted after about 50 endoscopic procedures would favor the existence of an operative learning curve for these parameters. This further highlights the benefits of subspecialization in pituitary surgery.

Research paper thumbnail of THREE-DIMENSIONAL ENDOSCOPIC PITUITARY SURGERY

Neurosurgery, 2009

ABBREVIATIONS: 3-D, 3-dimensional; 2-D, 2-dimensional THREE-DIMENSIONAL ENDOSCOPIC PITUITARY SURG... more ABBREVIATIONS: 3-D, 3-dimensional; 2-D, 2-dimensional THREE-DIMENSIONAL ENDOSCOPIC PITUITARY SURGERY OBJECTIVE: We describe a novel 3-dimensional (3-D) stereoendoscope and discuss our early experience using it to provide improved depth perception during transsphenoidal pituitary surgery. METHODS: Thirteen patients underwent endonasal endoscopic transsphenoidal surgery. A 6.5-, 4.9-, or 4.0-mm, 0-and 30-degree rigid 3-D stereoendoscope (Visionsense, Ltd., Petach Tikva, Israel) was used in all cases. The endoscope is based on "compound eye" technology, incorporating a microarray of lenses. Patients were followed prospectively and compared with a matched group of patients who underwent endoscopic surgery with a 2-dimensional (2-D) endoscope. Surgeon comfort and/or complaints regarding the endoscope were recorded. RESULTS: The 3-D endoscope was used as the sole method of visualization to remove 10 pituitary adenomas, 1 cystic xanthogranuloma, 1 metastasis, and 1 cavernous sinus hemangioma. Improved depth perception without eye strain or headache was noted by the surgeons. There were no intraoperative complications. All patients without cavernous sinus extension (7of 9 patients) had gross tumor removal. There were no significant differences in operative time, length of stay, or extent of resection compared with cases in which a 2-D endoscope was used. Subjective depth perception was improved compared with standard 2-D scopes. CONCLUSION: In this first reported series of purely 3-D endoscopic transsphenoidal pituitary surgery, we demonstrate subjectively improved depth perception and excellent outcomes with no increase in operative time. Three-dimensional endoscopes may become the standard tool for minimal access neurosurgery.

Research paper thumbnail of Algorithm for Reconstruction After Endoscopic Pituitary and Skull Base Surgery

Laryngoscope, 2007

Introduction: The expanding role of endoscopic skull base surgery necessitates a thorough underst... more Introduction: The expanding role of endoscopic skull base surgery necessitates a thorough understanding of the indications, techniques, and limitations of the various approaches to reconstruction. The technique and outcomes of endoscopic skull base reconstruction remain incompletely described in the literature.Study Design and Methods: Patients undergoing endoscopic skull base surgery underwent an algorithmic approach to reconstruction based on tumor location, defect size, and presence of intraoperative cerebrospinal fluid (CSF) leak. A prospective database was reviewed to determine the overall efficacy of reconstruction and to identify risk factors for postoperative CSF leak.Results: The diagnosis in the 127 patients in this series included pituitary tumor in 70 (55%) patients, encephalocele in 16 (12.6%) patients, meningioma in 11 (8.7%) patients, craniopharyngioma in 9 (7.1%) patients, and chordoma in 6 (4.7%) patients. Successful reconstruction was initially achieved in 91.3% of patients. Eleven (8.7%) patients experienced postoperative CSF leak, 10 of which resolved with lumbar drainage alone. One (0.8%) patient required revision surgery. Correlation between postoperative CSF leak and study variables revealed a statistically significant longer duration of surgery (243 vs. 178 min, P = .008) and hospitalization (12.1 vs. 4.5 days, P < .0001) and a trend toward larger tumors (mean, 3.2 vs. 2.3 cm; P = .058) in patients experiencing postoperative CSF leak.Conclusion: The algorithm for reconstruction after endoscopic surgery presented in this study is associated with excellent overall efficacy. A greater understanding of risk factors for postoperative CSF leak is imperative to achieve optimal results.

Research paper thumbnail of SAFETY OF LOW-DOSE INTRATHECAL FLUORESCEIN IN ENDOSCOPIC CRANIAL BASE SURGERY

Neurosurgery, 2007

Intraoperative identification of cerebrospinal fluid (CSF) leakage is critical in successful clos... more Intraoperative identification of cerebrospinal fluid (CSF) leakage is critical in successful closure after endoscopic cranial base surgery. Intrathecal injection of fluorescein is quite useful in identifying CSF leaks. However, complications have been reported with various doses and the technique has fallen out of favor. We explored the safety of low-dose intrathecal fluorescein administered to patients undergoing endoscopic cranial base surgery. A retrospective chart review and postoperative patient survey were performed. The nature and incidence of complications and subjective complaints were recorded in 54 patients who underwent endoscopic, endonasal approaches to the anterior cranial base and received intrathecal fluorescein after premedication with dexamethasone and diphenhydramine. Intraoperative CSF leak was identified with fluorescein in 46.3% of the patients and helped determine the reconstruction technique. Postoperative CSF leak occurred in 9.3% of the patients and resolved with lumbar drainage. There were no seizures. Most side effects were nonspecific, transient, and likely not caused by fluorescein including malaise (57.4%), headache (51.9%), dizziness (31.5%), or nausea/vomiting (24.1%). Three patients (5.6%) experienced persistent subjective lower extremity weakness (n = 2) and numbness (n = 2) postoperatively; however, two of them had undergone lumbar drainage. Low-dose injection of intrathecal fluorescein after premedication with steroid and antihistamine agents is generally safe. Most symptoms are nonspecific and transient, likely caused by the surgery or lumbar drainage. However, fluorescein should be administered with some caution because it may be responsible for occasional lower extremity weakness and numbness.

Research paper thumbnail of The Efficacy of Computer Assisted Surgery in the Endoscopic Management of Cerebrospinal Fluid Rhinorrhea

Otolaryngology-head and Neck Surgery, 2005

To determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and wi... more To determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and without computer assisted surgery. A review of all patients undergoing endoscopic closure of CSF rhinorrhea at a tertiary care medical center between 1994 and 2003. Charts from the 24 patients were reviewed for indications, location of leak, type of surgical closure, number of prior closure attempts, graft materials, use of computer assisted surgery, complications, and need for revision surgery. Analysis was performed to determine a possible correlation between success of CSF leak repair and use of computer assisted surgery. The etiology of the leak was previous sinus surgery in 10 patients (41.7%), trauma in 5 patients (20.8%), spontaneous leak in 5 patients (20.8%), and skull base surgery in 4 patients (16.7%). The most common sites of leak were the fovea ethmoidalis in 10 patients (41.7%), cribriform plate in 8 patients (33.3%), and sphenoid sinus in 6 patients (25%). Image guidance was employed in 66.7% (16 patients) of our first attempted repairs. Six patients underwent a total of 9 revision procedures. At last follow-up, 96% of patients had no evidence of CSF rhinorrhea. A comparison of patients in the 2 groups failed to reveal a statistically significant difference in the rate of CSF leak closure. Endoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. The use of computer assistance may improve the confidence of the surgeon and is a valuable adjunct in this procedure. Our study, however, did not demonstrate an improvement in the rates of successful closure with the use of computer assistance.

Research paper thumbnail of GASKET-SEAL” WATERTIGHT CLOSURE IN MINIMAL-ACCESS ENDOSCOPIC CRANIAL BASE SURGERY

Neurosurgery, 2008

Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midl... more Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;gasket seal&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.

Research paper thumbnail of Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions

Journal of Neurosurgery, 2007

tuberculum sellae meningioma may be removed by purely endoscopic techniques in near future. Keywo... more tuberculum sellae meningioma may be removed by purely endoscopic techniques in near future. Keywords: neuroendoscopy; operative experience; transsphenoidal removal; tuberculum sellae meningioma; endonasal endoscopic extended transsphenoidal approach Br J Neurosurg Downloaded from informahealthcare.com by 117.18.231.13 on 04/06/12

Research paper thumbnail of Intrathecal fluorescein in endoscopic skull base surgery

Otolaryngology-head and Neck Surgery, 2007

Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid... more Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid the morbidity of postoperative cerebrospinal fluid (CSF) leak. The impact on outcomes of CSF visualization with intrathecal fluorescein, however, is unknown. A retrospective review of patients undergoing endoscopic skull base surgery with intrathecal fluorescein. A possible correlation between intraoperative fluorescein identification and postoperative CSF leak was analyzed. 61 patients underwent surgery for a variety of lesions including pituitary adenoma (55.7%), encephalocele (14.8%), and meningioma (9.8%). Seven (19.4%) of the 37 patients with intraoperative fluorescein leak experienced postoperative CSF leak compared to 0 of the 24 patients who did not have intraoperative fluorescein leak (P = 0.02). All cases of CSF leak resolved with lumbar drainage alone. The lack of intraoperative fluorescein leakage correlates strongly with a low risk for postoperative CSF leak. This can be used to stratify the extent of skull base reconstruction required during endoscopic skull base surgeries.

Research paper thumbnail of ENDOSCOPIC CRANIAL BASE SURGERY: CLASSIFICATION OF OPERATIVE APPROACHES

Neurosurgery, 2008

OBJECTIVE: Endoscopic cranial base surgery is a minimal access, maximally aggressive alternative ... more OBJECTIVE: Endoscopic cranial base surgery is a minimal access, maximally aggressive alternative to traditional transfacial, transcranial, or combined open cranial base approaches. Previous descriptions of endoscopic approaches have used varying terminology, which can be confusing to the new practitioner. Indications for surgery are not well defined. Our objective was to create a comprehensive classification system of the various approaches and describe their indications with case examples. METHODS: We prospectively compiled a comprehensive database of our endonasal endoscopic operations, detailing the nasal sinus transgressed, the cranial base approach, and the intracranial target for the first 150 consecutive cases performed at our institution. All cases were performed collaboratively by a neurosurgeon and an otolaryngologist. RESULTS: We categorized the endonasal endoscopic cranial base operations into four nasal corridors, nine cranial base approaches, and 13 intracranial targets. Each of the various approaches is described in detail and illustrated with case examples. Pathology encountered included pituitary tumor (50%), meningocele/encephalocele (14%), craniopharyngioma and Rathke cleft cyst (10%), meningioma (8%), chordoma (5%), esthesioneuroblastoma (2%), and other (11%). CONCLUSION: Endonasal endoscopic cranial base surgery is a minimal access, maximally invasive alternative to open transcranial cranial base approaches for specific indications. A clear understanding of the possible approaches is facilitated by an awareness of the nasal corridors and intracranial targets. a Pituitary carcinoma, metastasis, hemangiopericytoma, rhabdomyosarcoma, adenoid cystic carcinoma, malignant salivary gland tumor, juvenile angiofibroma, schwannoma, enterogenous cyst, osteoma, papilloma, nasal glioma, lipoma, gout, rheumatoid pannus. 994 | VOLUME 62 | NUMBER 5 | MAY 2008 www.neurosurgery-online.com SCHWARTZ ET AL. FIGURE 3. Frequency of each approach used in endoscopic cranial base and pituitary surgery.

Research paper thumbnail of Endonasal Endoscopic Resection of an Os Odontoideum to Decompress the Cervicomedullary Junction: A Minimal Access Surgical Technique

Spine, 2009

Study Design. We report the case of a 50 year-old woman with os odontoideum and posterior atlanto... more Study Design. We report the case of a 50 year-old woman with os odontoideum and posterior atlantoaxial subluxation, who underwent an occipitocervical fusion followed by endonasal endoscopic anterior decompression of the cervicomedullary junction (CMJ).

Research paper thumbnail of Three-dimensional endoscopic sinus surgery: Feasibility and technical aspects

Otolaryngology-head and Neck Surgery, 2008

T he development of endoscopic techniques for a variety of sinonasal disorders has paralleled adv... more T he development of endoscopic techniques for a variety of sinonasal disorders has paralleled advances in technology and instrumentation including angled endoscopes, multi-chip cameras, and image guidance. Despite the progressive technological innovations in modern endoscopic surgery, the visualization that is currently used remains 2-dimensional (2D). This is associated with significant limitations, notably a lack of depth perception. Although visual and haptic cues allow for a surgeon to understand the spatial relationships of the various structures, current visualization technology fails to provide the 3-dimensional (3D) perspective that is available in open and microscopic surgery. The development of a miniature stereoscopic camera and its adaptation to rigid endoscopes allows for performance of 3D endoscopic sinus surgery. It is hypothesized that incorporation of 3D visualization may enhance the spatial resolution required in advanced endoscopic approaches with a theoretical potential to improve outcomes.

Research paper thumbnail of Incidence of Methicillin-Resistant Staphylococcus aureus Causing Chronic Rhinosinusitis

Laryngoscope, 2004

A case control study was carried out in order to evaluate the various factors which may influence... more A case control study was carried out in order to evaluate the various factors which may influence the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infections in a skilled nursing home. From April 1991 to March 1994, bacterial cultures were performed in 55 out of 102 residents in a nursing home based on various clinical aspects.

Research paper thumbnail of Office-Based Digital Video Endoscopy in Otolaryngology

Laryngoscope, 2006

... Email: Vijay K. Anand MD (vijayanandmd@aol.com). *Correspondence: Vijay K. Anand MD, VijayAna... more ... Email: Vijay K. Anand MD (vijayanandmd@aol.com). *Correspondence: Vijay K. Anand MD, VijayAnand, MD, 772 Park Avenue, New York, NY 10021, USA. † Dr. Vijay Anand is a paid consultant and a member of Medical Digital Developers, LLC. Publication History. ...

Research paper thumbnail of Endoscopic Transsphenoidal Pituitary Surgery with Intraoperative Magnetic Resonance Imaging

Neurosurgery, 2006

BACKGROUND: The use of the fiberoptic endoscope is a recent innovation in pituitary surgery. OBJE... more BACKGROUND: The use of the fiberoptic endoscope is a recent innovation in pituitary surgery. OBJECTIVE: To investigate the evidence of an operative learning curve after the introduction of endoscopic transsphenoidal surgery in our unit. METHODS: The first 125 patients who underwent endoscopic transnasal transsphenoidal surgery for pituitary fossa lesions between 2005 and 2007 performed by 1 surgeon were studied. Changes in a number of parameters were assessed between 2 equal 15-month time periods: period 1 (53 patients) and period 2 (72 patients). RESULTS: There were 67 patients (54%) with nonfunctioning adenomas, 22 (18%) with acromegaly, and 10 (8%) with Cushing's disease. Between study periods 1 and 2, there was a decrease in the mean duration of surgery for nonfunctioning adenomas (from 120 minutes to 91 minutes; P , .01). This learning effect was not apparent for functioning adenomas, the surgery for which also took longer to perform. The proportion of patients with an improvement in their preoperative visual field deficits increased over the study period (from 80% to 93%; P , .05). There were nonsignificant trends toward improved endocrine remission rates for patients with Cushing's disease (from 50% to 83%), but operative complications, notably the rates of hypopituitarism, did not change. Overall length of hospital stay decreased between time periods 1 and 2 (from 7 to 4 days median; P , .01). CONCLUSION: The improvements in the duration of surgery and visual outcome noted after about 50 endoscopic procedures would favor the existence of an operative learning curve for these parameters. This further highlights the benefits of subspecialization in pituitary surgery.

Research paper thumbnail of THREE-DIMENSIONAL ENDOSCOPIC PITUITARY SURGERY

Neurosurgery, 2009

ABBREVIATIONS: 3-D, 3-dimensional; 2-D, 2-dimensional THREE-DIMENSIONAL ENDOSCOPIC PITUITARY SURG... more ABBREVIATIONS: 3-D, 3-dimensional; 2-D, 2-dimensional THREE-DIMENSIONAL ENDOSCOPIC PITUITARY SURGERY OBJECTIVE: We describe a novel 3-dimensional (3-D) stereoendoscope and discuss our early experience using it to provide improved depth perception during transsphenoidal pituitary surgery. METHODS: Thirteen patients underwent endonasal endoscopic transsphenoidal surgery. A 6.5-, 4.9-, or 4.0-mm, 0-and 30-degree rigid 3-D stereoendoscope (Visionsense, Ltd., Petach Tikva, Israel) was used in all cases. The endoscope is based on "compound eye" technology, incorporating a microarray of lenses. Patients were followed prospectively and compared with a matched group of patients who underwent endoscopic surgery with a 2-dimensional (2-D) endoscope. Surgeon comfort and/or complaints regarding the endoscope were recorded. RESULTS: The 3-D endoscope was used as the sole method of visualization to remove 10 pituitary adenomas, 1 cystic xanthogranuloma, 1 metastasis, and 1 cavernous sinus hemangioma. Improved depth perception without eye strain or headache was noted by the surgeons. There were no intraoperative complications. All patients without cavernous sinus extension (7of 9 patients) had gross tumor removal. There were no significant differences in operative time, length of stay, or extent of resection compared with cases in which a 2-D endoscope was used. Subjective depth perception was improved compared with standard 2-D scopes. CONCLUSION: In this first reported series of purely 3-D endoscopic transsphenoidal pituitary surgery, we demonstrate subjectively improved depth perception and excellent outcomes with no increase in operative time. Three-dimensional endoscopes may become the standard tool for minimal access neurosurgery.

Research paper thumbnail of Algorithm for Reconstruction After Endoscopic Pituitary and Skull Base Surgery

Laryngoscope, 2007

Introduction: The expanding role of endoscopic skull base surgery necessitates a thorough underst... more Introduction: The expanding role of endoscopic skull base surgery necessitates a thorough understanding of the indications, techniques, and limitations of the various approaches to reconstruction. The technique and outcomes of endoscopic skull base reconstruction remain incompletely described in the literature.Study Design and Methods: Patients undergoing endoscopic skull base surgery underwent an algorithmic approach to reconstruction based on tumor location, defect size, and presence of intraoperative cerebrospinal fluid (CSF) leak. A prospective database was reviewed to determine the overall efficacy of reconstruction and to identify risk factors for postoperative CSF leak.Results: The diagnosis in the 127 patients in this series included pituitary tumor in 70 (55%) patients, encephalocele in 16 (12.6%) patients, meningioma in 11 (8.7%) patients, craniopharyngioma in 9 (7.1%) patients, and chordoma in 6 (4.7%) patients. Successful reconstruction was initially achieved in 91.3% of patients. Eleven (8.7%) patients experienced postoperative CSF leak, 10 of which resolved with lumbar drainage alone. One (0.8%) patient required revision surgery. Correlation between postoperative CSF leak and study variables revealed a statistically significant longer duration of surgery (243 vs. 178 min, P = .008) and hospitalization (12.1 vs. 4.5 days, P < .0001) and a trend toward larger tumors (mean, 3.2 vs. 2.3 cm; P = .058) in patients experiencing postoperative CSF leak.Conclusion: The algorithm for reconstruction after endoscopic surgery presented in this study is associated with excellent overall efficacy. A greater understanding of risk factors for postoperative CSF leak is imperative to achieve optimal results.

Research paper thumbnail of SAFETY OF LOW-DOSE INTRATHECAL FLUORESCEIN IN ENDOSCOPIC CRANIAL BASE SURGERY

Neurosurgery, 2007

Intraoperative identification of cerebrospinal fluid (CSF) leakage is critical in successful clos... more Intraoperative identification of cerebrospinal fluid (CSF) leakage is critical in successful closure after endoscopic cranial base surgery. Intrathecal injection of fluorescein is quite useful in identifying CSF leaks. However, complications have been reported with various doses and the technique has fallen out of favor. We explored the safety of low-dose intrathecal fluorescein administered to patients undergoing endoscopic cranial base surgery. A retrospective chart review and postoperative patient survey were performed. The nature and incidence of complications and subjective complaints were recorded in 54 patients who underwent endoscopic, endonasal approaches to the anterior cranial base and received intrathecal fluorescein after premedication with dexamethasone and diphenhydramine. Intraoperative CSF leak was identified with fluorescein in 46.3% of the patients and helped determine the reconstruction technique. Postoperative CSF leak occurred in 9.3% of the patients and resolved with lumbar drainage. There were no seizures. Most side effects were nonspecific, transient, and likely not caused by fluorescein including malaise (57.4%), headache (51.9%), dizziness (31.5%), or nausea/vomiting (24.1%). Three patients (5.6%) experienced persistent subjective lower extremity weakness (n = 2) and numbness (n = 2) postoperatively; however, two of them had undergone lumbar drainage. Low-dose injection of intrathecal fluorescein after premedication with steroid and antihistamine agents is generally safe. Most symptoms are nonspecific and transient, likely caused by the surgery or lumbar drainage. However, fluorescein should be administered with some caution because it may be responsible for occasional lower extremity weakness and numbness.

Research paper thumbnail of The Efficacy of Computer Assisted Surgery in the Endoscopic Management of Cerebrospinal Fluid Rhinorrhea

Otolaryngology-head and Neck Surgery, 2005

To determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and wi... more To determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and without computer assisted surgery. A review of all patients undergoing endoscopic closure of CSF rhinorrhea at a tertiary care medical center between 1994 and 2003. Charts from the 24 patients were reviewed for indications, location of leak, type of surgical closure, number of prior closure attempts, graft materials, use of computer assisted surgery, complications, and need for revision surgery. Analysis was performed to determine a possible correlation between success of CSF leak repair and use of computer assisted surgery. The etiology of the leak was previous sinus surgery in 10 patients (41.7%), trauma in 5 patients (20.8%), spontaneous leak in 5 patients (20.8%), and skull base surgery in 4 patients (16.7%). The most common sites of leak were the fovea ethmoidalis in 10 patients (41.7%), cribriform plate in 8 patients (33.3%), and sphenoid sinus in 6 patients (25%). Image guidance was employed in 66.7% (16 patients) of our first attempted repairs. Six patients underwent a total of 9 revision procedures. At last follow-up, 96% of patients had no evidence of CSF rhinorrhea. A comparison of patients in the 2 groups failed to reveal a statistically significant difference in the rate of CSF leak closure. Endoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. The use of computer assistance may improve the confidence of the surgeon and is a valuable adjunct in this procedure. Our study, however, did not demonstrate an improvement in the rates of successful closure with the use of computer assistance.

Research paper thumbnail of GASKET-SEAL” WATERTIGHT CLOSURE IN MINIMAL-ACCESS ENDOSCOPIC CRANIAL BASE SURGERY

Neurosurgery, 2008

Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midl... more Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;gasket seal&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.

Research paper thumbnail of Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions

Journal of Neurosurgery, 2007

tuberculum sellae meningioma may be removed by purely endoscopic techniques in near future. Keywo... more tuberculum sellae meningioma may be removed by purely endoscopic techniques in near future. Keywords: neuroendoscopy; operative experience; transsphenoidal removal; tuberculum sellae meningioma; endonasal endoscopic extended transsphenoidal approach Br J Neurosurg Downloaded from informahealthcare.com by 117.18.231.13 on 04/06/12

Research paper thumbnail of Intrathecal fluorescein in endoscopic skull base surgery

Otolaryngology-head and Neck Surgery, 2007

Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid... more Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid the morbidity of postoperative cerebrospinal fluid (CSF) leak. The impact on outcomes of CSF visualization with intrathecal fluorescein, however, is unknown. A retrospective review of patients undergoing endoscopic skull base surgery with intrathecal fluorescein. A possible correlation between intraoperative fluorescein identification and postoperative CSF leak was analyzed. 61 patients underwent surgery for a variety of lesions including pituitary adenoma (55.7%), encephalocele (14.8%), and meningioma (9.8%). Seven (19.4%) of the 37 patients with intraoperative fluorescein leak experienced postoperative CSF leak compared to 0 of the 24 patients who did not have intraoperative fluorescein leak (P = 0.02). All cases of CSF leak resolved with lumbar drainage alone. The lack of intraoperative fluorescein leakage correlates strongly with a low risk for postoperative CSF leak. This can be used to stratify the extent of skull base reconstruction required during endoscopic skull base surgeries.

Research paper thumbnail of ENDOSCOPIC CRANIAL BASE SURGERY: CLASSIFICATION OF OPERATIVE APPROACHES

Neurosurgery, 2008

OBJECTIVE: Endoscopic cranial base surgery is a minimal access, maximally aggressive alternative ... more OBJECTIVE: Endoscopic cranial base surgery is a minimal access, maximally aggressive alternative to traditional transfacial, transcranial, or combined open cranial base approaches. Previous descriptions of endoscopic approaches have used varying terminology, which can be confusing to the new practitioner. Indications for surgery are not well defined. Our objective was to create a comprehensive classification system of the various approaches and describe their indications with case examples. METHODS: We prospectively compiled a comprehensive database of our endonasal endoscopic operations, detailing the nasal sinus transgressed, the cranial base approach, and the intracranial target for the first 150 consecutive cases performed at our institution. All cases were performed collaboratively by a neurosurgeon and an otolaryngologist. RESULTS: We categorized the endonasal endoscopic cranial base operations into four nasal corridors, nine cranial base approaches, and 13 intracranial targets. Each of the various approaches is described in detail and illustrated with case examples. Pathology encountered included pituitary tumor (50%), meningocele/encephalocele (14%), craniopharyngioma and Rathke cleft cyst (10%), meningioma (8%), chordoma (5%), esthesioneuroblastoma (2%), and other (11%). CONCLUSION: Endonasal endoscopic cranial base surgery is a minimal access, maximally invasive alternative to open transcranial cranial base approaches for specific indications. A clear understanding of the possible approaches is facilitated by an awareness of the nasal corridors and intracranial targets. a Pituitary carcinoma, metastasis, hemangiopericytoma, rhabdomyosarcoma, adenoid cystic carcinoma, malignant salivary gland tumor, juvenile angiofibroma, schwannoma, enterogenous cyst, osteoma, papilloma, nasal glioma, lipoma, gout, rheumatoid pannus. 994 | VOLUME 62 | NUMBER 5 | MAY 2008 www.neurosurgery-online.com SCHWARTZ ET AL. FIGURE 3. Frequency of each approach used in endoscopic cranial base and pituitary surgery.

Research paper thumbnail of Endonasal Endoscopic Resection of an Os Odontoideum to Decompress the Cervicomedullary Junction: A Minimal Access Surgical Technique

Spine, 2009

Study Design. We report the case of a 50 year-old woman with os odontoideum and posterior atlanto... more Study Design. We report the case of a 50 year-old woman with os odontoideum and posterior atlantoaxial subluxation, who underwent an occipitocervical fusion followed by endonasal endoscopic anterior decompression of the cervicomedullary junction (CMJ).

Research paper thumbnail of Three-dimensional endoscopic sinus surgery: Feasibility and technical aspects

Otolaryngology-head and Neck Surgery, 2008

T he development of endoscopic techniques for a variety of sinonasal disorders has paralleled adv... more T he development of endoscopic techniques for a variety of sinonasal disorders has paralleled advances in technology and instrumentation including angled endoscopes, multi-chip cameras, and image guidance. Despite the progressive technological innovations in modern endoscopic surgery, the visualization that is currently used remains 2-dimensional (2D). This is associated with significant limitations, notably a lack of depth perception. Although visual and haptic cues allow for a surgeon to understand the spatial relationships of the various structures, current visualization technology fails to provide the 3-dimensional (3D) perspective that is available in open and microscopic surgery. The development of a miniature stereoscopic camera and its adaptation to rigid endoscopes allows for performance of 3D endoscopic sinus surgery. It is hypothesized that incorporation of 3D visualization may enhance the spatial resolution required in advanced endoscopic approaches with a theoretical potential to improve outcomes.

Research paper thumbnail of Incidence of Methicillin-Resistant Staphylococcus aureus Causing Chronic Rhinosinusitis

Laryngoscope, 2004

A case control study was carried out in order to evaluate the various factors which may influence... more A case control study was carried out in order to evaluate the various factors which may influence the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infections in a skilled nursing home. From April 1991 to March 1994, bacterial cultures were performed in 55 out of 102 residents in a nursing home based on various clinical aspects.