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Research Letter | Association of VA Surgeons

Outcomes of Patients Undergoing Endoscopic Endonasal Skull Base Surgery at a VA Hospital ONLINE FIRST

Michael Jones, MD1; Stephen Johans, MD1; Andrea Ziegler, MD2; Kevin C. Welch, MD3; Monica O. Patadia, MD2; Chirag R. Patel, MD2; Anand V. Germanwala, MD1
[+] Author Affiliations
1Department of Neurological Surgery, Loyola University, Maywood, Illinois
2Department of Otolaryngology, Loyola University, Maywood, Illinois
3Department of Otolaryngology–Head & Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
JAMA Surg. Published online September 21, 2016. doi:10.1001/jamasurg.2016.2916
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This study examines if outcomes of veterans undergoing endoscopic endonasal skull base surgery in the VA system rival those in other published studies.

Traditionally, sellar skull base pathology has been accessed using sublabial or transseptal transsphenoidal approaches with the assistance of an operating microscope.1 However, recently an endoscopic endonasal technique has become more popular.2 This technique provides a corridor of access that extends sagittally from the frontal sinus to the base of the odontoid. For pathology with significant suprasellar extension or lateral invasion of the cavernous sinus, this newer option may be associated with increased visualization, extent of resection, improved visual outcomes, and decreased length of hospital stay when compared with conventional approaches.3,4 Our study sought to determine if outcomes of veterans undergoing this procedure in the VA system rival those in other published studies.

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Figure.
Preoperative, Intraoperative, and Postoperative Views

A, Preoperative sagittal magnetic resonance imaging (MRI) with gadolinium demonstrating contrast-enhancing sellar mass with chiasmatic mass effect. B, Intraoperative endoscopic endonasal photograph demonstrating dural exposure from sellar osteotomy and identification of a medialized left cavernous internal carotid artery (arrowhead). C, Postoperative sagittal MRI with gadolinium demonstrating gross total resection and dural reconstruction with a nasoseptal flap.

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