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Theodore H. Schwartz

largest single series reported to date. However, their own data may lead other investigators to altogether different conclusions than the ones they themselves draw from the same data. Within this well-written and well-documented paper are several facts that are not highlighted by the authors but that are clearly apparent. First is the issue of repeat operations. The authors used 2 surgeries, or a staged approach, almost 40% of the time to achieve the rate of gross-total resection (GTR) reported in their paper. Generally this second surgery was another endonasal

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Theodore H. Schwartz and Dennis D. Spencer

O utcomes following surgery for medically intractable epilepsy have gradually improved over the second half of the twentieth century. In most modern series the percentage of patients rendered free from seizure after medial temporal resections generally approaches 70 to 80%, with an additional 15 to 25% of patients finding worthwhile improvement. 12, 17, 55 Similar outcomes are reported for extratemporal lesional epilepsy. 17, 55 Although nonlesional cases remain more difficult to manage, seizure-free rates approach 50%, with an additional 35% of cases

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Theodore H. Schwartz

Coburger et al. performed a retrospective study of 2 serial but nonconsecutive groups of patients in which microscope-based, paraseptal, fluoroscopically guided transsphenoidal surgery (TSS) was performed for mostly pituitary tumors, in which intraoperative MRI (iMRI) was not used in the first group and was used in the second group. 2 The authors claim that for those patients in whom gross-total resection (GTR) was intended there was a statistically higher rate of GTR in the iMRI group, and for the rest of the patients, in whom GTR was not intended, there

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Shaan M. Raza, Matei A. Banu, Angela Donaldson, Kunal S. Patel, Vijay K. Anand and Theodore H. Schwartz

queried a prospectively acquired database of 648 endonasal endoscopic skull base surgeries that were performed by the senior authors (T.H.S. and V.K.A.) at Weill Cornell Medical College, Sackler Brain and Spine Center, NewYork-Presbyterian Hospital. Only patients undergoing pure endonasal endoscopic approaches who received ITF were selected for this study. To avoid biases and errors that stem from retrospective analyses, we only included the most recent series of consecutive patients for whom complete data regarding intraoperative fluorescein detection had been

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Mark M. Souweidane, Caitlin E. Hoffman and Theodore H. Schwartz

T he techniques of ETV and endoscopic colloid cyst resection have been thoroughly described. All of these descriptions have been based on normal and relatively predictable intraventricular anatomy, however. Anatomical variants of the ventricular compartment, when encountered, would undoubtedly present some degree of unfamiliarity and potential morbidity during endoscopic intraventricular surgery. The CSP and CV occur with enough regularity, especially in the pediatric age group, that they may coexist in some patients who would normally benefit from

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Lessons learned in the evolution of endoscopic skull base surgery

JNSPG 75th Anniversary Invited Review Article

Theodore H. Schwartz, Peter F. Morgenstern and Vijay K. Anand

skull base surgery (ESBS) has rapidly proliferated throughout the field of neurosurgery. Like other technologies, it has been widely adopted in some countries and institutions and yet has met barriers and skepticism in other locations. The ease of adoption, myriad courses and training opportunities, and appeal to patients as a “minimally invasive approach” assisted its rapid expansion. However, the lack of randomized clinical trials supporting its use raises concerns regarding its true efficacy compared to more traditional approaches. Moreover, as with many other

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Peter J. Wilson, Sacit B. Omay, Ashutosh Kacker, Vijay K. Anand and Theodore H. Schwartz

the natural history of the disease. Nevertheless, non–hormone producing pituitary tumors are benign slow-growing tumors and cause morbidity primarily from mass effect. In the absence of symptoms, the decision to operate rests on a careful weighing of the risks and benefits of surgery. Several publications have outlined the risks of surgery in the elderly population using the operative microscope, but with the advent of the endonasal endoscopic approach, the risks of surgery may have changed. Few publications have examined the risks of endonasal endoscopic pituitary

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Edward D. McCoul, Vijay K. Anand and Theodore H. Schwartz

E ndoscopic skull base surgery has gained popularity over the past decade as an excellent alternative to microscope-assisted and open surgical approaches for selected cases. 21 Among the potential benefits of this surgery are a quicker recovery time, better wound healing, increased illumination and visualization of the operative field, and the ability to look around anatomical corners. Previous assessments of the efficacy of ESBS have generally focused on parameters such as the extent of resection and complications and have used these measures to compare

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Edward D. McCoul, Jeffrey C. Bedrosian, Olga Akselrod, Vijay K. Anand and Theodore H. Schwartz

removal of large pituitary adenomas. Likewise, based on the presumption that surgery is invasive and risky, surgical interventions for benign, slowly evolving pathology should be well tolerated by patients since competing nonsurgical therapies such as radiation or medical therapy may be used. 11 , 13 Despite the widespread use of surgery to manage pituitary adenomas, the effect on QOL has been incompletely studied. Quality of life is a patient-reported measure that aims to describe a patient’s perception of well-being while eliminating observer bias. Recent interest

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Anirudh Srinivasan

reoperations involved patients both with and without prior radiation, the impacts of reoperation and radiation had some overlap. Hence, this differential impact would probably become clearer if the authors had presented the resection rates and visual outcomes among reoperations without prior radiation and reoperations following radiation separately in comparison to primary surgery. References 1 Dhandapani S , Singh H , Negm HM , Cohen S , Souweidane MM , Greenfield JP , : Endonasal endoscopic reoperation for residual or recurrent craniopharyngiomas