Search

BackgroundHearing impairment is prevalent among older adults and has been identified as a risk factor for cognitive impairment and dementia. We evaluated the association of hearing impairment with long-term cognitive decline among community-dwelling older adults.MethodsA population-based longitudinal study of adults not using hearing aids who had hearing acuity and cognitive function assessed in 1992-1996, and were followed for a maximum of 24 years with up to five additional cognitive assessments. Hearing acuity was categorized based on pure-tone average (PTA) thresholds: normal (PTA ≤ 25 dB), mild impairment (PTA > 25-40 dB), moderate/severe impairment (PTA > 40 dB).ResultsOf 1,164 participants (mean age 73.5 years, 64% women), 580 (49.8%) had mild hearing impairment and 196 (16.8%) had moderate/severe hearing impairment. In fully adjusted models, hearing impairment was associated with steeper decline on the Mini-Mental State Examination (MMSE) (mild impairment β = -0.04, p = .01; moderate/severe impairment β = -0.08, p = .002) and Trails B (mild impairment β = 1.21, p = .003; moderate/severe impairment β = 2.16, p = .003). Associations did not differ by sex or apolipoprotein E (APOE) ϵ4 status and were not influenced by social engagement. The MMSE-hearing association was modified by education: mild hearing impairment was associated with steeper decline on the MMSE among participants without college education but not among those with college education. Moderate/severe hearing impairment was associated with steeper MMSE decline regardless of education level.ConclusionsHearing impairment is associated with accelerated cognitive decline with age, and should be screened for routinely. Higher education may provide sufficient cognitive reserve to counter effects of mild, but not more severe, hearing impairment.

Objective: To examine the impact of increased body mass index (BMI) on (1) tracheotomy timing and (2) short‐term surgical complications requiring a return to the operating room and 30‐day mortality utilizing data from the Multi‐Institutional Study on Tracheotomy (MIST). Methods: A retrospective analysis of patients from the MIST database who underwent surgical or percutaneous tracheotomy between 2013 and 2016 at eight institutions was completed. Unadjusted and adjusted logistic regression analyses were used to assess the impact of obesity on tracheotomy timing and complications. Results: Among the 3369 patients who underwent tracheotomy, 41.0% were obese and 21.6% were morbidly obese. BMI was associated with higher rates of prolonged intubation prior to tracheotomy accounting for comorbidities, indication for tracheotomy, institution, and type of tracheostomy (p = 0.001). Morbidly obese patients (BMI ≥35 kg/m2) experienced a longer duration of intubation compared with patients with a normal BMI (median days intubated [IQR 25%–75%]: 11.0 days [7–17 days] versus 9.0 days [5–14 days]; p < 0.001) but did not have statistically higher rates of return to the operating room within 30 days (p = 0.12) or mortality (p = 0.90) on multivariable analysis. This same finding of prolonged intubation was not seen in overweight, nonobese patients when compared with normal BMI patients (median days intubated [IQR 25%–75%]: 10.0 days [6–15 days] versus 10.0 days [6–15 days]; p = 0.36). Conclusion: BMI was associated with increased duration of intubation prior to tracheotomy. Although morbidly obese patients had a longer duration of intubation, there were no differences in return to the operating room or mortality within 30 days. Level of Evidence: 3 Laryngoscope, 134:4674–4681, 2024 [ABSTRACT FROM AUTHOR]

BackgroundCerebrospinal fluid (CSF) leak is a well-recognized complication after surgical resection of vestibular schwannomas and is associated with a number of secondary complications, including readmission and meningitis.ObjectiveTo identify risk factors for and timing of 30-d readmission with CSF leak.MethodsPatients who had undergone surgical resection of a vestibular schwannoma from 1995 to 2010 were identified in the California Office of Statewide Health Planning and Development database. The most common admission diagnoses were identified by International Classification of Disease, ninth Revision, diagnosis codes, and predictors of readmission with CSF leak were determined using logistic regression.ResultsA total of 6820 patients were identified. CSF leak, though a relatively uncommon cause of admission after discharge (3.52% of all patients), was implicated in nearly half of 490 readmissions (48.98%). Significant independent predictors of readmission with CSF leak were male sex (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.32-2.25), first admission at a teaching hospital (OR 3.32, 95% CI 1.06-10.39), CSF leak during first admission (OR 1.84, 95% CI 1.33-2.55), obesity during first admission (OR 2.10, 95% CI 1.20-3.66), and case volume of first admission hospital (OR of log case volume 0.82, 95% CI 0.70-0.95). Median time to readmission was 6 d from hospital discharge.ConclusionThis study has quantified CSF leak as an important contributor to nearly half of all readmissions following vestibular schwannoma surgery. We propose that surgeons should focus on technical factors that may reduce CSF leakage and take advantage of potential screening strategies for the detection of CSF leakage prior to first admission discharge.

The case refers to a middle-aged woman with an irregular calcified MCA aneurysm. No good endovascular options were thought to be feasible and she was referred for microsurgical therapy. The aneurysm was treated with multiple fenestrated clips and an M2 to M2 side-to-side bypass. She tolerated the procedure well.By Ali Alattar; Bhuvic Patel and Georgios ZenonosReported by Author; Author; Author [Extracted from the article]

This article examines the relationship between patient age and clinical characteristics and outcomes in endoscopic endonasal surgery (EES) for pediatric skull base neurosurgery. The study analyzes data from a single pediatric center over a 23-year period. The research finds that there are age-dependent differences in pathology, with younger patients more likely to have certain types of tumors and older patients more likely to have others. However, the study concludes that EES can be safely performed in patients of all age ranges, with no significant difference in complication rates. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, discusses the use of the endoscopic endonasal approach (EEA) for the resection of diaphragma sellae meningiomas. The study involved a retrospective review of patients who underwent EEA for the removal of these tumors between 2000 and 2023. The results showed that EEA was successful in achieving gross total resection in the majority of cases, with minimal postoperative complications. The study suggests that EEA is a viable and safe option for managing diaphragma sellae meningiomas, with potential advantages in preserving visual and pituitary function. [Extracted from the article]

This article presents a retrospective review of pediatric patients who underwent endoscopic endonasal surgery (EES) for skull base pathologies at a large tertiary pediatric hospital between 1999 and 2022. The study included 243 patients with a median age of 14.2 years, with a male predominance. Various pathologies were treated, including juvenile nasopharyngeal angiofibroma, craniopharyngioma, chordoma, pituitary adenoma, encephalocele, Rathke cleft cyst, and basilar invagination or odontoid pannus. Most patients were treated with EES alone, and the overall rate of postoperative complications was 14%. CSF leak was the most common complication. The study concludes that EES is an effective approach for pediatric skull base pathologies, with lower neurovascular complication rates compared to traditional open approaches. [Extracted from the article]

This article discusses the learning curve and changes in practice patterns for pediatric endoscopic endonasal surgery (EES) over a 23-year period at a single institution. The authors analyzed data from 243 patients with skull base pathologies treated with EES between 1999 and 2022. They found an increase in the proportion of patients with chordoma and a decrease in the proportion with pituitary adenoma. There were also changes in the anatomical locations of the pathologies treated and an increase in the utilization of advanced reconstruction techniques and adjunctive preoperative treatments. Overall, the authors observed minimal increased morbidity despite treating more complex cases. [Extracted from the article]

This article discusses the use of a suction nerve stimulator technique for the resection of pituitary adenomas that invade the cavernous sinus. The cavernous sinus is a complex region with many neurovascular structures, making surgical resection challenging. The study reviewed the cases of 50 patients who underwent the endoscopic endonasal approach for pituitary adenoma resection using the suction nerve stimulator device. The results showed that most patients with preoperative cranial nerve palsy experienced full recovery, and no new postoperative cranial neuropathies were reported. The authors suggest that this technique is safe and valuable in managing pituitary adenomas with cavernous sinus invasion, and further research could establish it as a standard protocol to minimize post-surgical complications. [Extracted from the article]