Publications by authors named "Catherine Merna"

11 Publications

  • Page 1 of 1

Determinants of Survival in Skull Base Osteosarcoma: A National Cancer Database Study.

World Neurosurg 2021 May 8. Epub 2021 May 8.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA; Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA. Electronic address:

Objective: Skull base osteosarcoma is a rare and aggressive tumor that is most commonly treated with primary surgical resection and adjuvant chemoradiation. Using the National Cancer Database, we analyzed demographic and clinical prognosticators for overall survival (OS).

Methods: The National Cancer Database was queried for cases of histologically confirmed skull base osteosarcoma treated between 2004 and 2015, excluding patients receiving palliation or having <1 month of follow-up. A total of 314 patients treated with surgery alone (n = 82), surgery with adjuvant radiotherapy (n = 35), surgery with chemotherapy (n = 114), or trimodality therapy (n = 56) were identified. The χ test for categorical variables, Cox proportional hazards models, and Kaplan-Meier log-rank analysis were used to test associations with treatment, OS, and survival time.

Results: None of the studied demographic characteristics (age, sex, race, overall health) and socioeconomic factors (income and average regional education) were associated with OS (none P < 0.05). Treatment modalities also did not show a significant association with OS (none P < 0.05). Certain tumor characteristics showed an association with OS, with fibroblastic and Paget histologic subtypes (each P = 0.003), poorly differentiated tumor grade (P = 0.03), and tumor size >5 cm (P = 0.045) associated with poorer OS.

Conclusions: Tumor histologic subtype, advanced tumor grade, and greater tumor size are predictors of worse OS in skull base osteosarcoma. No significant differences in OS were identified based on treatment modality, which warrants further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2021.04.135DOI Listing
May 2021

Evaluation of a High-Definition Intraoperative Exoscope in Rhinoplasty Education and Workflow.

Facial Plast Surg Aesthet Med 2021 Mar-Apr;23(2):144-145. Epub 2020 Nov 5.

Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, California, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/fpsam.2020.0479DOI Listing
November 2020

Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment.

Front Neurol 2020 15;11:1046. Epub 2020 Sep 15.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States.

A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and the middle ear cavity, mastoid, or intracranial cavity. A PLF most commonly forms when the integrity of the oval or round window is compromised, and it may be trauma-induced or may occur with no known cause (idiopathic). Controversy regarding the diagnosis of idiopathic PLF has persisted for decades, and the presenting symptoms may be vague. However, potential exists for this condition to be one of the few etiologies of dizziness, tinnitus, and hearing loss that can be treated surgically. The aim of this review is to provide an update on classification, diagnosis, and treatment of PLF. Particular attention will be paid to idiopathic PLF and conditions that may have a similar presentation, with subsequent information on how best to distinguish them. Novel diagnostic criteria for PLF and management strategy for PLF and PLF-like symptoms is presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2020.01046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522398PMC
September 2020

Clinical Characteristics, Complications, and Reasons for Readmission following Lingual Tonsillectomy.

Otolaryngol Head Neck Surg 2019 04 19;160(4):619-621. Epub 2019 Feb 19.

2 Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA.

This brief communication regards the indications and complications for and rates of readmission following lingual tonsillectomy. The National Readmissions Database (NRD) 2013-2014 was queried for all cases of lingual tonsillectomy occurring from 2013 to 2014. Among 602 lingual tonsillectomies (mean age 36.5 years, 58.2% male), the common indications for surgery were obstructive sleep apnea (58.7%), lingual tonsil hypertrophy/infection (18.8%), and neoplasia (15.9%). Overall, 49 (8.2%) of the cases were readmitted (95% confidence interval, 4.8%-13.5%), with an average readmission duration of 3.0 days and average readmission cost of $25.4K. The most common diagnoses at readmission were bleeding (1.9% of all lingual tonsillectomy cases); dysphagia (1.7%); fever, nausea, vomiting, or diarrhea (1.6%); acute pain (1.6%); and airway obstruction (1.4%). There were no mortalities during primary or subsequent admissions. Lingual tonsillectomy across age groups is relatively free of adverse events, with overall readmission and complication rates similar to those of palatine tonsillectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0194599819827820DOI Listing
April 2019

Simultaneous cerebrospinal fluid and hematologic metastases in a high-grade ependymoma.

Surg Neurol Int 2018 26;9:93. Epub 2018 Apr 26.

Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA.

Background: Ependymomas are relatively uncommon tumors that constitute about 7% of all primary intracranial neoplasms. Among these, high-grade ependymomas are locally aggressive and recur most commonly at the primary site following resection. Ependymomas are also known to be the one glial neoplasm that tends to frequently metastasize inside and outside the central nervous system (CNS) that complicates workup and management. Metastasis due to surgical manipulation is common and neurosurgeons should be well-versed in the most effective methods to remove these tumors in order to avoid such metastases.

Case Description: Here, we report a case of a 28-year-old female who initially presented with a parenchymal World Health Organization (WHO) grade III anaplastic ependymoma of the occipital lobe without metastasis. After multiple resections, the patient showed no evidence of disease recurrence for 2 years. During follow-up, new metastasis to the frontal lobe as well as to the lung were discovered 2 years after the initial surgery, without recurrence at the tumor's primary site.

Conclusions: While uncommon, this case demonstrates the possibility for ependymomas to metastasize via cerebrospinal fluid to other locations within the CNS and hematologically to extraneural locations without recurring locally.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/sni.sni_475_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938895PMC
April 2018

Surgical nuances of partial sacrectomy for chordoma.

Surg Neurol Int 2017 20;8:277. Epub 2017 Nov 20.

Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA.

Background: Sacral chordomas are rare, slow growing, locally aggressive tumors. Unfortunately, aggressive surgical resection is often associated with increased neurological morbidity.

Methods: This technical note focuses on the utilization of partial sacrectomy for the resection of complex spinal chordomas.

Results: The case presented documents the potential range of postoperative morbidity seen in patients undergoing partial sacrectomy for chordomas. Despite iatrogenic morbidity and tumor recurrence, with the cooperation of medical and surgical spine specialists, majority of patients can achieve good long-term outcomes.

Conclusions: Sacral chordomas are rare lesions and pose a therapeutic challenge for spinal surgeons and oncologists. surgical resection (e.g., partial sacrectomy) is the treatment of choice for these lesions, and the cooperation between subspecialists can lead to good neurologic outcomes, particularly if gross total resection is achieved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/sni.sni_230_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705930PMC
November 2017

Adult sacrococcygeal teratoma with coccygectomy: A case report with a review of the literature.

Surg Neurol Int 2017 24;8:260. Epub 2017 Oct 24.

Department of Neurosurgery, Kaiser Permanente Medical Center, Los Angeles, California, USA.

Background: Saccrococcygeal teratomas (SCT) are derived from embryonic germ cell layers. They frequently present at the base of the coccyx within the pelvis. While these tumors are common in children, they are exceedingly rare in adults. In adults, a majority of these tumors are intrapelvic and associated with a low risk of malignant transformation. Therefore, this contributes to a good prognosis following resection of mostly benign lesions.

Case Description: An adult female with chronic pelvic pain presented with a sacral teratoma. She failed conservative treatment and underwent a coccygectomy with an excision of the tumor. Microscopic histological analysis showed no evidence of immature or malignant elements, confirming the diagnosis of a mature, benign, cystic SCT.

Conclusions: Mature SCTs in adults are rare malignant lesions. In this case, the patient was cured following primary surgical excision requiring en-bloc coccygectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/sni.sni_224_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680643PMC
October 2017

Surgical nuances of circumferential lumbar spondylectomy: A case report and short literature review.

Surg Neurol Int 2017 24;8:253. Epub 2017 Oct 24.

Department of Neurosurgery, Kaiser Permanente Medical Center, Los Angeles, California, USA.

Background: Chordomas are uncommon malignant bone tumors that are often minimally symptomatic for several years. By the time they are diagnosed, these lesions are typically large, involve major neural, bony, and vascular structures, and are no longer readily resectable. This leads to a high recurrence rate.

Case Description: In this case report, we present a 67-year-old male with nonmechanical axial back pain, neurogenic claudication, and a large mass centered at the L3 level on magnetic resonance imaging consistent with a locally invasive chordoma. The patient underwent surgical resection that required a complete lumbar spondylectomy utilizing a three-stage approach, leading to incomplete tumor excision. The patient's residual postoperative symptoms included paresthesias/numbness in the right anterior thigh and a partial (4/5) right-sided foot drop. At the time of discharge, there were plans for future proton beam therapy.

Conclusions: Because of their relative resistance to chemotherapeutic agents, the optimal surgical management of chordomas is gross total excision. Unfortunately, this is rarely feasible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/sni.sni_225_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680665PMC
October 2017

Intraosseous mucoepidermoid carcinoma: Outcome review.

Laryngoscope 2018 05 22;128(5):1083-1092. Epub 2017 Aug 22.

Department of Head and Neck Surgery, University of California Irvine, Irvine.

Objective: Identify the effect of patient characteristics, disease traits, and treatment modality on patient outcomes in the rare disease process of intraosseous mucoepidermoid carcinoma.

Study Design: Retrospective review of institutional case records and literature.

Methods: This study includes one case report, a literature review of the MEDLINE database from 1950 through June 2017 using keywords "intraosseous" and "mucoepidermoid," and a query of the University of California, Los Angeles, Department of Pathology database for all documented cases of intraosseous mucoepidermoid carcinoma of the head and neck.

Results: Indicators of poorer prognosis were male gender (P = 0.0071) and higher histological grade (P = 0.0095). Lesion site, size, association with odontogenic cyst, and treatment type did not have a statistically significant correlation with patient outcomes. There also was no statistically significant correlation observed between treatment modality and recurrent or progressive disease when stratified by histological grade of the cancer.

Conclusion: This study identified male gender and high histological tumor grade as poor prognostic indicators; however, it did not reveal a statistically significant relationship between treatment modality and patient outcomes. Data regarding patient outcomes following treatment was limited due to loss to follow-up, suggesting that further investigation is required. Based on this review, decisions regarding treatment should be clinically guided and individually tailored to the patient's baseline health, disease severity, and the patient's treatment goals. A multi-disciplinary conference, as was utilized in the presented case report, may be the best approach to treatment planning for these patients at this time.

Level Of Evidence: 4. Laryngoscope, 128:1083-1092, 2018.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.26832DOI Listing
May 2018

Facial nerve stimulation following cochlear implantation for X-linked stapes gusher syndrome leading to identification of a novel POU3F4 mutation.

Int J Pediatr Otorhinolaryngol 2016 Dec 6;91:121-123. Epub 2016 Oct 6.

Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. Electronic address:

We report a case of a nine-year-old male who presented with facial nerve stimulation four years after cochlear implantation. Computed tomography was performed revealing a dilated internal auditory meatus and the cochlear implant electrode was found to be protruding into the fallopian canal at the level of the geniculate ganglion. Subsequent genetic analysis demonstrated X-linked deafness type 2 (DFNX2) caused by a novel c.769C > T nucleotide change in the POU domain, class 3, transcription factor 4 gene (POU3F4). Inactivation of electrodes 1 and 19-21 successfully abated facial nerve stimulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2016.10.003DOI Listing
December 2016

A treatment planning comparison between modulated tri-cobalt-60 teletherapy and linear accelerator-based stereotactic body radiotherapy for central early-stage non-small cell lung cancer.

Med Dosim 2016 2;41(1):87-91. Epub 2016 Jan 2.

Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address:

We evaluated the feasibility of planning stereotactic body radiotherapy (SBRT) for large central early-stage non-small cell lung cancer with a tri-cobalt-60 (tri-(60)Co) system equipped with real-time magnetic resonance imaging (MRI) guidance, as compared to linear accelerator (LINAC)-based SBRT. In all, 20 patients with large central early-stage non-small cell lung cancer who were treated between 2010 and 2015 with LINAC-based SBRT were replanned using a tri-(60)Co system for a prescription dose of 50Gy in 4 fractions. Doses to organs at risk were evaluated based on established MD Anderson constraints for central lung SBRT. R100 values were calculated as the total tissue volume receiving 100% of the dose (V100) divided by the planning target volume and compared to assess dose conformity. Dosimetric comparisons between LINAC-based and tri-(60)Co SBRT plans were performed using Student׳s t-test and Wilcoxon Ranks test. Blinded reviews by radiation oncologists were performed to assess the suitability of both plans for clinical delivery. The mean planning target volume was 48.3cc (range: 12.1 to 139.4cc). Of the tri-(60)Co SBRT plans, a mean 97.4% of dosimetric parameters per patient met MD Anderson dose constraints, whereas a mean 98.8% of dosimetric parameters per patient were met with LINAC-based SBRT planning (p = 0.056). R100 values were similar between both plans (1.20 vs 1.21, p = 0.79). Upon blinded review by 4 radiation oncologists, an average of 90% of the tri-(60)Co SBRT plans were considered acceptable for clinical delivery compared with 100% of the corresponding LINAC-based SBRT plans (p = 0.17). SBRT planning using the tri-(60)Co system with built-in MRI is feasible and achieves clinically acceptable plans for most central lung patients, with similar target dose conformity and organ at risk dosimetry. The added benefit of real-time MRI-guided therapy may further optimize tumor targeting while improving normal tissue sparing, which warrants further investigation in a prospective feasibility clinical trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.meddos.2015.09.002DOI Listing
December 2016