New applications for intracranial endoscopic surgery continue to evolve. The endoscope provides improved visualization of the skull base, where narrow recesses and angled trajectories impair the direct forward view of the operating microscope. Endoscopic surgery allows for a smaller craniotomy, less dissection and minimal retraction, without compromising the goals of the operation. Articles describing the use of angled endoscopes to assist microscopic removal of vestibular schwannomas suggest that endoscopes allow for complete visualization of the most lateral aspect of the internal auditory canal, identify exposed air cells, and provide more detailed images of the surrounding neurovascular structures. In this report we describe three fully endoscopic excisions of 2 - 3.5 cm vestibular schwannomas via 1.5 cm keyhole retrosigmoid craniotomies. The 0 degrees and 30 degrees endoscopes provided excellent exposure, allowing complete visualization of the most lateral aspect of the internal auditory canal, insuring complete tumor removal. The patients had excellent outcomes and were discharged within 72 hours post-operatively. From our experience we conclude that the endoscope is ideally suited for a minimally invasive retrosigmoid approach to vestibular schwannomas.
Background
To assess the relationship between lung cancer and emphysema subtypes.
Objective
Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment.
Methods
Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clínica Universidad de Navarra’s lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes.
Results
Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6).
Conclusions
Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk.
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