Publications by authors named "Rijul Kshirsagar"

Introduction: Unilateral sphenoid sinus opacification on computed tomography is caused by a variety of pathologies including inflammatory and infectious sinusitis, benign and malignant tumors, and encephaloceles. The purpose of this study was to report craniofacial pain locations and outcomes in inflammatory unilateral sphenoid sinusitis (USS) patients who underwent endoscopic sinus surgery (ESS).

Methods: A multi-institutional retrospective cohort study was conducted on all adult patients who had ESS for USS from 2015 to 2022.

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Objectives: Postoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery (FESS) are managed carefully due to concern for bleeding. Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area. We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids.

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Article Synopsis
  • Endoscopic sinus surgery (ESS) is crucial for treating odontogenic sinusitis (ODS), particularly in cases involving the frontal sinus, but the effectiveness of different surgical extents needs further study.
  • A multicenter study compared the outcomes of wide maxillary antrostomy (MA) against complete ESS in patients with ODS who showed involvement of frontal and anterior ethmoid sinuses.
  • The results indicated that, while both surgical methods led to significant symptom relief, complete ESS had a faster resolution of anterior ethmoidal sinus purulence compared to MA alone, although long-term outcomes were similar between the two groups.
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Objectives: There is growing interest in assessing patient quality of life (QOL) following treatment of sinonasal tumors, including inverted papilloma (IP). We aimed to elucidate the natural history of postoperative QOL outcomes in IP patients treated with surgery.

Methods: Cases of sinonasal IP treated surgically at 4 tertiary academic rhinology centers were retrospectively reviewed.

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Objective: Surgical frailty estimates a patient's ability to withstand the physiologic stress of an intervention. There is limited data regarding the impact of frailty on endoscopic cerebrospinal fluid (CSF) leak repair.

Methods: Patients undergoing CSF leak repair at two tertiary academic skull base programs were retrospectively reviewed.

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Objective: Functional endoscopic sinus surgery is a commonly performed otolaryngologic procedure that often uses the microdebrider device for tissue removal. Given the ubiquitous nature of the instrument, we sought to better define the patterns of device failure using the postmarket surveillance openFDA database.

Methods: The openFDA database was queried for all microdebrider-related adverse events from January 1, 2000 to November 1, 2020.

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Objectives: The use of topical corticosteroids to manage postoperative sinonasal symptoms after endoscopic skull base surgery (ESBS) has not been well studied. We quantified long-term impact of postoperative steroid irrigations (SIs) on quality of life of patients after ESBS.

Methods: Retrospective review of patients at the University of Pennsylvania undergoing ESBS from 2010 to 2019.

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Objectives: Ocular surface reactions (OSR) have been associated with dupilumab for atopic dermatitis (AD) treatment. However, the association of dupilumab-associated OSR (DA-OSR) for nasal polyps (CRSwNP) treatment has not been studied. We evaluated DA-OSR for CRSwNP treatment using the FDA Adverse Event Reporting System (FAERS).

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Objective: Frailty metrics estimate a patient's ability to tolerate physiologic stress and there are limited frailty data in patients undergoing expanded endonasal approaches (EEA) for suprasellar pathologies. Elevated frailty metrics have been associated with increased perioperative complications in patients undergoing craniotomies. We sought to examine this potential relationship in EEA.

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Objective: We sought to quantify trends in operative volumes and complications of endoscopic sellar surgery before and after the COVID-19 pandemic onset.

Study Design: We performed a retrospective analysis.

Setting: TriNetX database analysis.

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Purpose: Sinonasal squamous cell carcinoma (SCC) is an aggressive malignancy frequently requiring surgical resection and adjuvant treatment. Frailty is a metric that attempts to estimate a patient's ability to tolerate the physiologic stress of treatment. There is limited work describing frailty in patients with sinonasal cancer.

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Article Synopsis
  • - Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive cancer with a poor survival rate, typically treated with surgery and radiation; this study examined treatment delays and their effects on patient outcomes using data from the National Cancer Database (NCDB).
  • - The research analyzed the time intervals from diagnosis to surgery, surgery to radiation, and the duration of radiation, finding that longer treatment delays negatively impacted overall survival rates, especially in patients with positive surgical margins.
  • - Key findings highlighted that Black race, certain insurance types, and positive margins contributed to treatment delays; optimal treatment timelines were identified, indicating that faster intervention (such as surgery within 29 days of diagnosis) could lead to better survival outcomes. *
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Background: Carcinosarcomas are rare, aggressive malignancies that can arise in the nasal cavity and paranasal sinuses. There are limited outcome data available. Accordingly, we sought to use the National Cancer Database (NCDB) to characterize patient demographics and outcomes.

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Article Synopsis
  • * Among 196 patients studied, 74.5% experienced recurrence, with the most common type being isolated distant recurrence (42.8%).
  • * Findings indicate high recurrence rates and poor survival for SNMM; primary neck treatment showed no benefit, while immunotherapy improved 12-month post-recurrence survival for distant recurrence cases.
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 Although adjuvant radiotherapy may be indicated in patients with sinonasal squamous cell carcinoma (SNSCC) following primary surgery, some patients choose to forgo recommended postoperative radiation therapy (PORT). This study aimed to elucidate factors associated with patient refusal of recommended PORT in SNSCC and examine overall survival.  Retrospective analysis of patients with SNSCC treated with primary surgery from the National Cancer Database diagnosed between 2004 and 2016.

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 Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second-look procedure may require general anesthesia; however, there is currently little evidence assessing the benefit of this practice.  This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second-look debridement under general anesthesia following ESBS.

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Purpose Of Review: Craniopharyngiomas are rare tumors that that present with loss of pituitary function in most cases. They present in a bimodal age distribution and the most common treatment paradigms include gross total resection or subtotal resection followed by radiation. Endoscopic transnasal access to intradural tumors has become increasingly common due to improvements in equipment, increased familiarity with the surgical corridor and anatomy, and reconstruction techniques.

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Background: Sinonasal lymphoma (SL) is a heterogeneous, underrecognized neoplastic disorder with limited outcomes data. We sought to better define outcomes by subtype and treatment at 2 referral centers over the past 2 decades.

Methods: Demographics, clinicopathologic data, and treatment outcomes for patients treated for SL were queried from January 1, 2000 to December 31, 2021 at 2 tertiary academic medical centers.

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Article Synopsis
  • The extended endonasal approach is a surgical technique used to remove lesions from the anterior skull base in children, but patients can face challenges after surgery, like adhering to medical treatments and possible scarring.
  • This study involved examining medical records of pediatric patients who had the procedure between 2009 and 2021, comparing imaging results pre- and post-surgery using the Lund-Mackay scoring system for inflammation.
  • Results showed significant differences in LM scores across different imaging times, indicating transient inflammation but no long-term concerns about chronic sinusitis, as recent scores were not significantly different from pre-operative scores.
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Background: Chondrosarcomas of the sinonasal cavity and skull base are uncommon malignancies. We sought to provide long-term outcomes at two tertiary care centers.

Methods: Patients with chondrosarcoma treated between 2000 and 2021 were included.

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Objectives: Rathke cleft cysts (RCCs) arise from the development of the Rathke pouch. Recurrence is common after either drainage or cyst removal. The endoscopic endonasal approach (EEA) is increasingly utilized for the management of RCC.

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Objectives: Myoepithelial carcinoma (MECA) is a rare salivary gland tumor that can occur in the sinonasal cavity with poor outcomes. There are limited data on sinonasal outcomes to guide management. We sought to use the National Cancer Database (NCDB) to better define treatment outcomes in MECA.

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