Nelson M Oyesiku

Emory University, Atlanta, Georgia, United States

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Publications (69)173.14 Total impact

  • Jason Chu, Sarah K Wise, Zara M Patel, Nelson M Oyesiku
    Neurosurgery 12/2014; 10 Suppl 4:654. · 2.53 Impact Factor
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    ABSTRACT: To analyze current indications for transsphenoidal pituitary surgery. The current literature regarding transsphenoidal surgery for all subtypes of pituitary adenomas and other sellar lesions was examined. Alternate approaches for pituitary surgery were also reviewed. Transsphenoidal surgery continues to be the mainstay of surgical treatment for pituitary tumors, and has good outcomes in experienced hands. Pre- and postoperative management of pituitary tumors remains an important part of the treatment of patients with pituitary tumors. Even as medical and surgical treatment for pituitary tumors evolves, transsphenoidal surgery remains a mainstay of treatment. Outcomes after transshenoidal surgery have improved over time. Neurosurgeons must be aware of the indications, risks and alternatives to transsphenoidal pituitary surgery. Copyright © 2014 Elsevier Inc. All rights reserved.
    World Neurosurgery 12/2014; 82(6S):S147-S151. · 1.77 Impact Factor
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    ABSTRACT: The aim of this study was to compare outcomes of postoperative whole brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) alone in patients with resected brain metastases (BM). We reviewed records of patients who underwent surgical resection of BM followed by WBRT or SRS alone between 2003 and 2013. Local control (LC) of the treated resected cavity, distant brain control (DBC), leptomeningeal disease (LMD), overall survival (OS), and radiographic leukoencephalopathy rates were estimated by the Kaplan-Meier method. One-hundred thirty-two patients underwent surgical resection for 141 intracranial metastases: 36 (27 %) patients received adjuvant WBRT and 96 (73 %) received SRS alone to the resection cavity. One-year OS (56 vs. 55 %, p = 0.64) and LC (83 vs. 74 %, p = 0.31) were similar between patients receiving WBRT and SRS. After controlling for number of BM, WBRT was associated with higher 1-year DBC compared with SRS (70 vs. 48 %, p = 0.03); single metastasis and WBRT were the only significant predictors for reduced distant brain recurrence in multi-variate analysis. Freedom from LMD was higher with WBRT at 18 months (87 vs. 69 %, p = 0.045), while incidence of radiographic leukoencephalopathy was higher with WBRT at 12 months (47 vs. 7 %, p = 0.001). One-year freedom from WBRT in the SRS alone group was 86 %. Compared with WBRT for patients with resected BM, SRS alone demonstrated similar LC, higher rates of LMD and inferior DBC, after controlling for the number of BM. However, OS was similar between groups. The results of ongoing clinical trials are needed to confirm these findings.
    Journal of Neuro-Oncology 09/2014; · 3.12 Impact Factor
  • Pedram Daraei, Nelson M. Oyesiku, Zara M. Patel
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    ABSTRACT: Background Skull base reconstruction can be accomplished using various donor sites. Vascularized tissue, commonly the nasoseptal flap, is the most effective option for large defects or high flow leaks. In cases where the septum cannot be used, a mucoperiosteal flap from the nasal floor, pedicled from the sphenopalatine artery, is a viable option without reported outcomes. The aim of this work was to describe this flap and to report successful outcomes in a cohort of patients.Methods Retrospective chart review of patients seen by the senior author from 2011 to 2013 requiring skull base reconstruction for defects with cerebrospinal fluid leak.ResultsA total of 108 patients underwent endoscopic skull base reconstruction. Ten patients had reconstruction with use of a pedicled nasal floor flap. Mean age was 53.3 years. Defects involved the ethmoid roof in 5 patients, sellar floor in 2, clivus in 2, and planum sphenoidale in 1. Reasons why the septal flap could not be used were intentional sacrifice due to disease involvement, sacrifice for proper exposure, or previous septal perforation. Mean length of follow-up was 10.2 (range, 4 to 25) months. No patient developed cerebrospinal fluid leaks postoperatively.Conclusion Nasal floor pedicled flaps are an effective alternative to nasoseptal flaps for reconstruction of the skull base, and have not been previously described in the literature. Outcomes are promising in our small cohort of patients. If the septum must be sacrificed, attention should be paid to the nasal floor, which provides a large mucoperiosteal flap that can be consistently exposed and elevated by the experienced surgeon.
    International Forum of Allergy and Rhinology 09/2014; · 1.00 Impact Factor
  • Jason Chu, Nelson Oyesiku
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    ABSTRACT: These series of videos demonstrate 4 examples of endoscopic transsphenoidal resection of a craniopharyngioma. Figures and captions for relevant anatomy during tumor resection are depicted at the end of each video.Case 1 (0:06): The patient is a 54-year-old male that was found to have a 2.6 x 2.0 x 3.6 cm cystic sellar mass with suprasellar extension upon workup of headaches, fatigue, gynecomastia, and decreased libido. His laboratory studies demonstrated central hypogonadism and central hypothyroidism.Case 2 (2:28): The patient is a 29-year-old male that was found to have a 3.6 x 2.7 x 2.5 cm sellar mass with suprasellar extension upon workup of headaches, decreased libido, and visual field deficits. The mass has both a cystic and solid component. His pre-operative endocrine laboratory studies demonstrated adrenal insufficiency, hypogonadism, and hypothyroidism.Case 3 (4:39): The patient is a 61-year-old female that was found to have a 1.7 x 1.4 x 1.1 cm sellar mass with suprasellar extension upon workup of headaches, fatigue, vertigo, and blurry vision. The mass has both a cystic and solid component. Her pre-operative endocrine laboratory studies were unremarkable.Case 4 (5:58): The patient is a 32-year-old female that was found to have a 1.9 x 1.3 x 2.8 cm solid sellar mass with extension into the 3rd ventricle upon workup of headaches, horizontal diplopia, and bilateral abducens nerve palsies. Her pre-operative endocrine laboratory studies were unremarkable.
    Neurosurgery 08/2014; · 2.53 Impact Factor
  • Jason Chu, Nelson Oyesiku
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    ABSTRACT: This video demonstrates an endoscopic transsphenoidal resection of a nonfunctioning pituitary macroadenoma. The patient is a 47-year-old male that was found to have a 2.2 x 1.9 x 1.5 cm sellar mass upon workup of decreased libido by his PCP. His laboratory studies demonstrated central hypogonadism. A gross total resection without a CSF leak was achieved. Figures and captions for relevant anatomy during tumor resection are depicted at the end of the video.
    Neurosurgery 08/2014; · 2.53 Impact Factor
  • Jason Chu, Nelson Oyesiku
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    ABSTRACT: This video demonstrates an endoscopic transsphenoidal resection of a tuberculum sellae meningioma. The patient is a 49-year-old female that was discovered to have a 1 cm well circumscribed dural-based mass in the tuberculum sellae upon workup of headaches, diplopia, and visual field deficits. Her pre-operative endocrine labs were suggestive of GH deficiency. A gross total resection without a CSF leak was achieved. Figures and captions for relevant anatomy during tumor resection are depicted at the end of the video.
    Neurosurgery 08/2014; · 2.53 Impact Factor
  • Jason Chu, Nelson Oyesiku
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    ABSTRACT: This video demonstrates an endoscopic transsphenoidal resection of an ACTH secreting pituitary microadenoma. The patient is a 62-year-old male that was found to have a 5 mm pituitary adenoma after he exhibited signs and symptoms of Cushing's disease. His endocrine laboratory studies confirmed central hypercortisolism. This video highlights dissection of the adenoma pseudocapsule from the remainder of the pituitary gland for tumor removal. A gross total resection was achieved and his post-operative cortisol levels were consistent with a biochemical cure of his Cushing's disease. Figures and captions for relevant anatomy during tumor resection are depicted at the end of the video.
    Neurosurgery 08/2014; · 2.53 Impact Factor
  • Jason Chu, Nelson Oyesiku
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    ABSTRACT: This video demonstrates an endoscopic transsphenoidal resection of a Rathke's cleft cyst. The patient is a 34-year-old female with a known pituitary mass. It was presumed to be a craniopharyngioma and was initially managed with observation for 2 years. Her latest imaging revealed enlargement of her mass and she developed bitemporal hemianopia. The mass measures 1.4 x 1.55 x 1.65 with suprasellar extension and compression of the optic chiasm. Her pre-operative endocrine labs were unremarkable. A gross total resection without a CSF leak was achieved.
    Neurosurgery 05/2014; · 2.53 Impact Factor
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    ABSTRACT: Purpose The purpose of this study was to evaluate intracranial control and patterns of local recurrence (LR) for grade 2 meningiomas treated with intensity modulated radiation therapy (IMRT) with limited total margin expansions of ≤1 cm. Methods and Materials We reviewed records of patients with a neuropathological diagnosis of grade 2 meningioma who underwent IMRT at our institution between 2002 and 2012. Actuarial rates were determined by the Kaplan-Meier method from the end of RT. LR was defined as in-field if ≥90% of the recurrence was within the prescription isodose, out-of-field (marginal) if ≥90% was outside of the prescription isodose, and both if neither criterion was met. Results Between 2002 and 2012, a total of 54 consecutive patients underwent IMRT for grade 2 meningioma. Eight of these patients had total initial margins >1 cm and were excluded, leaving 46 patients for analysis. The median imaging follow-up period was 26.2 months (range, 7-107 months). The median dose for fractionated IMRT was 59.4 Gy (range, 49.2-61.2 Gy). Median clinical target volume (CTV), planning target volume (PTV), and total margin expansion were 0.5 cm, 0.3 cm, and 0.8 cm, respectively. LR occurred in 8 patients (17%), with 2-year and 3-year actuarial local control (LC) of 92% and 74%, respectively. Six of 8 patients (85%) had a known pattern of failure. Five patients (83%) had in-field LR; no patients had marginal LR; and 1 patient (17%) had both. Conclusions The use of IMRT to treat grade 2 meningiomas with total initial margins (CTV + PTV) ≤1 cm did not appear to compromise outcomes or increase marginal failures compared with other modern retrospective series. Of the 46 patients who had margins ≤1 cm, none experienced marginal failure only. These results demonstrate efficacy and low risk of marginal failure after IMRT treatment of grade 2 meningiomas with reduced margins, warranting study within a prospective clinical trial.
    International journal of radiation oncology, biology, physics 04/2014; 88(5):1004–1010. · 4.59 Impact Factor
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    ABSTRACT: Descriptions of the anatomy of the neural communications among the cranial nerves and their branches is lacking in the literature. Knowledge of the possible neural interconnections found among these nerves may prove useful to surgeons who operate in these regions to avoid inadvertent traction or transection. We review the literature regarding the anatomy, function, and clinical implications of the complex neural networks formed by interconnections among the lower cranial and upper cervical nerves. A review of germane anatomic and clinical literature was performed. The review is organized in two parts. Part I concerns the anastomoses between the trigeminal, facial, and vestibulocochlear nerves or their branches with any other nerve trunk or branch in the vicinity. Part II concerns the anastomoses among the glossopharyngeal, vagus, accessory and hypoglossal nerves and their branches or among these nerves and the first four cervical spinal nerves; the contribution of the autonomic nervous system to these neural plexuses is also briefly reviewed. Part I is presented in this article. An extensive anastomotic network exists among the lower cranial nerves. Knowledge of such neural intercommunications is important in diagnosing and treating patients with pathology of the skull base. Clin. Anat. 27:118–130, 2014. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 01/2014; 27(1). · 1.16 Impact Factor
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    Mohammadali M Shoja, Nelson M Oyesiku
    Clinical Anatomy 01/2014; 27(1):2-3. · 1.16 Impact Factor
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    ABSTRACT: Since the 19th century, many different approaches to sellar and parasellar pathology have been advocated and mastered by neurosurgeons and otolaryngologists. Today, with significant advances in operative technology, both open and endoscopic approaches to the sella have gained wide acceptance. Here, we discuss our open and endoscopic approaches to sellar and parasellar lesions.
    Operative Techniques in Otolaryngology-Head and Neck Surgery 12/2013; 24(4):208–212.
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    ABSTRACT: Knowledge of the possible neural interconnections found between the lower cranial and upper cervical nerves may prove useful to surgeons who operate on the skull base and upper neck regions in order to avoid inadvertent traction or transection. We review the literature regarding the anatomy, function, and clinical implications of the complex neural networks formed by interconnections between the lower cranial and upper cervical nerves. A review of germane anatomic and clinical literature was performed. The review is organized into two parts. Part I discusses the anastomoses between the trigeminal, facial, and vestibulocochlear nerves or their branches and other nerve trunks or branches in the vicinity. Part II deals with the anastomoses between the glossopharyngeal, vagus, accessory and hypoglossal nerves and their branches or between these nerves and the first four cervical spinal nerves; the contribution of the autonomic nervous system to these neural plexuses is also briefly reviewed. Part II is presented in this article. Extensive and variable neural anastomoses exist between the lower cranial nerves and between the upper cervical nerves in such a way that these nerves with their extra-axial communications can be collectively considered a plexus. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 11/2013; · 1.16 Impact Factor
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    ABSTRACT: Descriptions of the anatomy of the neural communications among the cranial nerves and their branches is lacking in the literature. Knowledge of the possible neural interconnections found among these nerves may prove useful to surgeons who operate in these regions to avoid inadvertent traction or transection. We review the literature regarding the anatomy, function, and clinical implications of the complex neural networks formed by interconnections among the lower cranial and upper cervical nerves. A review of germane anatomic and clinical literature was performed. The review is organized in two parts. Part I concerns the anastomoses between the trigeminal, facial, and vestibulocochlear nerves or their branches with any other nerve trunk or branch in the vicinity. Part II concerns the anastomoses among the glossopharyngeal, vagus, accessory and hypoglossal nerves and their branches or among these nerves and the first four cervical spinal nerves; the contribution of the autonomic nervous system to these neural plexuses is also briefly reviewed. Part I is presented in this article. An extensive anastomotic network exists among the lower cranial nerves. Knowledge of such neural intercommunications is important in diagnosing and treating patients with pathology of the skull base. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 11/2013; · 1.16 Impact Factor
  • Neurosurgery 09/2013; · 2.53 Impact Factor
  • Neurosurgery 06/2013; · 2.53 Impact Factor
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    ABSTRACT: BACKGROUND: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management. METHODS: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery-otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA. RESULTS: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy. CONCLUSION: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation is warranted in these cases.
    American Journal of Rhinology and Allergy 05/2013; 27(3):202-205.
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    ABSTRACT: Objective: Pituitary carcinomas are extremely rare tumors associated with poor prognosis despite surgery, radiation and chemotherapy. The hallmark of diagnosis implies subarachnoid, brain, or systemic tumor spread.Methods: We report a case of rapid transformation of atypical non-functioning pituitary adenoma to a carcinoma.Results: A 64-year-old woman presented with sudden onset of ophtalmoplegia. MRI scan showed a pituitary macroadenoma (2.2 × 2.1 cm) with invasion of the right cavernous sinus. Biochemical data was consistent with a non-functioning pituitary adenoma. Pathology showed a pituitary adenoma with negative immunohistochemistry for pituitary hormones. The patient returned a month later with weakness, lethargy, and a dilated non-reactive right pupil. MRI showed an invasive large mass (5 × 4.7 cm). After an emergent second transsphenoidal surgery, histopathologic examination revealed a widely infiltrative neoplasm invading the overlying mucosa and showing a high mitotic activity and necrosis and a very high Ki-67 (MIB-1) proliferation index (80%). MIB-1 retrospectively performed on the first specimen was also elevated (30%.). Soon after the second surgery, MRI showed a 7.9 × 8.0 cm mass that metastasized to dura mater, and extended into the right orbit, right middle cranial fossa, nasopharynx, clivus, posterior fossa, and along the right tentorium cerebelli, resulting in significant compression of the brainstem.Conclusion: Development of a pituitary carcinoma from an adenoma is an exceptional occurrence, and predictors of such course are currently lacking. A very high Ki-67 proliferation index should raise concern of a pituitary carcinoma in situ or premetastatic carcinoma.
    Endocrine Practice 02/2013; · 2.49 Impact Factor
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    ABSTRACT: Pituitary adenomas are generally considered benign tumors; however, a subset of these tumors displays aggressive behavior and are not easily cured. The protocol for nonsurgical treatment of aggressive pituitary lesions is less standardized than that of other central nervous system tumors. Aggressive surgical treatment, radiation, dopamine agonists, antiangiogenic drugs, and other chemotherapeutics all have roles in the treatment of aggressive pituitary tumors. More studies are needed to improve outcomes for patients with aggressive pituitary tumors.
    Neurosurgery clinics of North America 10/2012; 23(4):587-94. · 1.73 Impact Factor

Publication Stats

914 Citations
173.14 Total Impact Points

Institutions

  • 1991–2014
    • Emory University
      • • Department of Neurosurgery
      • • School of Medicine
      • • Department of Ophthalmology
      • • Department of Surgery
      Atlanta, Georgia, United States
  • 2013
    • University of Alabama at Birmingham
      • Department of Cell, Developmental and Integrative Biology (CDIB)
      Birmingham, Alabama, United States