Ballock, Bailey

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Graduate Medical Education Research Journal Volume 7 Issue 1 Article 55 June 2025 Pediatric Intracranial Non-germinomatous Germ Cell Tumor With Extracranial Extension: A Case Report Bailey Ballock University of Nebraska Medical Center Tell us how you used this information in this short survey. Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Ballock, B. Pediatric Intracranial Non-germinomatous Germ Cell Tumor With Extracranial Extension: A Case Report. Graduate Medical Education Research Journal. 2025 Jun 29; 7(1). https://digitalcommons.unmc.edu/gmerj/vol7/iss1/55 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. © 2025 The Authors Pediatric Intracranial Non-germinomatous Germ Cell Tumor With Extracranial Extension: A Case Report Abstract NA Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol7/iss1/55 Graduate Medical Education Research Journal41 Poster Presentations*Names in bold type indicate presenting author.#64 Pediatric Intracranial Non-germinomatous Germ Cell Tumor With Extracranial Extension: A Case ReportBailey Ballock1, Shreya Sharma1, Patricia Foley1, Christie Barnes11Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USAMentor: Christie BarnesProgram: OtolaryngologyType: Case ReportBackground: Primary intracranial germ cell tumors (GCT) are rare, accounting for only 3-5% of pediatric intracranial tumors. A subset of GCTs is non-germinomatous germ cell tumors (NGGCTs), a heterogenous group of tumors with a poor prognosis. Intracranial GCTs are most commonly located in the pineal or suprasellar regions with few reported cases of frontal lobe lesions. To our knowl-edge, no reports of intracranial NGGCT with extension into the paranasal sinuses currently exist in the literature. We present a rare case of intracranial GCT with extension into the anterior cranial fossa and erosion into the paranasal sinuses.Case: An eight-year-old female presented with one week history of worsening frontal headache pain and nausea. CT and MRI imaging (Figure 1) showed a large 4.4 cm mass originating at the level of the cribriform plate with extension into the anterior cranial fossa and inferiorly into the ethmoid and sphenoid sinuses. Transnasal endoscopic evaluation and biopsy were performed for histopathologic evaluation. Pathology and tumor marker results were consistent with NGGCT. Given the size and characteristics of patient’s tumor, chemotherapy was selected as an initial therapy with plans for surgical resec-tion and adjuvant radiation therapy. Conclusion: We present a rare case of intracranial NGGCT localized to the anterior cranial fossa with extracranial extension through the cribriform plate into the paranasal sinuses. Diagnosis of NGGCT combines clinical, radiological, and histological findings along with tumor markers. Accurate diagnosis is important as treatment of NGGCT requires aggressive chemoradiation therapy and often involves one or more surgical resections. #65 Development of Adult Multidisciplinary Tracheostomy Rounding Teams: Prevalence, Template for Starting and Analysis for Diffusion of InnovationSarah A. Schmoker1, Tony Satroplus1, Teresa Y. Rodriguez2, Bennett J. Berning3, Robert Morrison4, Jayme R. Dowdall11Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 2Department of Speech-Language Pathology, University of Nebraska Medical Center, Omaha, NE, USA 3Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 4Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Michigan, Ann Arbor, MI, USAMentor: Jayme R. DowdallProgram: OtolaryngologyType: Original ResearchBackground: Multidisciplinary tracheos-tomy rounding teams have been found to decrease days to speech and decannulation and decrease adverse events. The need of such teams and the characteristics that increase or inhibit the tracheostomy rounding team’s implementation rates have not been well described. This quality improvement study and interven-tion aimed to (a) characterize the prevalence of inpatient teams dedicated to adult trache-ostomy patients in the Middle Section; (b) describe strategies to develop a dedicated tracheostomy rounding team; (c) discuss plans to optimize Diffusion of the innovation based on Rodgers’ 1962 text that will increase adop-tion at other Middle Section institutions. Methods: Inquiries were sent to academic departments throughout the programs in the Middle Section of the Triological Society regarding the presence of a dedicated adult team. Two institutions simultaneously formed tracheostomy teams with different strategies. Results: Only one of the academic depart-ments that responded had a dedicated tracheostomy rounding team for adults. Analyzing the process of our tracheostomy team development, we share strategies to enhance the diffusion process, while recognizing that the time constraints and compensation of the stakeholders involved could be barriers moving forward. Figure 1. Coronal T2-weighted MRI imaging shows anterior cranial fossa mass demonstrating heterogenous signal intensity with surrounding edema and extension into the ethmoid air cells.June 2025  |  Vol. 7 Iss. 1 Poster Presentations 42*Names in bold type indicate presenting author.Conclusion: Overall, despite literature demonstrating that tracheostomy rounding teams lead to improved patient care and better navigation of the healthcare system by patients and their families, this type of multidisciplinary intervention is underutilized at many programs. Characterizing the devel-opment of a tracheostomy rounding team and creating a collaborative network for feedback and implementation help is necessary for its continued momentum and effectiveness.  #66 The Effects of Gastrostomy Tube Placement on the Utilization of Healthcare Services in Patients Undergoing Free Flap ReconstructionTimothy Corpuz1, Evan Ryan1, Steven Goicoechea1, Elizabeth Bradford Bell1, Tony Richa11Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USAMentors: Elizabeth Bradford Bell, Tony Richa Program: OtolaryngologyType: Original ResearchBackground: Free flap reconstruction (FFR) is a mainstay in the surgical treatment of head and neck cancers. Patients who require oral cavity FFR can develop dysphagia, requiring enteral nutrition in the form of a gastrostomy tube (GT). We set out to determine the effects of GT placement on operative times, length of hospitalization, and discharge placement. Methods: A retrospective chart review of patients undergoing FFR for oral cavity squamous cell carcinoma from 2017-2023 at University of Nebraska Medical Center was conducted. Patients were organized into three groups: patients who received GT prior to FFR (“Pre-operative GT), following FFR but during their hospitalization (“Post-operative GT”), and patients who did not receive a GT (“No GT”). Demographic, clinical, and surgical variables were examined. Results: A total of 87 patients were identified. Of these, 23, 22, and 42 patients were in the “Pre-operative GT”, “Post-operative GT”, and “No GT” group, respectively. Patients in the “No GT” group trended towards shorter operative times (566 minutes) compared to the “Pre-operative GT” group (730 minutes) and “Post-operative GT” group (649 minutes). Furthermore, patients in the “Pre-operative GT” group and “No GT” group had similar length of post-FFR hospitalization (9.0 days) compared to patients in the “Post-operative GT” group (14.5 days). Conclusion: Our study demonstrates that patients undergoing FFR who do not undergo GT placement trended towards shorter operative times, shorter hospitalizations, and less utilization of home health services on discharge. Our results show that GT place-ment related to oral cavity FFR may indicate increased utilization of healthcare services and healthcare spending.#67 Self-Removal of a Hypoglossal Nerve Stimulator: Challenges and Lessons LearnedObinnaya Wamuo1, Elizabeth Bradford Bell11Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USAMentor: Elizabeth Bradford BellProgram: OtolaryngologyType: Case ReportBackground: A 44-year-old female with a history of obstructive sleep apnea (OSA), depression, post-traumatic stress disorder, and self-harm presented to the ENT clinic for initial consultation regarding a hypoglossal nerve stimulator (Inspire). Sleep history was significant for Continuous Positive Airway Pressure (CPAP) intolerance, with a recent sleep study showing a qualifying apnea hypo-pnea index (AHI). Following a diagnostic drug induced sleep endoscopy (DISE), the patient was deemed an appropriate surgical candidate for the Inspire device. Case: In the months following surgical implantation, the patient made multiple visits to the emergency department, reporting concerns of neck erythema, pain, and dysphagia. These repeated visits would initially be resolved with reassurance and symptomatic management. Despite multiple efforts at reassurance in the both the emer-gency department and clinic, continued visits would culminate in the discovery that the patient had started picking out her device’s stimulating lead. (Figure 1) Subsequently, she was taken back to the operating room for device removal. Conclusion: This case highlights the complexities of managing OSA in patients with significant psychiatric comorbidities. While implantable devices like Inspire provide alternatives for CPAP-intolerant patients, this case illustrates the need for careful preoperative evaluation, including consideration of present psychiatric condi-tions. A multidisciplinary approach involving mental health professionals may improve patient selection, optimize outcomes, and mitigate postoperative challenges.Figure 1. The patient’s manipulation of the stimulation lead resulted in its eventual breach of the skin. Graduate Medical Education Research Journal43 Poster Presentations*Names in bold type indicate presenting author.#69 Impact of Insurance Status on Progression to Sinus Surgery Following CT Imaging in Patients With SinusitisSteven Goicoechea1, Jamie Yrastorza2, Joe Kleinsmith2, Obinnaya Wamuo, Christie Barnes1, Sam Pate11Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 2College of Medicine, University of Nebraska Medical Center, Omaha, NE, USAMentor: Sam PateProgram: OtolaryngologyType: Original ResearchBackground: Computed tomography (CT) scans are essential for the diagnosis of sinus disease and operative planning. We aim to assess the rate at which patients with chronic sinusitis progress to sinus surgery following CT scans based on insurance status. We also evaluate the impact of clinical and radio-graphic staging on progression to surgery with SNOT-22 and Lund-Mackay scores, respectively.Methods: A single-center retrospective chart review was performed on adult patients who received a CT scan of the sinuses from 2012 to 2023. Data gathered included demo-graphics, insurance status, imaging, clinical metrics, diagnosis, and surgical intervention. Trauma cases were excluded. Chi-squared and t-test were used to examine differences in surgical rates between patients based on insurance status. The UNMC IRB ruled the study exempt.Results: Two hundred thirty-two patients were identified. The overall rate of progres-sion to surgery following a CT scan of the sinuses was 38.4%. Patients with private insurance progressed to surgery at higher rates than patients with public insurance, with 43.2% vs 29.7%, respectively (p = 0.042). The average Lund-Mackay score was 6.4±3.8 for patients who progressed to surgery vs 2.7±2.7 for patients who did not (p < 0.0001). There was no significant difference in SNOT-22 scores between surgical and non-surgical patients with 42.7±20.8 vs 39.6±18.5, respec-tively (p = 0.41) (Figure 1).Conclusion: Patients with private insurance were more likely to proceed to sinus surgery after receiving a CT scan compared to those with public insurance. Lund-Mackay scores were more predictive of progression to surgery than SNOT-22 scores.#70 Impact of Associations With Travel Distance on Staging at Initial Presentation and Survival in Oral and Oropharyngeal CancerSteven Goicoechea1, Tony Satroplus1, Kaeli Samson2, Tony Richa1, Elizabeth Bradford Bell11Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA 2Department of Biostatistics, College of Public Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USAMentor: Elizabeth Bradford BellProgram: OtolaryngologyType: Original ResearchBackground: Socioeconomic factors have well-documented impacts on oral and oropha-ryngeal squamous cell carcinoma (SCC) outcomes. We aim to evaluate the impact of travel distance on stage and survival.Methods: Hospital-based multicenter retro-spective review of adult patients with oral and oropharyngeal SCC in the National Cancer Database from 2018-2021. Adjusted odds ratios (AORs) for advanced diagnoses were derived from logistic regression models. Cox proportional hazards regressions were used to generate adjusted hazard ratios (AHRs) for survival.Results: A total of 37,062 patients were identified with mean age of 63.6 years, 74% male, and 13% non-white race. Oral SCC accounted for 43% and oropharyngeal SCC 57%. Among patients with oral SCC, there was a lower adjusted risk of death in those that lived 50 (AHR=0.83, 95% CI: 0.75-0.91) or 100 miles away (AHR=0.73, 95% CI: 0.65-0.81) relative to 10 miles away. Among patients with oropharyngeal SCC, there was a lower adjusted risk of death in those that lived 50 miles away (AHR=0.74 95% CI: 0.65-0.83) and 100 miles away (AHR=0.64, 95% CI: 0.55-0.75) relative to 10 miles away (Figure 1). Among patients with oropharyn-geal SCC, patients had lower adjusted odds of being diagnosed at stage 3-4 relative to those who lived 10 miles away if they lived 50 (AOR=0.83, 95% CI: 0.75-0.90) or 100 miles away (AOR=0.77, 95% CI: 0.69-0.86).Conclusion: Patients with greater distance to treatment tended to have a decreased risk of death in oral and oropharyngeal SCC. Those with greater distance to treatment had lower odds of presenting with advanced oropharyn-geal SCC.Figure 1. SNOT-22 and Lund-Mackay scores in surgical vs non-surgical patients.

Pediatric Intracranial Non-germinomatous Germ Cell Tumor With Extracranial Extension: A Case Report

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Pediatric Intracranial Non-germinomatous Germ Cell Tumor With Extracranial Extension: A Case Report

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