- Osteoporosis
- Headaches
- Arthritis
- SinusitisThe cause of paranasal sinus neoplasms is unknown, however, some clinical data indicates that various industrial exposures may be related to cancer of the paranasal sinuses and nasal cavity, these risk factors include exposure to nickel, chromium, mustard gas, isopropyl alcohol, radium; and possibly chronic sinusitis. Benign squamous cell papillomas are thought to be caused by papovaviruses. Adenocarcinomas arising from the ethmoid or maxillary sinuses are frequently associated with exposure to industrial wood dust in the hardwood and shoe industries workers.
- Pediatric CarePositional (deformational) plagiocephaly refers to a misshapen (asymmetrical) shape of the head resulting from external repeated pressure to the same area of the head over a relatively long period of time causing a baby's head shape to be abnormal but with no real fusion of the skull sutures. The condition has become more common since the American Academy of Pediatrics recommended that infants sleep on their backs to reduce the incidence of sudden infant death syndrome (SIDS). Causes of positional plagiocephaly include prematurity, torticollis and cervical spine abnormalities.It is usually managed using non-surgical techniques except in severe persistent cases.
- Ear InfectionsIn addition to the physical characteristics common to Apert's syndrome, other associated abnormalities may include visual disturbances related to an imbalance of the muscles that move the eyes, cardiac anomalies, gastrointestinal malformations, cleft palate, hearing deficits due to recurrent ear infections, and varying degrees of acne. There can be a reduced intellectual capacity in these patients which may be secondary to cerebral cortical atrophy due to intracranial hypertension in some individuals, but many children have normal intelligence. Noisy breathing or sleep apnea may occur due to upper airway compromise that may result from small nasopharyngeal and oropharyngeal dimensions in the Apert craniofacial configuration.
- Constipation
- Erectile Dysfunction
- Female Infertility
- Pregnancy
- Labor and DeliveryA thorough medical history and neurological examination focused on assessing the presence of clinical manifestations of hyperprolactinemia, such as galactorrhea (spontaneous flow of milk from the breasts unassociated with childbirth or nursing) and on identification of clinical signs of estrogen deficiency. In men, the focus is on clinical signs of testosterone deficiency such as testicular size and the consistency and pattern of body hair as well as the rare occurrence of gynecomastia, galactorrhea, or both.
- Colon CancerIf left untreated acromegaly results in progressive physical and cosmetic deformities, and can result in serious illness such as diabetes mellitus and hypertension. It increases the patient's risk for cardiovascular disease, colon polyps that may lead to colon cancer and premature death. Treatment has the potential to improve facial appearance and soft tissue swelling, normalize the levels of GH and IGF-1, and relieve the pressure on the pituitary gland and the surrounding neurovascular structures. Following successful treatment, regular follow up is required.
- EndoscopyDr. Hrayr Shaninian is again at the forefront of research and development in the next phase of minimally invasive brain and skull base surgery. The only surgeon working with NASA's Jet Propulsion Laboratory in Pasadena, CA to develop the next generation of endoscopic tools, he is creating "super instruments," revolutionary tools that will bring together sweeping advancements in digital imaging, 3D endoscopy, tactile feedback, heads-up displays and smart micro - and nanotechnology. Dr. Shahinian's goal is to develop the most state-of-the-art tools for the least-invasive and most effective outcomes possible. While others embrace endoscopic surgery, Dr. Shahinian and SBI continue to take the field to the next level by innovating with newer tools, broader applications and a focus on patient recovery.
- Depression
- Anxiety
- Diabetes Care
- EndocrinologyWe conclude that the great majority of patients presenting to this tertiary Endocrinology clinic had periodic Cushing's syndrome as evident by normal testing on 1 or more occasions. Urinary 17-OHS was at least as sensitive as the more widely used test, UFC. We conclude that there is no single test that can always diagnose Cushing's syndrome and that the diagnosis needs to be made by a careful history and physical coupled with multiple tests assessing hypercortisolism.
- HypothyroidismProlactinomas, are the most common cause of hyperprolactinemia, but there are several other causes of hyperprolactinemia that most importantly include the use of certain "anti-dopaminergic" medications (prolactin secretion from the pituitary gland is normally suppressed by the brain chemical, "dopamine"), these include Metoclopramide (Reglan), or anti-depressants such as Fluoxetine (Prozac), an underactive thyroid gland (hypothyroidism), and other types of pituitary tumors that arise in or near the pituitary gland- as those may compress the pituitary stalk and block the flow of dopamine from the brain to the prolactin-secreting cells causing hyperprolactinemia, this is commonly known as "stalk effect".
- ThyroidEvaluation of a patient with a presumed orbital mass begins with a thorough ophthalmic and medical history including history of allergies, sinus infections, recent trauma to rule out all non-neoplastic sinonasal etiologies for the disease process.It is also important to ask about other medical conditions that may be associated with proptosis or other ocular manifestations, such as thyroid disorders, granulomatous diseases, and autoimmune disorders. In patients with the disease neurofibromatosis type I, orbital tumors are usually optic nerve gliomas. Laboratory evaluation with a complete blood count, sedimentation rate and thyroid function tests should be obtained to exclude infection, inflammation or thyroid disease as these conditions may cause ocular proptosis mimicking that caused by an orbital tumor.
- UltrasoundEither due to aneurysm size, location, or inadequate endovascular embolization many ruptured aneurysms require immediate surgical intervention. The goal of the operation is to place a surgical clip at the base of the aneurysm to control the bleeding and eliminate the risk of re-bleeding. Standard supportive treatments following aneurysm rupture include: bed rest, mild sedation, medications to prevent seizures and help reduce vasospasm. A Doppler ultrasound device is used to monitor the degree of vasospasm. Complications such as re-bleeding, severe vasospasm, and brain swelling are the major causes of morbidity and mortality after aneurysm rupture.
- MRIThe deformity is usually noticed at birth or soon after when the infant's head starts growing. There are usually no associated systemic abnormalities. Skull radiography (plain X-rays, computerized tomography (CT) scan and magnetic resonance imaging (MRI)) can confirm the diagnosis of scaphocephaly.
- X-Rays
- Computed TomographyCT scan is useful in evaluating any associated bony remodeling induced by the cyst and in assessing for the presence of calcification. The advantage of CT is its ability to depict small amounts of calcium; this advantage can be important because the presence of calcification tends to indicate an alternative diagnosis such as craniopharyngioma, although small calcifications are sometimes observed in some cases of RCCs.
- ChemotherapyRMS is treated by a combination of surgery, chemotherapy, and radiation. External beam radiation is usually used to deliver radiotherapy. Chemotherapeutic agents that are most commonly used are vincristine, cyclophosphamide, dactinomycin, adriamycin, and ifosfamide.
- Radiation TherapyTreatment options include surgical removal of the tumor, radiation therapy and medical therapy. A single modality or a combination of modalities could be followed based on multiple factors such as the overall health and medical history of the patient, extent of the disease at time of diagnosis and the individual's tolerance to specific medications.
- Radiation OncologySome of these patients have also required adjuvant radiation therapy and chemotherapy either systemically or intraarterially. For those patients we have combined our efforts with colleagues in the fields of radiation oncology and medical oncology in order to provide our patients with the most up to date multidisciplinary therapies available.
- General SurgeryIt was in his home city that Dr. Hrayr Shahinian began his quest for a career in medicine, first earning a bachelor's degree in biology/chemistry from the American University of Beirut before earning medical degrees from that institution and Pritzker Medical School at the University of Chicago. While there, he earned a distinguished membership in the prestigious Alpha Omega Alpha honor society for excellence in the medical community. He later relocated to Illinois to serve as a research associate at the University of Chicago's Department of Surgery before completing his training in general surgery at Vanderbilt University in Tennessee.
- Minimally Invasive SurgeryThe Skull Base Institute has made extraordinary advances in minimally invasive surgery. Tiny 2.7 mm wide and 20 cm long endoscopes with cameras and "surgical tips" are used to remove brain and skull base tumors. Today, "Same Day Brain Surgery" is a reality for treatment of those tumors and other skull base disorders. We invite you to review the details of the many procedures on the left with the hope it will help you make informed decisions.
- NeurosurgeryThe table below demonstrates the effectiveness of the fully endoscopic endonasal approach, as compared to the complications of traditional surgery. These large studies involve hundreds of patients and the complete articles have been published in the distinguished peer reviewed journals, Minimally Invasive Neurosurgery and Neurosurgery Quarterly. Both articles, along with many others, are available for reading in their entirety in the Treatments section of this website.
- Vascular SurgeryEndoscopic technology has allowed surgeons to look at traditional methods of treating vascular diseases with an eye toward innovation. The Skull Base Institute has pioneered Endoscopic Brain Aneurysm Clipping, revolutionizing the way that vascular surgery is performed with less disruption of normal brain tissue, less painful recovery, and a rapid return to daily activities.
- OtolaryngologyTo remove these tumors, surgeons have traditionally relied on one of two common approaches. The most frequently used procedure, the Translabyrinthine approach, involves several surgeons from different disciplines such as Otolaryngology and Neurosurgery who drill through the mastoid bone behind the external ear and through the labyrinth and inner ear mechanism to access the tumor. For smaller tumors, the "retrosigmoid" or" sub-occipital" approach offers the possibility of saving some hearing. Instead of going through the mastoid bone, surgeons make a large incision behind the ear, open the skull behind the mastoid bone, push the brain aside, and take the tumor out.
- Reconstructive SurgeryIn positional plagiocephaly, parents should try keeping the baby off the affected side. These positioning maneuvers are more successful when started early. Severe and persistent positional plagiocephaly can be treated with a head band or a helmet that is custom-molded to the baby's head and designed to apply gentle pressure on selective areas. The helmet is worn 23 hours a day and treatment length varies. Persistent, severe or a cosmetically obvious deformity can be corrected with reconstructive surgery.
- BotoxDr. Gupta: He visited a neurologist, ophthalmologist, acupuncturist, even tried botox to numb the muscles, but nothing worked and no one could diagnose the problem - until he met Dr. Hrayr Shahinian, a neurosurgeon.
- Eyelid SurgeryDepending on the severity of Apert's syndrome and the associated congenital abnormalities, other operations such as rhinoplasty - plastic surgery of the nose, genioplasty - plastic surgery of the chin, eye muscle surgery to correct strabismus or eyelid surgery to correct the abnormal downward tilt, and surgical separation of the fingers and/or toes are performed according to a staged treatment plan.
- Rhinoplasty
- Plastic SurgerySkull Base Surgery. In: Aston S, Beasley R, Thorne C, Grabb and Smith's Plastic Surgery. 6th ed. Boston: Little Brown & Company. Submitted.
- GynecomastiaIn men, hyperprolactinemia can cause reduced testosterone production and the most common symptoms of prolactinomas in men are erectile dysfunction, decreased libido, enlargement of breast tissue (gynecomastia), and infertility. As men have no reliable indicator such as menstruation to signal a problem, many men delay going to the doctor until they have headaches or eye problems caused by the prolactinoma and they may not notice the gradual decrease of sexual function or libido.
- Skin CancerThe most common malignant neoplasm of the paranasal sinuses is squamous cell carcinoma, occurring in 70-80% of all cases. Regional node involvement from primary squamous cell carcinoma of the paranasal sinuses occurs in about 15% of all cases and nodal spread and distant metastasis occur in approximately 9% of all cases. Other malignant tumors of the paranasal sinuses that occur less frequently are adenoid cystic carcinoma, mucoepidermoid carcinoma, malignant mixed tumor, adenocarcinoma, melanoma, lymphoma, fibrosarcoma, osteosarcoma, and chondrosarcoma.
- Acne Treatment
- Cyst
- LesionsFacial, vestibular and acoustic nerve disorders, such as trigeminal neuralgia, facial palsy, hemifacial spasm, vertigo and sensorineural hearing loss; aneurysms and arteriovenous malformations (AVMs); paragangliomas and vascular lesions requiring microvascular expertise.
- Physical TherapyIn positional molding, surgery is seldom indicated and infants improve with repositioning maneuvers and physical therapy for torticollis when present. In severe cases custom-molded helmets are used to correct the skull deformity.
- Allergies