摘要:

ObjectiveTo update the authors' experience with conservative management of acoustic neuromas.Study DesignRetrospective chart review.SettingPrivate practice and tertiary care referral setting.InterventionOf 600 patients with acoustic neuroma, 102 were treated with the “wait and scan” treatment option. At least two magnetic resonance imaging scans were required of all patients.Main Outcome MeasuresChange in tumor size over time was evaluated, as were clinical symptoms: hearing status, tinnitus, balance disturbance, aural fullness, vertigo, headache, and facial pain, numbness, or weakness.ResultsOf 102 patients, the average follow-up time interval was 28.5 months. Forty-five (44%) of 102 patients demonstrated a change in tumor size: an average total growth of 2.17 mm per year. In the remaining 54 patients (53%), no growth was demonstrated during a mean follow-up of 28.5 months. Three patients demonstrated actual tumor shrinkage. Of the 102 patients receiving conservative treatment, 85 (84%) reported hearing loss, 67 (66%) tinnitus, 37 (36%) balance disturbance, 29 (28%) aural fullness, 28 (27%) vertigo, 7 (7%) headache, 4 (4%) facial numbness, 2 (2%) facial weakness, and 0 (0%) facial pain.ConclusionConservative management—“wait and scan”—for selected patients with acoustic neuroma is a reasonable choice of management instead of radiation or microsurgery. In some situations the individual morbidities associated with surgery or radiation make those treatments not in the patient's best interests. A third option is necessary in patients who cannot or do not wish to undergo those other treatments.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe outcomes of surgery for acoustic neuromas have improved dramatically since the development of modern surgical techniques, the operating microscope, magnetic resonance imaging (MRI), and cranial nerve monitoring. The goals of acoustic neuroma surgery are now preservation of facial nerve function and, when feasible, hearing preservation. Many large series do not report standardized hearing and facial function grading, and they include patients who did not benefit from the most modern techniques. The purpose of this study was to present the results of acoustic neuroma surgery using the most modern techniques and equipment, using standardized grading systems.Study DesignRetrospective review.SettingTertiary referral center.Patients97 patients who underwent surgical removal of acoustic neuromas from 1992 to 1998.InterventionAll patients underwent acoustic neuroma surgery and had preoperative audiograms and MRI with contrast. In addition, all patients had preoperative and postoperative facial function graded by the House-Brackmann scale and intraoperative facial nerve monitoring. Hearing preservation was attempted in patients with tumors of any size who had preoperative function of grade A or B according to the Committee on Hearing and Equilibrium guidelines for reporting results of acoustic neuroma surgery.Main Outcome MeasuresHearing preservation was considered successful if the patient retained serviceable hearing grade A or B. House-Brackmann grade 1 or 2 was considered excellent facial function. Complications were recorded.ResultsFacial nerve integrity was preserved in 96 of 97 patients (99%). Eight of 8 (100%) patients with intracanalicular tumors had excellent facial nerve function (HB 1–2). Fifty-two of 55 (95%) of patients with small tumors had excellent facial nerve function, and 15 of 24 (63%) with medium tumors had HB grade 1–2. Hearing was preserved in 29% of patients with tumors under 2 cm. The overall complication rate was 20%; cerebrospinal fluid leak was the most common.ConclusionThese results show that with modern imaging and surgical techniques, acoustic neuroma surgery is extremely safe and outcomes are very good. Surgery remains the treatment of choice for most tumors until alternative therapies, such as gamma knife, use uniform grading scales and show long-term facial and hearing results.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo evaluate the indications for, techniques used in, and patient outcomes after surgery with the transcochlear approach in the treatment of petroclival tumors.MethodsRetrospective review of 24 cases between 1985 and 1995 at the House Ear Clinic (Los Angeles, CA, U.S.A.).ResultsMeningioma was the most common tumor. Complete removal was achieved in 82% of tumors after one-or two-stage surgeries (average follow-up time, 36 months). The second-stage surgery was a middle fossa transpetrous approach. Most patients had some degree of facial nerve dysfunction immediately after surgery, and 12 of 20 patients subsequently improved to House-Brackmann Grade III or better. Fifty-nine percent of patients had permanent neurologic sequelae because of either the surgery or their disease.ConclusionThe transcochlear approach is best suited to treating petroclival intradural tumors that extend ventrally to the brainstem in patients without serviceable hearing. Temporary facial weakness is expected as a result of posterior facial nerve transposition.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe exact mechanism of hearing loss, the most common presenting symptom in patients with vestibular schwannomas, remains unclear. To test whether increased pressure in the internal auditory canal from tumor growth is responsible for this clinical finding, the intracanalicular pressure in patients harboring these tumors was measured.Study DesignProspective study.SettingTertiary referral hospital.PatientsFifteen consecutive patients undergoing a retrosigmoid approach for resection of vestibular schwannomas were included in the study.InterventionThe intracanalicular pressure in every patient was measured by introducing a pressure microsensor into the internal auditory canal. The pressure readings, which were performed before tumor resection, were then correlated with tumor size and respective preoperative hearing status.ResultsPlacement of the pressure monitor into the internal auditory canal revealed a biphasic waveform in every patient. Whereas the mean intracanalicular pressure was 20 mm Hg, there was significant variability among patients (range, 1–45 mm Hg). The intracanalicular pressure directly correlated with the amount of tumor in the internal auditory canal (r> 0.63, p < 0.012) but not with the total tumor size (r≤ 0.40, p > 0.075). Furthermore, eight patients with class A preoperative hearing (American Academy of Otolaryngology–Head and Neck Surgery classification) had lower intracanalicular pressures than did five patients with class B hearing (16 ± 5 vs. 28 ± 4). Although this observation suggested an inverse correlation between the intracanalicular pressure and hearing function, the difference between the two groups was not statistically significant (p = 0.14).ConclusionPressure on the cochlear nerve as a result of tumor growth in the internal auditory canal may be responsible for hearing loss in patients with vestibular schwannomas. Modification of surgical techniques to address the elevated intracanalicular pressure may be beneficial in improving hearing preservation in these patients.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective and HypothesisPosttraumatic clear rhinorrhea should result in immediate concern for a suspected cerebrospinal fluid (CSF) fistula in patients with skull base injuries, including surgical trauma. However, in addition to CSF rhinorrhea, the differential diagnosis may also include postinjury autonomic dysfunction. Pseudo–cerebrospinal fluid rhinorrhea (PCSFR) is a term used to describe rhinorrhea resulting from injury to preganglionic parasympathetic fibers supplying the sphenopalatine ganglion. This ganglion plays a critical role in this pathway secondary to its anatomic course and physiologic function. Differentiating between PCSFR and true CSF rhinorrhea can be a diagnostic challenge and may result in unnecessary and costly invasive testing and treatment.Case StudyThe authors present an illustrative case of noniatrogenic posttraumatic PCSFR in a previously healthy patient who experienced a head injury in a horseback riding accident.DiscussionFeatures of PCSFR include a history of skull base surgery or trauma with involvement of autonomic structures in this region, rhinorrhea within months or years after injury, decreased lacrimation on the involved side, absence of clinical signs of meningitis, and a negative &bgr;2-transferrin test result. Management of PCSFR is aimed at restoring the normal autonomic homeostasis in the nasal cavity. Treatment options include topical medicines such as anticholinergics and the various surgical procedures aimed at disruption of parasympathetic preganglionic fibers proximal to or at the sphenopalatine ganglion.ConclusionThis case and its diagnosis and management provide an additional mechanism of PCSFR, a clinical entity that must be considered in the evaluation of all patients with previous skull base trauma.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID