RESUMO
OBJECTIVE: To prospectively evaluate the association between hearing preservation after cochlear implantation (CI) and intracochlear electrocochleography (ECochG) amplitude parameters. STUDY DESIGN: Multi-institutional, prospective randomized clinical trial. SETTING: Ten high-volume, tertiary care CI centers. PATIENTS: Adults (n = 87) with sensorineural hearing loss meeting CI criteria (2018-2021) with audiometric thresholds of ≤80 dB HL at 500 Hz. METHODS: Participants were randomized to CI surgery with or without audible ECochG monitoring. Electrode arrays were inserted to the full-depth marker. Hearing preservation was determined by comparing pre-CI, unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to LF-PTA at CI activation. Three ECochG amplitude parameters were analyzed: 1) insertion track patterns, 2) magnitude of ECochG amplitude change, and 3) total number of ECochG amplitude drops. RESULTS: The Type CC insertion track pattern, representing corrected drops in ECochG amplitude, was seen in 76% of cases with ECochG "on," compared with 24% of cases with ECochG "off" ( p = 0.003). The magnitude of ECochG signal drop was significantly correlated with the amount of LF-PTA change pre-CI and post-CI ( p < 0.05). The mean number of amplitude drops during electrode insertion was significantly correlated with change in LF-PTA at activation and 3 months post-CI ( p ≤ 0.01). CONCLUSIONS: ECochG amplitude parameters during CI surgery have important prognostic utility. Higher incidence of Type CC in ECochG "on" suggests that monitoring may be useful for surgeons in order to recover the ECochG signal and preventing potentially traumatic electrode-cochlear interactions.
Assuntos
Audiometria de Resposta Evocada , Implante Coclear , Perda Auditiva Neurossensorial , Humanos , Audiometria de Resposta Evocada/métodos , Implante Coclear/métodos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Perda Auditiva Neurossensorial/cirurgia , Perda Auditiva Neurossensorial/fisiopatologia , Estudos Prospectivos , Implantes Cocleares , Cóclea/cirurgia , Cóclea/fisiopatologia , Adulto , Audição/fisiologia , Audiometria de Tons PurosRESUMO
There are several surgical approaches for vestibular schwannoma (VS) resection. However, management has gradually shifted from microsurgical resection, toward surveillance and radiosurgery. One of the arguments against microsurgery via the middle fossa approach (MFA) is the risk of temporal lobe retraction injury or sequelae. Here, we sought to evaluate the incidence of temporal lobe retraction injury or sequela from a MFA via a systematic review of the existing literature. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Relevant studies reporting temporal lobe injury or sequela during MFA for VS were identified. Data was aggregated and subsequently analyzed to evaluate the incidence of temporal lobe injury. 22 studies were included for statistical analysis, encompassing 1522 patients that underwent VS resection via MFA. The overall rate of temporal lobe sequelae from this approach was 0.7%. The rate of CSF leak was 5.9%. The rate of wound infection was 0.6%. Meningitis occurred in 1.6% of patients. With the MFA, 92% of patients had good facial outcomes, and 54.9% had hearing preservation. Our series and literature review support that temporal lobe retraction injury or sequelae is an infrequent complication from an MFA for intracanalicular VS resection.
Assuntos
Neuroma Acústico , Lobo Temporal , Humanos , Neuroma Acústico/cirurgia , Lobo Temporal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Fossa Craniana Média/cirurgia , Microcirurgia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
BACKGROUND AND OBJECTIVE: Optimizing the extent of resection (EOR) and facial nerve outcomes (FNO) remain a challenge in medium to large vestibular schwannomas (VS). Currently, tumor size has been the only consistently reported factor predicting FNO and EOR. Here, we sought to evaluate whether the degree of the tumor's compression on the middle cerebellar peduncle (PC) influences FNO and EOR in medium to large VS. METHODS: This retrospective case series included 99 patients who underwent surgical resection of their VSs from 2014 to 2022. Preoperative MR imaging was used to measure the degree of PC. Patient medical records were queried to determine the EOR and FNO. RESULTS: Patients with unfavorable FNO (HB 3 +) immediately post-op had significantly greater PC than those with favorable FNO (19.9 vs. 15.4 mm, P = .047). This significance was not observed at the last follow-up but there was a trend. When medium-sized tumors (15-30 mm) were analyzed separately, patients with unfavorable FNO immediate post-op and at last follow-up had significantly greater PC than their favorable counterparts (14.1 vs 8.7 mm). Significantly greater PC was also observed in patients who underwent subtotal resection (20.7 mm) compared to near (14.3 mm) and gross total resection (10.8 mm). Multivariate analyses confirmed these findings in medium-sized tumors, but not large-sized tumors. CONCLUSION: The degree of PC as measured on preoperative imaging can predict FNO and EOR in medium-sized vestibular schwannomas. Medium-sized tumors with > 15 mm of PC likely will have worse FNO and lower EOR.
Assuntos
Pedúnculo Cerebelar Médio , Neuroma Acústico , Humanos , Nervo Facial/diagnóstico por imagem , Nervo Facial/cirurgia , Nervo Facial/patologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/cirurgia , Neuroma Acústico/complicações , Estudos Retrospectivos , Pedúnculo Cerebelar Médio/patologia , Procedimentos Neurocirúrgicos/métodos , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: The combined petrosectomy is one of the workhorse skull base approaches to the petroclival region. Traditionally, this approach starts with a temporosuboccipital craniotomy, followed by the mastoidectomy/anterior petrosectomy, and completed with the dural opening/tumor resection. This sequence of events (neurosurgery-neuro-otology-neurosurgery) involves at least 2 handoffs and change of surgical teams and instrumentation. This report describes a resequencing of events and a modification of the technique used to craft the temporosuboccipital craniotomy, with aims to reducing handoffs between surgical teams and improving operating room workflow. METHODS: Adhering to PROCESS guidelines, a case series is provided in addition to the surgical technique and surgical images. RESULTS: The technique for performing a combined petrosectomy is described with illustrations. This description shows that the temporal bone drilling may be performed before the craniotomy to allow for direct visualization of the dura and sinuses before completing the craniotomy. In doing so, only 1 transition between the otolaryngologist and neurosurgeon is necessary, thereby improving operating room workflow and time management. A series of 10 patients is presented, showing the feasibility of this procedure and providing operative details that were previously absent in the peer-reviewed literature. CONCLUSIONS: Combined petrosectomy, although often performed in a 3-step manner with the neurosurgeon starting the craniotomy, can be performed as described here in a 2-step manner, with similar outcomes and reasonable operating time.
Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirurgia , Osso Petroso/cirurgia , Osso Petroso/patologia , Fluxo de Trabalho , Craniotomia/métodos , Neoplasias Meníngeas/cirurgiaRESUMO
OBJECTIVES: To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation. STUDY DESIGN: Prospective, randomized clinical trial. SETTING: Ten high-volume, tertiary care CI centers. PATIENTS: Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI. METHODS: Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation. RESULTS: Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was "good" (i.e., LF-PTA change 0-15 dB) in 34.5%, "fair" (i.e., LF-PTA change >15-29 dB) in 22.5%, and "poor" (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG "on," mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG "off" ( p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli. CONCLUSIONS: Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG "on" compared with ECochG "off."
Assuntos
Implante Coclear , Implantes Cocleares , Adulto , Audiometria de Resposta Evocada/métodos , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Implante Coclear/métodos , Implantes Cocleares/efeitos adversos , Audição , Humanos , Estudos ProspectivosRESUMO
PURPOSE: Determine the relationship between time elapsed between sequential bilateral cochlear implantation (BiCI) and speech intelligibility scores in post-lingually deafened adults. MATERIALS AND METHODS: Retrospective review of post-lingually deafened adults who received bilateral cochlear implants from January 1, 2011 to January 1, 2018 at an ambulatory tertiary referral center. RESULTS: 113 patients (226 cochlear implants) were initially reviewed, with 56 patients (112 implants) being included in the final analysis. Median inter-implant interval was 187.5 days (IQ range 54.25-346.5). Maximum interval was 1787 days. Mean age at first implant was 60.66 ± 13.37. Bilateral AzBio score in quiet and inter-implant interval showed no significant correlation (r = 0.034, p = 0.815). There was no significant difference in mean bilateral AzBio scores in quiet between the simultaneous and sequential implantation groups (p = 0.22). Similar non-significant results were seen when examining the correlation between AzBio Difference and inter-implant interval (r = -0.07, p = 0.66). No significant result between mean AzBio Difference of simultaneous and sequential implant recipients was found (p = 0.06). CONCLUSIONS: For the inter-implant intervals examined, there seems to be no significant decline in speech intelligibility scores for patients receiving sequential bilateral cochlear implants compared to simultaneously implanted patients. There was no significant correlation noted between increasing inter-implant intervals and speech intelligibility scores.
Assuntos
Implante Coclear/métodos , Implantes Cocleares , Audição , Fala , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemAssuntos
Malformação de Arnold-Chiari/complicações , Perda Auditiva/etiologia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/cirurgia , Perda Auditiva/diagnóstico , Perda Auditiva/cirurgia , Humanos , Masculino , Resultado do TratamentoRESUMO
Stereotactic radiosurgery is generally accepted as one of the best treatment options for vestibular schwannomas. We question whether growth control is an accurate measure of success in vestibular schwannoma treatment. We aim to clarify the success rate of stereotactic radiosurgery and adjust the reported results to the benign natural history of untreated tumors. All articles were taken from a PubMed search of the English literature from the years 2000-2011. Inclusion criteria were articles containing the number of patients treated, radiation technique, average tumor size, follow-up time, and percentage of tumors growing during follow-up. Data were extracted from 19 articles. Success rates were adjusted using published data that 17% to 30% of vestibular schwannomas grow. The average reported success rate for stereotactic radiosurgery across all articles was 95.5%. When considering 17% or 30% natural growth without intervention, the adjusted success rates became 78.2% and 86.9% respectively. These rates were obtained by applying the natural history growth percentages to any tumors not reported to be growing before radiosurgical intervention. Success in the treatment of vestibular schwannomas with stereotactic radiosurgery is often defined as lack of further growth. Recent data on the natural growth history of vestibular schwannomas raise the question of whether this is the best definition of success. We have identified a lack of continuity regarding the reporting of success and emphasize the importance of the clarification of the success of radiosurgery to make informed decisions regarding the best treatment options for vestibular schwannoma.
Assuntos
Neuroma Acústico/diagnóstico , Neuroma Acústico/cirurgia , Radiocirurgia/tendências , Animais , Humanos , Resultado do TratamentoRESUMO
OBJECT: Recent natural history studies of vestibular schwannomas (VSs) suggest that most of these tumors do not grow. The impact of these new data on management trends in the US is currently unknown. The aim in the present study was to evaluate current trends in the treatment of VS in the US by analyzing a national cancer database. METHODS: The Surveillance, Epidemiology, and End Results Program is a national database maintained by the National Cancer Institute representing 26% of the US population. Data from the database were downloaded using provided software. Cases were isolated based on histology codes and the site code. Data from 2004 to 2007 were included in the analysis. The number of patients undergoing resection was compared with the number treated with beam radiation and observation, based on tumor size. RESULTS: Three thousand six hundred fifty cases were identified in the database. Over the study period, management choices for VSs showed a significant change only for tumors with a diameter < 2 cm. In this tumor category, a decrease in resection and an increase in radiation were observed, with observation showing a modest increase but remaining low at an average of 25%. CONCLUSIONS: Study data demonstrated a shift in the management of small VSs in the US between 2004 and 2007, with microsurgical removal giving way to radiation treatment and the overall rate for observation remaining low and stable. With recent literature suggesting that the majority of small tumors do not grow, the authors assert that VSs are being overtreated in the US.
Assuntos
Gerenciamento Clínico , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Programa de SEER/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Humanos , Pessoa de Meia-Idade , Neuroma Acústico/epidemiologia , Procedimentos Neurocirúrgicos , Radioterapia , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Emotions are communicated through facial expression. Happiness, confusion, and frustration can be expressed with a slight smile, eyebrow shift, or wrinkled nose. Injury to the facial nerve and subsequent inability of perform volitional mimetic movement can provoke anxiety. This article explores the causes, treatment, and prevention of facial nerve paralysis.
Assuntos
Paralisia Facial/diagnóstico , Descompressão Cirúrgica , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Fraturas Ósseas/cirurgia , Humanos , Nervo Hipoglosso/transplante , Doença Iatrogênica , Complicações Intraoperatórias , Nervo Sural/transplante , Osso Temporal/lesões , Osso Temporal/cirurgia , Ferimentos Penetrantes/cirurgiaRESUMO
OBJECTIVE: To evaluate the long-term outcome of correction of nasal valve collapse with a porous polyethylene implant. STUDY DESIGN AND SETTING: Retrospective review from November 1999 to December 2005. Nasal valve collapse was corrected with a porous polyethylene implant in 12 adults. Main outcome measures included relief of nasal obstruction and complications. Independent variables included other causes of nasal obstruction and need for revision surgery. Simple statistical analysis was performed. RESULTS: Median follow-up was 5.6 years (58 months). 75% had complete resolution of nasal obstruction. 100% had complete resolution of nasal obstruction at 6 months and had coexisting causes of nasal obstruction. The implant extrusion rate was 21%. 42% went on to have revision surgery. CONCLUSION: Correction of nasal valve collapse with a porous polyethylene implant provided good long-term symptomatic relief of nasal obstruction, but with significant incidence of infection, implant extrusion, and need for revision surgery. The use of this implant should be reserved for cases in which autogenous graft material is not available.
Assuntos
Materiais Biocompatíveis , Obstrução Nasal/cirurgia , Nariz/cirurgia , Polietileno , Próteses e Implantes , Adulto , Idoso , Materiais Biocompatíveis/química , Remoção de Dispositivo , Feminino , Seguimentos , Corpos Estranhos/etiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Polietileno/química , Porosidade , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
We investigated the effects of tinnitus on measures of arousal and attention at various levels of the neuraxis to derive a profile of the pathophysiology of tinnitus. Individuals with tinnitus of at least 6 months' duration (14 male, 15 female) and healthy controls (14 male, 21 female) were tested for arousal and habituation to repetitive stimulation at the brainstem-thalamus level by measuring the P50 potential, a scalp-recorded, auditory-evoked response, using pairs of click stimuli. We used the psychomotor vigilance task, a reaction-time test, to assess attentional processes mediated by thalamocortical functions. We then correlated deficits in arousal and attention, as measured by these tests, with perceived tinnitus severity. Results showed no difference between tinnitus patients and controls in level of arousal or habituation to repetitive sensory stimulation, as measured by the amplitude of the P50 potential and the ability to suppress a second, closely paired stimulus, respectively. However, reaction-time assessments showed that patients with tinnitus have attentional deficits relative to controls (p = .02). We found no significant correlation between sleep disturbance or tinnitus severity and reaction-time testing.
Assuntos
Nível de Alerta/fisiologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Zumbido/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Audiometria de Resposta Evocada , Tronco Encefálico/fisiologia , Estudos de Casos e Controles , Potenciais Evocados Auditivos/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Análise e Desempenho de Tarefas , Tálamo/fisiologia , Zumbido/complicaçõesRESUMO
Many options are available to manage a patient who has atelectatic ears. Establishing normal middle ear ventilation and aeration is the cornerstone to successful control of these ears. Often, medical management with nasal steroids and decongestants is all that is needed. If recurrent infections have weakened the tympanic membrane progressively, or the middle ear environment is so severe that medical management does not correct the problem, then surgical correction is often necessary. This article explores the pathogenesis of middle ear atelectasis and explains a classification system to help the clinician determine the best course of management.
Assuntos
Otopatias , Orelha Média/fisiopatologia , Orelha Média/cirurgia , Otopatias/etiologia , Otopatias/fisiopatologia , Otopatias/cirurgia , Tuba Auditiva/fisiopatologia , Tuba Auditiva/cirurgia , Humanos , Membrana Timpânica/fisiopatologia , Membrana Timpânica/cirurgiaRESUMO
Eustachian tube dysfunction has been linked to causing middle ear pathology. One of the sequelae seen is tympanic membrane retraction. Concern occurs when this physiological state becomes chronic, leading to adhesive otitis media followed by debris collection and fulminate cholesteatoma. This chapter explores the role the eustachian tube plays in regulating middle ear and mastoid aeration, the causes of eustachian tube dysfunction, and the treatment of this disorder.
Assuntos
Colesteatoma da Orelha Média/fisiopatologia , Otopatias/fisiopatologia , Tuba Auditiva/fisiopatologia , Otopatias/etiologia , Otopatias/cirurgia , Tuba Auditiva/anatomia & histologia , Tuba Auditiva/cirurgia , Humanos , Otite Média com Derrame/fisiopatologia , Procedimentos Cirúrgicos Otológicos/métodosRESUMO
The incidence of complications of chronic otitis media and cholesteatoma has decreased since the proliferation of antibiotics early in the twentieth century. However, these complications continue to occur, and can be lethal if they are not identified and treated properly. Therapy for the complications associated with chronic otitis media, unlike that of acute otitis media, usually involves surgical intervention. As medical (antibiotic) therapy continues to improve, and new imaging techniques are introduced, less invasive treatment modalities may be shown to be as effective as the classic, time-tested, surgical options.
Assuntos
Encefalopatias/etiologia , Colesteatoma da Orelha Média/etiologia , Otite Média Supurativa/complicações , Antibacterianos/uso terapêutico , Encefalopatias/microbiologia , Colesteatoma da Orelha Média/fisiopatologia , Colesteatoma da Orelha Média/cirurgia , Humanos , Otite Média Supurativa/tratamento farmacológico , Otite Média Supurativa/microbiologiaAssuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Orelha Média/patologia , Doenças do Nervo Facial/diagnóstico , Neurilemoma/diagnóstico , Idoso , Audiometria , Neoplasias dos Nervos Cranianos/patologia , Diagnóstico Diferencial , Orelha Média/diagnóstico por imagem , Doenças do Nervo Facial/patologia , Feminino , Auxiliares de Audição , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/reabilitação , Humanos , Imageamento por Ressonância Magnética , Neurilemoma/patologia , Osso Temporal/diagnóstico por imagem , Osso Temporal/patologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: This article seeks to demonstrate the use of the extended middle cranial fossa approach in the treatment of tumors arising in the anterior cerebellopontine angle and petroclival region. STUDY DESIGN: We conducted a retrospective chart review. SETTING: Tertiary referral center. PATIENTS: : Ten-year retrospective chart review of over 800 skull base surgical cases demonstrated 16 cases in which the senior author used the extended middle cranial fossa as the sole approach to access the posterior cranial fossa, petroclival junction, or the anterior cerebellopontine angle. There were five males and 11 females, 13 meningiomas, 2 trigeminal schwannomas, and 1 brainstem glioma. Presenting symptoms were dependent on extent of brainstem compression and involvement of surrounding cranial nerves. The symptoms are broken down as follows: hydrocephalus, one; balance disturbance, three; diplopia, five; trigeminal neuralgia, two; hemifacial numbness, one; seizures, one; expressive aphasia, one; and hearing loss, two. RESULTS: Of the 16 patients in this study, one patient needed postoperative care in a skilled nursing facility. Postoperative facial nerve weakness was not experienced in any patient. One patient developed a transient cerebrospinal fluid leak that resolved spontaneously. One patient developed a pseudomeningocele secondary to postoperative hydrocephalus. This was corrected with wound exploration and placement of a ventricular peritoneal shunt. Hearing was not maintained in one patient. Two patients developed new fourth nerve paresis and two patients developed new sixth nerve palsies. There were no postoperative infections and no deaths. CONCLUSIONS: The extended middle cranial fossa approach provides excellent access and exposure to tumors in the anterior cerebellopontine angle and petroclival junction. The approach allows more direct access to the area anterior to the internal auditory canal. The key to the approach is adequate bone removal of the petrous apex to provide exposure down to the inferior petrosal sinus and anteriorly to Meckel's cave and the petroclival junction. Extradural elevation of the temporal lobe with suitable brain relaxation minimizes postoperative complications.
Assuntos
Ângulo Cerebelopontino/cirurgia , Fossa Craniana Média/cirurgia , Fossa Craniana Posterior/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adulto , Idoso , Neoplasias do Tronco Encefálico/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Feminino , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Doenças do Nervo Trigêmeo/cirurgiaRESUMO
OBJECTIVE: The objective of this study was to compare the effectiveness of direct eighth nerve monitoring (DENM) and auditory brainstem response (ABR) in facilitating hearing preservation during vestibular schwannoma resection. STUDY DESIGN: This was a retrospective study. SETTING: : Tertiary referral center. METHODS: We conducted a retrospective clinical study of the use of ABR and DENM during vestibular schwannoma removal. Tumors were removed through a retrosigmoid craniotomy. The rate of hearing preservation between the two monitoring modalities was compared. The additional outcome measures of facial nerve function and cerebral spinal fluid leak rate were also evaluated. RESULTS: Hearing preservation was attempted in 77 patients with vestibular schwannomas. Tumor sizes ranged from 0.5 cm to 2.5 cm. Hearing was preserved in 71% of patients with tumors 1 cm or less and in 32% of patients with tumors between 1 and 2.5 cm when direct eighth nerve monitoring was used. Hearing preservation rates with ABR for tumors 1 cm or less were 41% and 10% in patients with tumors between 1 and 2.5 cm (p=0.03) Facial nerve preservations rates were 94% (House-Brackmann 1-2) for tumors less than 2 cm. CONCLUSIONS: DENM provides significantly higher rates of hearing preservation during vestibular schwannoma resection when compared with ABR.
Assuntos
Nervo Coclear/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico , Perda Auditiva Neurossensorial/prevenção & controle , Monitorização Intraoperatória , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Humanos , Monitorização Intraoperatória/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The purpose of this study was to further examine whether fluid homeostasis in the endolymphatic system could be regulated by a locally effective paracrine system involving atrial natriuretic peptides (ANPs) and their receptors. We assessed the biologic activity of the 3 ANP receptors (ANP-A, ANP-B, ANP-C) in the rat inner ear by measuring receptor upregulation after inner ear administration of ANPs. After appropriate anesthesia, female Lewis rats were injected with ANP via the round window. The animals were sacrificed 24 hours later, and RNA was isolated for reverse transcription-polymerase chain reaction (RT-PCR). Electrophoresis of RT-PCR products showed the presence of all 3 ANP receptor genes in both injected and control animals. Gene expression was significantly higher 24 hours after injection. These findings demonstrate that ANP receptors in the inner ear can be upregulated after injection of ANPs.
Assuntos
Fator Natriurético Atrial/administração & dosagem , Orelha Interna/fisiologia , Receptores do Fator Natriurético Atrial/fisiologia , Regulação para Cima , Animais , Densitometria , Orelha Interna/metabolismo , Eletroforese , Saco Endolinfático/metabolismo , Saco Endolinfático/fisiologia , Feminino , Glicerol/administração & dosagem , Homeostase , Doença de Meniere/tratamento farmacológico , Doença de Meniere/etiologia , Doença de Meniere/fisiopatologia , RNA/isolamento & purificação , Ratos , Ratos Endogâmicos Lew , Receptores do Fator Natriurético Atrial/efeitos dos fármacos , Receptores do Fator Natriurético Atrial/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de TempoRESUMO
OBJECTIVE: To estimate whether a dosage of 50 microg of misoprostol tablets moistened with 3% acetic acid and administered intravaginally is more efficacious for labor induction than a similar dosage regimen using dry tablets. METHODS: A total of 177 women who presented with an indication for cervical ripening and labor induction were randomly assigned to one of two treatment groups: 1) intravaginal misoprostol in dry tablet form, or 2) intravaginal misoprostol moistened with 1 mL of 3% acetic acid solution. The primary outcome assessed was the interval from start of induction to vaginal delivery. To detect at least a 3.5-hour difference in the primary outcome with 80% power, 87 subjects were required in each group. RESULTS: Among 162 patients evaluated, 80 were allocated to the misoprostol dry group and 82 to the misoprostol moistened group. No significant difference was noted for the mean +/- standard deviation interval to vaginal delivery: 1130 +/- 636 minutes for the group who received dry tablets and 1004 +/- 636 minutes for those who received moistened misoprostol tablets (P =.25). Additionally, no statistically significant differences were noted between the groups with respect to need for oxytocin, proportion of patients delivered after a single dose, intrapartum complications (including tachysystole and uterine hyperstimulation), mode of delivery, or perinatal outcomes. CONCLUSION: Tablet moistening with 3% acetic acid solution does not seem to improve the efficacy of intravaginally administered misoprostol for labor induction.