Cerebrospinal fluid leak rate after the use of BioGlue in translabyrinthine vestibular schwannoma surgery: a prospective study.

OBJECTIVE: To determine the effectiveness of BioGlue surgical adhesive in dural and middle ear closure after translabyrinthine vestibular schwannoma surgery. STUDY DESIGN: A prospective study. SETTING: Tertiary neurotological referral center. PATIENTS: There were 24 patients in the BioGlue series. BioGlue was used in the same manner in all cases. All patients received similar postoperative care. INTERVENTIONS: We studied the use of BioGlue and its possible effect on further reducing our department's cerebrospinal fluid leak rate for translabyrinthine vestibular schwannoma surgery. MAIN OUTCOME MEASURES: Postoperative events were documented that enabled us to determine the overall cerebrospinal fluid leak rate (including incidence of various leak routes and morbidity). RESULTS: The overall cerebrospinal fluid leak rate was 62.5% (15 of 24). Rhinorrhoea was the commonest route (80%), followed by postaural wound leak (33.3%) and external auditory canal otorrhoea (33.3%). Forty percent of cases had more than one cerebrospinal fluid leak route; 73.3% of leak cases required lumbar drain insertion, 40% needed pressure bandaging, and 66.7% had to undergo formal surgical repair. Forty percent had recurrent leaks after the initial episode had completely ceased. The mean extra stay in hospital as a result of the cerebrospinal fluid leak was 13.3 days. CONCLUSION: Our preliminary prospective study of the use of BioGlue for dural and middle ear closure in translabyrinthine vestibular schwannoma surgery demonstrated poor results. The high cerebrospinal fluid leak rate associated with the unusual presentations and ensuing management difficulties in controlling these leaks lead us to recommend that BioGlue not be used in translabyrinthine vestibular schwannoma surgery. The manufacturers have noted our results and have considered adding our recommendation to the product data sheet.

Stenosis of the internal auditory meatus masquerading as bilateral vestibular schwannomas: a cautionary tale.

Stenotic malformations of the internal auditory meatus (IAM) are rare. They are known to symptomatically mimic vestibular schwannomas leading to potential diagnostic error. We present a case (along with literature review) where a stenotic IAM was clinically and radiologically misdiagnosed as a vestibular schwannoma.

Patient satisfaction survey of outpatient-based topical local anesthetic KTP laser inferior turbinectomy: a prospective study.

BACKGROUND: The aim of this study was to determine patient satisfaction and feasibility of performing KTP laser inferior turbinectomy under topical anesthetic/decongestant spray. A prospective survey study was performed in the Outpatients' Department of a District General Hospital. METHODS: Thirty-nine consecutive patients suffering from allergic or nonallergic vasomotor rhinitis were prospectively entered into the study. Preoperative details were gathered including current nasal obstruction score as indicated on a visual analog score (VAS). Lidocaine hydrochloride 5% w/v and phenylephrine hydrochloride 0.5% w/v was applied via topical spray to anesthetize and decongest the nose. The inferior turbinates (ITs) were reduced by parallel mucosal cuts using the KTP laser. Intraoperative details were recorded included pain experienced and bleeding. We studied the subjective clinical effectiveness and patient satisfaction. RESULTS: All patients were followed up at standard intervals by telephone over a 6-month period. At each interval, current nasal obstruction, pain, bleeding, and crusting on VAS were collected. Morbidity was determined in terms of return to work, return to hospital, or recurrence of symptoms. At the end of 6 months all patients were asked if they would have the procedure repeated again and/or recommend it to a friend. Reduction of ITs under topical anesthesia was acceptable to 83% of all patients. Eighty-seven percent of all patients felt they would recommend the procedure and mode of anesthesia to a friend. Our patients obtained the maximum subjective benefit at 6 weeks postoperatively. A significant improvement in nasal obstruction was achieved. There was subjective improvement in associated symptoms including hyposmia/anosmia, rhinorrhea, and sneezing. Only 28% of all patients required medication again to aid symptom control. Postoperative bleeding was insignificant. The return to a ward or clinic was minimal and 82% of all employed patients were back at work within a week. CONCLUSION: Our study showed that KTP laser inferior turbinectomy is suitable to be performed in the outpatient department under topical anesthetic/decongestant spray and provides excellent relief for nasal obstruction and high patient compliance and satisfaction.