Primary parapharyngeal tumours: a review of 21 cases.

BACKGROUND: The diagnostic and therapeutic procedures performed in a series of patients with primary parapharyngeal space (PPS) tumours treated at the ENT Departments of San Giovanni Bosco Hospital, Turin, and of the Pugliese-Ciaccio Hospital, Catanzaro, Italy, in the period 2001-2010 are evaluated. MATERIALS AND METHODS: The retrospective review included 20 patients, 11 male and 9 female, average age of 41 years operated on for 21 primary PPS tumours. The most common tumours found were neurogenic neoplasms, while those of salivary origin were the next most common. RESULTS: There were 14 paragangliomas (7 originating from carotid glomus, 5 from vagal and 2 from tympanicum), 1 sympathetic chain schwannoma and 6 pleomorphic adenomas. All the tumours were benign in nature and gave rise to few signs or symptoms. Patients underwent preoperative computed tomography (CT) scan or magnetic resonance imaging (MRI) or both. Most contrast-enhanced masses were submitted to some type of angiography. Most of the surgeries were planned through imaging alone, as preoperative fine needle aspiration (FNA) biopsy was performed only in six cases. Four different approaches were adopted for tumour removal: transcervical, transcervical/transparotid, cervical-transparotid-transmandibular and infratemporal fossa approach. There was no operative mortality, though neurologic morbidity was significant. Follow-up, extended to a maximum of 11 years, did not reveal any recurrences. In conclusion, neurogenic tumours may be the most common of PPS masses. Surgery is the mainstay treatment and external approaches offer the potential for satisfactory tumour resection. Of such external approaches, transcervical and cervical/transparotid are the most often used in benign forms. CONCLUSION: The number of perioperative complications encountered in this series confirms the difficulty of performing surgery in this complex area, even in benign cases. The chances of avoiding vascular damage and saving the trunks or most of the nerve fibres involved depend not only on the skill and experience of the surgeon but also on the anatomy of the lesion, the type of connection between the tumour and the nerve from which it originates and the distribution of neural fibres in or around the tumour mass.

Surgery of thyroid cancer: twelve years' personal experience.

Diagnosis and treatment of thyroid carcinoma require a multidisciplinary approach. The close and long-standing collaboration between the Otorhinolaryngology, Pathological Anatomy and Nuclear Medicine Departments of Legnano Hospital has led to a precise diagnostic and therapeutic protocol in thyroid patients. In the 1990-2002 period, 131 patients underwent total thyroidectomy after diagnosis of thyroid cancer at the Otorhinolaryngology--Head and Neck Surgery Department. Patients submitted to lobectomy for differentiated thyroid cancer were excluded from the present study. The patient population is composed of 96 females (73%) and 36 males (27%) aged between 22 and 85 years. Of the 131 patients, 115 (87%) presented papillary carcinoma, 13 (10%) follicular carcinoma, 2 (2%) medullary carcinoma and one (1%) undifferentiated carcinoma. Two patients (2%) suffered from a preoperative monolateral recurrent nerve palsy. Total thyroidectomy was performed in all 131 patients. Selective neck dissection was performed only in patients with positive lymph nodes for papillary (37/115, 32%) and follicular carcinoma histotype (2/13, 15%) and, in both patients with medullary carcinoma (100%). Of the 131 patients, 15 (11%) did not undergo routine follow-up and were, therefore, excluded from the study, the remainder completed a mean follow-up of 47 months. During follow-up, the incidence of the two most frequent complications of thyroid surgery were evaluated: recurrent nerve paralysis and permanent hypoparathyroidism (exceeding the postoperative 6 months). Results of treatment have been evaluated considering the incidence of local and/or distant recurrences and patient survival rate. As far as concerns papillary and follicular histotype, we have considered as healed (absence of signs suggesting loco regional and distant recurrence) only those patients presenting both negligible levels of plasma thyroglobulin and a negative total-body 131I scintigraphy. Briefly, in 3 cases (3%), all papillary carcinomas, local recurrence occurred; 9 (8%), all with papillary carcinoma, developed lateral neck recurrence; 6 (5%), 5 with papillary carcinoma and one with follicular carcinoma, developed distant metastases, of which 3 pulmonary, 2 bone and 1 hepatic. Serum thyroglobulin values were considered during the last control visit in 95/113 patients (84%). Of these, 86 (91%) with negligible thyroglobulin levels and negative 131I scintigraphy, were considered healed. All 113 patients with differentiated thyroid carcinoma were alive at the last control visit. Both patients with medullary carcinoma are alive with no sign of illness at the last follow-up control. The patient presenting undifferentiated carcinoma died 2 months after surgery. In conclusion, at the last follow-up control, 1 (1%) patient has died, 5 patients (4%) are alive with disease (2 of whom suffered from multiple recurrences) and the remaining 110 (95%) patients are alive without evidence of disease. As far as concerns complications of surgery, iatrogenic recurrent palsy and permanent hypoparathyroidism are present in 2 (2%) and 10 patients (8%), respectively.

Posterior fossa vestibular neurotomy as primary surgical treatment of Menière's disease: a re-evaluation.

Fifty-eight patients underwent vestibular neurotomy via the posterior fossa approach between September 1992 and December 1998 at the ENT department of Legnano. All patients presented a history of disabling unilateral Menière's disease and underwent complete neuro-otologic evaluation following the 1985 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. All patients underwent MRI imaging, ABR and electronystagmographic testing before surgery. Objective analysis of results is reported using the criteria published by the Committee on Hearing and Equilibrium of the AAO-HNS in 1985. According to the AAO formula, 52 patients obtained a score of 0, indicating complete control of major vertigo spells, while four were classified within the 'substantial control' group. Immediate hearing results indicated that 93 per cent of the patients maintained a level within 10 dB from the pre-operative level. Only one patient experienced a subtotal hearing loss yet retained measurable hearing. No major complications were reported. We conclude that a retrosigmoid approach to vestibular neurotomy can be considered a safe and effective procedure in relieving medically refractory vertigo in Menière's disease while preserving the hearing. Tinnitus and long-term hearing deterioration are not influenced by the procedure.

[Trans-labyrinthine approach for the resection large and giant acoustic nerve neuromas]. / Abordaje translaberíntico para resección de neurinomas de gran tamaño y gigantes del nervio acústico.

The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current "enlarged" approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano.

Abordaje translaberíntico para resección de neurinomas de gran tamaño y gigantes del nervio acústico / Translabyrinthine approach for the resection large and giant acoustic nerve neuromas

El abordaje translaberíntico clásico para la exéresis de neurinomas del acústico fue introducido por William House en 1964. En el curso de los años el abordaje translaberíntico original ha sido progresivamente modificado hacia el actual abordaje "ampliado", extendiendo el área de resección ósea. Esta modificación permite la exéresis de tumores prácticamente de cualquier tamaño del ángulo pontocerebeloso. Se presentan los resultados de 71 neurinomas del nervio acústico grandes (52) o gigantes (19) operados entre los años 1993-1998 por abordaje translaberíntico en el Servicio de Otorrinolaringología del Hospital de Legnano. (AU)

The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current «enlarged» approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano (AU)

[Petrous bone cholesteatoma: surgical strategy]. / I colesteatomi della rocca: strategia chirurgica.

Petrous bone cholesteatoma is a rare pathology which grows slowly and is often asymptomatic. This work presents a series of 25 cases of Petrous bone cholesteatoma and discusses the diagnostic impact, the surgical approach, the results and the complications. Currently our surgical orientation favors translabyrinthine and transcochlear approaches which, better than other ones, allow both radical excision of the lesion and preservation of the main neuro-vascular structures. Out of the 25 patients undergoing surgery, 22 were treated with the translabyrinthine (6 cases) or transcochlear (16 cases) approaches, in 1 case an infratemporal type A approach was used while the remaining 2 were treated with a median cranial fossa approach. Paralysis of the facial nerve is the most dreaded complication, particularly when a deficit is already present prior to surgery. In just a few cases did the hearing justify an attempt at preservation but in no case should this compromise radical removal of the cholesteatoma.

Evaluation of the sensitivity of microfilter paper assays in an anthropological study: results of samples from Cameroon and Tanzania.

Microfilter absorbed whole blood samples from 223 Tanzanian babies and 189 adults from Cameroon have been examined. Blood specimens are difficult to obtain from African suburban and rural areas, and lack of storage and transportation facilities can prevent the collection of samples. We evaluated some microassays employing whole blood collected on filter paper. This method is a well established technique in neonatal screening for endocrinometabolic diseases. We also developed microassays for whole dried blood spots to type AB0 blood groups and HIV disease using commercial reagents. Phenotype and gene frequencies for AB0 and hemoglobin systems as well as our results concerning the typings of thyroxine (T4), thyroid stimulating hormone (TSH), human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are reported.

[Analgesic activity of Benexol-B12 in the painful vertebral syndrome]. / Attività antidolorifica del Benexol B12 nella sindrome vertebrale dolorosa.

In order to verify the analgesic activity of an association of vitamin B1 - B6 - B12 (Benexol B12) in the painful vertebral syndrome, the Authors have performed a comparative trial between 20 patients treated with the association and 20 patients treated with a brain phospholipid extract (Cronassial). The results obtained in the two groups of patients are discussed.