Endonasal Endoscopic and Hybrid Surgery Techniques for Blunt Trauma Fractures of the Skull Base With Cerebrospinal Fluid Leaks.

ABSTRACT: Cerebrospinal fluid (CSF) leakage caused by skull base fracture represents high risks of bacterial meningitis, and a rate of mortality of 8.9%. Endoscopic endonasal repair of CSF leaks is quite safe and effective procedure with high rates of success. The aim of this study is to describe our technique for management of skull base CSF leaks secondary to craniofacial trauma based on the anatomic location of the leak. This is a retrospective case series of 17 patients with diagnosis of craniofacial trauma, surgically treated with sole endonasal endoscopic and combined endonasal/transcranial approaches with diagnosis of CSF leak secondary to skull base fractures. Seventeen patients met inclusion criteria for this study. Mean age was 46 years old. Most common etiology was motor vehicle. Early surgery was performed in 8 patients, and late surgery in 9 patients. The most common site of CSF leak was at ethmoid cells or at the fronto-ethmoid junction in 9 patients. Thirteen patients (76.4%) were treated only with endonasal endoscopic technique, and 4 (23.5%) with hybrid surgery, combining endonasal endoscopic and cranial bicoronal approaches with nasal and pericranial vascularized flaps, and nasal mucosal free flaps. Mean hospital stay was 23.7 days.The mean follow-up time was 25.6 months. When surgical reconstruction is indicated for CSF leaks secondary to skull base fractures, endonasal endoscopic techniques should be part of the surgical management either as a sole procedure, or in combination with classical transcranial approaches with high rates of success and low morbidity.

Endolymphatic Sac Surgery for Ménière's Disease - Current Opinion and Literature Review.

Introduction The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymph homeostasis for the inner ear, and its dysfunction may contribute to the pathophysiology of Ménière's disease. Throughout the years, different surgical procedures for intractable vertigo secondary to Ménière's disease have been described, and though many authors consider these procedures as effective, there are some who question its long-term efficacy and even those who think that vertigo control is achieved more due to a placebo effect than because of the procedure itself. Objective To review the different surgical procedures performed in the endolymphatic sac for the treatment of Ménière's disease. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis We focus on describing the different surgical procedures performed in the endolymphatic sac, such as endolymphatic sac decompression, endolymphatic sac enhancement, endolymphatic sac shunting and endolymphatic duct blockage, their pitfalls and advantages, their results in vertigo control and the complication rates. The senior author also describes his experience after 30 years of performing endolymphatic sac surgery. Conclusions The endolymphatic sac surgery, with all its variants, is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.

Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière's disease: a two-year prospective, placebo-controlled, double-blind, randomized trial.

OBJECTIVE: To investigate the efficacy of dexamethasone inner ear perfusion by intratympanic injection in hearing loss, tinnitus, aural fullness, and vertigo in the treatment of unilateral Ménière's disease and compare it with the control group. STUDY DESIGN AND SETTING: A prospective, randomized, double-blind study with 2-year follow-up comparing changes secondary to dexamethasone inner ear perfusion versus placebo consisting of saline solution. PATIENTS: Twenty-two patients having definite Ménière's disease as outlined by the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium. All the patients were older than 18 years of age and were not receiving any other form of treatment with steroids for their Ménière's disease. METHOD: Five consecutive daily intratympanic injections of dexamethasone or placebo to the involved ear. RESULTS: In the dexamethasone group at 2-year follow-up, complete control of vertigo (class A) was achieved in 9 of 11 patients (82%) and substantial control of vertigo (class B) in the remaining 2 patients (18%.) In the control group only 7 of 11 patients (64%) finished the 2-year follow-up because in the other 4 patients (36%) we had to give another treatment for the continuing vertigo and thus they were classified as failure (class F.) From the 7 patients who have finished the follow-up of 2 years in the control group, 4 patients (57%) achieved class A, 2 patients (29%) achieved class C, and 1 patient (14%) class F. CONCLUSIONS: Dexamethasone (4 mg/mL) inner ear perfusion in a group of patients with unilateral Ménière's disease (Shea's stage III) showed 82% of complete control of vertigo over placebo (57%). There was also a subjective improvement in tinnitus (48%), hearing loss (35%), and aural fullness (48%) in the dexamethasone group compared with 20%, 10%, and 20% respectively in the control group.

Tratamiento del acúfeno mediante instilación transtimpánica de lidocaina. Reporte preliminar / Treatment of acufens with lidocaine transtimpanic inyection preliminary report

Actualmente existe una amplia variedad de tratamientos para el acúfeno con resultados no concluyentes. Se ha reportado que la lidocaina aplicada en forma intravenosa puede reducir del 50 al 75 por ciento el acúfeno; sin embargo, las complicaciones por esta vía de administración limitan el uso de este tipo de tratamiento. En este trabajo se reporta la experiencia con la aplicación de lidocaína transtimpánica en 24 pacientes con acúfeno incapacitante, obteniendo mejoría en 75 por ciento de los casos. El evento adverso más frecuente fue el vértigo que siguió a su aplicación con una duración entre 4 a 6 horas. Los resultados concuerdan con los reportados en diversos artículos al aplicar lidocaina intravenosa, pero sin los riesgos que conlleva esta vía de administración.

Electrococleografía transoperatoria en cirugía de saco endolinfático / Intraoperative electrocochleography in endolumphatic sac surgery

Objetivos. Analizar los cambios en la relación potencial de suma-potencial de acción (PS/PA) en la Electrococleografía (EcoG) intraoperatoria a través de registros efectuados al descomprimir y abrir el saco endolinfático, tratar de identificar la posición del saco endolinfático en pacientes sometidos a cirugía de saco endolinfático con enfermedad de Meniére. Diseño. Prospectivo. longitudinal, comparativo, observacional. Material y métodos. En el periodo comprendido de Septiembre a Diciembre de 1998, en el servicio de Neurotología del Instituto Nacional de Neurología y Neurocirugía, se estudiaron 8 pacientes con diagnóstico de enfermedad de Meniére con falla a tratamiento médico, realizándoles audiometría, logoaudiometría, electronistagmografía y electrococleografía. Aceptaron se practicara cirugía de descompresión y apertura de saco endolinfático y 4 registros de electrococleografía transoperatoria. Resultados. La comparación de los valores obtenidos en el EcoG durante la descompresión y apertura del saco endolinfático mostró valores absolutos PS/PA, con una significancia del 99.9 por ciento, lo cual equivale a P. Los 8 (100 por ciento) pacientes mostraron disminución de la amplitud del PS en la EcoG intraoperatoria en algún momento del monitoreo. Todos los pacientes en su EcoG de control postquirúrgico mostraron una relación PS/PA a 30 por ciento, cuando en el registro prequirúrgico tenían registro a 35 por ciento. Conclusiones: Aunque nuestra muestra es pequeña, es significativa, ya que encontramos en el 100 por ciento de los pacientes disminución de la relación PS/PA en la EcoG intraoperatoria.