Hearing restoration in NF2 patients and patients with vestibular schwannoma in the only hearing ear: report of two cases.

OBJECTIVE: To explore audiologic outcome of auditory brain stem implantation (ABI) and cochlear implantation (CI) in NF2 patients and patients with vestibular schwannoma (VS) in the only hearing ear. PATIENTS AND METHODS: Study includes retrospective analysis of 2 cases. One is totally deaf patient due to NF2, and the other one is totally deaf due to VS development in only hearing ear. Tumor was removed by retrosigmoid approach in NF2 patient and ABI was performed simultaneously. For the VS in only hearing ear case, tumor was removed by translabyrinthine approach and CI was performed simultaneously. RESULTS: ABI patient showed quite well outcome during the 15 months of follow-up. She has 25 dB hearing threshold at speaking frequencies. She developed open set speech discrimination with 87.5% word discrimination score, and 70% sentence discrimination score. She uses device daily manner, she can use telephone. For CI patient, outcome is not perfect but satisfactory. She couldn't develop open set speech discrimination during the 18 months of follow-up. She has 67% the disyllabic words recognition score (close set). She is daily user of device. CI improves quite well lip reading. CONCLUSION: ABI and CI are the two options to restore hearing in VS caused deafness. We advocate giving every effort to preserve cochlear nerve during the VS resection and place CI simultaneously. However if it is not possible to preserve cochlear nerve during surgery, ABI is also a good alternative for hearing restoration.

Clinical outcome of surgically treated low-grade gliomas: a retrospective analysis of a single institute.

OBJECTIVE: Low grade gliomas (LGGs) are slow-growing primary brain tumors with heterogeneous clinical behaviors. The aim of our study is to review the treatment outcome of 63 patients with LGGs focusing on surgical outcome and the current therapeutic strategy. METHODS: We retrospectively enrolled 63 patients surgically treated for LGGs. The gross total resection (GTR) was performed in 35 patients (60.3%), subtotal resection (STR) was performed in 19 patients (31.7%) and partial resection (PR) or biopsy was performed in 9 patients (14.3%). We analyzed their progression-free survival (PFS), overall survival (OS), and malignant transformation with regard to age, gender, Karnofsky performance score (KPS), clinical presentation, tumor location, radiologic pattern, contrast enhancement, extent of removal, pathologic subtype, chemotherapy (CT) and radiotherapy (RT) treatment. RESULTS: Among all LGGs, the 3-year OS rate was 80% and the 5-year OS was 76%. The 3-year PFS rate was 83.6% and the 5-year PFS was 25%. The non-eloquent area location showed a longer PFS than the eloquent area location (p=0.05). Oligodendroglial pathology showed a longer PFS compared to oligoastrocytomas and astrocytomas (p=0.02). Patients older than 60 years had poorer OS than younger patients (p<0.05). Female gender had a shorter OS than male gender (p<0.05), and a KPS of 90 or 100 had a longer OS than a KPS of 80 (p<0.05). Oligodendroglial pathology statistically correlated with a longer OS (p<0.05). CONCLUSION: The findings from our study, which were confirmed by uni- and multivariate analyses, demonstrated that radical tumor resection was associated with better long-term outcomes and tumor progression for patients with LGG.

Paraganglioma in sella.

We report a very rare case of a paraganglioma arising from sellar and suprasellar region which has been treated with radiotherapy following multiple surgeries.