[Acoustic neuroma surgery. Results and complications in 348 cases]. / Le traitement chirurgical des schwannomes vestibulaires et ses conséquences. Etude rétrospective à propos de 348 cas.

OBJECTIVES: The aim of this study was to evaluate post-operative complications after acoustic neuroma surgery. METHODS: This was a retrospective study of 348 patients, who had acoustic neuroma surgery between 1984 and 1999. Symptoms, pre-operative evaluation, surgery and post-operative complications were analysed. RESULTS: 174 men and 174 women had an operation. Mean age was 51.8 years (11-78). 31 patients had a grade I tumour, 106 a grade II, 71 a grade III and 140 had a grade IV tumour. 195 patients have been operated through the translabyrinthine approach, 110 through the retrolabyrinthine approach, 42 through the sub-occipital approach, and one through the transcochlear approach. Mortality was 0.85%, 59.2% patients had a post-operative facial paralysis. Most of patients had post-operative dizziness, and 30% still had vestibular disturbances after one year. 9 patients (2.6%) had a cerebrospinal rhinorrhea and 24 patients had a cerebrospinal wound leak (6.9%). 22 patients had post-operative meningitis (6.3%). 2 patients had a cerebello pontine angle haemorrhage, and 3 patients had a brain stem infarct. CONCLUSION: Transpetrous approaches are safe for acoustic neuroma removal and the post-operative complication rate is low. The retrolabyrinthine approach seems to be a good hearing preservative approach, regardless of tumour volume.

A multicenter study of the Vibrant Soundbridge middle ear implant: early clinical results and experience.

OBJECTIVE: The Vibrant Soundbridge (VBS; Symphonix Devices, Inc., San Jose, CA, U.S.A.) is an active, semi-implantable, middle ear hearing device that directly drives the ossicular chain and is used in the treatment of patients with mild to severe sensorineural hearing loss. The benefits of the VBS and the effects of surgery were examined and compared with the preoperative aided condition in 25 patients with implants. STUDY DESIGN: Single-subject repeated-measures evaluations were performed with each patient acting as his or her own control. Objective audiologic measures and subjective questionnaires also were used. SETTING: Five tertiary referral and teaching hospitals. SUBJECTS: Adult patients had bilateral sensorineural hearing loss (average hearing loss, 56 dB; range, 33-80 dB). Twenty-one patients had worn a conventional hearing aid before surgery (11 binaurally, 10 monaurally). Four patients had not used a conventional hearing aid before surgery. INTERVENTION: Rehabilitative. RESULTS: No significant change in residual hearing after surgery was observed. Functional gain was significantly superior with the VBS. No significant differences were observed for aided speech recognition in quiet. A significant improvement in communication in various listening conditions was reported with the VBS as compared with conventional hearing aids. CONCLUSION: The VBS surgical implantation procedure does not affect the residual hearing level in the implanted ear, nor does it present any unacceptable risk. Measurable benefit from the VBS in comparison with conventional amplification was demonstrated with regard to the provision of superior usable amplification and greater ease in communication in daily listening environments for the majority of patients.

[Malignant melanoma of the nasosinal mucosa. Retrospective study apropos of 20 cases]. / Mélanomes malins des muqueuses naso-sinusiennes. Etude rétrospective à propos de 20 cas.

Twenty patients were treated for malignant melanoma (MM) of the mucosal surfaces of the nose and sinuses between 1987 and 1999 in our department. The mean age of these patients was 64 years, and there were 11 females and 9 males (sex ratio 1.2). Two patients had a past history of cutaneous or choroidal malignant melanoma, and were considered as having secondary melanoma. All patients presented with nasal obstruction and/or recurrent epistaxis. None of the patients with primary MM had either lymphadenopathy or distant metastases. 17 patients were treated surgically by the transfacial approach, aiming to obtain a cure. Radiotherapy and chemiotherapy were given only to the patients with secondary MM. Six patients have since presented with single or multiple local recurrence, and nine had distant metastases. The 3-year survival rate was 60%. This retrospective study has allowed us to compare the results of our series with these in the literature, and to review the treatment of this rare condition.