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1.
Laryngoscope ; 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32663339

RESUMO

OBJECTIVE: To report the outcomes on a large series of elderly patients who underwent cochlear implantation (CI) surgery under local anesthesia with conscious sedation (LA-CS). METHODS: Retrospective chart review on 100 consecutive elderly patients (> 65 years) who underwent CI with LA-CS at a tertiary care center between August 2013 and January 2020. An age-matched control group of 50 patients who underwent CI with general anesthesia (GA) are used for comparison. Outcomes measured included time in the operating room, time in the postanesthesia care unit (PACU), and rate of adverse events. RESULTS: Cochlear implant surgery under LA-CS was successfully performed in 99 (99%) patients. One patient requiring conversion to GA intraoperatively. No patients in the LA-CS group experienced cardiopulmonary adverse events; however, three patients (6%) in the GA group experienced minor events including atrial fibrillation and/or demand ischemia. Overnight observation in the hospital due to postoperative medical concerns or prolonged wake-up from anesthesia was required in one patient (1%) from the LA-CS cohort and 12 patients (24%) from the GA cohort. Perioperative adverse events exclusive to the LA-CS group included severe intraoperative vertigo (8%), temporary facial nerve paresis (3%), and wound infection (1%). The average amount of time spent in the operating room was 37 minutes less for procedures performed under LA-CS compared to GA (P < .05). The average amount of time in recovery was similar for both groups (P > .05). CONCLUSION: Cochlear implant surgery under LA-CS offers many benefits and is a safe, feasible, and cost-effective alternative to GA when performed by experienced CI surgeons. LEVEL OF EVIDENCE: 3 Laryngoscope, 2020.

3.
Otol Neurotol ; 41(6): 767-774, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32229760

RESUMO

OBJECTIVE: To evaluate the performance changes after sequential bilateral cochlear implantation in a pediatric population of bimodal cochlear implant (CI) users. To evaluate the factors which influence the parental and recipient decision to discontinue hearing aid use and seek a second implant. STUDY DESIGN: Retrospective case review, within-subject comparison. SETTING: Tertiary referral center. PATIENTS: Thirty-one pediatric (<18 yr) bimodal CI users who underwent sequential bilateral CI. INTERVENTIONS: Sequential bilateral CI. MAIN OUTCOME MEASURES: Parental and/or recipient's reasons for discontinuing their hearing aid and pursuing a second implant, device usage from datalogs, speech understanding in the bimodal and bilateral CI condition. RESULTS: Parents/patients were motivated to pursue sequential bilateral CI based on their positive performance with CI1, the expectation of further improvement with a second CI, and the prospect of having a second independently functional ear. In the bimodal condition, mean word recognition score (WRS), sentence recognition in quiet (SIQ), and sentence recognition in noise (SIN) scores were 87.4, 97.3, and 92.9% respectively. At 1-year post-sequential bilateral CI, the mean WRS, SIQ, and SIN score were 92.7, 98.7, and 97.7%, respectively. The improvement in bilateral CI speech scores compared with bimodal scores was statistically significant for WRS (p = 0.015). A ceiling effect limited the ability to detect further meaningful differences on speech perception testing. CONCLUSIONS: The bilateral CI condition demonstrates equivalent or slightly superior performance compared with the bimodal condition. Several non-speech benefits were elicited from parents as reasons for pursuing a second implant. Close monitoring of the residual acoustic hearing, inquiring about the perceived benefits provided by the HA, and early counseling regarding the potential for sequential bilateral CI are important aspects in determining if and when a second implant is indicated.

4.
Laryngoscope ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32065422

RESUMO

OBJECTIVE: To describe our experience with children undergoing unilateral cochlear implantation (CI) for treatment of single-sided deafness (SSD). STUDY DESIGN: Retrospective case series. METHODS: A retrospective case review from a tertiary referral center involving 14 pediatric patients (<18 years) with SSD who underwent unilateral CI. Speech perception testing in quiet and noise in the CI-only and bimodal conditions with at least 1 year of device use and device usage from data logs represent the main outcome measures. RESULTS: The mean age at CI was 5.0 years (median 4.4, range 1.0-11.8 years). The mean duration of deafness was 3.0 years (median 2.4, range 0.6-7.0 years). Mean follow-up was 3.4 years. Speech perception testing with a minimum of 1 year post-CI was available in eight patients. The mean word recognition scores (WRS) in the CI-only condition was 56%; a significant improvement from baseline. Testing in background noise with spatially separated speech and noise revealed that patients scored as well or better with the CI-on versus CI-off in all conditions and in no cases was interference from the CI noted. Data logs were reviewed for device usage which revealed an average use of 6.5 hr/d. CONCLUSION: Cochlear implantation is a viable treatment option for pediatric SSD in this self-selected cohort. Open-set speech and improvement in background noise can be achieved. Careful patient selection and thorough counseling on expectations is paramount to achieving successful outcomes. LEVEL OF EVIDENCE: IV Laryngoscope, 2020.

5.
Otolaryngol Clin North Am ; 53(1): 103-113, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31648821

RESUMO

Auditory brainstem implants (ABIs) stimulate the auditory system at the cochlear nucleus, bypassing the peripheral auditory system including the auditory nerve. They are used in patients who are not cochlear implant candidates. Current criteria for use in the United States are neurofibromatosis type 2 patients 12 years or older undergoing first- or second-side vestibular schwannoma removal. However, there are other nontumor conditions in which patients may benefit from an ABI, such as bilateral cochlear nerve aplasia and severe cochlear malformation not amendable to cochlear implantation. Recent experience with ABI in the pediatric population demonstrates good safety profile and encouraging results.


Assuntos
Implante Auditivo de Tronco Encefálico/métodos , Implantes Auditivos de Tronco Encefálico , Neoplasias da Orelha/cirurgia , Perda Auditiva/cirurgia , Neurofibromatose 2/cirurgia , Criança , Nervo Coclear , Humanos , Seleção de Pacientes , Percepção da Fala , Resultado do Tratamento
6.
Laryngoscope Investig Otolaryngol ; 4(3): 279-284, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31236459

RESUMO

Objective: The narrative operative report (NR) bears testimony to critical elements of patient care. Residents' NRs also provide insights into their comprehension of the procedure. NR documentation is an informal element of surgical residency training but data regarding quality of such training are scant. We aim to evaluate the NR within a residency training program. Methods: The quality of NRs for endoscopic sinus surgery (ESS) was evaluated through a retrospective analysis of 90 NRs for ESS. Thirty-four elements that the attending surgeon regards as "critical" variables, or quality indicators (QIs), that should be documented, were studied to evaluate quality. A "performance metric (PM)," defined as the average percent of QIs dictated/total word count, was determined. Subgroup analysis by the level of training was additionally performed. Results: Surgical indications, procedural steps, and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest proportion of included key elements (89% ± 6.2%) followed by junior residents (87% ± 5.7%) and then senior residents (80% ± 14%) (P = .008). The attending surgeon also demonstrated the highest PM, followed by senior and then junior residents (P < .0001). Conclusions: The quality of NRs was found to be high overall, but not "perfect" for either the attending or trainee surgeon. The PM among residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs. Level of Evidence: 3.

7.
J Neurol Surg B Skull Base ; 80(2): 169-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30931225

RESUMO

A cochlear implant (CI) is a surgically implanted device for the treatment of severe to profound sensorineural hearing loss in children and adults. It works by transducing acoustic energy into an electrical signal, which is used to stimulate surviving spiral ganglion cells of the auditory nerve. The past 2 decades have witnessed an exponential rise in the number of CI surgeries performed. Continual developments in programming strategies, device design, and minimally traumatic surgical technique have demonstrated the safety and efficacy of CI surgery. As a result, candidacy guidelines have expanded to include both pre and postlingually deaf children as young as 1 year of age, and those with greater degrees of residual hearing. A growing proportion of patients are undergoing CI for off-label or nontraditional indications including single-sided deafness, retrocochlear hearing loss, asymmetrical sensorineural hearing loss (SNHL) in adults and children with at least 1 ear that is better than performance cut-off for age, and children less than 12 months of age. Herein, we review CI design, clinical evaluation, indications, operative technique, and outcomes. We also discuss the expanding indications for CI surgery as it relates to lateral skull base pathology, comparing CI to auditory brainstem implants, and address the concerns with obtaining magnetic resonance imaging (MRI) in CI recipients.

8.
J Neurol Surg B Skull Base ; 80(2): 203-208, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30931229

RESUMO

An auditory brainstem implant (ABI) is a surgically implanted central neural auditory prosthesis for the treatment of profound sensorineural hearing loss in children and adults who are not cochlear implant candidates due to a lack of anatomically intact cochlear nerves or implantable cochleae. The device consists of a multielectrode surface array which is placed within the lateral recess of the fourth ventricle along the brainstem and directly stimulates the cochlear nucleus, thereby bypassing the peripheral auditory system. In the United States, candidacy criteria for ABI include deaf patients with neurofibromatosis type 2 (NF2) who are 12 years or older undergoing first- or second-side vestibular schwannoma resection. In recent years, several non-NF2 indications for ABI have been explored, including bilateral cochlear nerve avulsion from trauma, complete ossification of the cochlea due to meningitis, or a severe cochlear malformation not amenable to cochlear implantation. In addition, growing experience with ABI in infants and children has been documented with encouraging outcomes. While cochlear implantation generally remains the first-line option for hearing rehabilitation in NF2 patients with stable tumors or post hearing preservation surgery where hearing is lost but a cochlear nerve remains accessible for stimulation, an ABI is the next alternative in cases where the cochlear nerve is absent and/or if the cochlea cannot be implanted. Herein, we review ABI device design, clinical evaluation, indications, operative technique, and outcomes as it relates to lateral skull base pathology.

9.
Laryngoscope ; 129(10): 2420-2423, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30588640

RESUMO

Upper airway stimulation is now a well-established treatment option for selected patients with obstructive sleep apnea. The implanted pulse generator of this system activates the hypoglossal nerve and is routinely placed in a subcutaneous pocket overlying the pectoralis muscle. This case report describes a patient with a history of bilateral mastectomy and radiation for breast cancer who required explantation due to device exposure and infection. The patient was successfully reimplanted by placing the implantable pulse generator deep to the pectoralis major muscle. Clinical circumstances involving the chest wall may warrant subpectoral placement of the implanted pulse generator. Laryngoscope, 129:2420-2423, 2019.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Mastectomia/efeitos adversos , Implantação de Prótese/efeitos adversos , Reoperação/métodos , Apneia Obstrutiva do Sono/cirurgia , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Feminino , Humanos , Nervo Hipoglosso/cirurgia , Músculos Peitorais/cirurgia , Apneia Obstrutiva do Sono/complicações
10.
Otol Neurotol ; 39(9): e872-e875, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30080763

RESUMO

OBJECTIVE: Evaluate prevalence and pattern of occipital pneumatization (OP). PATIENTS: Individuals with imaging evidence of OP on computed tomography (CT). INTERVENTION(S): High resolution CT scans of the temporal bone. MAIN OUTCOME MEASURE: The prevalence and pattern of OP on 1000 CT scans performed at a large academic healthcare system. RESULTS: OP had a prevalence of 11.8% (n = 118) while occipital condyle pneumatization occurred in only 0.3%. Occipital air cells were right-sided in 27.1% (n = 32), left-sided in 51.7% (n = 61), and bilateral in 21.2% (n = 25), and OP was contiguous with the occipitomastoid suture. In cases of unilateral OP, the contralateral jugular foramen demonstrated relative enlargement (p = 0.006), but a direct association could not be established. CONCLUSIONS: The occipital bone is an accessory site of skull base pneumatization in 11.8% of the population undergoing temporal bone CT, while air cell extension into the occipital condyle occurs more rarely. These occipital air cells have a left-sided predilection and are always in direct proximity to the occipitomastoid suture, suggesting developmental egress from the mastoid. OP is a normal variant and lacks features of craniocervical pneumatization, which is a rare disorder.


Assuntos
Doenças Ósseas/epidemiologia , Osso Occipital/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Doenças Ósseas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
11.
J Neurosurg Pediatr ; 22(3): 283-287, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29905497

RESUMO

Epstein-Barr virus-associated smooth-muscle tumors are rare tumors seen in immunocompromised patients. Most cases occur in the context of AIDS and organ transplantation, and very rarely in the setting of congenital immunodeficiency, with only 5 case reports of the latter published so far in the literature. The authors report the case of a previously healthy 8-year-old girl with headaches and precocious puberty who was found to have a large skull base lesion. There was a synchronous left adrenal lesion. She underwent resection of the skull base lesion and a left adrenalectomy. Thorough evaluation for immunodeficiency was negative for a known congenital immunodeficiency syndrome. She had a short course of intravenous immunoglobulin and has had no recurrence of disease or new lesions in the 17 months since presentation. Continued surveillance for the development of opportunistic infections and new or recurrent lesions is warranted in this case. Repeat surgery for surgically accessible tumors or chemoradiation would be recommended for any additional lesions.


Assuntos
Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4/patogenicidade , Base do Crânio/patologia , Base do Crânio/virologia , Tumor de Músculo Liso/complicações , Tumor de Músculo Liso/virologia , Antígenos CD/metabolismo , Proteínas Sanguíneas/metabolismo , Criança , Infecções por Vírus Epstein-Barr/diagnóstico por imagem , Infecções por Vírus Epstein-Barr/cirurgia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Tumor de Músculo Liso/diagnóstico por imagem , Tumor de Músculo Liso/cirurgia , Tomógrafos Computadorizados , Proteínas da Matriz Viral/metabolismo
13.
Otol Neurotol ; 38(7): 948-955, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28604576

RESUMO

OBJECTIVES: To compare the diagnostic yield of high-resolution volumetric T2-weighted MRI (HRT2-MRI) with high-resolution computed tomography (HRCT) for diagnosis of large vestibular aqueduct (LVA). STUDY DESIGN: Three board-certified neuroradiologists performed an independent, blinded radiological review for diagnosing LVA with 2:1 age-matched controls on patients with both HRCT and HRT2-MRI imaging. SETTING: Tertiary referral center. PATIENTS: All patients between 2002 and 2016 with hearing loss who underwent both HRCT and HRT2-MRI and were diagnosed with LVA on either modality. MAIN OUTCOME MEASURES: Concordance rate for LVA between HRCT and HRT2-MRI. RESULTS: Concordance rate for HRCT and HRT2-MRI for diagnosing LVA was 88% (124/141) when assessing both the midpoint and external aperture diameters. Fifteen ears had LVA on computed tomography (CT), but not on magnetic resonance imaging (MRI); in comparison, two ears had LVA on MRI, but not on CT (p = 0.002). Excellent inter-rater reliability among the three radiologists was demonstrated. CONCLUSION: Historically, HRCT has been the imaging modality of choice for diagnosing LVA. Although a higher concordance rate of HRT2-MRI was found compared with previous studies utilizing earlier MRI technology, HRCT still detected a larger number of patients with clinically significant hearing loss compared with MRI. Given the high concordance rate and efficacy of both modalities in diagnosing LVA, the ultimate decision of which modality to choose may depend on other patient-specific and clinical factors.


Assuntos
Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Aqueduto Vestibular/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Perda Auditiva/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Aqueduto Vestibular/anormalidades , Adulto Jovem
14.
Otol Neurotol ; 38(6): 907-915, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28498272

RESUMO

OBJECTIVES: To report a contemporary review from a single-institution series on Paget's disease of the temporal bone (PDTB). STUDY DESIGN: Retrospective chart review of patients evaluated from 1998 to 2016. SETTING: Quaternary referral center. PATIENTS: Patients with radiographically confirmed PDTB. MAIN OUTCOME MEASURES: Clinical, audiological, and radiological features and management strategies of PDTB. RESULTS: A total of 50 temporal bones in 27 patients (15 men) were diagnosed with PDTB. Symptoms at presentation included hearing loss (n = 23, 85%), headache (n = 18, 67%), dizziness (n = 14, 52%), tinnitus (n = 5, 19%), chronic otitis media (n = 2, 7%), hemifacial spasm without facial paralysis (n = 1, 4%), multiple cranial neuropathies (n = 1, 4%), and neoplastic transformation (n = 1, 4%). Of the 23 ears with audiometric data available for review, 65% exhibited sensorineural hearing loss, and 35% mixed hearing loss. Long-term audiometric follow-up was available on two patients, both of whom demonstrated hearing loss at a rate greater than would be expected for normal aging. Two patients underwent successful cochlear implantation, achieving open-set speech recognition. Radiographic features of temporal bone involvement are reviewed and illustrated. CONCLUSION: This is the largest single-institution clinical series examining patients with PDTB in the English literature. Variable patterns of temporal bone involvement by Paget's disease are observed leading to a diverse set of clinical symptoms, including slowly progressive hearing loss, tinnitus, compressive cranial neuropathies, and benign or malignant tumorigenesis. Involvement typically begins in the petrous apex and progresses laterally. Otic capsule bone demineralization occurs late in the disease process. Cochlear implantation appears to be an effective management strategy for patients with severe-to-profound hearing loss.


Assuntos
Osteíte Deformante , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteíte Deformante/complicações , Osteíte Deformante/patologia , Osteíte Deformante/terapia , Estudos Retrospectivos
15.
Am J Otolaryngol ; 38(3): 309-315, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28258767

RESUMO

BACKGROUND: Primary melanoma of the external ear (PMEE) is rare and therefore well-suited for large population-based registry analysis. The objective of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) set of cancer registries to determine the incidence, treatment, and survival characteristics of PMEE. METHODS: A retrospective cohort analysis of SEER data from 2004 to 2013 identified all cases of PMEE stage I-IV by AJCC 7th edition guidelines. Population-based incidence was calculated. Cancer-specific survival data by stage was assessed using Kaplan-Meier analysis and the relative effects of tumor characteristics were analyzed with Cox regression models. RESULTS: A total of 5481 patients were analyzed (mean age 66.7years, 86.5% male, 93.6% non-Hispanic white). The incidence of PMEE was 1.91 per 100,000 persons-per-year. At diagnosis, 68.1% were stage I, 15.2% were stage II, 4.7% were stage III, 1.5% were stage IV, and 10.8% were unknown. The five-year overall and cancer-specific survival was 78.8% and 90.0%, and, according to AJCC stage, was 85.7% and 95.3% for stage I (n=2287), 64.6% and 81.1% for stage II (n=453), 50.8% and 57.0% for stage III (n=154), 17.2% and 20.5% for stage IV (n=34), and 71.0% and 87.1% for unknown stage (n=330), respectively. The multivariable Cox model identified tumor characteristics that were independently associated with survival. CONCLUSIONS: This is the first study to characterize the epidemiology, presentation and outcome of PMEE using the SEER registries. Older age, increasing Breslow thickness, stage, presence of ulceration, positive lymph nodes and distant metastasis each independently predicted time to cancer-specific death.


Assuntos
Orelha Externa , Melanoma/epidemiologia , Vigilância da População/métodos , Sistema de Registros , Programa de SEER , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
16.
Cochlear Implants Int ; 18(4): 226-229, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28235385

RESUMO

OBJECTIVES: To determine whether the cochlea basal diameter (A value) measurement can be consistently and precisely obtained from high-resolution temporal bone imaging for use in cochlear length estimation. METHODS: A feasibility study at a tertiary referral center was performed using the temporal bone CTs of 40 consecutive patients. The distance from the round window to the lateral wall was measured for each cochlea by two independent reviewers, a neuroradiologist and an otolaryngologist. The interrater reliability was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. RESULTS: Forty patients (19 males, 21 females) for a total of 80 cochleae were included. Interrater reliability on the same ear had a high level of agreement by both the ICC and the Bland-Altman plot. ICCs were 0.90 (95% CI: 0.82, 0.94) for the left ear and 0.96 (95% CI: 0.92, 0.98) for the right ear. Bland-Altman plot confirmed interrater reliability with all 96% of measurements falling within the 95% limits of agreement. CONCLUSIONS: Measurement between the round window and lateral cochlear wall can be consistently and reliably obtained from high-resolution temporal bone CT scans. Thus, it is feasible to utilize this method to estimate the cochlear length of patients undergoing cochlear implantation.


Assuntos
Cóclea/diagnóstico por imagem , Janela da Cóclea/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Cóclea/anatomia & histologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Janela da Cóclea/anatomia & histologia , Osso Temporal/anatomia & histologia
17.
Otol Neurotol ; 38(3): e8-e12, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27898606

RESUMO

OBJECTIVE: To present an unusual case of a temporal bone meningioma with intrafascicular spread throughout the temporal facial nerve from cerebellopontine angle (CPA) to stylomastoid foramen. PATIENT: Four-year-old female with progressive facial weakness and normal hearing. MAIN OUTCOME MEASURE: Clinical, radiological, and histopathological findings of temporal bone meningiomas. RESULTS: A patient presented with progressive facial weakness and normal hearing. Imaging demonstrated a mass within the left internal auditory canal radiologically consistent with a schwannoma. Asymmetric enlargement with enhancement of the left facial nerve from CPA to the stylomastoid foramen suggested facial schwannoma. At surgery, gross tumor was noted in the internal auditory canal, the fallopian canal seemed expanded and the facial nerve was enlarged and had an irregular contour. Resection of the facial nerve from the CPA to just proximal to its exit at the stylomastoid foramen was necessary to achieve negative margins. Cable grafting was performed. The histopathologic diagnosis was transitional meningioma with intraneural growth throughout the length of the resected facial nerve segment. CONCLUSION: Meningiomas involving the temporal bone are exceedingly rare. We report a rare case of a child presenting with progressive facial weakness due to a presumed facial schwannoma spreading along the facial nerve throughout its intratemporal course that at surgery was found to be an intrafascicular CN VII meningioma.


Assuntos
Neoplasias dos Nervos Cranianos/complicações , Doenças do Nervo Facial/complicações , Nervo Facial/patologia , Paralisia Facial/etiologia , Neurilemoma/complicações , Osso Temporal/patologia , Ângulo Cerebelopontino/patologia , Pré-Escolar , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Nervo Facial/cirurgia , Doenças do Nervo Facial/patologia , Doenças do Nervo Facial/cirurgia , Paralisia Facial/patologia , Paralisia Facial/cirurgia , Feminino , Humanos , Neurilemoma/patologia , Osso Temporal/cirurgia , Resultado do Tratamento
18.
Laryngoscope ; 127(3): 715-719, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27320780

RESUMO

OBJECTIVES/HYPOTHESIS: To report two patients with a history of microvascular decompression (MVD) for hemifacial spasm who presented with Teflon granulomas (TG) mimicking cerebellopontine angle (CPA) tumors and to perform a systematic review of the English-language literature. STUDY DESIGN: Case series at a single tertiary academic referral center and systematic review. METHODS: Retrospective chart review with analysis of clinical, radiological, and histopathological findings. Systematic review using PubMed, Embase, MEDLINE, and Web of Science databases. RESULTS: Two patients with large skull base TGs mimicking CPA tumors clinically and radiographically were managed at the authors' institution. The first presented 4 years after MVD with asymmetrical sensorineural hearing loss, multiple progressive cranial neuropathies, and brainstem edema due to a growing TG. Reoperation with resection of the granuloma confirmed a foreign-body reaction consisting of multinucleated giant cells containing intracytoplasmic Teflon particles. The second patient presented 11 years after MVD with asymmetrical sensorineural hearing loss and recurrent hemifacial spasm. No growth was noted over 2 years, and the patient has been managed expectantly. Only one prior case of TG after MVD for hemifacial spasm has been reported in the English literature. CONCLUSIONS: TG is a rare complication of MVD for hemifacial spasm. The diagnosis should be suspected in patients presenting with a new-onset enhancing mass of the CPA after MVD, even when performed decades earlier. A thorough clinical and surgical history is critical toward establishing an accurate diagnosis to guide management and prevent unnecessary morbidity. Surgical intervention is not required unless progressive neurologic complications ensue. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:715-719, 2017.


Assuntos
Neoplasias Cerebelares/diagnóstico , Granuloma de Corpo Estranho/diagnóstico , Espasmo Hemifacial/cirurgia , Cirurgia de Descompressão Microvascular/efeitos adversos , Politetrafluoretileno/efeitos adversos , Centros Médicos Acadêmicos , Adulto , Biópsia por Agulha , Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino/cirurgia , Diagnóstico Diferencial , Feminino , Seguimentos , Granuloma de Corpo Estranho/etiologia , Granuloma de Corpo Estranho/cirurgia , Espasmo Hemifacial/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Masculino , Cirurgia de Descompressão Microvascular/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Estudos Retrospectivos , Amostragem , Resultado do Tratamento
19.
Otol Neurotol ; 38(2): 283-289, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27832008

RESUMO

HYPOTHESIS: Endoscopically assisted packing of the Eustachian tube (ET) will improve visualization of the protympanic space compared with standard techniques with the microscope. BACKGROUND: Postoperative cerebrospinal fluid (CSF) leakage after translabyrinthine tumor resection remains a problem. Current techniques of packing the ET are limited by inadequate visualization. The objective of this study is to demonstrate the feasibility and usefulness of transmastoid endoscopic-assisted ET packing during translabyrinthine tumor resection. METHODS: Eight human cadaveric temporal bone dissections were performed on four heads to test the visualization that could be obtained of the ET orifice with an endoscope via transmastoid-facial recess approach. The incus body and incus buttress were removed, the aditus ad antrum enlarged, and tensor tympani muscle was cut. The scope was placed where the incus buttress had previously resided. The ET orifice was visualized and subsequently packed. RESULTS: In all eight temporal bones, the endoscope was successfully able to visualize the ET orifice, with improved visualization of the orifice compared with standard techniques. Surgical technique and potential pitfalls are discussed. CONCLUSIONS: The transmastoid endoscopic approach for packing the ET improves visualization of the ET orifice. Packing under direct visualization provided greater reassurance that the material entered the true ET lumen as opposed to a false passage. The technique can be performed without any significant changes to standard surgical technique, allowing for a fast and accurate closure of the ET orifice and has application in potentially decreasing postoperative CSF leak rates.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/prevenção & controle , Endoscopia/métodos , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/métodos , Cadáver , Tuba Auditiva/cirurgia , Estudos de Viabilidade , Humanos , Neuroma Acústico/cirurgia , Osso Temporal
20.
Laryngoscope ; 127(8): 1916-1919, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-27726152

RESUMO

Pantopaque (iophendylate) is an oily contrast medium historically used during spine imaging. Due to its persistence in the subarachnoid space and the potential to lead to severe arachnoiditis, it is no longer used today. We present a 40-year-old male with new-onset headaches, imbalance, and vertigo. Brain magnetic resonance imaging revealed a 2-mm T1 -hyperintense intracanalicular lesion. Numerous hyperdense foci were scattered throughout the subarachnoid space on computed tomography. Further history revealed the patient received Pantopaque 30 years prior, after sustaining spinal trauma. Remnant Pantopaque contrast is an important differential when evaluating a patient with a suspected intracranial tumor in order to avoid unwarranted surgical intervention. Laryngoscope, 127:1916-1919, 2017.


Assuntos
Ângulo Cerebelopontino/diagnóstico por imagem , Ângulo Cerebelopontino/metabolismo , Meios de Contraste/efeitos adversos , Meios de Contraste/metabolismo , Orelha Interna/diagnóstico por imagem , Orelha Interna/metabolismo , Iodofendilato/efeitos adversos , Iodofendilato/metabolismo , Imagem por Ressonância Magnética , Neuroma Acústico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Fatores de Tempo
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