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1.
Otol Neurotol ; 41(6): e759-e762, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32271262

RESUMO

OBJECTIVE: To report and discuss the effectiveness of stereotactic radiosurgery (SRS) or fractionated radiotherapy (FRT) for tumor control following surgical resection of endolymphatic sac tumors (ELST). STUDY DESIGN: Retrospective case series. SETTING: Multi-institutional academic referral centers. PATIENTS: Patients undergoing surgical resection for ELST followed by SRS or FRT. INTERVENTION(S): Surgical resection followed by radiotherapy. MAIN OUTCOME MEASURES: Local tumor control. RESULTS: Two of the five patients experienced tumor recurrence after gross total microsurgical at 78 and 11 months, respectively. The former patient received salvage 3D conformal radiotherapy (3D-CRT) and while the latter patient underwent three courses of salvage SRS for recurrence, two of which were in-field and was disease-free at last follow up. Two additional patients underwent subtotal tumor resection (STR) followed by intensity-modulated radiation therapy (IMRT) and are currently without disease. One patient underwent STR followed by proton-beam therapy (PBT) and was free of disease at most recent follow-up. CONCLUSION: SRS/FRT remains a useful adjuvant for treatment of residual or recurrent ELSTs, where the risk of revision microsurgical resection is high.

2.
Otolaryngol Head Neck Surg ; 162(6): 942-949, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32204657

RESUMO

OBJECTIVE: To investigate audiometric outcomes and incidence of chronic ear disease following lateral skull base repair (LSBR) of cerebrospinal fluid (CSF) leaks. STUDY DESIGN: Retrospective review. SETTING: Tertiary skull base center. SUBJECTS AND METHODS: Consecutive adults undergoing LSBR of CSF leaks between 2012 and 2018 were reviewed. Audiometric data included mean air conduction pure-tone average (PTA), air-bone gap (ABG), speech recognition threshold (SRT), and word recognition score (WRS). The incidence and management of the following were collected: effusion, retraction, otitis media and externa, perforation, and cholesteatoma. RESULTS: Seventy-three patients underwent transmastoid (n = 5), middle cranial fossa (n = 2), or combined approach (n = 67) for repair of spontaneous leaks (sCSFLs, n = 41) and those occurring in the setting of chronic ear disease (ceCSFLs, n = 32). ABG decreased 7.23 dB (P = .01) in sCSFL patients. Perforations (P = .01) were more likely in ceCSFL. No sCSFL patient developed a cholesteatoma, perforation, or infection. Effusions (n = 7) were transient, and retractions (n = 2) were managed conservatively in the sCSFL cohort. Eight ceCSFL patients required tubes, 3 underwent tympanoplasties with (n = 2) and without (n = 1) ossicular chain reconstruction (OCR), and 1 had tympanomastoidectomy with OCR. CONCLUSION: Lateral skull base repair of CSF leaks maintained or improved hearing. Patients with preexisting chronic ear disease were more likely to require additional intervention to sustain adequate middle ear aeration compared to the sCSFL cohort. LSBR of sCSFL does not appear to increase risk for developing chronic ear disease.

3.
Otol Neurotol ; 41(2): e262-e267, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31789797

RESUMO

OBJECTIVE: Accurate volume assessment is essential for the management of vestibular schwannoma after stereotactic radiosurgery (SRS). A cuboidal approximation for volume is the standard surveillance method; however, this may overestimate tumor volume. We sought to evaluate several volumetric models and their suitability for post-SRS surveillance. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: We evaluated 54 patients with vestibular schwannoma before and after SRS. INTERVENTION(S): Gold-standard volumes were obtained by a radiation oncologist using contouring software. Volume was also calculated by cuboidal, ellipsoidal, and spherical formulae using tumor diameters obtained by a neuroradiologist. MAIN OUTCOME MEASURE(S): Percent error (PE) and absolute percent error (APE) were calculated. Paired t test evaluated bias, and the Bland-Altman method evaluated reproducibility. Linear regression evaluated predictors of model error. RESULTS: All models overestimated volume compared with the gold standard. The cuboidal model was not reproducible before SRS (p < 0.001), and no model was reproducible after SRS (cuboidal p < 0.001; ellipsoidal p = 0.02; spherical p = 0.02). Significant bias was present before SRS for the cuboidal model (p < 0.001), and post-SRS for all models [cuboidal (p < 0.001), ellipsoidal (p < 0.02), and spherical (p = 0.005)]. Model error was negatively associated with pretreatment volume for the cuboidal (PE p = 0.03; APE p = 0.03), ellipsoidal (PE p = 0.03; APE p = 0.04), and spherical (PE p = 0.02; APE p = 0.03) methods and lost linearity post-SRS. CONCLUSIONS: The standard cuboidal practice for following vestibular schwannoma tumor volume after SRS overestimates size. Ellipsoidal and spherical estimations have improved performance but also overestimate volume and lack reliability post-SRS. The development of other volumetric models or application of contouring software should be investigated.

4.
Laryngoscope ; 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31774936

RESUMO

OBJECTIVE: To investigate the prevalence and impact of obstructive sleep apnea (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of various etiologies. METHODS: Retrospective case review at a tertiary skull base center was conducted of consecutive adults undergoing LSBR via transmastoid, middle cranial fossa, or combined approach between 2013-2018. The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma or chronic ear disease were excluded. RESULTS: Ninety-four patients (67.4% female, mean age 53.5 ± 12.9 years) underwent repair for spontaneous (sCSFL, 44%) and other etiology (nsCSFL) leaks. nsCSFL served as a comparison group consisting of leaks status-post lateral skull base surgery, temporal bone fractures, and chronic ear disease. Class III obesity (P = .02), OSA (P = .03), and imaging findings of empty sella (OR = 3.32, P = .02), and skull base thinning including contralateral tegmen thinning (31%, OR = 4.3, P = .02), arachnoid granulations (26%, OR = 4.35, P = .02), and superior canal dehiscence (15.8%, OR = 8.57, P = .04) were more common in sCSFL. Four patients (4.2%) required surgical revision for recurrence, and another four (4.2%) resolved with shunting. Evidence of elevated intracranial hypertension was present in nine patients with sCSF leaks and was predictive of need for revision or shunt procedures (P < .01). CONCLUSION: Obesity, OSA, and imaging consistent with elevated intracranial pressures were more common among patients with sCSFL. Elevated intracranial pressure predicted outcomes following multilayer repair of spontaneous CSF leaks LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

6.
Otolaryngol Head Neck Surg ; 160(3): 480-487, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30105922

RESUMO

OBJECTIVES: We investigated the prevalence and impact of sarcopenia on disease-free survival (DFS) and overall survival (OS) in advanced oropharyngeal cancer. STUDY DESIGN: Retrospective study. SETTING: Single-institution tertiary cancer care center. SUBJECTS AND METHODS: We identified patients with advanced oropharyngeal cancer with pretreatment positron emission tomography-computed tomography scans for image analysis. Data were collected on the following variables: age, sex, smoking and alcohol status, stage (TNM and American Joint Committee on Cancer), human papillomavirus (HPV) status, body mass index (BMI), and treatment modality. RESULTS: Of 113 patients identified with oropharyngeal cancer, 32 had sarcopenia: these patients were older (63.5 vs 57.6 years, P = .01), were less likely to be male (53.1% vs 76.5%, P = .03), and had a lower mean BMI (24.5 vs 28.4 kg/m2, P = .009). Eighty-five subjects had HPV-positive disease, and they had a higher BMI (28.2 vs 24.2 kg/m2, P = .01) than that of patients without HPV. Twenty-one subjects who were HPV positive had less cancer recurrence (24.7% vs 48.1%, P = .04) than that of their HPV-negative counterparts. Log-rank testing showed no difference in DFS ( P = .06) associated with sarcopenia but a significant difference in OS ( P = .049). There were differences in DFS ( P = .009) and OS ( P = .023) based on HPV status. According to univariable and multivariable models, HPV positivity exhibited improved DFS and OS. Sarcopenia was not statistically significant in survival models; however, it was associated with increased mortality and recurrence. CONCLUSION: Sarcopenia is a prognostic factor affecting OS independent of HPV status in advanced oropharyngeal cancer.


Assuntos
Carcinoma de Células Escamosas/complicações , Neoplasias Orofaríngeas/complicações , Sarcopenia/epidemiologia , Idoso , Índice de Massa Corporal , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/patologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prevalência , Estudos Retrospectivos , Sarcopenia/diagnóstico , Taxa de Sobrevida
8.
Front Physiol ; 9: 724, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30140230

RESUMO

Electrical stimulation of the central and peripheral nervous systems - such as deep brain stimulation, spinal cord stimulation, and epidural cortical stimulation are common therapeutic options increasingly used to treat a large variety of neurological and psychiatric conditions. Despite their remarkable success, there are limitations which if overcome, could enhance outcomes and potentially reduce common side-effects. Micromagnetic stimulation (µMS) was introduced to address some of these limitations. One of the most remarkable properties is that µMS is theoretically capable of activating neurons with specific axonal orientations. Here, we used computational electromagnetic models of the µMS coils adjacent to neuronal tissue combined with axon cable models to investigate µMS orientation-specific properties. We found a 20-fold reduction in the stimulation threshold of the preferred axonal orientation compared to the orthogonal direction. We also studied the directional specificity of µMS coils by recording the responses evoked in the inferior colliculus of rodents when a pulsed magnetic stimulus was applied to the surface of the dorsal cochlear nucleus. The results confirmed that the neuronal responses were highly sensitive to changes in the µMS coil orientation. Accordingly, our results suggest that µMS has the potential of stimulating target nuclei in the brain without affecting the surrounding white matter tracts.

9.
Am J Otolaryngol ; 39(6): 657-663, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30153950

RESUMO

PURPOSE: The purpose of this work is to explore audiometry following cochlear implantation (CI) in patients with enlarged vestibular aqueduct (EVA) and to investigate the effects of inner ear morphological variation on post CI audiometry. METHODS: This was a retrospective review of both natural and cochlear-implant-aided audiometry results, using all available measurements in a mixed-effects model accounting for longitudinal change and the grouping structure of ears. Patients who visited our tertiary academic medical center between 2000 and 2016 were identified as having EVA according to Cincinnati criteria on radiological examination; patients eligible for CI were then selected for analysis. RESULTS: Multivariable modeling showed a statistically significant hearing improvement in ears with EVA undergoing CI with regards to pure tone average (-64.0 dB, p < 0.0001), speech reception threshold (-57.90 dB, p < 0.0001), and word score (34.8%, p > 0.0001). Vestibular aqueduct midpoint size and the presence of incomplete partition type II (IP II) did not have significant independent associations with audiometric findings. However, multivariable modeling revealed a statistically significant interaction between IP II and CI such that IP II ears demonstrated a decrease in WS improvement of 30.2% (p = 0.0059) compared to non-IP II ears receiving CI. CONCLUSION: There is a statistically significant audiometric benefit to ears with EVA receiving CI. Morphology, specifically the presence of IP II, may hinder CI benefit in terms of word score however this finding needs clinical validation. This data improves personalization of surgical counseling and planning for patients with EVA considering CI.


Assuntos
Implante Coclear , Perda Auditiva Neurossensorial/patologia , Perda Auditiva Neurossensorial/terapia , Aqueduto Vestibular/anormalidades , Audiometria de Tons Puros , Limiar Auditivo , Pré-Escolar , Implantes Cocleares , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Humanos , Lactente , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Aqueduto Vestibular/diagnóstico por imagem , Aqueduto Vestibular/patologia
10.
Oral Oncol ; 78: 194-199, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29496050

RESUMO

OBJECTIVES: The submental artery island flap (SIF) has recently been described in temporal bone defects. At our institution we have broadened the application of the SIF and modified the harvest technique for complex lateral facial and skull base defects. Our primary aim is to evaluate the outcomes of patients undergoing complex lateral facial soft tissue, parotidectomy, and temporal bone defects who are reconstructed with the SIF to a similar cohort undergoing free tissue transfer reconstruction. MATERIALS AND METHODS: Nineteen patients undergoing SIF and 54 patients undergoing free tissue flaps for oncologic lateral facial, parotidectomy and temporal bone defects were retrospectively identified. Comparative statistics were used to analyze variables between the two cohorts, specifically operative time, flap size, length of stay, regional recurrence, disease free survival, and overall survival. RESULTS: No significant difference in demographic and disease related variables was observed. Operative time was significantly lower in SIF group with mean of 412.9 (SD 93.4) minutes compared to 544.1 (SD 139.9) minutes in free flap group. Flap size was significantly larger in free tissue transfer, 32.4 (SD 17.5) cm2 (SIF) compared to mean area of 105.2 (SD 53.2) cm2 (Free tissue transfer). A significant difference in length of stay was also noted between groups. There was no regional recurrence of disease in level I-III in SIF group. There was no significant difference in DFS or OS between the two groups. CONCLUSION: SIF is an oncologically sound option for reconstruction of lateral facial soft tissue, parotidectomy, and temporal bone defects.


Assuntos
Face/cirurgia , Retalhos de Tecido Biológico , Glândula Parótida/cirurgia , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Am J Otolaryngol ; 38(4): 496-497, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28483147

RESUMO

BACKGROUND: Primary hyperparathyroidism (PHPT) is a frequently encountered endocrine disorder due to benign neoplastic lesions or gland hyperplasia. It is often discovered incidentally when routine lab work reveals hypercalcemia. METHODS: This case presents a 55-year-old male with a neck mass and electrolyte irregularities consistent with PHPT. However, his laboratory values suddenly normalized prior to surgery. RESULTS: Post-operative pathologic analysis of the specimen demonstrated massive infarction of the affected gland, and explained the spontaneous resolution of the patient's electrolyte derangements. CONCLUSIONS: The objective of this case study is to demonstrate the importance of further investigation in patients with fluctuating lab values and emphasize the potential dangers of gland infarction.


Assuntos
Hipercalcemia/etiologia , Hiperparatireoidismo Primário/etiologia , Infarto/complicações , Infarto/diagnóstico , Glândulas Paratireoides/irrigação sanguínea , Humanos , Hipercalcemia/patologia , Hiperparatireoidismo Primário/patologia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Remissão Espontânea
12.
Am J Otolaryngol ; 38(3): 285-290, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28214024

RESUMO

OBJECTIVES: To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration. STUDY DESIGN: Retrospective case series and patient survey. SETTING: Tertiary university hospital. PATIENTS: Meniere's disease (MD) patients that failed medical therapy and subsequently underwent an endolymphatic sac shunt procedure. All patients had definitive or probable MD and at least 18-months of follow-up. INTERVENTIONS: Three variations on endolymphatic sac decompression with shunt placement were performed: Group A received no local steroids, Group B received intratympanic dexamethasone prior to incision, and Group C received dexamethasone via both intratympanic injection and direct endolymphatic sac instillation. MAIN OUTCOME MEASURE(S): Vertigo control, hearing results, and survey responses. RESULTS: Between 2002 and 2013, 124 patients with MD underwent endolymphatic sac decompression with shunt placement. 53 patients met inclusion criteria. Groups A, B, and C had 6 patients, 20 patients, and 27 patients, respectively. Mean follow-up was 56months. Vertigo control improved in 66%, 83%, and 93% of Groups A, B, and C. Functional level improved for Group B (-2.0) and Group C (-2.2) but was unchanged in Group A. Pure-tone average and speech discrimination scores changed by +22dB and -30%, +6dB and -13%, and +6dB and -5% in Groups A, B, and C. The long-term hearing results were significantly better with steroids (Groups B and C) according to the AAO-HNS 1995 criteria but did not meet significance on non-parametric testing. CONCLUSIONS: Endolymphatic sac shunt procedures may benefit from steroid instillation at the time of shunt placement.


Assuntos
Dexametasona/administração & dosagem , Saco Endolinfático/cirurgia , Anastomose Endolinfática/métodos , Audição/fisiologia , Doença de Meniere/terapia , Procedimentos Cirúrgicos Otológicos/métodos , Adulto , Idoso , Audiometria de Tons Puros , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Injeção Intratimpânica , Instilação de Medicamentos , Masculino , Doença de Meniere/diagnóstico , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Laryngoscope ; 127(2): 383-390, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27900766

RESUMO

OBJECTIVES/HYPOTHESIS: To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). STUDY DESIGNS: Retrospective chart review. METHODS: Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied. RESULTS: Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. CONCLUSIONS: The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist. LEVEL OF EVIDENCE: 4. Laryngoscope, 2016 127:383-390, 2017.


Assuntos
Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/terapia , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/terapia , Artéria Carótida Externa , Artéria Carótida Interna , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Comunicação Interdisciplinar , Colaboração Intersetorial , Hemorragia Bucal/etiologia , Hemorragia Bucal/terapia , Neoplasias Otorrinolaringológicas/complicações , Neoplasias Otorrinolaringológicas/terapia , Dispositivo para Oclusão Septal , Stents , Idoso , Algoritmos , Carcinoma de Células Escamosas/mortalidade , Doenças das Artérias Carótidas/mortalidade , Terapia Combinada , Angiografia por Tomografia Computadorizada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/terapia , Hemorragia Bucal/mortalidade , Neoplasias Otorrinolaringológicas/mortalidade , Inibidores da Agregação de Plaquetas/administração & dosagem , Fatores de Risco , Retalhos Cirúrgicos , Taxa de Sobrevida , Veias/transplante
14.
Nat Rev Dis Primers ; 2: 16028, 2016 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-27170253

RESUMO

Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.


Assuntos
Doença de Meniere/complicações , Doença de Meniere/fisiopatologia , Antieméticos/farmacologia , Antieméticos/uso terapêutico , Audiometria/métodos , Benzodiazepinas/farmacologia , Benzodiazepinas/uso terapêutico , Ablação por Cateter/métodos , Dimenidrinato/farmacologia , Dimenidrinato/uso terapêutico , Orelha Interna/patologia , Orelha Interna/fisiopatologia , Endolinfa/metabolismo , Gânglios Sensitivos/anormalidades , Gânglios Sensitivos/lesões , Perda Auditiva/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Meclizina/farmacologia , Meclizina/uso terapêutico , Doença de Meniere/epidemiologia , Prometazina/farmacologia , Prometazina/uso terapêutico , Qualidade de Vida/psicologia , Zumbido/etiologia , Vertigem/etiologia
15.
Am J Otolaryngol ; 37(4): 379-82, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27045766

RESUMO

Cerebral venous sinus thrombosis (CVST) is a rare complication of surgical treatment of vestibular schwanomma. We present a rare case of extensive venous sinus thrombosis after trans-labyrinthine approach that was refractory to systemic anti-coagulation. Mechanical aspiration thrombectomy was utilized to re-canalize the venous sinuses and resulted in successful resolution of neurological symptoms. Indications of utilizing endovascular approaches are discussed that will enable skull base surgeons to address this uncommon yet potentially fatal complication.


Assuntos
Neoplasias da Orelha/cirurgia , Procedimentos Endovasculares , Neurilemoma/cirurgia , Trombose dos Seios Intracranianos/cirurgia , Vestíbulo do Labirinto , Neoplasias da Orelha/complicações , Neoplasias da Orelha/diagnóstico por imagem , Feminino , Humanos , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Adulto Jovem
16.
Otol Neurotol ; 37(2): e96-103, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26756161

RESUMO

OBJECTIVES: To analyze audiometric outcomes after bilateral cochlear implantation in patients with isolated enlarged vestibular aqueduct (EVA) syndrome and associated incomplete partition (IP) malformations. Secondary objective was to analyze rate of cerebrospinal fluid (CSF) gusher in patients with IP-EVA spectrum deformities and compare this with the existing literature. STUDY DESIGN: Retrospective chart review. METHODS: Thirty-two patients with EVA syndrome who received unilateral or bilateral cochlear implants between June 1999 and January 2014 were identified in the University Hospitals Case Medical Center cochlear implant database. Isolated EVA (IEVA) and Incomplete Partition Type II (IP-II) malformations were identified by reviewing high-resolution computed tomography (HRCT) imaging. Demographic information, age at implantation, surgical details, postimplantation audiometric data including speech reception thresholds (SRT), word, and sentence scores were reviewed and analyzed. Intra- and postoperative complications were analyzed as well and compared with the literature. RESULTS: Seventeen patients (32 implanted ears) had pediatric cochlear implantation for EVA-associated hearing loss. Data from 16 controls (32 implanted ears) were used to compare audiometric and speech outcomes of EVA cohort. Mean age at implantation was 6.8 years for EVA cohort and 6.0 years for controls. There was no statistically significant difference in long-term postoperative SRT, monaurally aided word scores, and binaurally tested word scores between pediatric EVA group and controls. The EVA patients had a long-term mean sentence score of 85.92%. A subset of EVA patients implanted at mean age of 3.18 years (n = 15 ears) had similar audiometric outcomes to another control group with Connexin 26 mutations (n = 20 ears) implanted at a similar age. Further subset analysis revealed no significant differences in age at implantation, SRT, and word scores in patients with IEVA and IP-II malformation. There was no significant association between size of vestibular aqueduct and age at implantation. There was no CSF gusher or other intra- or postoperative complications reported in our series. CONCLUSION: Bilateral sequential cochlear implantation can be performed safely in patients with EVA. Audiometric outcomes are excellent and comparable to pediatric cochlear implant patients with no malformations. CSF gusher rates can be minimized by trans-round window approach. Further long-term studies are needed to identify differences within IP-EVA spectrum deformities, audiometric outcomes, and proportions of EVA patients who will need cochlear implantation for hearing rehabilitation.


Assuntos
Implante Coclear/métodos , Perda Auditiva Neurossensorial/cirurgia , Aqueduto Vestibular/anormalidades , Adolescente , Criança , Pré-Escolar , Implante Coclear/efeitos adversos , Implantes Cocleares , Feminino , Audição , Testes Auditivos , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Síndrome , Resultado do Tratamento , Aqueduto Vestibular/cirurgia
17.
Otolaryngol Clin North Am ; 48(2): 317-30, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25650230

RESUMO

Endolymphatic sac tumors (ELST) are slow-growing, locally aggressive, low-grade malignancies that originate from the epithelium of the endolymphatic duct and sac. ELST often present with sensorineural hearing loss, tinnitus, and vertigo, which may mimic Meniere disease. Large tumors may present with additional cranial neuropathies. Management is primarily via microsurgical excision. Radiation therapy has a limited role for residual or unresectable disease. Early detection may enable hearing preservation techniques. ELST have an association with von Hippel-Lindau disease.


Assuntos
Saco Endolinfático/cirurgia , Neoplasias/patologia , Neoplasias/cirurgia , Doença de von Hippel-Lindau/complicações , Saco Endolinfático/patologia , Perda Auditiva Neurossensorial , Humanos , Imagem por Ressonância Magnética , Doença de Meniere/diagnóstico , Estadiamento de Neoplasias , Neoplasias/complicações , Zumbido , Tomografia Computadorizada por Raios X , Vertigem
18.
Front Syst Neurosci ; 8: 167, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25294990

RESUMO

Fusiform cells are the main integrative units of the mammalian dorsal cochlear nucleus (DCN), collecting and processing inputs from auditory and other sources before transmitting information to higher levels of the auditory system. Despite much previous work describing these cells and the sources and pharmacological identity of their synaptic inputs, information on the three-dimensional organization and utltrastructure of synapses on these cells is currently very limited. This information is essential since an understanding of synaptic plasticity and remodeling and pathologies underlying disease states and hearing disorders must begin with knowledge of the normal characteristics of synapses on these cells, particularly those features that determine the strength of their influence on the various compartments of the cell. Here, we employed serial block face scanning electron microscopy (SBFSEM) followed by 3D reconstructions to map and quantitatively characterize synaptic features on DCN fusiform cells. Our results reveal a relative sparseness of synapses on the somata of fusiform cells but a dense distribution of synapses on apical and basal dendrites. Synapses on apical dendrites were smaller and more numerous than on basal dendrites. The vast majority of axosomatic terminals were found to be linked to other terminals connected by the same axon or different branches of the same axon, suggesting a high degree of divergent input to fusiform cells. The size of terminals was correlated with the number of mitochondria and with the number of active zones, which was highly correlated with the number of postsynaptic densities, suggesting that larger terminals exert more powerful influence on the cell than smaller terminals. These size differences suggest that the input to basal dendrites, most likely those from the auditory nerve, provide the most powerful sources of input to fusiform cells, while those to apical dendrites (e.g., parallel fiber) are weaker but more numerous.

19.
JAMA Otolaryngol Head Neck Surg ; 139(11): 1219-25, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24077023

RESUMO

IMPORTANCE: The present study addresses the survival benefit of aggressive surgical treatment of head and neck cancer involving the carotid artery. OBJECTIVE: To assess survival outcomes in patients treated for advanced squamous cell carcinoma involving the carotid artery using different treatment strategies. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study at a tertiary care center of 44 consecutive patients with squamous cell carcinoma involving the carotid artery from 2005 to 2012 with a median follow-up of 12 months. The radiologist was blinded to the outcome of surgical procedures. INTERVENTIONS: Surgery with or without radiotherapy, and definitive chemoradiation. MAIN OUTCOMES AND MEASURES: Overall survival and rates of locoregional and distant failures. The hypothesis was formulated before data collection. RESULTS: Of 44 patients, 35 (80%) were treated with curative intent with surgery with or without adjuvant therapy (n = 27 [61%]) or definitive chemoradiation therapy (n = 8 [18%]), while 9 patients (21%) were treated in a palliative fashion. Patients treated with curative intent had improved overall survival (median survival, 13.5 months) compared with the palliative group (median survival, 3.6 months) (P = .001). Of patients treated with curative intent, those with previously untreated disease (n = 14 [40%]) had an improved outcome relative to patients with recurrent or persistent disease (n = 21 [60%]), with median survival of 38.7 and 9.6 months, respectively (P = .008). Patients were treated with curative intent using 3 different treatment strategies (ie, carotid artery resection with or without reanastamosis) (n = 6 [17%]), curative peeling with or without adjuvant therapy (n = 21 [ 60%]), and definitive chemoradiation therapy (n = 8 [23%]). Survival outcome was not significantly different between subgroups treated with curative intention (P = .47). When reviewed by a head and neck radiologist in a blinded fashion (n = 30), preintervention imaging had a positive predictive value of 72.7% for resectability of cancer involving the carotid artery. In cases with almost circumferential involvement (>270°) and narrowing of the carotid artery, the disease was unresectable (n = 3). CONCLUSIONS AND RELEVANCE: Advanced head and neck cancer involving the carotid artery can be treated with curative intent with favorable results in most patients. If disease burden merits, an aggressive approach involving resection with or without reanastamosis of the carotid artery can be used without significant added morbidity.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Artérias Carótidas , Neoplasias de Cabeça e Pescoço/mortalidade , Esvaziamento Cervical , Neoplasias Vasculares/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Ohio/epidemiologia , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Taxa de Sobrevida/tendências , Fatores de Tempo , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia
20.
Nat Commun ; 4: 2463, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24030203

RESUMO

Electrical and transcranial magnetic stimulations have proven to be therapeutically beneficial for patients suffering from neurological disorders. Moreover, these stimulation technologies have provided invaluable tools for investigating nervous system functions. Despite this success, these technologies have technical and practical limitations impeding the maximization of their full clinical and preclinical potential. Recently, micro-magnetic stimulation, which may offer advantages over electrical and transcranial magnetic stimulation, has proven effective in activating the neuronal circuitry of the retina in vitro. Here we demonstrate that this technology is also capable of activating neuronal circuitry on a systems level using an in vivo preparation. Specifically, the application of micro-magnetic fields to the dorsal cochlear nucleus activates inferior colliculus neurons. Additionally, we demonstrate the efficacy and characteristics of activation using different magnetic stimulation parameters. These findings provide a rationale for further exploration of micro-magnetic stimulation as a prospective tool for clinical and preclinical applications.


Assuntos
Sistema Nervoso Central/fisiologia , Colículos Inferiores/fisiologia , Fenômenos Magnéticos , Animais , Potenciais Evocados/fisiologia , Masculino , Mesocricetus , Neurônios/fisiologia
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