Clinical practice guideline on the management of vestibular schwannoma.

INTRODUCTION: Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. MATERIAL AND METHODS: This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. RESULTS: A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. CONCLUSIONS: This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.

Double medial and lateral graft in myringoplasty. / Miringoplastia con injerto doble medial y lateral.

OBJECTIVES: A surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results. MATERIAL AND METHOD: The presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed. RESULTS: The results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20dB in 85% of the cases. Less than 10dB in 38%, and between 10 and 20dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain. CONCLUSIONS: It is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation.

Miringoplastia con injerto doble medial y lateral / Double medial and lateral graft in myringoplasty

Objetivos: Se describe la técnica quirúrgica del injerto doble medial y lateral de fascia autóloga, sus indicaciones y resultados. Material y método: Se estudian las características preoperatorias y al año de la intervención de 100 casos intervenidos de miringoplastia con la técnica de injerto doble medial y lateral de fascia autóloga. Se analizan los resultados anatómicos y funcionales. Resultados: Los resultados se valoran al año de la intervención. En el 95% de los casos conseguimos el cierre de la perforación. La incidencia de persistencia de las perforaciones es del 12,5% en los niños menores de 10 años y del 2,5% en niños mayores de 10 años y adultos. Las complicaciones son un 4% de perlas epiteliales con engrosamiento del neotímpano, un 1% de retracciones del neotímpano y un 3% de epitelitis que se resuelven con tratamiento médico tópico. La recuperación auditiva es del 85% de cierres del UDA medio a menos de 20 dB (el 38% a menos de 10dB y el 47% entre 10 y 20 dB). Se analizan las posibles causas del cierre incompleto del UDA, posiblemente relacionados con fibrosis y esclerosis de los restos timpánicos y/o la cadena osicular. Conclusiones: Se concluye que esta metodología nos proporciona los mejores resultados en comparación con otras que hemos utilizado y hemos relegado a situaciones muy específicas atendiendo al tamaño y localización de la perforación

Objectives: A surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results. Material and method: The presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed. Results: The results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20 dB in 85% of the cases. Less than 10 dB in 38%, and between 10 and 20 dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain. Conclusions: It is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation