Role of magnetic resonance imaging in predicting late facial motor function after removal of vestibular schwannomas by the translabyrinthine approach.

Facial motor function was assessed in 61 patients 18 months after surgical resection, by the translabyrinthine approach, of vestibular schwannoma involving both the cerebellopontine angle (CPA) and the auditory canal. Pre-operative magnetic resonance imaging (MRI) was performed to measure the maximum extracanalicular diameter of the tumour between the porus and the farthest extension in the CPA on transverse slices and to calculate extracanalicular tumour volume. Post-operative facial motor function was graded according to the House and Brackmann system. There was a statistically significant relationship between late facial motor function and extracanalicular diameter. The best cut-off point for good and poor results was 20mm. There was no relationship between the tumour volume and the late post-operative facial motor function grade. In this study the best pre-operative radiological predictor of the late facial motor function in patients operated on by the translabyrinthine approach was the maximum diameter measured by MRI.

[Functional results of the surgery of unilateral acoustic neuroma]. / Les résultats fonctionnels de la chirurgie des neurinomes de l'acoustique unilatéraux.

The authors sent a circumstantial questionnaire to 224 surviving patients out of a 228 unilateral acoustic neurinoma operated on from June 83 to December 90 range of patients in order to assess their complaints. Seventy-two per cent of these neurinomas were Stade III or IV of Koos. Translabyrhintine approach was used for 85% and suprapetrous approach for 15%. The post-operative mortality rate is 1.75%. At the end of the procedure, the removal seemed total in 99% of cases and the anatomical facial nerve continuity was preserved in 94% of cases. Our patients kept or recovered a normal (Grade I of House--52%) or almost normal (Grade II of House--14%) facial motion in 66% of cases. A normal facial rest stretching with a complete eyelid closure but an asymmetrical facial mimic (Grade III of House) were in 20% of cases, and a more important facial palsy with incomplete eyelid closure was in 4% of cases (Grade IV of House). Patients needed an hypoglosso-facial anastomosis in 10% of cases. Always, this anastomosis restored a good facial motion near the Grade III of House. Hearing preservation was achieved for 45% of the attempts (through a suprapetrous approach) but hearing so preserved was functional (pure tone loss less than 50 db) in 37.5% of cases (5% of all the patients of this series) and only 61% of these patients kept or recovered a normal or almost normal facial motion. Varying, often regressive, complications were observed: C.S.F. leakages (7.5%) through the operative wound in two third of cases, owing to a pressure raising due to meningitis or C.S.F. circulatory constraint and usually cured by lumbar punctures and, if need be, antibiotics and, in one third of cases, through the tympanic cavity then nostril because of a hole remaining on the petrous drilled wall and usually needing a reintervention, swallowing difficulties (3%), due to a contralateral vagus nerve palsy in half of cases, postoperative hematomas (1.75%), fatal in one out of two times, brain traumatism (1.75%), meningitis (0.4%). The answers of patients were proper enough to be used for this study in 80% of cases (178). Their subjective answers about facial motion agreed with our objective assessment in 84% of cases that is emphasizing the difficulties of all attempt to this type of valuation. Our patients point out balance troubles in 67% of cases.(ABSTRACT TRUNCATED AT 400 WORDS)

[Endoscopic ear surgery. Initial evaluation]. / Otochirurgie endoscopique. Premier bilan.

The authors describe an endoscopic procedure of surgery of the ear and report on their experience in surgery for cholesteatoma with a closed procedure in the first step and the systematic second-look. The use of such a system is an essential complement for the surgical microscope to control some regions of the middle ear such as the sinus tympani. The study deals with 72 cases of cholesteatoma operated successively. The number if residual cholesteatomas is analyzed. The merits of controlling assemblies in some ossiculoplasties with an endoscopic system are discussed.

[Enlarged trans-temporal crania fossa approach. Technique and indications]. / La voie sus-pétreuse élargie. Technique et indications.

The authors report their experience using an enlarged middle cranial fossa approach for the removal of 33 acoustic neurinomas and 10 cerebellopontine angle meningiomas. The Technique is defined. This approach proved suitable for stage I neurinomas, ensuring total removal in all 13 patients with stage I lesions, hearing conservation in 9 (69.2%) of these patients, grade 1 + 2 facial nerve function in 80% of patients and grade 3 function in 20% of patients. While total removal was always possible for stage II neurinomas, the functional results were poor with hearing conservation in only 3 of 15 patients (20%), grade 1 + 2 facial nerve function in 45% of patients and grade 3 function in 54% of patients. Total removal was possible in only 1 of 4 patients with stage III neurinomas. This approach proved excellent for cerebellopontine anale meningiomas, providing wide access to the tumor and protecting the acoustico-facial bundle situated behind the tumor. Among the 10 patients operated by this route, 8 had conservation of hearing and all 10 had normal facial motricity (grade I) at 3 months.