Significant tumor compression of the middle cerebellar peduncle is associated with worse facial nerve outcomes and lower extent of resection in surgery for medium-sized vestibular schwannomas - A radiographic analysis of a case series.

Background And Objective: Optimizing the extent of resection (EOR) and facial nerve outcomes (FNO) remain a challenge in medium to large vestibular schwannomas (VS). Currently, tumor size has been the only consistently reported factor predicting FNO and EOR. Here, we sought to evaluate whether the degree of the tumor's compression on the middle cerebellar peduncle (PC) influences FNO and EOR in medium to large VS.

Optimizing Workflow in Combined Petrosectomy Approaches: Surgical Technique and Case Series.

Background And Objective: The combined petrosectomy is one of the workhorse skull base approaches to the petroclival region. Traditionally, this approach starts with a temporosuboccipital craniotomy, followed by the mastoidectomy/anterior petrosectomy, and completed with the dural opening/tumor resection. This sequence of events (neurosurgery-neuro-otology-neurosurgery) involves at least 2 handoffs and change of surgical teams and instrumentation.

Systematic Review of Endolymphatic Sac Tumor Treatment and Outcomes.

Objective: Endolymphatic sac tumors are rare neoplasms originating in the endolymphatic sac. Current literature is limited to case reports and small case series. The objective of this study was to systematically review the literature to better describe clinical presentation, treatment options, and outcomes in endolymphatic sac tumors.

A Systematic Review of Closure Techniques in Lateral Skull Base Tumor Surgery.

 Tumors of the lateral skull base often require collaboration between neurosurgeons and neurotologists for the surgical approach. The three main transosseous surgical approaches are retrosigmoid (RS), translabyrinthine (TL), and middle fossa (MF). The literature reflects a relative paucity regarding the various closure techniques for these approaches and the postoperative complications.

Use of Lasers in Otosclerosis Surgery.

Lasers were introduced as an atraumatic modality for accomplishing several of the crucial steps in otosclerosis surgery. Advances in laser technology have spurred coevolution of refinements in the technique of the operation. Several varieties of laser systems are available to suit individual preference and to augment a surgeon's armamentarium; however, a clear advantage in terms of surgical outcome or patient safety remains to be demonstrated.

Pneumatization Patterns of the Petrous Apex and Lateral Sphenoid Recess.

 The petrous apex poses a challenge for surgical intervention due to poor access. As intraoperative image guidance and surgical instrumentation improve, newer endoscopic approaches are increasingly favored. This study aims to provide normative data on the anatomy of the lateral sphenoid sinus recess and petrous apex.

Spontaneous Otorrhagia after Laparoscopic Pelvic Surgery: A Report of Two Cases.

Spontaneous otorrhagia following laparoscopic pelvic surgery is a complication that is rarely reported and incompletely understood. Few case reports have described this phenomenon, though its true incidence is unknown. It has been hypothesized that a combination of extreme patient positioning and abdominal insufflation is the contributing factor.

Middle ear barotrauma causing transient facial nerve paralysis after scuba diving.

Middle ear barotrauma is a well known entity with typical injury occurring when diving or ascending in a commercial jetliner. Patients often present with symptoms of acute onset otalgia, hearing loss and sometimes haemotympanum (with or without tympanic membrane perforation). On rare occasions, facial nerve paralysis can occur when the tympanic segment of the facial nerve is dehiscent within the middle ear.

Denervation of the Eustachian Tube and Hearing Loss Following Trigeminal Schwannoma Resection.

Objectives To discuss eustachian tube dysfunction (ETD) as a cause of hearing loss and to discuss its pathogenesis following resection of trigeminal schwannomas. Methods Presented herein are two cases of trigeminal schwannoma that were resected surgically with sacrifice of the motor branch of the trigeminal nerve. Neither of the cases had evidence of extracranial extension nor preoperative ETD.

Anterior Petrosectomy: Consecutive Series of 46 Patients with Attention to Approach-Related Complications.

Objective Anterior petrosectomy(AP) was popularized in the 1980s and 1990s as micro-neurosurgery proliferated. Original reports concentrated on the anatomy of the approach and small case series. Recently, with the advent of additional endonasal approaches to the petrous apex, the morbidity of AP remains unclear.

Radiographic analysis of cochlear nerve vascular compression.

Objectives: We analyzed whether radiographically demonstrated anterior inferior cerebellar artery (AICA) vascular compression of the cochleovestibular nerve in asymmetric hearing loss could be correlated to either the symptomatic ear or to cochlear nerve diameter.

Methods: We undertook a retrospective case-control study in which patients were enrolled into a database if audiometry demonstrated asymmetry of 20 dB at one frequency, asymmetry of 10 dB at two frequencies, or a difference of 20% on word recognition scores. If AICA vascular contact was demonstrated on subsequent magnetic resonance imaging of the cerebellopontine angle, patients were included in the study.

Mastoiditis on MRI: fact or artifact?

Fluid signal in the mastoid can be an incidental finding on T2-weighted magnetic resonance imaging and often is interpreted as mastoiditis by radiologists. This study examines 28 consecutive cases of such erroneously diagnosed "mastoiditis" and documents the presence or absence of otologic symptoms and clinical signs. We found a very low prevalence of otologic symptoms or pathology and no cases of mastoiditis in these patients, and we determined that magnetic resonance imaging is not an effective screening modality for mastoiditis.

Effects of anesthesia on efferent-mediated adaptation of the DPOAE.

Distortion product otoacoustic emissions (DPOAE) adapt after primary tone onset, with an approximately 100 ms time constant, due to feedback effects of medial olivocochlear (MOC) activity elicited by the primary tones. We tracked DPOAE postonset adaptation as a metric of MOC reflex strength, before during and after induction of anesthesia in guinea pigs. Reflex strength was significantly diminished by the barbiturate/neuroleptic anesthesia most commonly used in this species.

Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale.

Objective: To develop and validate a patient-based instrument to measure both facial impairment and disability, the Facial Clinimetric Evaluation (FaCE) Scale.

Study Design: Prospective instrument validation.

Methods: Eighty-six patients with a documented history of facial paralysis completed a preliminary, 51-item instrument (alpha FaCE Scale), as well as the previously developed Facial Disability Index (FDI) and the Medical Outcomes Study Short Form 36 Item Questionnaire (SF-36).

Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo.

Objective: Benign paroxysmal positional vertigo (BPPV) is a common condition seen by otolaryngologists. The purpose of this study is to determine the ability of the modified Epley maneuver to treat BPPV.

Study Design: Retrospective review.