Retrosigmoid Approach for Sporadic Vestibular Schwannoma: Patient Selection, Technical Pearls, and Hearing Results.

The retrosigmoid corridor provides the most broadly applied approach for resection of sporadic vestibular schwannoma. It may be utilized for any size tumor and for patients with intact hearing with the intention of hearing preservation. For larger tumors, the skull base surgeon must weigh the benefits the retrosigmoid approach against those of the translabyrinthine route.

Twelve-Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation.

Objective: Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI).

Study Design: Prospective cohort study.

Setting: Tertiary referral center.

Hydroxyapatite cement cranioplasty in the setting of simultaneous translabyrinthine resection of cerebellopontine angle tumors and cochlear implantation.

Cochlear implantation (CI) has become an option for the treatment of hearing loss after translabyrinthine resection of vestibular schwannomas. The surgical video presents the case of a 67-year-old male who had translabyrinthine resection of vestibular schwannoma with simultaneous CI and closure with a hydroxyapatite (HA) cement cranioplasty. HA cement cranioplasty can be utilized in place of abdominal fat graft for the closure of translabyrinthine approaches with similar efficacy and complication profile.

Cost-Effectiveness of Routine Type and Screens in Select Endonasal Skull Base Surgeries.

 The study aimed to evaluate the cost-effectiveness of obtaining preoperative type and screens (T/S) for common endonasal skull base procedures, and determine patient and hospital factors associated with receiving blood transfusions.  Retrospective database analysis of the 2006 to 2015 National (nationwide) Inpatient Sample and cost-effectiveness analysis.  Multivariate regression analysis was used to identify factors associated with transfusions.

Early Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation.

Objectives/hypothesis: Hearing rehabilitation after translabyrinthine resection of a vestibular schwannoma (VS) has largely been based on the transfer of acoustic stimulus to the contralateral ear, typically through a contralateral routing of signal hearing aid or bone-anchored hearing aid (BAHA). Cochlear implant, either as a subsequent surgery or simultaneously, has become a more common treatment option; however, there is still relatively limited data available on its success. The purpose of this study is to evaluate the early outcomes of simultaneous cochlear implantation in patients with sporadic VS undergoing translabyrinthine resection.

Natural History of Facial Weakness Following Surgery of the Cerebellopontine Angle: A Tertiary Care Cohort.

Objective: Facial function is a key outcome in surgery of the cerebellopontine angle (CPA). This study describes the natural history of facial weakness after CPA surgery.

Study Design And Setting: Retrospective study of two tertiary centers.

Impact of cochlear modiolus dose on hearing preservation following stereotactic radiosurgery for non-vestibular schwannoma neoplasms of the lateral skull base: a cohort study.

Objective: Radiation dose to the cochlea has been proposed as a key prognostic factor in hearing preservation following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). However, understanding of the predictive value of cochlear dose on hearing outcomes following SRS for patients with non-VS tumors of the lateral skull base (LSB) is incomplete. The authors investigated rates of hearing loss following high-dose SRS in patients with LSB non-VS lesions compared with patients with VS.

Anterior Extension of Tumor is as Important as Tumor Size to Facial Nerve Outcome and Extent of Resection for Vestibular Schwannomas.

 We examined vestibular schwannoma tumor dimension and direction of growth to determine whether these correlate with facial nerve outcome as well as extent of resection (EOR).  Retrospective review of prospectively maintained databases.  206 patients were a part of this study.

Pituitary and skull-base lesions and the litigious patient.

Background: The objective of this research was to evaluate litigation relating to the diagnosis and management of pituitary and ventral skull base lesions and delineate allegations involved in the decision to pursue medicolegal proceedings.

Methods: Publically available federal and court records were accessed via the Westlaw Next database. Jury verdict and settlement reports relevant to pituitary and anterior skull-base lesions were accessed, and litigation was reviewed for alleged injuries, defendant specialty, patient demographics, and other factors raised in proceedings.

Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma.

Objective: The management of vestibular schwannoma (VS) remains controversial. One commonly cited advantage of microsurgery over other treatment modalities is that tumor removal provides the greatest chance of long-term cure. However, there are very few publications with long-term follow-up to support this assertion.

Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?

Objectives/hypothesis: To explore the relationship between lower airway disease and postoperative cerebrospinal fluid (CSF) rhinorrhea among patients undergoing pituitary surgery STUDY DESIGN: Retrospective review.

Methods: A retrospective review of the Healthcare Cost and Utilization Project's 2013 National Inpatient Sample was conducted to characterize the hospital stay and surgical outcomes of patients undergoing pituitary surgery. Patients with lower airway disease (including chronic obstructive pulmonary disease and asthma) were compared to a disease-free population identifying demographics and complications over-represented in the lower airway group.

Pretreatment growth rate as a predictor of tumor control following Gamma Knife radiosurgery for sporadic vestibular schwannoma.

OBJECTIVE Over the last 30 years, stereotactic radiosurgery (SRS) has become an established noninvasive treatment alternative for small- to medium-sized vestibular schwannoma (VS). This study aims to further define long-term SRS tumor control in patients with documented pretreatment tumor growth for whom conservative observation failed. METHODS A prospective clinical database was queried, and patients with sporadic VS who elected initial observation and subsequently underwent SRS after documented tumor growth between 2004 and 2014 were identified.

Malignant peripheral nerve sheath tumors of the eighth cranial nerve arising without prior irradiation.

OBJECTIVE Malignant peripheral nerve sheath tumors (MPNSTs) of the eighth cranial nerve (CN) are exceedingly rare. To date the literature has focused on MPNSTs occurring after radiation therapy for presumed benign vestibular schwannomas (VSs), while MPNSTs arising without prior irradiation have received little attention. The objectives of the current study are to characterize the epidemiology, clinical presentation, disease course, and outcome using a large national cancer registry database and a systematic review of the English literature.

Pediatric pituitary resection: characterizing surgical approaches and complications.

Background: Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery.

Methods: The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions.

Stereotactic Radiosurgery for Cystic Vestibular Schwannomas.

Background: The optimum treatment for cystic vestibular schwannoma (VS) remains controversial. Anecdotally, many treating physicians feel that cystic VSs do not respond to stereotactic radiosurgery (SRS) as well as noncystic tumors.

Objective: To present outcomes after treatment of predominantly cystic VS with SRS.

Volumetric analysis of tumor control following subtotal and near-total resection of vestibular schwannoma.

Objectives/hypothesis: The primary goals of microsurgery for vestibular schwannoma (VS) include preservation of neural function and complete tumor removal. In a subset of patients, adherent tumor remnant may be intentionally left behind in order to minimize risk of new neurologic deficits. It is not well established if residual tumor volume predicts likelihood of tumor remnant growth.

The Short-Term and Intermediate-Term Risk of Second Neoplasms After Diagnosis and Treatment of Unilateral Vestibular Schwannoma: Analysis of 9460 Cases.

Purpose: To determine the incidence of second intracranial neoplasms after the diagnosis and treatment of sporadic vestibular schwannoma (VS).

Methods And Materials: Analysis of the Surveillance, Epidemiology, and End Results (SEER) database including all patients identified with a diagnosis of VS and a second intracranial tumor. The Kaplan-Meier method was used to determine the incidence of second tumors while allowing for censoring at loss to follow-up or death.

Temporal Lobe Gliosarcoma After Gamma Knife Radiosurgery for Vestibular Schwannoma.

Objective: Secondary tumorigenesis after exposure to ionizing radiation is a well-described phenomenon. The probability of developing a malignancy after stereotactic radiosurgery (SRS) is theoretically less than conventional external beam radiation therapy; however, the exact risk remains unknown. Such information is important for patient counseling when considering treatment of benign conditions such as vestibular schwannoma (VS).

Penetrating head injuries in children due to BB and pellet guns: a poorly recognized public health risk.

OBJECT Nonpowder guns, defined as spring- or gas-powered BB or pellet guns, can be dangerous weapons that are often marketed to children. In recent decades, advances in compressed-gas technology have led to a significant increase in the power and muzzle velocity of these weapons. The risk of intracranial injury in children due to nonpowder weapons is poorly documented.

Understanding the Impact of Obesity on Short-term Outcomes and In-hospital Costs After Instrumented Spinal Fusion.

Background: Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion.

Objective: To evaluate the impact of obesity on resource utilization and early complications in patients undergoing surgery for degenerative spine disease.

Methods: A single-institution retrospective analysis was conducted on patients with degenerative spine disease requiring instrumentation between 2008 and 2012.

The Impact of Obesity on Perioperative Resource Utilization after Elective Spine Surgery for Degenerative Disease.

Study Design Retrospective case series. Objective To determine the effect of obesity on the resource utilization and cost in 3270 consecutive patients undergoing elective noninstrumented decompressive surgeries for degenerative spine disease at Mayo Clinic Rochester between 2005 and 2012. Methods Groups were assessed for baseline differences (age, gender, and American Society of Anesthesiologists [ASA] classification, procedure type, and number of operative levels).

Incidentally Discovered Unruptured AICA Aneurysm After Radiosurgery for Vestibular Schwannoma: A Case Report and Review of the Literature.

Objective: This is a case report and review of the literature of aneurysm formation after stereotactic radiosurgery (SRS) in the posterior fossa. Cerebral aneurysm formation is not a commonly recognized complication of SRS. We present the first case of an unruptured anteroinferior cerebellar artery aneurysm incidentally found at surgery in a patient with trigeminal neuralgia secondary to a vestibular schwannoma (VS) first treated with Gamma Knife radiosurgery.

The Changing Landscape of Vestibular Schwannoma Management in the United States--A Shift Toward Conservatism.

Objective: To characterize the evolving management of vestibular schwannoma (VS) in the United States.

Study Design: Retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database.

Setting: SEER database.

Superficial siderosis of the central nervous system associated with incomplete dural closure following posterior fossa surgery: report of 3 cases.

This report reviews a series of 3 patients who developed superficial siderosis following posterior fossa operations in which dural closure was incomplete. In all 3 patients, revision surgery and complete duraplasty was performed to halt the progression of superficial siderosis. Following surgery, 2 patients experienced resolution of their CSF xanthochromia while 1 patient had reduced CSF xanthochromia.

The effect of diabetes mellitus on 30-day outcomes following single-level open lumbar microdiscectomy: an aged-matched case-control study.

Background: Diabetes mellitus (DM) is a known risk factor for post-surgical complications. However, few reports specifically study lumbar spine surgical outcomes in diabetics. The purpose of this study was to assess 30-day outcomes in patients with DM undergoing single-level open lumbar microdiscectomy (oLMD).