The Experience of a Facial Nerve Unit in the Treatment of Patients With Facial Paralysis Following Skull Base Surgery.

: The management of facial paralysis following skull base surgery is complex and requires multidisciplinary intervention. This review shows the experience of a facial nerve (FN) unit in a tertiary university referral center. A multidisciplinary approach has led to the breaking of some old treatment paradigms.

Facial nerve repair: the impact of technical variations on the final outcome.

Objectives: To analyze the outcome of facial nerve (FN) reconstruction, the impact of technical variations in different conditions and locations, and the importance of additional techniques in case of suboptimal results.

Study Design: Retrospective study.

Setting: University-based tertiary referral center.

Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology.

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma.

Evolution of Patients With Immediate Complete Facial Paralysis Secondary to Acoustic Neuroma Surgery.

Objective: To study the evolution of patients with immediate complete facial paralysis after acoustic neuroma surgery in different scenarios and assess different facial reanimations techniques.

Methods: This study included 50 patients with complete facial paralysis immediately after acoustic neuroma surgery. Data were analyzed into 4 groups according to the need and type of reconstruction of the facial nerve, either none, immediate, or on a deferred basis.

NF2 genetic alterations in sporadic vestibular schwannomas: clinical implications.

Hypothesis: NF2 gene alterations may have a clinical impact in non-NF2 vestibular schwannomas (VSs).

Background: It has been suggested that NF2 mutations might correlate with clinical expression of VS in NF2 patients. The aim of this study was to analyze the impact of genetic alterations in the NF2 gene on epidemiologic, clinical, and radiologic features of patients with sporadic VS.

Novel multitarget ligand ITH33/IQM9.21 provides neuroprotection in in vitro and in vivo models related to brain ischemia.

ITH33/IQM9.21 is a novel compound belonging to a family of glutamic acid derivatives, synthesized under the hypothesis implying that multitarget ligands may provide more efficient neuroprotection than single-targeted compounds. In rat hippocampal slices, oxygen plus glucose deprivation followed by re-oxygenation (OGD/Reox) elicited 42% cell death.

CDP-choline at high doses is as effective as i.v. thrombolysis in experimental animal stroke.

Use of thrombolysis in acute ischaemic stroke may be limited by a narrow benefit/risk ratio. Pharmacological inhibition of the ischaemic cascade may constitute an effective and safer approach to stroke treatment. This study compared the effects of high doses of cytidine diphosphate-choline (CDP-choline; 1000 mg/kg) with recombinant tissue plasminogen activator (rt-PA; 5 mg/kg) in an experimental animal model of embolic stroke.

Human cadaver brain infusion skull model for neurosurgical training.

Background: Microsurgical technique and anatomical knowledge require extensive laboratory training. Human cadaver models are especially valuable as they supply a good microsurgical training environment simultaneously providing authentic brain anatomy. We developed the "skull infusion model" as an extension of our previous "brain infusion model" taking it a step further maintaining simplicity but enhancing realism.

Reversible posterior leukoencephalopathy syndrome after lateral skull base surgery.

Objective: To describe the clinical course, diagnostic features and management of a case of reversible posterior leukoencephalopathy syndrome after a lateral cranial base removal.

Patient: A 58-year-old male patient with an inconspicuous clinical history presented with a lethargic state without localized neurologic deficit in the postoperative period of a subtotal petrosectomy for an adenoid cystic carcinoma of the temporal bone.

Interventions: Cranial T2-weighted magnetic resonance imaging showed increased signal intensity in the occipital and cerebellar regions, centered at the cortical and subcortical white matter.

Cyclin D1 expression and facial function outcome after vestibular schwannoma surgery.

Hypothesis: The proto-oncogen cyclin D1 has been implicated in the development and behavior of vestibular schwannoma. This study evaluates the association between cyclin D1 expression and other known prognostic factors in facial function outcome 1 year after vestibular schwannoma surgery.

Methods: Sixty-four patients undergoing surgery for vestibular schwannoma were studied.

[CSF fistulae following surgery for cerebellopontine angle tumours and their relationship with the body mass index].

Introduction: The most frequent complication after vestibular schwannoma surgery is cerebrospinal fluid (CSF) fistula.

Material And Methods: Retrospective study of 170 patients who had vestibular schwannoma (163) or other tumours in the cerebello pontine angle (CPA) (7). Resection was carried out using different approaches: retrosigmoid (66%), translabyrinthine (24%), middle cranial fossa (5%) and others (5%).

Assessment of 31P-NMR analysis of phospholipid profiles for potential differential diagnosis of human cerebral tumors.

We describe a novel protocol for the non-histological diagnosis of human brain tumors in vitro combining high-resolution (31)P magnetic resonance spectroscopy ((31)P-MRS) of their phospholipid profile and statistical multivariate analysis. Chloroform/methanol extracts from 40 biopsies of human intracranial tumors obtained during neurosurgical procedures were prepared and analyzed by high-resolution (31)P-MRS. The samples were grouped in the following seven major classes: normal brain (n = 3), low-grade astrocytomas (n = 4), high-grade astrocytomas (n = 7), meningiomas (n = 9), schwannomas (n = 3), pituitary adenomas (n = 4), and metastatic tumors (n = 4).

[Hemi-hypoglossal-facial intratemporal side to side anastomosis].

Conventional hypoglossal-facial anastomosis and the interposition jump graft variation are the most popular techniques for facial nerve reconstruction resulting from proximal facial nerve injury. We present a modification of this technique, the hemi-hypoglossal facial intratemporal side to side anastomosis, which overcomes many of the failings of previous techniques. The method involves mobilization of the intratemporal facial nerve, which is anastomosed to a partially incised hypoglossal nerve.

Cyclin D1 expression and histopathologic features in vestibular schwannomas.

Objective: To evaluate cyclin D1 expression in vestibular schwannoma and its relationship with histologic, clinical, and radiologic features.

Patients: Twenty-one patients with histologically confirmed vestibular schwannoma.

Intervention: Immunohistochemistry analysis was performed with anticyclin D1.

Facial nerve schwannoma of the cerebellopontine angle: a diagnostic challenge.

Facial nerve schwannomas are rare lesions that may involve any segment of the facial nerve. Because of their rarity and the lack of a consistent clinical and radiological pattern, facial nerve schwannomas located at the cerebellopontine angle (CPA) and internal auditory canal (IAC) represent a diagnostic and therapeutic challenge for clinicians. In this report, a case of a CPA/IAC facial nerve schwannoma is presented.

Impact of facial dysfunction on quality of life after vestibular schwannoma surgery.

Objectives: This study was performed to evaluate the impact of facial dysfunction on quality of life in patients who underwent surgery for vestibular schwannoma. Other factors with a possible impact on quality of life were also assessed.

Methods: We performed a retrospective review of 95 patients who underwent removal of a unilateral vestibular schwannoma.

DNA methylation of multiple genes in vestibular schwannoma: Relationship with clinical and radiological findings.

Hypothesis: The purpose of this study was to examine the DNA methylation profile of several genes in a series of vestibular schwannomas, and to analyze its relationship with clinical and radiological features.

Background: Aberrant methylation of promoter regions is a major mechanism for silencing of tumor suppressor genes in several tumors. There is limited information about methylation status in vestibular schwannoma, with no clinical or radiological implications described to date.

Effect of combined therapy with thrombolysis and citicoline in a rat model of embolic stroke.

An approach combining reperfusion mediated by thrombolytics with pharmacological neuroprotection aimed at inhibiting the physiopathological disorders responsible for ischemia-reperfusion damage, could provide an optimal treatment of ischemic stroke. We investigate, in a rat embolic stroke model, the combination of rtPA with citicoline as compared to either alone as monotherapy, and whether the neuroprotector should be provided before or after thrombolysis to achieve a greater reduction of ischemic brain damage. One hundred and nine rats have been studied: four were sham-operated and the rest embolized in the right internal carotid artery with an autologous clot and divided among 5 groups: 1) control; 2) iv rtPA 5 mg/kg 30 min post-embolization 3) citicoline 250 mg/kg ip x3 doses, 10 min, 24 h and 48 h post-embolization; 4) citicoline combined with rtPA following the same pattern; 5) rtPA combined with citicoline, with a first dose 10 min after thrombolysis.

New goals in ischemic stroke therapy: the experimental approach--harmonizing science with practice.

Undeniable advances have been made in clinical and experimental investigation into the pathophysiology, diagnosis, and treatment of cerebral ischemia. However, with the exception of intravenous thrombolysis and some neuroprotectors, such as citicoline, the majority of the drugs successfully tested in experimental studies have failed in clinical trials. Valuable lessons for the improvement of research methodology and appropriate coordination of experimental and clinical research can be learnt from the analysis of discrepancies between the laboratory and clinic, which will allow us to increase the power and cost-effectiveness of the studies.

The intraluminal thread model revisited: rat strain differences in local cerebral blood flow.

There are major differences in the outcome of focal cerebral ischemia between rat strains. This study aimed to investigate whether inter-strain differences exist in the local cerebral blood flow, changes produced by intraluminal middle cerebral artery occlusion (MCAO). Fifty-four male Long-Evans, Sprague-Dawley or Wistar rats were subjected to 60 minutes of transient MCAO, carried out with a silicone-coated 4-0 nylon monofilament.