Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss.

Importance: Regaining the ability to walk safely is a high priority for adults with vestibular loss. Thus, practitioners need comprehensive knowledge of vestibulopathic gait to design, provide, and/or interpret outcomes of interventions. To date, few studies have characterized the effects of vestibular loss on gait.

Combined Transcavernous and Kawase's Approach for Gross Total Resection of a Cavernous Sinus Meningioma.

Microsurgery of cavernous sinus (CS) lesions is generally considered to be associated with a high rate of morbidity and cranial nerve deficits. The success for surgical removal of CS meningiomas is debatable and achieving a good functional outcome with preservation of the cranial nerves is the goal. Surgery of these lesions is challenging, recurrence rates are high, and therapeutic strategies remain controversial.

The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance.

Objective: To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction.

Design: The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed.

Validation of a next-generation sensory organization test in adults with and without vestibular dysfunction.

Background: The traditional Sensory Organization Test (T-SOT) is a gold standard balance test; however, the psychometric properties of assessing sensory organization with a virtual-reality-based posturography device have not been established.

Objective: Our overall aims were to assess the criterion, concurrent, and convergent validity of a next-generation Sensory Organization Test (NG-SOT).

Methods: Thirty-four adults (17 vestibular-impaired) participated.

Effect of Repetitive Administration of a Next-generation Sensory Organization Test in Adults With and Without Vestibular Dysfunction.

Hypothesis: The overall aim was to assess the effects of repetitive testing on performance on a next-generation Sensory Organization Test (NG-SOT).

Background: The psychometric properties of sensory organization assessment with a next-generation posturography device are not fully characterized. Thus, a better understanding of the reliability of the NG-SOT is required to support its use as an outcome measure.

Aggressive, Multidisciplinary Staged Microsurgical Resection of a Giant Cervicomedullary Junction Chordoma.

Chordomas of the cranial base are locally destructive tumors since they are surrounded by significant complex neurovascular structures. Thus, their surgical removal is challenging, recurrence rates are high, and their therapeutic strategies remain controversial. In this video, we present a 47-year-old man with a recent onset of swallowing difficulties, hoarseness, and weight loss for several weeks.

The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage.

Objective: To report the rate of major soft tissue complications after cochlear implantation and to describe the use of the temporoparietal fascia (TPF) flap for such complications.

Study Design: Retrospective case series.

Setting: Tertiary care, University Hospital.

Gross Total Resection of a Jugular Foramen Thyroid Medullary Metastasis via a Transjugular Transsigmoid Approach.

Surgical resection of jugular foramen tumors poses a significant challenge to skull base surgeons with the selection of an appropriate surgical approach, a matter of some debate. Jugular foramen metastatic tumors may mimic paragangliomas, and in some selected cases surgical resection is needed. In this video, we demonstrate the microsurgical gross total resection of a jugular foramen tumor via a postauricular trans-jugular trans-sigmoid approach.

Resection of middle petroclival meningioma via combined anterior transpetrosal and retrosigmoid approaches at two separate stages: 3D operative video.

Surgical access to the petroclival region poses a challenge to neurosurgeons. A wide range of approaches has been demonstrated in the past. In this video, the authors present a 69-year-old male patient who presented with 3-month history of worsening left-sided numbness.

Transmastoid approach to the superior semicircular canal: An anatomical study.

Objective: We examined the anatomic features of the top of the superior semicircular canal (SSC) to help guide the surgeon considering resurfacing or plugging of an associated dehiscence, thorough the transmastoid (TM) approach.

Methods: 19 selected cadaveric temporal bones, which had no supralabyrinthine tract, were dissected, and distances between the SSC and various structures within the temporal bone were measured with a, fine caliper.

Results: The average distances from the sino-dural angle, horizontal canal top, and subacurate artery, to the top of the SSC were 31.

Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery.

Unlabelled: The pupose of this study is to assess the long-term outcome and toxicity of fractionated stereotactic radiation therapy (FSRT) and stereotactic radiosurgery (SRS) for 100 vestibular schwannomas treated at a single institution. From 1993 to 2007, 104 patients underwent were treated with radiation therapy for vestibular schwannoma. Forty-eight patients received SRS, with a median prescription dose of 12.

Retromandibular fossa approach to the high cervical internal carotid artery: an anatomic study.

Objective: Access to the high cervical internal carotid artery (ICA) is technically challenging for the treatment of lesions in and around this region. The aims of this study were to analyze the efficacy of approaching the high cervical ICA through the retromandibular fossa and to compare preauricular and postauricular incisions. In addition, the relevant neural and vascular structures of this region are demonstrated in cadaveric dissections.

Endolymphatic sac decompression as a treatment for Meniere's disease.

Objectives/hypothesis: Endolymphatic sac decompression is a surgical treatment option for patients with medically intractable Meniere's disease. However, effectiveness is debated because published data show great variability. Outcome-based research studies are useful in incorporating the patient's perspective on the success of treatment.

Effects of vestibular and balance rehabilitation on sensory organization and dizziness handicap.

This retrospective study was undertaken to assess balance recovery and dizziness handicap in 32 patients after a vestibular and balance rehabilitation program. Outcomes were compared between 12 patients with peripheral vestibular disorders and 20 patients with central or mixed balance disorders. The patients were tested with posturography (sensory organization test [SOT]) and the Dizziness Handicap Inventory (DHI) before and after their therapy program.

Outcomes in vestibular ablative procedures.

Objective: To assess dizziness handicap and postural recovery in 17 patients undergoing a vestibular ablative procedure.

Study Design: Outcomes were compared between nine patients who underwent selective vestibular neurectomy and eight patients who underwent a transmastoid labyrinthectomy.

Setting: Patients underwent ablative procedures at a tertiary care facility.

Correlation between auditory function and internal auditory canal pressure in patients with vestibular schwannomas.

Object: Hearing loss is the most common presenting symptom in patients who harbor a vestibular schwannoma (VS). Although mechanical injury to the cochlear nerve and vascular compromise of the auditory apparatus have been proposed, the exact mechanism of this hearing loss remains unclear. To test whether pressure on the cochlear nerve from tumor growth in the internal auditory canal (IAC) is responsible for this clinical finding, the authors prospectively evaluated intracanalicular pressure (ICaP) in patients with VS and correlated this with preoperative brainstem response.