Gruppo Otologico

Piacenza, Italy

Gruppo Otologico

Piacenza, Italy
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Free R.H.,University of Groningen | Falcioni M.,Gruppo Otologico | Di Trapani G.,Gruppo Otologico | Giannuzzi A.L.,Gruppo Otologico | And 2 more authors.
Otology and Neurotology | Year: 2013

OBJECTIVE: To report and review 32 cases of subtotal petrosectomy (SP) in cochlear implant (CI) surgery and to define the indications and contraindications for this procedure STUDY DESIGN: Retrospective case review + case reports. SETTING: Tertiary skull base center. PATIENTS: Cochlear implant database: 32 subtotal petrosectomies in 31 patients. INTERVENTIONS: Subtotal petrosectomy with blind sac closure of the external auditory canal, closure of Eustachian tube, and abdominal fat obliteration in combination with cochlear implantation. RESULTS: Indications for SP in CI surgery were as follows: chronic otitis media (n = 4), previous radical cavity (n = 13), previous subtotal petrosectomy (n = 4), ossification of the cochlea (n = 5), malformation of the inner ear (n = 2), and temporal bone fracture (n = 4). One patient was simultaneously bilaterally implanted; 2 cases were revisions. All procedures were performed in 1 stage. In 2 cases, complications were encountered (6%), one of which lead to reoperation (3%). None of the patients was explanted. CONCLUSION: Subtotal petrosectomy combined with cochlear implantation is a procedure required in specific situations and lowers the risk of repetitive ear infections, CSF leakage, and meningitis by closing off all connection with the external environment. Additionally, it gives excellent visibility and access in difficult anatomy or in drill-out procedures. The complication rate of 6% is comparable with normal cochlear implantation. Preservation of residual hearing can be considered the only absolute contraindication as an open external meatus is necessary for use of electroacoustic stimulation. Risks of the SP+CI procedure are infection of the abdominal fat, breakdown of the blind sac closure, and entrapped cholesteatoma. Follow-up with CT imaging is therefore mandatory. © 2013, Otology &Neurotology, Inc.

Ben Ammar M.,Tunis el Manar University | Piccirillo E.,Gruppo Otologico | Topsakal V.,University Utrecht | Taibah A.,Gruppo Otologico | And 2 more authors.
Neurosurgery | Year: 2012

Background: Vestibular schwannomas (VSs) are the most common cerebellopontine angle tumors, accounting for 75% of all lesions in this location. Objective: To evaluate the results after removal of VS through the enlarged translabyrinthine approach, which is a widening of the classic translabyrinthine approach that gives larger access and provides more room to facilitate tumor removal and to minimize surgery-related morbidities. Methods: This was a retrospective study of 1865 patients who underwent VS excision through the enlarged translabyrinthine approach between 1987 and 2009. Mean age was 50.39 years. Mean tumor size was 1.8 cm. Median follow-up was 5.7 years. Results: Total removal was achieved in 92.33% of cases; 143 patients had incomplete resection with evidence of regrowth in 8. In the 1742 previously untreated patients, anatomic preservation of facial nerve was achieved in 1661 cases (95.35%), and House-Brackmann grade I or II was reached in 1047 patients (59.87%). Facial nerve outcome was significantly better in tumors ≤ 20 mm. Surgical complications included cerebrospinal fluid leakage in 0.85%, meningitis in 0.10%, intracranial bleeding in 0.80%, non - VII/VIII cranial nerve palsy in 0.96%, cerebellar ataxia in 0.69%, and death in 0.10%. The technical modifications that evolved with increasing experience are described. Conclusion: The enlarged translabyrinthine approach is a safe and effective approach for the removal of VS. In our experience, the complication rate is very low and tumor size is still the main factor influencing postoperative facial nerve function with a cutoff point at around 20 mm. Copyright © 2011 by the Congress of Neurological Surgeons.

Tanbouzi Husseini S.,Gruppo Otologico | Piccirillo E.,Gruppo Otologico | Taibah A.,Gruppo Otologico | Paties C.T.,Ospedale G. da Saliceto | And 3 more authors.
Laryngoscope | Year: 2011

Objectives/Hypothesis: A relation between conventional radiotherapy and the development of intracranial neoplasma is well known, but radiation-associated tumor following stereotactic radiotherapy of vestibular schwannoma is underestimated. In this article we will study this relation by doing a complete literature review on all the malignant intracranial tumors that appeared following radiosurgery and adding a case of malignant vestibular schwannoma following stereotactic radiotherapy in a Neurofibromatosis type 2 patient. Methods: Literature review and discussion. Results: We found 26 cases of malignant brain tumor following stereotactic radiotherapy including our case. In 13 cases the tumor occurred in context of Neurofibromatosis type 2. None of the patients had a tumor size less than 2.5 cm. and the mean latency period between the radiotherapy and malignant tumor development was 5.8 years. Conclusion: Patients with vestibular schwannoma should be made aware of the low incidence of the radiation-induced malignant changes and long-term follow-up is mandatory. © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Angeli R.D.,Gruppo Otologico | Piccirillo E.,Gruppo Otologico | Di Trapani G.,Gruppo Otologico | Sequino G.,Gruppo Otologico | And 2 more authors.
Otology and Neurotology | Year: 2011

Objective: To describe and analyze the main outcomes achieved in a series of patients with sporadic vestibular schwannoma (VS) larger than 40 mm in extrameatal diameter, defined as giant VS, submitted to microsurgery by the enlarged translabyrinthine approach with transapical extension. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: A retrospective chart review was conducted on 2,133 patients who underwent surgery for VS from April 1987 to July 2009. One hundred ten cases of giant VS were elected for analysis. Main Outcome Measures: Extent of removal, residual or recurrent disease, facial nerve integrity during surgery, long-term facial nerve function, and postoperative complications. Results: Total removal was accomplished in 91.8% of cases. In 5 patients (4.5%), total removal was accomplished in 2 stages. Near-total removal was performed in 7 patients (6.3%). The facial nerve was anatomically preserved in 76.4% of cases. Intraoperative facial nerve reconstruction was performed in 8 cases. Facial nerve function after 1 year of follow-up was House-Brackmann grades I to III in 75% of cases. There were no deaths in this series. Neurovascular life-threatening complications occurred in 2 patients. Cerebrospinal fluid leak was present in 1.8% of cases. Conclusion: Results indicate the enlarged translabyrinthine approach with transapical extension as an elective approach for removal of giant VS. The method permits achievement of a high rate of total removal with low incidence of complications. © 2010, Otology & Neurotology, Inc.

Sanna M.,Gruppo Otologico | Di Lella F.,Gruppo Otologico | Guida M.,Gruppo Otologico | Merkus P.,VU University Amsterdam
Otology and Neurotology | Year: 2012

OBJECTIVE: Neurofibromatosis Type 2 (NF2) patients have multiple central nervous system tumors and, specifically, bilateral vestibular schwannomas (VSs) causing bilateral deafness. If the cochlear nerve is not preserved during tumor removal, the only hearing rehabilitation in these patients could be via an auditory brainstem implant (ABI). STUDY DESIGN: Retrospective case study and literature review. SETTING: Tertiary referral cranial base center. PATIENTS: In 24 NF2 patients, 25 ABIs were placed in the lateral recess of the fourth ventricle after VS surgery via a translabyrinthine approach. RESULTS: In this series, a large range of results are observed: from open speech and use of the telephone to no ABI use, because of the poor sound identification ability. Of the 24 patients, 19 use their ABI on a daily basis, 4 are nonusers, and 1 died of NF2 progression. A multivariate analysis did not reveal a good predictor for ABI outcome.In literature, the results of ABI in NF2 are difficult to compare, and the overall outcome was poor compared with cochlear implantation results. CONCLUSION: Auditory brainstem implantation in NF2 patients directly after tumor removal is a safe procedure and the best means of hearing rehabilitation if the cochlear nerve is not preserved. The results in NF2 cases in the literature and these series are poor compared with cochlear implantation. If a cochlear implant is possible, it has the preference over an ABI, also in NF2. Nevertheless, the majority of the patients have benefit of the ABI during daily life particularly in combination with lip reading. © 2012, Otology & Neurotology, Inc.

Pandya Y.,Gruppo Otologico | Piccirillo E.,Gruppo Otologico | Mancini F.,Gruppo Otologico | Sanna M.,Gruppo Otologico
Annals of Otology, Rhinology and Laryngology | Year: 2010

Objectives: In a retrospective analysis of a quaternary referral neuro-otologic private practice, we identify complex cases of petrous bone cholesteatoma (ie, cases with encasement of vital structures such as the internal carotid artery, jugular bulb, and sigmoid sinus, with further extension to the clivus, sphenoid sinus, or rhinopharynx), review surgical approaches and techniques of management of vital structures, and propose the ideal surgical management. Methods: We performed a retrospective case study of 130 cases of petrous bone cholesteatoma submitted to surgery between 1979 and 2009 to identify the complex cases and their classification, approach used, outcomes, and recurrences. Results: Of 130 cases, 13 were complex. Facial palsy was the presenting feature in 11 cases, 7 of which presented with grade VI palsy. A long duration of facial palsy (more than 3 years) was seen in 5 cases. Clival involvement was seen in 6 cases; 1 case extended to the sphenoid sinus, and 1 to the rhinopharynx. The internal carotid artery was encased in 11 cases in the vertical and the horizontal parts. The jugular bulb was involved in 7 cases. Modified transcochlear approaches or infratemporal fossa approaches were used in all cases. There were no recurrences. Conclusions: Classification is fundamental to choosing the right surgical approach. Transotic and modified transcochlear approaches hold the key to treating complex cases. Infratemporal fossa approach type B has to be used for extension into the clivus, sphenoid sinus, or rhinopharynx. Internal carotid artery, jugular bulb, and sigmoid sinus involvement should be identified before operation. © 2010 Annals Publishing Company. All rights reserved.

Odat H.A.,Jordan University of Science and Technology | Piccirillo E.,Gruppo Otologico | Sequino G.,Gruppo Otologico | Taibah A.,Gruppo Otologico | Sanna M.,Gruppo Otologico
Otology and Neurotology | Year: 2011

OBJECTIVES: To discuss our management strategy of vestibular schwannoma in patients with neurofibromatosis type 2 (NF2). STUDY DESIGN: Retrospective study. SETTING: Quaternary referral skull base center. METHODS: Thirty-eight NF2 patients who had undergone 48 operations at the Gruppo Otologico between January 1988 and December 2008. The mean age at time of surgery was 36.3 years (range, 17-65 yr), and the average tumor size was 3.1 cm (range, 0.6-6 cm). There were 27 female and 21 male ears, and 25cases were right side ears, whereas 23 were left sided. The average follow-up time was 3.7 years. Surgical approaches, hearing, and facial nerve functions, as well as hearing rehabilitation and facial nerve reconstruction outcomes, are discussed. RESULTS: Total tumor resection was achieved in 44 cases (92%). Facial nerve function was postoperatively House-Brackmann grades I-III in 36 cases (77%); it was grade I in 17 cases (35%) and grade II in 8 cases (17%). In 7 cases, hearing preservation was attempted, and a measurable hearing has been recorded in 5 cases (71%). Auditory brainstem implant was inserted in 25 cases, and concomitant cochlear implants were inserted in 5 cases. CONCLUSION: Early diagnosis and treatment of bilateral vestibular schwannoma in patients with NF2 will achieve the best outcomes regarding facial nerve, hearing preservation, and postoperative complications. The watchful waiting policy will decrease the chance of reaching these goals. Cochlear implants and auditory brainstem implant have made hearing rehabilitation possible in NF2 patients who had bilateral sensorineural hearing loss. © 2011, Otology &Neurotology, Inc.

Falcioni M.,Gruppo Otologico | Fois P.,University of Parma | Taibah A.,Gruppo Otologico | Sanna M.,Gruppo Otologico
Journal of Neurosurgery | Year: 2011

Object. The object of this study was to evaluate long-term postoperative facial nerve (FN) function in patients undergoing vestibular schwannoma (VS) surgery. Methods. The authors retrospectively reviewed the clinical course of patients affected by isolated VSs with normal preoperative FN function, with no previous surgical or radiotherapeutic treatment, and who underwent surgery between 1987 and 2007. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) scale. The minimum postoperative follow-up was 12 months. Results. Among the 1550 patients surgically treated at the authors' center, 1151 matched inclusion criteria for the present study. The FN was anatomically interrupted in 48 cases (4.2%), and 51 patients (4.4%) underwent subtotal tumor removal and were considered separately. Among the 1052 patients with anatomically preserved FNs and total tumor removal, 684 (65%) enjoyed postoperative HB Grade I or II and 309 (29.4%) enjoyed Grade III, with the remaining 59 cases (5.6%) suffering unsatisfactory results (HB Grades IV-VI). As expected, FN function results deteriorated in cases of larger tumors. Conclusions. The main factor influencing postoperative FN function was tumor size. Although there was a progressive deterioration in FN function outcome in relation to tumor size, a cutoff point between satisfactory and unsatisfactory results could be identified at around 2 cm in maximum extrameatal tumor diameter, with the "optimal size" for surgery identified at < 1 cm. This finding emphasizes the importance of an early diagnosis and should be kept in mind when selecting the correct timing for VS removal. For small lesions, the results following a middle cranial fossa approach were significantly worse as compared with those following the translabyrinthine and retrosigmoid- retrolabyrinthine approaches.

Ozmen O.A.,Uludag University | Falcioni M.,Gruppo Otologico | Lauda L.,Gruppo Otologico | Sanna M.,Gruppo Otologico
Otology and Neurotology | Year: 2011

OBJECTIVE: To investigate the factors that were effectual on the recovery of the facial nerve functions after repair with grafting. STUDY DESIGN: Retrospective case review. SETTING: Private neuro-otologic and cranial base quaternary referral center. PATIENTS: One hundred ninety-four patients underwent facial nerve grafting during lateral cranial base surgery between July 1989 and December 2009. The mean age of the patients was 44.1 ± 15.8 years (range, 2-79 yr). There were 94 male and 100 female patients. Facial nerve functions were normal in 89 patients, whereas facial nerve paresis or paralysis was present for a mean duration of 25.4 months (range, 1-600 mo) in the rest of the patients. MAIN OUTCOME MEASURE: Final facial nerve motor function. RESULTS: Best outcome, which was Grade III according to House-Brackmann scale, was achieved in 105 of 155 patients with a follow-up of 1 year or longer (67.7%). Final result was grade IV in 23 (14.8%), grade V in 8 (5.2%), and grade VI in 19 patients (12.3%). Preoperative deficit duration was found to be the only significant factor that affected the prognosis (p = 0.027). Receiver operating characteristic curve analysis revealed that the most critical time for recovery to grades III and IV function is 6 months (p < 0.001). CONCLUSION: A number of factors were implicated to affect the success rate of facial nerve grafting, but only the duration of preoperative facial nerve deficit was found to be significant. Thus, timely management of facial nerve problems is critical for achieving optimal results. © 2011, Otology &Neurotology, Inc.

Giannuzzi A.L.,Gruppo Otologico | Merkus P.,VU University Amsterdam | Falcioni M.,Gruppo Otologico
Otology and Neurotology | Year: 2013

OBJECTIVE: To document the effect of intratympanic gentamicin as treatment of disabling vertigo secondary to a vestibular schwannoma in elderly patients. PATIENTS: Four elderly patients with a vestibular schwannoma, with an extrameatal diameter of less than 1 cm, experiencing disabling vertigo and followed a wait-and-scan policy. INTERVENTION: Intratympanic injection of gentamicin. MAIN OUTCOME MEASURES: Subjective improvement of quality of life and audiologic and vestibular assessment. RESULTS: We obtained a subjective improvement in the quality of life for all the 4 patients. In fact, disabling vertigo disappeared in all cases; 3 patients recovered their posttreatment unsteadiness after a period of vestibular rehabilitation, whereas one of them complained of persistent unsteadiness. The hearing remained unchanged in 3 patients, whereas in one, the pretreatment severe sensorineural hearing loss progressed to anacusis. CONCLUSION: This treatment represents an additional option in patients with small not-growing tumor affected by vestibular symptoms to be combined with a wait-and-scan policy. © 2013, Otology &Neurotology, Inc.

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