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Piacenza d'Adige, Italy

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. Source

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. Source

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. Source

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. Source

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. Source

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