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Piacenza d'Adige, Italy

Shin S.-H.,CHA Medical University | Sivalingam S.,Gruppo Otologico Piacenza Rome | De Donato G.,Gruppo Otologico Piacenza Rome | Falcioni M.,Gruppo Otologico Piacenza Rome | And 2 more authors.
Audiology and Neurotology | Year: 2012

Objectives: To present the management and outcomes of cases of tympanojugular paraganglioma (TJP) with vertebral artery (VA) involvement, and to propose the addition of the new 'V' category to the Fisch classification. Materials and Methods: Retrospective analysis of data from a quaternary neuro-otologic and skull base referral center. We studied 230 TJP patients to identify the cases with VA involvement and present their management, surgical findings and outcome. Results: Out of 230 patients, 8 patients were found to have VA involvement by TJP. The extradural artery was involved in 1 patient and the intradural VA was involved in 6 patients. The intradural and extradural VA were simultaneously involved in 1 patient. Seven of the 8 patients underwent surgery. In 2 patients, preoperative occlusion was performed (1 with balloon, 1 with coils). In 5 of these 7 patients, the tumor was successfully separated from the VA by microdissection with or without endovascular intervention. In another patient, the tumor together with the involved VA was removed. Of 7 patients who had surgery, 1 patient did not undergo endovascular intervention and had subtotal tumor removal from the VA. There were no serious complications in removing the tumor from around the VA. Conclusion: Although uncommon, the intradural or extradural VA can be involved by TJP. To avoid vascular accidents, the VA should be thoroughly evaluated at the planning stage. We advocate that the addition of a 'V' category would help to identify patients who need individualized VA management as part of a complete surgical evaluation. © 2011 S. Karger AG, Basel.

Sbaihat A.,Gruppo Otologico Piacenza Rome | Bacciu A.,University of Parma | Pasanisi E.,University of Parma | Sanna M.,Gruppo Otologico Piacenza Rome | Sanna M.,University of Chieti Pescara
Annals of Otology, Rhinology and Laryngology | Year: 2013

Objectives: We describe our experience in the management of patients with skull base chondrosarcoma, an uncommon neoplasm of the skull base. Methods: Thirteen cases of surgically treated skull base chondrosarcomas were identified. The patients' follow-ups ranged from 7 to 86 months (mean, 47 months). Results: The most common tumor locations were the jugular foramen (5 cases), the petrous apex (3 cases), and the petroclival region (3 cases). An infratemporal fossa type A approach was performed in 2 cases, and 2 patients underwent an infratemporal fossa type B approach. Two patients underwent a transotic approach, 1 patient underwent a petro-occipital transsigmoid approach, and a petro-occipital transsigmoid approach combined with a transotic approach was chosen in 1 case. One patient underwent an infratemporal fossa type C approach combined with a transotic approach, and 2 patients underwent an infratemporal fossa type B approach combined with a transotic approach. One patient underwent an infratemporal fossa type B approach combined with a transzygomatic approach, and the last patient underwent a transmastoid approach. Gross total tumor removal was achieved in all patients. Postoperative radiotherapy was performed in 7 cases. The most common complications were lower cranial nerve deficits. Two patients experienced recurrences, 36 months and 6 years after surgical removal. Conclusions: We believe that the primary treatment for chondrosarcomas of the skull base is gross total surgical resection. We usually do not recommend radiotherapy as the primary treatment for patients with skull base chondrosarcomas; however, radiotherapy may be considered as an alternative primary treatment in selected cases in which there are serious medical contraindications to surgery, as well as in elderly patients. We reserve postoperative radiotherapy for patients with histologically aggressive tumors (grade II or III), as well as for cases of subtotal resection or recurrent tumors. © 2013 Annals Publishing Company. All rights reserved.

Bacciu A.,University of Parma | Lella F.D.,Gruppo Otologico Piacenza Rome | Lella F.D.,University of Chieti Pescara | Ventura E.,University of Parma | And 5 more authors.
Annals of Otology, Rhinology and Laryngology | Year: 2014

Objectives: Lipomas of the internal auditory canal (IAC) and cerebellopontine angle (CPA) are exceedingly rare lesions. The purpose of this report was to describe our experience with lipomas of the IAC and CPA and perform a review of the literature. Methods: We report 8 cases of lipomas involving the IAC and/or the CPA that were managed at Gruppo Otologico between April 1987 and October 2012. Results: Four cases of entirely intracanalicular lipomas were radiologically misinterpreted as vestibular schwannomas and underwent tumor removal by a translabyrinthine approach. Two of these patients experienced postoperative facial nerve palsy. Lipomas were suspected in 4 patients on the basis of imaging findings and were managed conservatively. Of these 4 cases, 3 did not show any growth after an average period of 28 months, and 1 case demonstrated tumor growth on follow-up imaging. Conclusions: Neuroimaging represents an extremely important tool for this diagnosis. Attempts to achieve complete resection may result in severe neurologic sequelae, especially in large lesions. Observation with repeated imaging in order to detect growth of the lesion is usually recommended. Debulking of the tumor, mainly aimed at brain stem and cranial nerve decompression, should be considered in cases of disabling and uncontrolled neurologic symptoms and signs. © The Author(s) 2014.

Di Lella F.,Gruppo Otologico Piacenza Rome | Merkus P.,Gruppo Otologico Piacenza Rome | Di Trapani G.,Gruppo Otologico Piacenza Rome | Taibah A.,Gruppo Otologico Piacenza Rome | And 2 more authors.
Annals of Otology, Rhinology and Laryngology | Year: 2013

Objectives: We sought to delineate the role of cochlear implantation in the management of vestibular schwannoma or other cerebellopontine angle tumors in the only hearing ear. Methods: We performed a retrospective analysis in a quaternary referral skull base center of all patients who were affected by vestibular schwannoma (or other lesions of the cerebellopontine angle) in the only hearing ear and received a cochlear implant before or after tumor treatment (surgery or radiotherapy) or during the wait-and-scan follow-up. We also performed a systematic review of the English-language literature. Results: The clinical and audiological results of 10 patients are reported. All patients were managed with contralateral cochlear implantation. In 7 patients, cochlear implantation was performed before tumor removal, while hearing in the ear with the tumor was still present. In 3 patients, the implant was placed after curative surgery. Nine of the 10 patients routinely use their implant with subjective benefit and fairly good auditory performance (median disyllabic word recognition, 90%; median sentence comprehension, 75%). The literature search retrieved no major series with assessment of the long-term efficacy of cochlear implantation in this rare clinical scenario. Conclusions: Patients affected by vestibular schwannoma in their only hearing ear may significantly benefit from a cochlear implant on the contralateral side prior to tumor removal. Recent and significant hearing deterioration and tumor growth represent the main indications for cochlear implantation. © 2013 Annals Publishing Company. All rights reserved.

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