House Ear Institute and House Ear Clinic

Los Angeles, California, United States

House Ear Institute and House Ear Clinic

Los Angeles, California, United States
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PubMed | House Ear Institute and House Ear Clinic
Type: Journal Article | Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology | Year: 2010

To review the clinical presentation, evaluation, and management of 18 patients with geniculate ganglion hemangiomas seen at the House Clinic.Retrospective case review.Private neurotological tertiary referral center.Eighteen patients with geniculate ganglion hemangiomas treated at the House Clinic between 1986 and 2008.Observation or surgical intervention using the middle fossa or translabyrinthine craniotomy for decompression or excision of the hemangioma with or without facial nerve resection and grafting.Postoperative facial function using the House-Brackmann grading system, postoperative audiograms and postoperative follow-up magnetic resonance imaging or computed tomographic scan of the temporal bone.Approximately 13 patients (72%) were female subjects, and 5 (28%) were male subjects. Mean age was 54 years, and follow-up was 73 months. 17 (94%) of 18 patients presented with facial paresis or paralysis. Facial twitching was present in 10 (56%) of 18 cases. Four patients (22%) presented with hearing loss. Facial nerve function was House-Brackmann grade I/II in 7(38%), III/IV in 5 (28%), and V/VI in 6 (34%) patients, respectively. Approximately 13 patients (72%) underwent middle fossa craniotomy for excision or decompression of their hemangiomas, and 2 (11%) underwent translabyrinthine removal. The facial nerve was preserved in 11 (73%) of 15 patients and was excised and grafted in 4 (27%) of 15. Recovery to a House-Brackmann grade I/II was seen in 8 (72%) of 11 patients in whom the integrity of the facial nerve was preserved. In the surgical group, hearing remained stable in 64% of hearing preservation cases and worsened in 38%. Facial function remained stable in the nonsurgical group.Geniculate ganglion hemangiomas are rare vascular malformations that produce facial paralysis despite their relative small size at presentation. When possible, excision with neural preservation yields better long-term facial function. Recurrences are rare.


PubMed | House Ear Institute and House Ear Clinic
Type: Journal Article | Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology | Year: 2010

To describe the diagnosis, management, and treatment outcome of jugular foramen (JF) tumors.Retrospective chart review.Charts of the 83 patients diagnosed with JF tumors between January 1997 and May 2008 were reviewed. Presenting symptoms, otologic and neurotologic examination, audiologic thresholds, treatment procedure, surgical technique, tumor size and classification, and postoperative complications were recorded. Facial nerve function was graded using the House-Brackmann scale. Extent of tumor removal was determined at time of surgery, followed by routine radiographic follow-up.The mean age of patients with JF tumors was 48.5 years (standard deviation, 16.3 yr), and women (79.5%) outnumbered men (20.5%). Most had glomus jugulare (GJ) tumors (n = 67, 80.7%); 9 patients had lower cranial nerve schwannomas (10.8%), and 7 patients had meningiomas (8.4%). The most frequent initial symptoms included pulsatile tinnitus (84.3%), conductive hearing loss (75.9%), and hoarseness (34.9%). Sixty-one patients (73.5%) underwent surgery, 18.1% had radiotherapy, and 8.4% were observed. Total tumor removal was achieved in 81% of surgery cases. New lower cranial nerve (CN) deficits occurred after surgery in 18.9% of GJ, 22.2% of schwannoma, and 50% of the 4 meningiomas. At last follow-up, 88.1% of surgical patients had normal or near-normal (House-Brackmann I or II) facial function.Total resection of GJ tumors, meningiomas, and lower CN schwannomas can be a curative treatment. However, subtotal removal may be required to preserve CN function, vital vascular structures, and the brainstem. Postoperative radiotherapy is used to control residual tumor. When postoperative complications develop in patients, early rehabilitation is important to decrease mortality and morbidity. Therefore, patients should be closely followed.

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