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Letter to the editor in response to Mawby et al. A UK experience of daycase cochlear implant surgery.
Cochlear Implants Int. 2016 Feb 4;
Authors: Trudel M, Côté M, Philippon D, Bussières R
PMID: 26843387 [PubMed - as supplied by publisher]
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Intraoperative seizure and cerebrospinal fluid leak during adult cochlear implant surgery.
Cochlear Implants Int. 2016 Feb 4;
Authors: Musser AB, Golub JS, Samy RN, Phero JC
Abstract
Objective and Importance To report a rare case of cerebrospinal fluid gusher and subsequent seizure immediately after cochlear implant electrode insertion. Clinical Presentation After the cochlear implant electrode was inserted, brisk flow of 10 mL of cerebrospinal fluid was seen. The electrode was promptly inserted and the leak was additionally sealed with fascia. Seconds later, the patient had a tonic-clonic seizure lasting 30 seconds. Two additional episodes occurred during the case. Her postoperative course was uneventful with no subsequent seizures. The device has been successfully activated. Intervention & Technique Postoperative imaging showed correct intracochlear placement of the electrode as well as an incidental enlarged vestibular aqueduct. Neurology consultation including electroencephalogram was unremarkable. Conclusion To our knowledge, this is the first report of a seizure temporally associated with cochlear implant electrode insertion. The significance and possible casual relationship between these two events is discussed.
PMID: 26843205 [PubMed - as supplied by publisher]
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Prior exposure to a reverberant listening environment improves speech intelligibility in adult cochlear implant listeners.
Cochlear Implants Int. 2016 Feb 4;
Authors: Srinivasan NK, Tobey EA, Loizou PC
Abstract
Objectives The goal of this study is to investigate whether prior exposure to reverberant listening environment improves speech intelligibility of adult cochlear implant (CI) users. Methods Six adult CI users participated in this study. Speech intelligibility was measured in five different simulated reverberant listening environments with two different speech corpuses. Within each listening environment, prior exposure was varied by either having the same environment across all trials (blocked presentation) or having different environment from trial to trial (unblocked). Results Speech intelligibility decreased as reverberation time increased. Although substantial individual variability was observed, all CI listeners showed an increase in the blocked presentation condition as compared to the unblocked presentation condition for both speech corpuses. Conclusion Prior listening exposure to a reverberant listening environment improves speech intelligibility in adult CI listeners. Further research is required to understand the underlying mechanism of adaptation to listening environment.
PMID: 26843090 [PubMed - as supplied by publisher]
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The Sound Access Parent Outcomes Instrument (SAPOI): Construction of a new instrument for children with severe multiple disabilities who use cochlear implants or hearing aids.
Cochlear Implants Int. 2016 Feb 4;
Authors: Hayward DV, Ritter K, Mousavi A, Vatanapour S
Abstract
Objective To report on the Phase 2 development of the Sound Access Parent Outcomes Instrument (SAPOI), a new instrument focused on formalizing outcomes that parents of children with severe multiple disabilities (SMD) who use amplification prioritize as important. Methods Phase 2 of this project involved item selection and refinement of the SAPOI based on (a) Phase 1 study participant input, (b) clinical specialist feedback, and (c) test-retest instrument reliability. Phase 1 participant responses were utilized to construct a draft version of the SAPOI. Next, clinical specialists examined the instrument for content validity and utility and instrument reliability was examined through a test-retest process with parents of children with SMD. Results The draft SAPOI was constructed based on Phase 1 participant input. Clinical specialists supported content validity and utility of the instrument and the inclusion of 19 additional items across four categories, namely Child Affect, Child Interaction, Parent Well-being, and Child's Device Use. The SAPOI was completed twice at one-month intervals by parents of children with SMD to examine instrument reliability across the four categories (Child Affect, Child Interaction, Parent Well-being, and Child's Device Use). Instrument reliability was strong-to-excellent across all four sections. Discussion The SAPOI shows promise as a much-needed addition to the assessment battery currently used for children with SMD who use cochlear implants and hearing aids. It provides valuable information regarding outcomes resulting from access to sound in this population that currently used assessments do not identify.
PMID: 26841928 [PubMed - as supplied by publisher]
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Speech perception scores in cochlear implant recipients: An analysis of ceiling effects in the CUNY sentence test (Quiet) in post-lingually deafened cochlear implant recipients.
Cochlear Implants Int. 2016 Feb 4;
Authors: Ebrahimi-Madiseh A, Eikelboom RH, Jayakody DM, Atlas MD
Abstract
Objectives To evaluate the clinical utility of the City University of New York sentence test in a cohort of post-lingually deafened cochlear implants recipients over time. Methods 117 post-lingually deafened, Australian English-speaking CI recipients aged between 23 and 98 years (M = 66 years; SD = 15.09) were recruited. CUNY sentence test scores in quiet were collated and analysed at two cut-offs, 95% and 100%, as ceiling scores. Results CUNY sentence scores ranged from 4% to 100% (M = 86.75; SD = 20.65), with 38.8% of participants scoring 95% and 16.5% of participants reaching the 100% scores. The percentage of participants reaching the 95% and 100% ceiling scores increased over time (6 and 12 months post-implantation). The distribution of all post-operative CUNY test scores skewed to the right with 82% of test scores reaching above 90%. Discussion This study demonstrates that the CUNY test cannot be used as a valid tool to measure the speech perception skills of post-lingually deafened CI recipients over time. This may be overcome by using adaptive test protocols or linguistically, cognitively or contextually demanding test materials. Conclusion The high percentage of CI recipients achieving ceiling scores for the CUNY sentence test in quiet at 3 months post-implantation, questions the validity of using CUNY in CI assessment test battery and limits its application for use in longitudinal studies evaluating CI outcomes. Further studies are required to examine different methods to overcome this problem.
PMID: 26841858 [PubMed - as supplied by publisher]
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Experiences from Auditory Brainstem Implantation (ABIs) in four paediatric patients.
Cochlear Implants Int. 2016 Feb 4;
Authors: Lundin K, Stillesjö F, Nyberg G, Rask-Andersen H
Abstract
Introduction Indications for auditory brainstem implants (ABIs) have been widened from patients with neurofibromatosis type 2 (NF2) to paediatric patients with congenital cochlear malformations, cochlear nerve hypoplasia/aplasia, or cochlear ossification after meningitis. We present four ABI surgeries performed in children at Uppsala University Hospital in Sweden since 2009. Methods Three children were implanted with implants from Cochlear Ltd. (Lane Cove, Australia) and one child with an implant from MedEl GMBH (Innsbruck, Austria). A boy with Goldenhar syndrome was implanted with a Cochlear Nucleus ABI24M at age 2 years (patient 1). Another boy with CHARGE syndrome was implanted with a Cochlear Nucleus ABI541 at age 2.5 years (patient 2). Another boy with post-ossification meningitis was implanted with a Cochlear Nucleus ABI24M at age 4 years (patient 3). A girl with cochlear aplasia was implanted with a MedEl Synchrony ABI at age 3 years (patient 4). In patients 1, 2, and 3, the trans-labyrinthine approach was used, and in patient 4 the retro-sigmoid approach was used. Results Three of the four children benefited from their ABIs and use it full time. Two of the full time users had categories of auditory performance (CAP) score of 4 at their last follow up visit (6 and 2.5 years postoperative) which means they can discriminate consistently any combination of two of Ling's sounds. One child has not been fully evaluated yet, but is a full time user and had CAP 2 (responds to speech sounds) after 3 months of ABI use. No severe side or unpleasant stimulation effects have been observed so far. There was one case of immediate electrode migration and one case of implant device failure after 6.5 years. Conclusion ABI should be considered as an option in the rehabilitation of children with similar diagnoses.
PMID: 26841821 [PubMed - as supplied by publisher]
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Effects of Age, Sex and Syllable Number on Voice Onset Time: Evidence from Children's Voiceless Aspirated Stops.
Lang Speech. 2015 Jun;58(Pt 2):152-67
Authors: Yu VY, De Nil LF, Pang EW
Abstract
Voice onset time (VOT) is a temporal acoustic parameter that reflects motor speech coordination skills. This study investigated the patterns of age and sex differences across development of voice onset time in a group of 70 English-speaking children, ranging in age from 4.1 to 18.4 years, and 12 young adults. The effect of the number of syllables on VOT patterns was also examined. Speech samples were elicited by producing syllables /pa/ and /pataka/. Results supported previous findings showing that younger children produce longer VOT values with higher levels of variability. Markedly higher VOT values and increased variability were found for boys at ages between 8 and 11 years, confirming sex differences in VOT patterns and patterns of variability. In addition, all participants consistently produced shorter VOT with higher variability for multisyllables than monosyllables, indicating an effect of syllable number. Possible explanations for these findings and clinical implications are discussed.
PMID: 26677640 [PubMed - indexed for MEDLINE]
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Task type affects location of language-positive cortical regions by repetitive navigated transcranial magnetic stimulation mapping.
PLoS One. 2015;10(4):e0125298
Authors: Hauck T, Tanigawa N, Probst M, Wohlschlaeger A, Ille S, Sollmann N, Maurer S, Zimmer C, Ringel F, Meyer B, Krieg SM
Abstract
OBJECTIVES: Recent repetitive TMS (rTMS) mapping protocols for language mapping revealed deficits of this method, mainly in posterior brain regions. Therefore this study analyzed the impact of different language tasks on the localization of language-positive brain regions and compared their effectiveness, especially with regard to posterior brain regions.
METHODS: Nineteen healthy, right-handed subjects performed object naming, pseudoword reading, verb generation, and action naming during rTMS language mapping of the left hemisphere. Synchronically, 5 Hz/10 pulses were applied with a 0 ms delay.
RESULTS: The object naming task evoked the highest error rate (14%), followed by verb generation (13%) and action naming (11%). The latter revealed more errors in posterior than in anterior areas. Pseudoword reading barely generated errors, except for phonological paraphasias.
CONCLUSIONS: In general, among the evaluated language tasks, object naming is the most discriminative task to detect language-positive regions via rTMS. However, other tasks might be used for more specific questions.
PMID: 25928744 [PubMed - indexed for MEDLINE]
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Cervical vestibular-evoked myogenic potential in vestibular schwannoma after gamma-knife surgery.
Auris Nasus Larynx. 2015 Aug;42(4):265-70
Authors: Lee YF, Lee CC, Wang MC, Liu KD, Wu HM, Guo WY, Shiao AS, Pan DH, Chung WY, Hsu SP
Abstract
OBJECTIVE: Gamma-knife radiosurgery (GKS) for vestibular schwannomas (VSs) has become popular during the last two decades, and a promising tumor control rate has been reported. Therefore, the evaluation and preservation of auditory-vestibular nerve function after GKS have become more and more important in these patients with long-term survival. We have traditionally used pure-tone audiometry (PTA) for evaluation of auditory nerve function, and the caloric test for superior vestibular nerve function. Vestibular-evoked myogenic potential (VEMP) has recently emerged from various neurophysiological examinations for assessment of the integrity of the inferior vestibular nerve function. This novel tool has been established to represent a sacculo-collic reflex. By using these three tools, the auditory-vestibular nerve function of VS patients can be evaluated and monitored before and after GKS.
METHODS: Fourteen patients with unilateral VS that underwent GKS were prospectively recruited. All of them received a battery of auditory-vestibular function tests including PTA, caloric, and cVEMP tests before and after GKS at each time point (1, 6, and 12 months). Our data also included the tumor volumes and their relationship with the PTA, caloric, and cVEMP test results.
RESULTS: The PTA, caloric, and cVEMP tests showed abnormal results before GKS in 85.7%, 78.6% and 78.6% of our VS patients, respectively. The PTA, caloric, and cVEMP results did not show strong correlations between each other. However, there was a tendency that when the tumor grew larger, the auditory-vestibular function deficits became more severe. The PTA and cVEMP test results remained stable during the 1-year follow-up after GKS. However, the caloric test showed transient deterioration at the 6th month follow-up, which then recovered by the 1-year follow-up.
CONCLUSION: The combination of these three tests can help us diagnose VS and assess the change in auditory-vestibular nerve function during the post-GKS follow-up period. The results of these three tests were independent for smaller tumors, but all tests may show abnormal findings with larger tumors. Although the study is still ongoing, the preliminary data showed that GKS treatment would not affect the auditory-vestibular nerve function within a 1-year follow-up period.
PMID: 25666552 [PubMed - indexed for MEDLINE]
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Assessment of nasal mucociliary activity in patients with Behçet's disease.
J Laryngol Otol. 2016 Feb 4;:1-4
Authors: Ozbay I, Kucur C, Temİzturk F, Ozkan Y, Kahraman C, Oghan F
Abstract
OBJECTIVE: To investigate nasal mucociliary clearance in patients with Behçet's disease.
METHODS: Thirty patients with Behçet's disease, diagnosed on the basis of criteria defined by the International Study Group for Behçet's Disease, and 30 healthy individuals were recruited. In both groups, individuals with conditions that could affect nasal mucociliary clearance were excluded. Nasal mucociliary clearance time was evaluated using saccharin tests. The time between placement of a saccharin tablet and the tasting of the saccharin was measured and recorded as the saccharin clearance time.
RESULTS: The mean nasal mucociliary clearance time was significantly longer in the Behçet's disease patients than in the control subjects (p < 0.001). Furthermore, there was a positive correlation between Behçet's disease duration and nasal mucociliary clearance time (p < 0.001, r = 0.882).
CONCLUSION: The results suggest that nasal mucociliary clearance time is longer in Behçet's disease patients than in control subjects, and is positively correlated with disease duration.
PMID: 26841706 [PubMed - as supplied by publisher]
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Early Commencement of Oral Intake and Physical Function are Associated with Early Hospital Discharge with Oral Intake in Hospitalized Elderly Individuals with Pneumonia.
J Am Geriatr Soc. 2015 Oct;63(10):2183-5
Authors: Koyama T, Maeda K, Anzai H, Koganei Y, Shamoto H, Wakabayashi H
PMID: 26480980 [PubMed - indexed for MEDLINE]
High-frequency ultrasound-guided injection for the generation of a novel orthotopic mouse model of human thyroid carcinoma.
Thyroid. 2016 Feb 4;
Authors: Greco A, Albanese S, Auletta L, Mirabelli P, Zannetti A, D'alterio C, Di Maro G, Orlandella FM, Salvatore G, Soricelli A, Salvatore M
Abstract
BACKGROUND: Thyroid carcinoma is the most common endocrine malignancy and has an increasing incidence. High frequency ultrasound (HFUS) has a spatial resolution of 30 µm, which is a property that has been exploited for thyroid visualization and analysis in mice. The aim of this study was to generate a novel orthotopic mouse model of human follicular thyroid carcinoma (FTC) using an HFUS-guided injection system.
METHODS: Twenty Balb/C nude mice were injected in the right lobe of the thyroid with 2 x 106 FTC-133 cells using the microinjection HFUS-guided system, and 20 mice, used as a control, underwent surgical orthotopic implantation of 2 x 106 FTC-133 cells in the right lobe of the thyroid. All mice underwent HFUS imaging 2 weeks after cell injection; HFUS examinations and tumor volume (TV) measurements were repeated weekly. Micro-CT was performed at different time points to determine whether lung metastasis had occurred. TVs were compared between the two models (surgical versus HFUS-guided) using the Mann-Whitney U test, and the Mantel-Cox log-rank test was applied to evaluate the death hazard. Hematoxylin and eosin (H&E) analysis of formalin-fixed, paraffin-embedded mouse tissue was performed to validate the <i>in vivo</i> imaging results.
RESULTS: Nine of eighteen HFUS-guided injected mice survived up to 40 days after the injection of tumor cells. Mice injected surgically had 100% mortality at day 29. Of 38 mice, 29 (14/18 HFUS, 15/20 surgical) showed metastasis in the salivary glands and lymph nodes, and 13 (10/18 HFUS, 3/20 surgical) also showed metastasis in the lungs, which was confirmed by histological analysis. In the surgical group, there was an evident, frequent (12/20 mice) involvement of the contralateral lobe of the thyroid, whereas this feature was only detected in 1 of 18 mice in the HFUS group. The statistical analysis showed the same pattern of growth in the two groups and a significant hazard in the surgical-group mice (P=0.03).
CONCLUSIONS: In our study, we demonstrated the technical feasibility of an HFUS-guided orthotopic mouse model of FTC. The HFUS-guided orthotopic model is easily reproducible and allows prolonged monitoring of the disease because the animals showed an increased survival rate.
PMID: 26844598 [PubMed - as supplied by publisher]
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[Future perspective of immune checkpoint inhibitors in colorectal cancer].
Gan To Kagaku Ryoho. 2015 Nov;42(11):1374-8
Authors: Higuchi H
PMID: 26841457 [PubMed - indexed for MEDLINE]
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[Adjuvant chemo/chemoradiation therapy for colorectal cancer].
Gan To Kagaku Ryoho. 2015 Nov;42(11):1368-73
Authors: Sato T, Nakamura T, Naito M, Ogura N, Yamanashi T, Kosaka Y, Miura H, Tsutsui A, Watanabe M
PMID: 26841456 [PubMed - indexed for MEDLINE]
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[Current status of laparoscopic surgery for colorectal cancer].
Gan To Kagaku Ryoho. 2015 Nov;42(11):1363-7
Authors: Shiomi A
PMID: 26841455 [PubMed - indexed for MEDLINE]
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[Aspirin for the prevention of colorectal cancer].
Gan To Kagaku Ryoho. 2015 Nov;42(11):1357-62
Authors: Nakamura Masato
PMID: 26841454 [PubMed - indexed for MEDLINE]
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[Lower G.I./colon and rectum cancer].
Gan To Kagaku Ryoho. 2015 Nov;42(11):1355-6
Authors: Terashima M
PMID: 26841453 [PubMed - indexed for MEDLINE]
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[III. Fertility preservation for breast cancer patients--approach at our institution].
Gan To Kagaku Ryoho. 2015 Dec;42(13):2444-6
Authors: Doihara H, Shien T
PMID: 26841452 [PubMed - in process]
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[II. Reproductive issues in women with breast cancer--development of a clinical guide on onco-fertility].
Gan To Kagaku Ryoho. 2015 Dec;42(13):2441-3
Authors: Shimizu C
PMID: 26841451 [PubMed - in process]
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[I. Pregnancy-associated breast cancer].
Gan To Kagaku Ryoho. 2015 Dec;42(13):2435-40
Authors: Dobashi K, Akagawa G, Kikutani M
PMID: 26841450 [PubMed - in process]
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[Perinatal care and reproductive technique for patients with breast cancer].
Gan To Kagaku Ryoho. 2015 Dec;42(13):2434
Authors: Saeki T
PMID: 26841449 [PubMed - in process]
Racial, ethnic, and socioeconomic disparities in pituitary surgery outcomes.
Laryngoscope. 2016 Feb 4;
Authors: Goljo E, Parasher AK, Iloreta AM, Shrivastava R, Govindaraj S
Abstract
OBJECTIVES/HYPOTHESIS: To investigate the association of race, ethnicity, socioeconomic status, and hospital volume with outcomes in pituitary surgery.
STUDY DESIGN: Retrospective cross-sectional study of the 2008-2012 National (Nationwide) Inpatient Sample.
METHODS: Patient demographics, hospital characteristics, postoperative complications, and in-hospital mortality for patients undergoing pituitary surgery were compared between white, black, and Hispanic patients. Hierarchal logistic regression analysis was used to assess the association of patient and hospital variables on complication rates.
RESULTS: A total of 8,812 patients met the inclusion criteria, and 5,924 (67.2%) patients were white, 1,590 (18.0%) were black, and 1,296 (14.7%) were Hispanic. Black and Hispanic patients were more likely to live in the poorest income areas, be insured with Medicaid, and be treated at lower-volume pituitary surgery centers. Patients with Medicaid had a higher likelihood of complications compared to Medicare patients, whereas patients with private insurance were significantly less likely to experience any complications. Likelihood of complications was significantly higher for patients treated at lower-volume pituitary surgery centers. When controlled for patient and hospital characteristics, regression analysis showed that the likelihood of postoperative complications was higher in black and Hispanic patients compared to white patients.
CONCLUSIONS: Racial, ethnic, and socioeconomic disparities exist for outcomes after pituitary surgery. Black and Hispanic patients have worse postoperative outcomes compared to white patients, as well as disproportionate utilization of Medicaid and low-volume pituitary surgery centers. Further investigations are necessary to uncover the sources of these disparities in an effort to provide safer and more affordable care to all patients.
LEVEL OF EVIDENCE: 2c. Laryngoscope, 2016.
PMID: 26845457 [PubMed - as supplied by publisher]
Endoscope holders in Cranial Neurosurgery: Part I - technology, trends and implications.
World Neurosurg. 2016 Feb 1;
Authors: Paraskevopoulos D, Roth J, Constantini S
Abstract
OBJECTIVE: Cranial neuroendoscopy is becoming increasingly popular. Endoscopes may be used freehand or with endoscope holders (EH). Aim of this paper is to summarize the evolution of EH and attempt an overview of currently available devices, features and usage, identifying weaknesses and focusing on feasibility.
METHODS: A systematic review was conducted on Pubmed, OvidSP, EBSCO and Google Scholar. Targeted search through cross-references was also implemented, followed by personal contacts, interviews, company websites and operating manuals. A pilot survey was performed to acquire an impression on current state of usage. This was conducted by approaching surgeons from several countries, via email and online through a neurosurgical exchange forum. A more extensive survey will follow as Part II.
RESULTS: EH may be devided into manual and pneumatic. The use of micromanipulators is sometimes implemented. Different characteristics have been described, such as pneumatic, mechanical, friction, micromanipulator, robotic, hybrid, air-locking, voice-control. Twenty eight surgeons responded. The majority (75%) do not routinely use EH. The rest utilize holders mainly for intraventricular rather than skull base procedures. Nearly all surgeons (96%) stated using a second surgeon regularly. Reported weaknesses included crude movements, downward drift, loss of depth perception, lack of flexibility, iatrogenic injury, cost, bulky construct.
CONCLUSION: Although EH have a role in Neuroendoscopy, their use seems limited and their features are regarded as suboptimal. There are no clear indications regarding the procedures that should be performed using EH. Many factors affect the implication of EH, including safety, type of surgery, surgeon's preference and mechanical properties.
PMID: 26844875 [PubMed - as supplied by publisher]
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Nonthermal ablation of deep brain targets: A simulation study on a large animal model.
Med Phys. 2016 Feb;43(2):870
Authors: Top CB, White PJ, McDannold NJ
Abstract
PURPOSE: Thermal ablation with transcranial MRI-guided focused ultrasound (FUS) is currently limited to central brain targets because of heating and other beam effects caused by the presence of the skull. Recently, it was shown that it is possible to ablate tissues without depositing thermal energy by driving intravenously administered microbubbles to inertial cavitation using low-duty-cycle burst sonications. A recent study demonstrated that this ablation method could ablate tissue volumes near the skull base in nonhuman primates without thermally damaging the nearby bone. However, blood-brain disruption was observed in the prefocal region, and in some cases, this region contained small areas of tissue damage. The objective of this study was to analyze the experimental model with simulations and to interpret the cause of these effects.
METHODS: The authors simulated prior experiments where nonthermal ablation was performed in the brain in anesthetized rhesus macaques using a 220 kHz clinical prototype transcranial MRI-guided FUS system. Low-duty-cycle sonications were applied at deep brain targets with the ultrasound contrast agent Definity. For simulations, a 3D pseudospectral finite difference time domain tool was used. The effects of shear mode conversion, focal steering, skull aberrations, nonlinear propagation, and the presence of skull base on the pressure field were investigated using acoustic and elastic wave propagation models.
RESULTS: The simulation results were in agreement with the experimental findings in the prefocal region. In the postfocal region, however, side lobes were predicted by the simulations, but no effects were evident in the experiments. The main beam was not affected by the different simulated scenarios except for a shift of about 1 mm in peak position due to skull aberrations. However, the authors observed differences in the volume, amplitude, and distribution of the side lobes. In the experiments, a single element passive cavitation detector was used to measure the inertial cavitation threshold and to determine the pressure amplitude to use for ablation. Simulations of the detector's acoustic field suggest that its maximum sensitivity was in the lower part of the main beam, which may have led to excessive exposure levels in the experiments that may have contributed to damage in the prefocal area.
CONCLUSIONS: Overall, these results suggest that case-specific full wave simulations before the procedure can be useful to predict the focal and the prefocal side lobes and the extent of the resulting bioeffects produced by nonthermal ablation. Such simulations can also be used to optimally position passive cavitation detectors. The disagreement between the simulations and the experiments in the postfocal region may have been due to shielding of the ultrasound field due to microbubble activity in the focal region. Future efforts should include the effects of microbubble activity and vascularization on the pressure field.
PMID: 26843248 [PubMed - in process]
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Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas.
Am J Otolaryngol. 2015 May-Jun;36(3):382-9
Authors: Patnaik U, Prasad SC, Medina M, Al-Qahtani M, D'Orazio F, Falcioni M, Piccirillo E, Russo A, Sanna M
Abstract
OBJECTIVE: To analyze the long term outcomes after surgery in tympanomastoid paragangliomas.
STUDY DESIGN: Retrospective study.
METHODS: The charts of 145 patients with tympanomastoid paragangliomas managed between 1988 and 2013 were reviewed. The clinical features, audiological data, pre- and postoperative notes were noted. The tumors were staged according to the modified Fish and Mattox classification. The surgical approaches for all patients were formulated according to the surgical algorithm developed at our center.
RESULTS: 34 (23.5%), 46 (31.7%), 22 (15.2%), 18 (12.4%) and 25 (17.2%) patients were diagnosed to have TMP class A1, A2, B1, B2 and B3 tumors respectively. Gross tumor resection was achieved in 141 (97.2%) patients. The facial nerve was uncovered in four patients and infiltrated in three. The cochlea was found eroded in seven cases. The mean follow-up was 48.4 months. Recurrence was seen in one patient (0.7%). In the cases where the facial nerve was preserved (n=143), the nerve function was graded as HB grade 1 in 138 patients (97%). Postoperatively, the mean AC showed an improvement in all categories except in class B2 and B3, which corresponds to the classes that include patients who underwent subtotal petrosectomy.
CONCLUSION: We report the long term surgical outcomes in tympanomastoid paragangliomas in the largest series published till date. It is possible to completely eradicate all types of tympanomastoid paragangliomas with minimum sequelae by choosing the correct surgical approach to achieve adequate exposure for individual tumor classes as described in our classification and algorithm.
LEVEL OF EVIDENCE: IIb.
PMID: 25697086 [PubMed - indexed for MEDLINE]
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Selective partial middle turbinectomy to minimize postoperative obstruction following Lester Jones tube placement.
Am J Otolaryngol. 2015 May-Jun;36(3):330-3
Authors: Fang CH, Patel P, Huang G, Langer PD, Eloy JA
Abstract
PURPOSE: Conjunctivodacryocystorhinostomy (CDCR) with the insertion of a Jones tube is a surgical procedure used to relieve epiphora caused by upper lacrimal system dysfunction from extensive proximal canalicular obstruction, canalicular stenosis, or canalicular flaccidity. Jones tube obstruction, which is the second most frequent complication of CDCR with tube placement, can result from tube placement against the anterior end of the middle turbinate. In this study, we describe our results in 5 patients who underwent anterosuperior partial middle turbinectomy to prevent obstruction.
METHODS: A retrospective analysis was performed on 5 patients who underwent selective anterosuperior partial middle turbinectomy to prevent Jones tube obstruction. Three of these patients developed Jones tube obstruction due to contact between a previously placed Jones tube and the anterosuperior aspect of the adjacent middle turbinate. Two other patients had observed contact between the Jones tube and middle turbinate at initial Jones tube placement and underwent anterosuperior partial middle turbinectomy to prevent development of obstruction. Patency of the Jones tube was assessed symptomatically and by nasal endoscopy at the latest follow-up.
RESULTS: All 5 patients displayed a patent Jones tube after a mean follow-up of 29.6 months without complications. Longer-term complications associated with CDCR with Jones tube placement, including continuous epiphora, dacrocystitis, and poor patient satisfaction, were not observed.
CONCLUSIONS: Selective anterosuperior partial middle turbinectomy may prevent or relieve Jones tube obstruction, provide increased room along the lateral nasal wall along which to place the Jones tube, and decrease the need for further surgeries arising from tube blockage.
PMID: 25498993 [PubMed - indexed for MEDLINE]
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Endoscopic endonasal cranial base surgery simulation using an artificial cranial base model created by selective laser sintering.
Neurosurg Rev. 2015 Jan;38(1):171-8; discussion 178
Authors: Oyama K, Ditzel Filho LF, Muto J, de Souza DG, Gun R, Otto BA, Carrau RL, Prevedello DM
Abstract
Mastery of the expanded endoscopic endonasal approach (EEA) requires anatomical knowledge and surgical skills; the learning curve for this technique is steep. To a great degree, these skills can be gained by cadaveric dissections; however, ethical, religious, and legal considerations may interfere with this paradigm in different regions of the world. We assessed an artificial cranial base model for the surgical simulation of EEA and compared its usefulness with that of cadaveric specimens. The model is made of both polyamide nylon and glass beads using a selective laser sintering (SLS) technique to reflect CT-DICOM data of the patient's head. It features several artificial cranial base structures such as the dura mater, venous sinuses, cavernous sinuses, internal carotid arteries, and cranial nerves. Under endoscopic view, the model was dissected through the nostrils using a high-speed drill and other endonasal surgical instruments. Anatomical structures around and inside the sphenoid sinus were accurately reconstructed in the model, and several important surgical landmarks, including the medial and lateral optico-carotid recesses and vidian canals, were observed. The bone was removed with a high-speed drill until it was eggshell thin and the dura mater was preserved, a technique very similar to that applied in patients during endonasal cranial base approaches. The model allowed simulation of almost all sagittal and coronal plane EEA modules. SLS modeling is a useful tool for acquiring the anatomical knowledge and surgical expertise for performing EEA while avoiding the ethical, religious, and infection-related problems inherent with use of cadaveric specimens.
PMID: 25323096 [PubMed - indexed for MEDLINE]
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Recurrent petroclival meningiomas: clinical characteristics, management, and outcomes.
Neurosurg Rev. 2015 Jan;38(1):71-86; discussion 86-7
Authors: Li D, Hao SY, Wang L, Tang J, Xiao XR, Jia GJ, Wu Z, Zhang LW, Zhang JT
Abstract
This study seeks to elucidate the prognostic predictors and outcomes of recurrent/progressive petroclival meningiomas (PCMs). We reviewed our cohort of 39 recurrent/progressive PCMs (27 females, 69.2%) and analyzed the results from the literature. Twenty-three patients underwent reoperations, 2 received radiotherapy alone, and 14 declined any treatment. During a follow-up of 70.4 months, 7 patients experienced a 2nd recurrence/progression (R/P) and 18 patients died. In the 23 patients, gross total resection (GTR), subtotal resection (STR), and partial resection (PR) were achieved in 8, 8, and 7 patients, respectively. The percentage of the 2nd R/P-free survival of GTR, STR, and PR was 88%, 67%, and 40%, respectively. The overall survival following the 1st R/P of GTR, STR, and PR was 88%, 63%, and 33%, respectively. Patients rejecting treatment suffered from significantly poor overall survival (7%; p = 0.001) and short survival duration (42.0 months; p = 0.016) compared with that of the patients receiving treatment (67% and 86.9 months). The GTR was the only independent favorable predictor. In the 21 included studies with 98 recurrent/progressive PCM patients, 17 patients presented with a 2nd R/P and 10 died of a 2nd R/P; patients undergoing observation had a significantly poor tumor regrowth control rate compared with patients undergoing surgery (p = 0.004) or radiotherapy alone (p < 0.001). Proactive treatment should be performed for patients with recurrent/progressive PCMs. Observation can lead to relentless outcome. GTR as a preferential therapeutic strategy should be pursued as far as possible on the condition of minimal functional impairment.
PMID: 25319087 [PubMed - indexed for MEDLINE]
[Epilepsy, vertigo, dizziness, headache, emesis as neurological manifestation in a Giteleman's Sindrome case].
G Ital Nefrol. 2015 Nov-Dec;32(6)
Authors: Delsere M, Campogiani V, Carletti V, Mancini S, Piccinini N, Castelli P, Sopranzi F
Abstract
We report the case of a woman presenting the recent onset of multiple seizure and epilepsy episodes combined with other neurological symptoms (e.g. vertigo, dizziness, vomiting, headache). She was resistant to antiepileptic and symptomatic therapy, having been first admitted to the neurology ward and subsequently to the general medicine ward. In this case, several patient assessments and imaging exams were not conclusive evidence of specific etiopathogenesis, or definitive neurological illness; however, the patient showed laboratory indexes compatible with Gitelmans Syndrome. The correction of the electrolytic imbalances of tubulopathy (including low magnesium and potassium levels) led to the progressive improvement of clinical manifestations and the eventual interruption of the antiepileptic therapy.
PMID: 26845215 [PubMed - as supplied by publisher]
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Treatment of hemorrhagic acute disseminated encephalomyelitis with cyclophosphamide.
Am J Health Syst Pharm. 2016 Feb 15;73(4):202-5
Authors: Jaskowiak JM
Abstract
PURPOSE: Improvements in hemorrhagic and clinical symptoms in a patient with hemorrhagic acute disseminated encephalomyelitis (ADEM) treated with i.v. cyclophosphamide are reported.
SUMMARY: A 49-year-old woman was hospitalized with progressively worsening left-sided weakness, dysphagia, diplopia, and vertigo. Shortly before hospital admission, the patient had been treated at another facility with corticosteroids and plasma exchanges. Brain magnetic resonance imaging (MRI) studies conducted at the time of admission showed demyelinating lesions of the pons consistent with ADEM; rapid progression of the patient's symptoms also suggested an autoimmune, demyelinating process, and viral studies ruled out an infectious etiology. Despite initial treatment with i.v. immune globulin and additional corticosteroid courses, the patient's condition continued to deteriorate over the next few weeks, with development of respiratory distress requiring intubation. Repeat MRI revealed a new brain lesion in the splenial region of the corpus callosum, prompting the initiation of i.v. cyclophosphamide therapy (180 mg daily). Approximately 19 days after cyclophosphamide therapy was initiated, an MRI scan revealed substantial reduction of the pontine hemorrhage and a normal splenium appearance, with no new lesion development. The use of cyclophosphamide for hemorrhagic ADEM refractory to other treatments has been previously reported.
CONCLUSION: After approximately three weeks of daily i.v. cyclophosphamide therapy, a patient with hemorrhagic ADEM was noted to have stable to improved brain MRI findings along with limited improvement of mental status and movement symptoms.
PMID: 26843496 [PubMed - in process]
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Infarction of the corpus callosum: a retrospective clinical investigation.
PLoS One. 2015;10(3):e0120409
Authors: Li S, Sun X, Bai YM, Qin HM, Wu XM, Zhang X, Jolkkonen J, Boltze J, Wang SP
Abstract
OBJECTIVES: The aim of this study was to investigate patients with ischemic infarctions in the territory of the corpus callosum to advance our understanding of this rare stroke subtype by providing comprehensive descriptive and epidemiological data.
METHODS: From January 1, 2010 to June 30, 2014, all cases of acute ischemic stroke diagnosed by clinical manifestation and diffusion weighted imaging in Dalian Municipal Central Hospital were investigated. The patients presenting with corpus callosum infarctions were selected and further allocated into genu and/or body and splenium infarction groups. Proportion, lesion patterns, clinical features, risk factors and etiology of corpus callosum infarction were analyzed.
RESULTS: Out of 1,629 cases, 59 patients (3.6%) with corpus callosum infarctions were identified by diffusion weighted imaging, including 7 patients who had ischemic lesions restricted to the corpus callosum territory. Thirty six patients had lesions in the splenium (61.0%). Corpus callosum infarction patients suffered from a broad spectrum of symptoms including weakness and/or numbness of the limbs, clumsy speech, and vertigo, which could not be explained by lesions in corpus callosum. A classical callosal disconnection syndrome was found in 2 out of all patients with corpus callosum infarctions. Statistical differences in the risk factor and infarct pattern between the genu and/or body group and splenium group were revealed.
CONCLUSION: Corpus callosum infarction and the callosal disconnection syndrome were generally rare. The most susceptible location of ischemic corpus callosum lesion was the splenium. Splenium infarctions were often associated with bilateral cerebral hemisphere involvement (46.2%). The genu and/or body infarctions were associated with atherosclerosis. The most common cause of corpus callosum infarction probably was embolism.
PMID: 25785450 [PubMed - indexed for MEDLINE]
