Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
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The preoperative, intraoperative, and postoperative variables of patients experiencing hearing improvement after middle fossa resection of vestibular schwannomas were evaluated as potential prognostic indicators. ⋯ Middle fossa resection of vestibular schwannoma offers patients the possibility of hearing improvement after treatment. The chance of hearing improvement is significantly higher than with other forms of treatment such as radiation therapy or translabyrinthine surgery. Although preoperative ABR abnormality may be an indicator of poor prognosis for hearing preservation, those patients who enjoy hearing improvement come from the group of patients with abnormal preoperative ABRs. Other factors identified as associated with hearing improvement include poor SDS with more normal PTA 2, and significantly decreased electronystagmographic caloric function (as an indicator of superior vestibular nerve tumors). Hearing improvement to the functional range after surgical resection is possible in some patients previously thought to be poor candidates for hearing preservation attempts. Hearing improvement may continue for many months after surgery.
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Case Reports
Internal auditory canal involvement of acoustic neuromas: surgical correlates to magnetic resonance imaging findings.
Factors that play a role in the selection of surgical approach for acoustic neuromas include patient health and age, size of tumor, hearing status, and location of tumor in the internal auditory canal (IAC) and the cerebellopontine angle. Deep extension into the IAC makes hearing preservation extremely difficult when a retrosigmoid craniotomy is used, and the best approach is a middle fossa subtemporal route. Modern gadolinium-enhanced magnetic resonance imaging (MRI) can be inaccurate in identifying the presence of tumor laterally in the IAC. This may affect the selection of a surgical approach. ⋯ Gadolinium-enhanced T1-weighted MRI findings of the depth of penetration into the lateral aspect of the IAC do not always correlate with intraoperative findings and thus may have implications in the selection of surgical approaches to acoustic neuromas.
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This study was designed to assess the value of high-resolution multislice computed tomography (MSCT) data of the petrous bone for the virtual endoscopic visualization of the tympanic cavity. ⋯ MSCT data sets allow for generating virtual endoscopic views closely resembling otoendoscopic images. The technique is especially useful when ossicular pathologic changes are present as well as for preoperative and postoperative imaging of otologic procedures.
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The outcomes of surgery for acoustic neuromas have improved dramatically since the development of modern surgical techniques, the operating microscope, magnetic resonance imaging (MRI), and cranial nerve monitoring. The goals of acoustic neuroma surgery are now preservation of facial nerve function and, when feasible, hearing preservation. Many large series do not report standardized hearing and facial function grading, and they include patients who did not benefit from the most modern techniques. The purpose of this study was to present the results of acoustic neuroma surgery using the most modern techniques and equipment, using standardized grading systems. ⋯ These results show that with modern imaging and surgical techniques, acoustic neuroma surgery is extremely safe and outcomes are very good. Surgery remains the treatment of choice for most tumors until alternative therapies, such as gamma knife, use uniform grading scales and show long-term facial and hearing results.
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The aim of the current study was to assess the mechanical stiffness properties of the normal pars flaccida and to compare the results with those obtained in earlier studies on the pars tensa. ⋯ Reference values for displacement versus pressure characteristics of the normal gerbil pars flaccida were obtained using a moiré interferometry method. The mechanical stiffness properties of the normal pars flaccida were strongly different from those of the pars tensa.