scholarly journals Retrosigmoid Transmeatal Endoscope-Assisted Approach in Semi-Sitting Position for Resection of Vestibular Schwannoma: 2-D operative Video

2018 ◽  
Vol 79 (S 05) ◽  
pp. S385-S386
Author(s):  
Rocio Evangelista-Zamora ◽  
Stefan Lieber ◽  
Florian Ebner ◽  
Marcos Tatagiba
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Sitting Position ◽  
Speech Discrimination ◽  
Endoscopic Assistance ◽  
Set Up ◽  
One Year ◽  
The Right ◽  
Neurovascular Structures

We present a case of a mid-sized vestibular schwannoma (T3b according to the Hannover classification) that was resected through a retrosigmoid transmeatal approach in semi-sitting position under endoscopic assistance. The patient is a 52-year-old male with acute loss of functional hearing on the right side. Audiometry confirmed a loss of up to 60 dB and lost speech discrimination, there were no associated symptoms such as tinnitus or vertigo. This 2D video demonstrates positioning, OR set-up, anatomical and surgical nuances of the skull base approach and the operative technique for microdissection of the tumor from the critical neurovascular structures, especially the facial and cochlear nerves. A gross total resection was achieved and the patient discharged home after four days with unaltered function of the facial nerve (HB I). At one year follow up there was no indication of residual or recurrence.In summary, the retrosigmoid transmeatal approach is an important and powerful tool in the armamentarium for the microsurgical management of all kinds of vestibular schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semi-sitting position is safe and effective. If needed, the approach can be complemented by the use of an endoscope for visualization of the distal internal auditory canal.The link to the video can be found at: https://youtu.be/pPKT4_5nIn0.

scholarly journals Recovery from Transient Global Amnesia Following Restoration of Hippocampal and Fronto–Cingulate Perfusion

2010 ◽  
Vol 22 (3-4) ◽  
pp. 131-139 ◽  
Author(s):  
Paolo Caffarra ◽  
Letizia Concari ◽  
Simona Gardini ◽  
Sabrina Spaggiari ◽  
Francesca Dieci ◽  
...  
Keyword(s):  
Acute Phase ◽  
Neuropsychological Testing ◽  
Transient Global Amnesia ◽  
Normal Limits ◽  
Global Amnesia ◽  
One Year ◽  
The Right ◽  
Rcbf Spect ◽  
Subject Comparison

A patient who suffered a transient global amnesia (TGA) attack underwent regional cerebral blood flow (rCBF) SPECT imaging and neuropsychological testing in the acute phase, after one month and after one year. Neuropsychological testing in the acute phase showed a pattern of anterograde and retrograde amnesia, whereas memory was within age normal limits at follow up. SPECT data were analysed with a within subject comparison and also compared with those of a group of healthy controls. Within subject comparison between the one month follow up and the acute phase detected increases in rCBF in the hippocampus bilaterally; further rCBF increases in the right hippocampus were detected after one year. Compared to controls, significant hypoperfusion was found in the right precentral, cingulate and medial frontal gyri in the acute phase; after one month significant hypoperfusion was detected in the right precentral and cingulate gyri and the left postcentral gyrus; after one year no significant hypoperfusion appeared. The restoration of memory was paralleled by rCBF increases in the hippocampus and fronto-limbic-parietal cortex; after one year neither significant rCBF differences nor cognitive deficits were detectable. In conclusion, these data indicate that TGA had no long lasting cognitive and neural alterations in this patient.

Transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder

2002 ◽  
Vol 12 (3) ◽  
pp. 224-228 ◽  
Author(s):  
Haifa Abdul Latiff ◽  
Mazeni Alwi ◽  
Hasri Samion ◽  
Geetha Kandhavel
Keyword(s):  
Transcatheter Closure ◽  
Standard Procedure ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Term Outcome ◽  
Long Term Follow Up ◽  
One Year ◽  
The Right

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer® Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer® device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 ± 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

AVASCULAR NECROSIS OF THE TRIQUETRUM: A CASE REPORT

Hand Surgery ◽  
2005 ◽  
Vol 10 (01) ◽  
pp. 91-94 ◽  
Author(s):  
Y. C. POR ◽  
W. Y. CHEW ◽  
I. Y. Y. TSOU
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
Total Ischemia ◽  
One Year ◽  
The Right

A case of total ischemia of the triquetrum after a crushing injury to the right wrist by a dumbbell is reported. He was treated conservatively with splinting and analgesia. There was complete clinical and radiological recovery after a follow-up of one year.

scholarly journals Peritonea-vaginal canal pathologies at Regional Hospital Center of Lomé-Commune (Togo): Epidemiological, anatomoclinical and therapeutic aspects

2017 ◽  
Vol 3 (3) ◽  
pp. 10
Author(s):  
Simlawo Kpatékana ◽  
Tchangaï B ◽  
Kanassoua K ◽  
Boumé MA ◽  
Sakye A ◽  
...  
Keyword(s):  
Study Data ◽  
Regional Hospital ◽  
Average Hospital ◽  
Scrotal Hematoma ◽  
Scrotal Swelling ◽  
Vaginal Canal ◽  
One Year ◽  
The Right ◽  
Hospital Center

Objective: To describe epidemiological, anatomo-clinical and therapeutic aspects of peritoneo-vaginal canal pathologies (PVCP).Methods: We performed a retrospective and descriptive study on the files of PVCP cases operated in Lomé-Commune Regional Hospital (Togo). The study data concerned: the age, the occuring mode, anatomo-clinical classification, the side and treatment outcomes.Results: 107 files were collected from January 2011 to December 2015. The average age was 9.2 ± 8 years with a range from 16 months to 47 years. Twelve patients were less than 2 years and 14 patients were adults. The main consultation motive was an intermittent and painless inguinal or inguino-scrotal swelling in 89 cases (83.18%). The PVCP was in the right side in 66 patients (61.68%) and bilateral in 8 patients (7.47%). Concerning anatomo-clinical types, inguinal or inguino-scrotal hernia were more frequent (62.6%). The treatment was surgical in all cases and the average hospital stay was 2.1 days. The operative follow up was satisfactory in 94.3%. However, we noticed 4 cases of scrotal hematoma and 2 cases of parietal suppuration. The mortality rate after surgery was zero. One year back, we noticed two cases of testicular atrophy.Conclusions: Pathologies of the peritoneo-vaginal canal are frequent in our urological practice. Inguinal hernia and inguinoscrotal hernia are more represented. The surgical treatment results are successful.

Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery

2013 ◽  
Vol 118 (3) ◽  
pp. 571-578 ◽  
Author(s):  
Andrew M. Baschnagel ◽  
Peter Y. Chen ◽  
Dennis Bojrab ◽  
Daniel Pieper ◽  
Jack Kartush ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Gamma Knife Surgery ◽  
Speech Discrimination ◽  
Before And After ◽  
Nerve Dysfunction ◽  
Preservation Rate

Object Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea. Methods Forty patients with vestibular schwannoma with serviceable hearing were treated using GKS with a median marginal dose of 12.5 Gy (range 12.5–13 Gy) to the 50% isodose volume. Audiometry was performed prospectively before and after GKS at 1, 3, and 6 months, and then every 6 months thereafter. Hearing preservation was based on pure tone average (PTA) and speech discrimination (SD). Serviceable hearing was defined as PTA less than 50 dB and SD greater than 50%. Results The median cochlear maximum and mean doses were 6.9 Gy (range 1.6–16 Gy) and 2.7 Gy (range 0.7–5.0 Gy), respectively. With a median audiological follow-up of 35 months (range 6–58 months), the 1-, 2-, and 3-year actuarial rates of maintaining serviceable hearing were 93%, 77%, and 74%, respectively. No patient who received a mean cochlear dose less than 2 Gy experienced serviceable hearing loss (p = 0.035). Patients who received a mean cochlear dose less than 3 Gy had a 2-year hearing preservation rate of 91% compared with 59% in those who received a mean cochlear dose of 3 Gy or greater (p = 0.029). Those who had more than 25% of their cochlea receiving 3 Gy or greater had a higher rate of hearing loss (p = 0.030). There was no statistically significant correlation between serviceable hearing loss and age, tumor size, pre-GKS PTA, pre-GKS SD, pre-GKS Gardner-Robertson class, maximum cochlear dose, or the percentage of cochlear volume receiving 5 Gy. On multivariate analysis there was a trend toward significance for serviceable hearing loss with a mean cochlear dose of 3 Gy or greater (p = 0.074). Local control was 100% at 24 months. No patient developed facial or trigeminal nerve dysfunction. Conclusions With a median mean cochlear dose of 2.7 Gy, the majority of patients with serviceable hearing retained serviceable hearing 3 years after GKS. A mean cochlear dose less than 3 Gy was associated with higher serviceable hearing preservation.

Nodular enhancement within the internal auditory canal following retrosigmoid vestibular schwannoma resection: a unique radiological pattern

2011 ◽  
Vol 115 (4) ◽  
pp. 835-841 ◽  
Author(s):  
Matthew L. Carlson ◽  
Kathryn M. Van Abel ◽  
William R. Schmitt ◽  
Colin L. W. Driscoll ◽  
Brian A. Neff ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
High Rate ◽  
Preoperative Imaging ◽  
Incomplete Resection ◽  
Tumor Margin ◽  
Tertiary Referral Center ◽  
Original Tumor

Object The authors describe the unique occurrence of nodular enhancement within the fundus of the internal auditory canal (IAC) lateral to the preoperative radiological tumor margin following gross-total vestibular schwannoma (VS) resection. Methods The nature of the study was a retrospective chart review of records. The authors reviewed the cases of all patients who underwent microsurgical resection of a VS between January 2000 and January 2010 at a single tertiary referral center. Patients with incomplete resection, neurofibromatosis Type 2, and those with fewer than 2 postoperative MR images available for review were excluded. Postsurgical patients with IAC enhancement located lateral to the preoperative imaging–delineated tumor margin were identified. Lesion morphology was characterized on serial MR imaging studies. Clinical follow-up and outcomes were recorded. Results Over the past decade, 350 patients underwent microsurgical VS resection. Of these, 16 patients met study criteria and were found to have postsurgical enhancement in the distal aspect of the IAC lateral to the imaging limits of the preoperative tumor margin on the first postoperative MR imaging study (37.5% women, median age 45 years). Initial MR imaging was performed at a mean of 3.1 months following surgery, and the mean radiological follow-up duration was 39.8 months (range 16.4–101.9 months). None of the 16 patients developed recurrence during the follow-up course. Conclusions In contrast to previous publications that have reported a high rate of recurrence in cases involving nodular enhancement within the original tumor bed, postoperative enhancement in the IAC lateral to the original tumor margin appears to carry much less risk for tumor recurrence. These findings may be helpful when counseling patients on the recommended frequency of postoperative follow-up imaging.

Electrochemotherapy with intra-tumoral cisplatin for the treatment of fibrosarcoma in a horse

2018 ◽  
Author(s):  
M. Bharathidasan ◽  
B. Justin William ◽  
Ravi Sundar George Sundar George ◽  
A. Arunprasad ◽  
R. Sivasankar
Keyword(s):  
Complete Response ◽  
Tumour Volume ◽  
Needle Aspiration ◽  
Medial Aspect ◽  
History Of ◽  
Subcutaneous Tissues ◽  
Needle Aspiration Cytology ◽  
One Year ◽  
The Right

A two years old Kathiawar stallion was reported with the history of two, pedunculated hard mass medially on the thigh and hock of the right hind limb, progressively increasing for the past two months. Fine needle aspiration cytology revealed fibrosarcoma.The tumour on the medial aspect of the thigh was injected with cisplatin intra-tumorally at a dose rate of 0.3 mg/cm3 of tumour volume and was exposed to ECT. The tumour on the medial aspect of the hock was excised incompletely to preserve skin and subcutaneous tissues around the tumour for wound opposition and treated with intra-tumoral injection of cisplatin followed by ECT. Following electrochemotherapy complete response was noticed onthe 3rd and 4th week for the tumours on the thigh and hock respectively. No recurrence was noticed during the follow-up period of one year revealing ETC with cisplatin as a single treatment and also in combination with surgery is effective for the treatment of fibrosarcoma in equines.

Dumbbell-shaped cervical spinal neurilemmoma presenting as neck mass

2005 ◽  
Vol 119 (12) ◽  
pp. 1018-1020 ◽  
Author(s):  
Cheng-Lin Lu ◽  
Ming-Hong Chen ◽  
Ting-Kuang Chao
Keyword(s):  
Neck Mass ◽  
Decompression Surgery ◽  
Computed Tomographic ◽  
Complete Tumour ◽  
Cervical Approach ◽  
Spinal Roots ◽  
Staged Operation ◽  
One Year ◽  
The Right

Cervical neurilemmoma may originate from any nerve sheath tissue in the neck including the vagus nerve, glossopharyngeal nerve, brachial plexus, sympathetic trunk and cervical spine. We report an unusual case of a dumbbell-shaped neurilemmoma arising from the cervical spinal roots in a patient who complained of having had a neck mass for several months. Computed tomographic scan and magnetic resonance imaging revealed a dumbbell-shaped tumour extending from the C4 spinal level through the intervertebral foramen into the right parapharyngeal space. Decompression surgery was performed first via the cervical approach. Five months later, the patient received laminectomy and a complete tumour excision. The symptoms and signs were significantly relieved without neurological sequelae. No evidence of recurrence was noted after one-year follow up. This two-staged operation could offer an alternative surgical approach yielding ideal therapeutic results in such a rare disease.

Headache after Removal of Vestibular Schwannoma Via the Retrosigmoid Approach: A Long-Term Follow-Up-Study

2003 ◽  
Vol 128 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Bernhard Schaller ◽  
Ariane Baumann
Keyword(s):  
Fibrin Glue ◽  
Aseptic Meningitis ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Bone Flap ◽  
Posterior Aspect ◽  
Dural Closure ◽  
Postoperative Headache

OBJECTIVE: Our goal was to study the occurrence and source of origin of postcraniotomy headache syndrome after removal of vestibular schwannoma via the retrosigmoid approach. METHODS: A retrospective chart analysis was conducted of all patients with headache at 3 months after removal of vestibular schwannoma from January 1981 through March 1997 and with a minimum of 24 months of follow-up. Diagnosis was made according to the headache classification and was graded using the HARNER scale. Recovery outcome was compared in selected groups of patients with and without headache. A descriptive statistical analysis was used to analyze differences between groups. RESULTS: Of the patients who underwent retrosigmoid craniotomy for removal of vestibular schwannomas, 52 of 155 patients (34%) reported having severe headache of requiring medication every day and/or feeling incapacitated 3 months after surgery. Headache was more prevalent in those who had the bone flap replaced (94% versus 27%), if there was duraplastic or direct dura closure (0% versus 100%). Laboratory-proven aseptic meningitis, most likely due to the use of fibrin glue and drilling of posterior aspect of the internal auditory canal, was mainly associated with postoperative headache (81% versus 2%). In 75% of these cases, calcifications along the brainstem had been noted. CONCLUSION: The origin of postoperative headaches after retrosigmoid vestibular schwannoma resections is not yet fully understood. Different factors may play a role in preventing or reducing headache: dural adhesions to nuchal muscles or to subcutaneous tissues and dural tension in the case of direct dural closure may explain postoperative headache from dural tension. Intradural drilling and the use of fibrin glue may be the source of aseptic meningitis as the etiology of persistent postoperative headache. Prevention of postoperative headache may include the replacement of bone flap at the end of surgery, duraplastic instead of direct dural closure, and prevention of the use of fibrin glue or extensive drilling of the posterior aspect of internal auditory canal.

Arachnoid Cyst Confined to the Internal Auditory Canal—Endoscope-Assisted Resection: Case Report and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. E267-E270 ◽  
Author(s):  
Steffen Kristian. Fleck ◽  
Jörg. Baldauf ◽  
Soenke. Langner ◽  
Silke. Vogelgesang ◽  
Henry Werner. Siegfried Schroeder
Keyword(s):  
Arachnoid Cyst ◽  
Cyst Wall ◽  
Internal Auditory Canal ◽  
Rare Condition ◽  
Nerve Fibers ◽  
Neurological Deficits ◽  
Microsurgical Technique ◽  
Endoscopic Assistance ◽  
Microsurgical Resection ◽  
Neurovascular Structures

abstract BACKGROUND AND IMPORTANCE: An arachnoid cyst confined to the internal auditory canal is a rare condition. Different pathogeneses are discussed, and a progressive enlargement of the cysts has been reported. This case illustrates the beneficial aspect of endoscopic assistance in microsurgical resection of this lesion. CLINICAL PRESENTATION: A slowly progressive hearing loss developed in a 35-year-old woman over 2 years; she reported experiencing tinnitus for 7 years. Magnetic resonance imaging revealed a cystic lesion in the internal auditory canal appearing hypointense on T1-weighted images and hyperintense on T2-weighted images, suggesting an arachnoid cyst. INTERVENTION: The cyst wall was fenestrated and partially resected in an endoscope-assisted microsurgical technique. Adherent vestibular nerve fibers in the cyst wall prevented total removal of the cyst. The histological examination confirmed the diagnosis of an arachnoid cyst. CONCLUSION: The endoscope-assisted microsurgical technique enables a safe cyst resection with good visualization of important neurovascular structures within the internal auditory canal. Small remnants of the capsule that are firmly attached to important neurovascular structures should be left in place rather than risk neurological deficits.

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