scholarly journals Hearing Preservation in Vestibular Schwannoma Surgery

2019 ◽  
Vol 80 (02) ◽  
pp. 149-155 ◽  
Author(s):  
Joe Saliba ◽  
Rick Friedman ◽  
Roberto Cueva
Keyword(s):  
Patient Selection ◽  
Intraoperative Monitoring ◽  
Imaging Techniques ◽  
Preoperative Assessment ◽  
Hearing Preservation ◽  
Surgical Approaches ◽  
Middle Fossa ◽  
Benign Nature ◽  
Vs Removal ◽  
Hearing Outcomes

AbstractModern imaging techniques allow early detection of small vestibular schwannomas (VSs) with minimal or no hearing impairment. While controversy surrounds the management of these tumors, given their benign nature and unpredictable natural history, microsurgical excision is the only modality that offers the opportunity to cure the tumor and preserve hearing. Hearing preservation in VS surgery may be accomplished via the middle fossa or retrosigmoid approaches. Appropriate patient selection and surgical approach is critical in achieving the best hearing outcomes. This article highlights the preoperative assessment, patient selection and prognostic factors, intraoperative monitoring of hearing, and surgical approaches to optimize hearing preservation during VS removal.

Optimal outcomes for hearing preservation in the management of small vestibular schwannomas

2016 ◽  
Vol 130 (7) ◽  
pp. 606-610 ◽  
Author(s):  
K A Peng ◽  
E P Wilkinson
Keyword(s):  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Middle Fossa ◽  
Stereotactic Radiation ◽  
Middle Fossa Approach ◽  
Small Tumour ◽  
Optimal Outcomes ◽  
Definitive Therapy ◽  
Hearing Outcomes

AbstractObjective:To undertake a systematic review of the role of microsurgery, in relation to observation and stereotactic radiation, in the management of small vestibular schwannomas with serviceable hearing.Methods:The Medline database was searched for publications that included the terms ‘vestibular schwannoma’ and/or ‘acoustic neuroma’, occurring in conjunction with ‘hearing’. Articles were manually screened to identify those concerning vestibular schwannomas under 1.5 cm in greatest dimension. Thereafter, only publications discussing both pre-operative and post-operative hearing were considered.Results:Twenty-six papers were identified. Observation is an acceptable strategy for small tumours with slow growth where hearing preservation is not a consideration. In contrast, microsurgery, including the middle fossa approach, may provide excellent hearing outcomes, particularly when a small tumour has begun to cause hearing loss. Immediate post-operative hearing usually predicts long-term hearing. Recent data on stereotactic radiation suggest long-term deterioration of hearing following definitive therapy.Conclusion:In patients under the age of 65 years with small vestibular schwannomas, microsurgery via the middle fossa approach offers durable preservation of hearing.

The history of neurosurgery at the House Clinic in Los Angeles

2020 ◽  
Vol 133 (3) ◽  
pp. 749-755 ◽  
Author(s):  
Gautam U. Mehta ◽  
Gregory P. Lekovic
Keyword(s):  
Los Angeles ◽  
Vestibular Schwannoma ◽  
Video Transmission ◽  
Collaborative Work ◽  
Hearing Preservation ◽  
Auditory Brainstem ◽  
Team Approach ◽  
Middle Fossa ◽  
History Of ◽  
Operative Microscope

Although most widely known as the birthplace of neuro-otology, the House Clinic in Los Angeles has been the site of several major contributions to the field of neurosurgery. From the beginning of the formation of the Otologic Medical Group in 1958 (later renamed the House Ear Clinic), these contributions have been largely due to the innovative and collaborative work of neurosurgeon William E. Hitselberger, MD, and neuro-otologist William F. House, MD, DDS. Together they were responsible for the development and widespread adoption of the team approach to skull-base surgery. Specific neurosurgical advances accomplished at the House Clinic have included the first application of the operative microscope to neurosurgery, the application of middle fossa and translabyrinthine approaches for vestibular schwannoma, and the development of combined petrosal, retrolabyrinthine, and other alternative petrosal approaches and of hearing preservation surgery for vestibular schwannoma. The auditory brainstem implant, invented at the House Clinic in 1979, was the first ever successful application of central nervous system neuromodulation for restoration of function. Technological innovations at the House Clinic have also advanced neurosurgery. These include the first video transmission of microsurgery, the first suction irrigator, the first debulking instrument for tumors, and the House-Urban retractor for middle fossa surgery.

766 Endoscopic Surgery for Sporadic Vestibular Schwannoma Resection: A Systematic Review of Surgical Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Chiuta ◽  
S Raza-Knight ◽  
A Alalade
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Extent Of Resection ◽  
Current Data ◽  
Resection Rate ◽  
Eighth Cranial Nerve ◽  
Nerve Preservation ◽  
Microsurgical Resection ◽  
Hearing Outcomes ◽  
Series Report

Abstract Introduction Vestibular schwannomas (VS) are benign intracranial tumours originating from the vestibular division of the eighth cranial nerve. The mainstay of their surgical management is microsurgery, other options are radiotherapy or radiological monitoring. Endoscopy (ES) is becoming widely used in neurosurgery and may have a role in improving visualisation and outcomes by enhancing extent of resection, facial nerve, and hearing preservation in VS resection and describe the postoperative outcomes. Method The review was conducted according to the PRISMA guidelines and yielded 31 studies for inclusion. Systematic searches of literature databases were done for studies where endoscopic-assisted and/or endoscopic resection of VS were reported. Results ES facial nerve preservation rates (median 91.3%, range 39.0 - 100%) were comparable to microsurgical treatment. Hearing outcomes were more variable in ES series and were under-reported. A median gross total resection rate of 97.4% (61.0 - 100%) was achieved in the ES series. Conclusions Current data suggest that ES-assisted resection of sporadic VS is not inferior to microsurgical resection with respect to facial nerve outcomes and extent of resection. However, some ES series report poor hearing outcomes, which are under-reported in the literature.

scholarly journals Emergency Drug Kits: Pharmacological and Technical Considerations

2014 ◽  
Vol 61 (4) ◽  
pp. 171-179 ◽  
Author(s):  
Daniel E. Becker
Keyword(s):  
Adverse Events ◽  
Continuing Education ◽  
General Anesthesia ◽  
Intraoperative Monitoring ◽  
Preoperative Assessment ◽  
Procedural Sedation ◽  
Dental Procedures ◽  
Dental Practices ◽  
Emergency Drugs ◽  
Technical Considerations

Abstract The risk for complications while providing dental procedures is greatest when caring for patients having significant medical compromise. It is comforting that significant adverse events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, the office team must be prepared to manage untoward events should they arise. This continuing education article will address basic emergency drugs that should be available in all dental practices and additional agents that become essential for those practices providing various levels of procedural sedation or general anesthesia.

Adaptation of the Standardized Hearing Outcomes Scattergram to Hearing Preservation in Cochlear Implantation

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Elizabeth L. Perkins ◽  
Nauman F. Manzoor ◽  
David S. Haynes ◽  
Matthew O’Malley ◽  
René Gifford ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Hearing Preservation ◽  
Hearing Outcomes

Intraoperative Assessment of the Breast: Guidelines and Potential Pitfalls

2005 ◽  
Vol 129 (12) ◽  
pp. 1565-1574 ◽  
Author(s):  
Rodolfo Laucirica
Keyword(s):  
Frozen Section ◽  
Imaging Techniques ◽  
Error Rates ◽  
Disease Assessment ◽  
Surgical Approaches ◽  
Pathology Laboratory ◽  
Simplified Approach ◽  
Intraoperative Management ◽  
The Many ◽  
Careful Assessment

Abstract Context.—Intraoperative evaluation of breast tissue has changed as newer imaging techniques and surgical approaches to the treatment of breast cancer have placed the pathologist in a pivotal role in the management of this disease. Assessment of the index lesion and surgical margins are but two of the many tasks we face when the specimen arrives in the surgical pathology laboratory. We are also called on to correlate changes in the mammogram with the gross pathology, particularly in those cases in which the lesion is nonpalpable. More recently, pathologists have been asked to analyze 1 or more sentinel lymph nodes at the time of frozen section to look for metastatic disease. This review discusses many of these issues and also provides a simplified approach to the differential diagnosis of a variety of breast lesions one may encounter intraoperatively. Objective.—To provide guidelines for and address potential pitfalls in the intraoperative management of the breast. Data Sources.—Author's experience and pertinent literature. Conclusions.—Careful assessment of the gross specimen coupled with prudent utilization of frozen sections is pivotal to reducing intraoperative error rates and preventing needless anxiety for the patient.

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