scholarly journals Petrous Bone Cholesteatoma: Facial and Hearing Preservation

2021 ◽  
pp. 014556132110565
Author(s):  
Annalisa Pace ◽  
Irene Claudia Visconti ◽  
Giannicola Iannella ◽  
Alessandro Milani ◽  
Valeria Rossetti ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
Hearing Preservation ◽  
Petrous Bone ◽  
Endoscopic Approach ◽  
Surgical Removal ◽  
Translabyrinthine Approach ◽  
Petrous Bone Cholesteatoma

Objectives: Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods: This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna’s classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results: PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions: The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes.

Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

2016 ◽  
Vol 21 (5) ◽  
pp. 275-285 ◽  
Author(s):  
Sampath Chandra Prasad ◽  
Gianluca Piras ◽  
Enrico Piccirillo ◽  
Abdelkader Taibah ◽  
Alessandra Russo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Petrous Bone ◽  
Common Type ◽  
Active Management ◽  
Nerve Grafting ◽  
The Mean ◽  
Transotic Approach ◽  
Petrous Bone Cholesteatoma

Objective: To review the classification and management of petrous bone cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions. Methods: This was a retrospective study. The setting was a quaternary referral center for skull base pathology in Italy. A total of 200 patients with 201 PBCs were included in the study. All patients diagnosed radiologically with PBCs were classified according to the Sanna classification. All patients were surgically treated and followed up with radiology. The main outcome measures - classification of PBCs, the surgical approach used, disease control, and FN outcomes - were analyzed. Results: Supralabyrinthine PBCs were the most common type with 92 cases (45.8%) followed by the massive PBCs with 72 cases (35.8%). Preservation of preoperative FN function was highest in the infralabyrinthine (72.2%) and infralabyrinthine-apical (73.3%) types. The transotic approach was used in 66 cases (32.8%) in this series. The modified transcochlear approach type A was applied in 55 cases (27.3%). Active management of the nerve (rerouting, anastomosis, or grafting) was required in 53 cases (26.4%). Postoperatively, of the 116 cases with FN House-Brackmann grade I and II, 107 cases (92.2%) retained the same grade or improved. Recurrence was seen in 7 cases (3.5%). The mean duration of follow-up was 6.3 years. Conclusions: Radical disease clearance must take precedence over hearing and FN preservation in PBCs. Active FN management, including rerouting, end-to-end anastomosis, and cable nerve grafting, routinely come to play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach

1999 ◽  
Vol 6 (2) ◽  
pp. E1
Author(s):  
Todd H. Lanman ◽  
Derald E. Brackmann ◽  
William E. Hitselberger ◽  
Bill Subin
Keyword(s):  
Facial Nerve ◽  
Residual Tumor ◽  
Hearing Preservation ◽  
Cerebrospinal Fluid Leakage ◽  
Surgical Removal ◽  
Time Interval ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Total Tumor Removal ◽  
Functional Preservation

Object The choice of approach for surgical removal of large acoustic neuromas is still controversial. The authors reviewed the results in a series of patients who underwent removal of large tumors via the translabyrinthine approach. Methods The authors conducted a database analysis of 190 patients (89 men and 101 women) with acoustic neuromas 3 cm or greater in size. The mean age of these patients was 46.1 ± 15.6 years. One hundred seventy-eight patients underwent primary translabyrinthine surgical removal and 12 underwent surgery for residual tumor. Total tumor removal was accomplished in 183 cases (96.3%). The tumor was adherent to the facial nerve to some degree in 64% of the cases, but the facial nerve was preserved anatomically in 178 (93.7%) of the patients. Divided nerves were repaired by primary attachment or cable graft. Facial nerve function was assessed immediately after surgery, at the time of discharge, and at 3 to 4 weeks and 1 year after discharge. Excellent function (House-Brackmann facial nerve Grade I or II) was present in 55%, 33.9%, 38.8%, and 52.6% of the patients for each time interval, respectively, with acceptable function (Grades I–IV) in 81% at 1 year. Cerebrospinal fluid leakage that required surgical repair occurred in only 1.1% of the patients and meningitis occurred in 3.7%. There were no deaths. Conclusions Use of the translabyrinthine approach for removal of large tumors resulted in good anatomical and functional preservation of the facial nerve, with minimum incidence of morbidity and no incidence of mortality. The authors continue to recommend use of this approach for acoustic tumors larger than 3 cm and for smaller tumors when hearing preservation is not an issue.

Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach

1999 ◽  
Vol 90 (4) ◽  
pp. 617-623 ◽  
Author(s):  
Todd H. Lanman ◽  
Derald E. Brackmann ◽  
William E. Hitselberger ◽  
Bill Subin
Keyword(s):  
Facial Nerve ◽  
Residual Tumor ◽  
Hearing Preservation ◽  
Cerebrospinal Fluid Leakage ◽  
Surgical Removal ◽  
Time Interval ◽  
Content Type ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Fine Print

Object. The choice of approach for surgical removal of large acoustic neuromas is still controversial. The authors reviewed the results in a series of patients who underwent removal of large tumors via the translabyrinthine approach.Methods. The authors conducted a database analysis of 190 patients (89 men and 101 women) with acoustic neuromas 3 cm or greater in size. The mean age of these patients was 46.1 ± 15.6 years. One hundred seventy-eight patients underwent primary translabyrinthine surgical removal and 12 underwent surgery for residual tumor. Total tumor removal was accomplished in 183 cases (96.3%). The tumor was adherent to the facial nerve to some degree in 64% of the cases, but the facial nerve was preserved anatomically in 178 (93.7%) of the patients. Divided nerves were repaired by primary attachment or cable graft. Facial nerve function was assessed immediately after surgery, at the time of discharge, and at 3 to 4 weeks and 1 year after discharge. Excellent function (House—Brackmann facial nerve Grade I or II) was present in 55%, 33.9%, 38.8%, and 52.6% of the patients for each time interval, respectively, with acceptable function (Grades I—IV) in 81% at 1 year. Cerebrospinal fluid leakage that required surgical repair occurred in only 1.1% of the patients and meningitis in 3.7%. There were no deaths.Conclusions. Use of the translabyrinthine approach for removal of large tumors resulted in good anatomical and functional preservation of the facial nerve, with minimum incidence of morbidity and no incidence of mortality. The authors continue to recommend use of this approach for acoustic tumors larger than 3 cm and for smaller tumors when hearing preservation is not an issue.

Petrous Bone Cholesteatoma Removal With Hearing Preservation

2011 ◽  
Vol 32 (2) ◽  
pp. 236-241 ◽  
Author(s):  
Pascal Senn ◽  
Rudolf Haeusler ◽  
Eugène Panosetti ◽  
Marco Caversaccio
Keyword(s):  
Hearing Preservation ◽  
Petrous Bone ◽  
Petrous Bone Cholesteatoma

Hearing Preservation Using the Middle Fossa Approach for the Treatment of Vestibular Schwannoma

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 334-341 ◽  
Author(s):  
Joe Walter Kutz ◽  
Tyler Scoresby ◽  
Brandon Isaacson ◽  
Bruce E. Mickey ◽  
Christopher J. Madden ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Academic Medical Center ◽  
Hearing Preservation ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Class A ◽  
Facial Function ◽  
Grade Iii

Abstract BACKGROUND: The incidence of small vestibular schwannomas in patients with serviceable hearing is increasing because of the widespread use of MRI. The middle fossa approach provides the patient with an opportunity for tumor removal with hearing preservation. OBJECTIVE: To determine the rate of hearing preservation and facial nerve outcomes after removal of a vestibular schwannoma with the use of the middle fossa approach. METHODS: A retrospective case review at a tertiary, academic medical center was performed identifying patients from 1998 through 2008 that underwent removal of a vestibular schwannoma by the middle fossa approach. Preoperative and postoperative audiograms were compared to determine hearing preservation rates. In addition, facial nerve outcomes at last follow-up were recorded. RESULTS: Forty-six patients underwent a middle fossa craniotomy for the removal of a vestibular schwannoma. Of the 38 patients that had class A or class B hearing preoperatively, 24 (63.2%) retained class A or B hearing and 29 (76.3%) retained class A, B, or C hearing. When tumors were 10 mm or less in patients with class A or B preoperative hearing, 22 of 30 patients (73.3%) retained class A or B hearing. When the tumor size was greater than 10 mm in patients with class A or B preoperative hearing, 2 of 8 patients (25%) retained class A or B hearing. At most recent follow-up, 76.1% of patients had House-Brackmann grade I facial function, 13.0% had House-Brackmann grade II facial function, and 10.9% had House-Brackmann grade III facial function. CONCLUSION: Hearing preservation rates are excellent using the middle fossa approach, especially for smaller tumors. No patient experienced long-term facial nerve function worse than House-Brackmann grade III.

Clinical case for removal infralabyrinthine petrous bone cholesteatoma with preservation the facial nerve

2019 ◽  
Vol 84 (3) ◽  
pp. 56 ◽  
Author(s):  
I. A. Anikin ◽  
N. N. Khamgushkeeva ◽  
S. V. Astashchenko ◽  
T. A. Bokuchava
Keyword(s):  
Facial Nerve ◽  
Clinical Case ◽  
Petrous Bone ◽  
Petrous Bone Cholesteatoma

Sensorineural hearing loss following induction chemotherapy plus concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma

2015 ◽  
Vol 129 (8) ◽  
pp. 767-772 ◽  
Author(s):  
V Atchariyasathian ◽  
K Pruegsanusak ◽  
S Wongsriwattanakul
Keyword(s):  
Hearing Loss ◽  
Nasopharyngeal Carcinoma ◽  
Sensorineural Hearing Loss ◽  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
Hearing Preservation ◽  
Sensorineural Hearing ◽  
Choice Of Treatment

AbstractObjective:To compare the incidence of sensorineural hearing loss between those treated with docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by carboplatin concurrent chemoradiotherapy and those treated with conventional concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma.Methods:Serial pure tone audiometry was conducted in 36 nasopharyngeal carcinoma patients who were randomised into 2 groups. The first group received docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by carboplatin concurrent chemoradiotherapy. The second group received conventional concurrent chemoradiotherapy.Results:The incidence of sensorineural hearing loss at speech frequency in the first group was 10 per cent and in the second group was 50 per cent (p = 0.0027). Bone conduction thresholds were significantly increased after completion of the treatment at 2–4 kHz in the first group and at all frequencies in the second group.Conclusion:The docetaxel, cisplatin and 5-fluorouracil induction chemotherapy regimen followed by concurrent chemoradiotherapy was associated with a lower incidence of sensorineural hearing loss than conventional concurrent chemoradiotherapy. This regimen may be the preferred choice of treatment for hearing preservation.

Facial Nerve Neuromas: Report of 10 Cases and Review of the Literature

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 450-456 ◽  
Author(s):  
Jonathan D. Sherman ◽  
Elias Dagnew ◽  
Myles L. Pensak ◽  
Harry R. van Loveren ◽  
John M. Tew
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Outpatient Basis ◽  
Nerve Sheath Tumor ◽  
Facial Paresis ◽  
Presenting Symptoms ◽  
Nervus Intermedius

Abstract OBJECTIVE: This study reviewed the management and outcomes of facial neuromas during the past decade at our institution. The goal was to analyze differences in presentation on the basis of location of the facial neuroma, review facial nerve function and hearing preservation postoperatively, and understand the characteristics of patients with tumors limited to the cerebellopontine angle or internal auditory canal. We also report an unusual case of a facial neuroma limited to the nervus intermedius. METHODS: Nine patients with facial neuromas and one with Jacobson's nerve neuroma underwent surgery, and total resection was accomplished in nine patients. A chart review for pre- and postoperative data was performed, after which all patients were evaluated on an outpatient basis. RESULTS: The mean age of the patients was 47 years; mean follow-up time was 33.1 months. The most common presenting symptoms were hearing loss (six patients) and facial paresis (five patients). A total of five patients had progressive (four patients) or recurrent (one patient) facial paresis. No patient experienced worsened hearing as a result of surgery, and one experienced improvement in a conductive hearing deficit. Five patients required cable graft repair of the facial nerve; four improved to House-Brackmann Grade 3 facial paresis. Four of five patients with preserved anatomic continuity of the facial nerve regained normal facial function. There were no surgical complications. No tumors have recurred during follow-up. We report the second nerve sheath tumor limited to the nervus intermedius. CONCLUSION: This series documents that facial neuromas can be resected safely with preservation of facial nerve and hearing function. Preservation of anatomic continuity of the facial nerve should be attempted, and it does not seem to lead to frequent recurrence. Tumors limited to the cerebellopontine angle/internal auditory canal are a unique subset of facial neuromas with characteristics that vary greatly from facial neuromas in other locations, and they are indistinguishable clinically from acoustic neuromas.

Outcome After Microsurgery for Meningiomas Involving the Internal Auditory Canal

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1236-1242 ◽  
Author(s):  
Kajetan L von Eckardstein ◽  
Colin L W Driscoll ◽  
Michael J Link
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Entire Group ◽  
Surgical Removal ◽  
Nerve Function ◽  
Canal Wall ◽  
Facial Nerve Function ◽  
Clinical Exam ◽  
Hearing Outcomes

Abstract BACKGROUND: The subset of patients suffering from meningiomas truly originating in or extending into the internal auditory canal is not well described in the literature. OBJECTIVE: To evaluate postoperative facial motor and hearing outcomes in patients undergoing resection of meningiomas originating in or extending into the internal auditory canal. METHODS: Chart reviews were done of 19 consecutive patients undergoing surgery for meningiomas originating in or extending into the internal auditory canal at the Mayo Clinic, Rochester, with emphasis on clinical exam and audiometry. RESULTS: Median follow-up for the entire group was 29 months. Seventy-four percent of patients had stable facial nerve function. One patient experienced improvement. Postoperative cochlear nerve function was unchanged in 74% of patients and worsened in 21% of patients. One patient with a sudden preoperative hearing loss improved to full hearing at 3 months. CONCLUSION: Every attempt should be made to preserve hearing and facial motor function in surgical removal of posterior fossa meningiomas that originate in or extend into the internal auditory canal. Normal or nearly normal facial nerve function can be preserved in 88% of patients presenting with normal facial nerve function; serviceable hearing can be preserved in 92% of patients who present with normal hearing. A standard retrosigmoid craniotomy with drilling of the posterior canal wall of the internal auditory canal worked well in the majority of cases.

Preservation of Facial, Cochlear, and other Nerve Functions in Acoustic Neuroma Treatment

1994 ◽  
Vol 110 (2) ◽  
pp. 146-155 ◽  
Author(s):  
Jean-Marc Sterkers ◽  
Gavin A. J. Morrison ◽  
Olivier Sterkers ◽  
Mohamed M. K. Badr El-Dine
Keyword(s):  
Facial Nerve ◽  
Cranial Nerves ◽  
Surgical Excision ◽  
Hearing Preservation ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Translabyrinthine Approach ◽  
Number Of Patients ◽  
Facial Nerve Monitoring ◽  
Facial Function

Between March 1966 and September 1992, 1400 acoustic neuromas were treated in Paris, France, by surgical excision. The findings over the last 7 years are presented. The translabyrinthine approach has been used in more than 85% of cases. Where hearing preservation is attempted, the middle fossa approach has been adopted for intracanilicular tumors and the retrosigmoid approach for small tumors extending into the cerebellopontine angle, in which the fundus of the internal meatus is free of tumor. The main goal is to achieve a grade I or II result in facial function within 1 month of surgery. Results improved during 1991 after the introduction of continuous facial nerve monitoring and the use of the Beaver mini-blade for dissection of tumor from nerve. With these techniques, facial function at grade I or II at 1 month improved from 20% to 52% for large tumors (larger than 3 cm), from 42% to 81% for medium tumors (2 to 3 cm), and from 70% to 92% for small tumors (up to and including 2 cm extracanalicular). The facial nerve was at greater risk using the retrosigmoid or middle fossa approaches than by the translabyrinthine route. Since 1985, success in hearing preservation has changed little, with useful hearing being preserved in 38.2% of cases operated on by means of the retrosigmoid route and 36.4% of cases after the middle fossa approach. In older patients with good hearing and small tumors, observation with periodic MRI scanning is recommended. Despite earlier diagnosis, the number of patients suitable for hearing preservation surgery remains very limited and careful selection is required. Trigeminal nerve signs were present in 20% of cases preoperativey, in 10% postoperatively, and recovered spontaneously. Palsies of the other cranial nerves after surgery were much rarer and were as follows: sixth nerve (abducens), 0.5%; ninth nerve (glossopharyngeal), 1.4%; and tenth nerve (vagus), 0.7%. The importance of preservation of function of the nervus intermedius of Wrisberg is stressed. These results emphasize the advantages of the translabyrinthine approach, offering greater security to the facial nerve and lower morbidity.

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