The history of neurosurgery at the House Clinic in Los Angeles

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.

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Combined translabyrinthine, anterior petrosal approach for resection of collision vestibular schwannoma and petrous apex meningioma in neurofibromatosis type 2, with auditory brainstem implant placement

Neurosurgical Focus: Video ◽

10.3171/2021.7.focvid21130 ◽

2021 ◽

Vol 5 (2) ◽

pp. V17

Author(s):

Usman A. Khan ◽

Jillian H. Plonsker ◽

Rick A. Friedman ◽

Marc S. Schwartz

Keyword(s):

Vestibular Schwannoma ◽

Neurofibromatosis Type ◽

Auditory Brainstem ◽

Neurofibromatosis Type 2 ◽

Petrous Apex ◽

Surgical Decision ◽

Implant Placement ◽

History Of ◽

Sporadic Tumors

The natural history of neurofibromatosis type 2 (NF2) is profound bilateral hearing loss. The decision to pursue microsurgery may be more complicated in NF2 than with sporadic tumors. Schwannomas in NF2 often occur with other skull base tumors. Treatment should be tailored to preserve auditory perception for as long as possible. The authors present the case of a man with NF2 and a vestibular schwannoma who has poor hearing on the same side as a large petrous apex meningioma, both opposite to a well-hearing ear. This case highlights surgical decision-making and technical nuances during resection of collision tumors in NF2. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21130

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

Neurosurgery ◽

10.1227/neu.0b013e31823110f1 ◽

2011 ◽

Vol 70 (2) ◽

pp. 334-341 ◽

Cited By ~ 26

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.

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Influence of Vestibular Schwannoma Morphology on Hearing Preservation in Patients Operated by the Middle Fossa Approach

Skull Base ◽

10.1055/s-2007-984006 ◽

2007 ◽

Vol 17 (S 1) ◽

Author(s):

Kazimierz Niemczyk ◽

Krzysztof Morawski ◽

Andrzej Marchel ◽

Antoni Bruzgielewicz ◽

Arkadiusz Nowak ◽

...

Keyword(s):

Vestibular Schwannoma ◽

Hearing Preservation ◽

Middle Fossa ◽

Middle Fossa Approach

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Is the middle fossa approach the treatment of choice for intracanalicular vestibular schwannoma?

Otolaryngology ◽

10.1016/j.otohns.2004.09.027 ◽

2005 ◽

Vol 132 (3) ◽

pp. 459-466 ◽

Cited By ~ 29

Author(s):

Vittorio Colletti ◽

Francesco Fiorino

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Selection Criteria ◽

Surgical Techniques ◽

Internal Auditory Canal ◽

Hearing Preservation ◽

Middle Fossa ◽

Middle Fossa Approach ◽

Class A ◽

Longitudinal Investigation

OBJECTIVES: To compare the 2 surgical techniques most commonly used during vestibular schwannoma (VS) surgery, i.e., the middle fossa (MF) and the retrosigmoid-transmeatal (RS-TM) routes, when hearing preservation is attempted. STUDY DESIGN: A longitudinal study of a series of consecutive patients operated on with the 2 techniques by the same surgeon was conducted. Selection criteria included tumor confined to the internal auditory canal (IAC) with a length ranging from 4 to 12 mm and hearing class A or B. Patients were alternately assigned to 1 of the 2 groups regardless of auditory class and distance of the tumor from the IAC fundus. Thirty-five subjects were operated on with the RS-TM technique and 35 via the MF route. RESULTS: No significant differences in auditory and facial nerve function results between the 2 techniques were observed. The RS-TM approach, however, showed better facial nerve results at discharge. VS size, IAC enlargement, and, particularly, the distance from the IAC fundus were found to influence the postoperative results more than the type of approach itself. CONCLUSIONS: The MF approach has been described as being the better technique for VS surgery in terms of auditory results. However, this claim lacks statistical substantiation because no prospective studies are to be found in the literature. The present longitudinal investigation shows that the MF approach does not afford any particular advantages over the RS-TM route in terms of auditory results in intracanalicular VS, with the exception of tumors reaching the IAC fundus.

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Effects of CyberKnife therapy for vestibular schwannoma on hearing: a retrospective study

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001500 ◽

2018 ◽

Vol 132 (9) ◽

pp. 796-801

Author(s):

O Çakır ◽

G Berkiten ◽

B Tutar ◽

A B Yılmazer ◽

T L Kumral ◽

...

Keyword(s):

Hearing Loss ◽

Vestibular Schwannoma ◽

Hearing Preservation ◽

Auditory Brainstem ◽

Auditory Brainstem Responses ◽

Speech Discrimination ◽

Before And After ◽

Cyberknife Radiosurgery ◽

The Mean

AbstractObjectivesTo evaluate the effects of CyberKnife stereotactic radiotherapy for the treatment of vestibular schwannoma on hearing, as evaluated by audiological tests.MethodsPatients with vestibular schwannoma were evaluated before and after CyberKnife radiosurgery. Evaluation included pure tone thresholds, speech discrimination scores, auditory brainstem responses and radiological signs.ResultsThe study comprised 26 patients diagnosed with vestibular schwannoma and subsequently treated with CyberKnife radiosurgery. The mean follow-up time was 16.4 months. The mean post-treatment hearing preservation rate was 69.23 per cent. There was no significant relationship between hearing loss after treatment and patient age, radiation dosage during treatment, or size of tumour. With regard to auditory brainstem responses, patients with hearing loss following treatment had a significantly higher inter-peak latency between waves I–III than patients with preserved hearing.ConclusionStereotactic CyberKnife radiosurgery is an excellent alternative treatment modality for patients with vestibular schwannoma, and results in acceptable preservation of hearing. Residual hearing following CyberKnife therapy is not significantly affected by factors such as age, size of tumour or dosage of treatment.

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Quality of life after vestibular schwannoma surgery: does hearing preservation make a difference?

The Journal of Laryngology & Otology ◽

10.1017/s0022215109992040 ◽

2009 ◽

Vol 124 (4) ◽

pp. 370-373 ◽

Cited By ~ 8

Author(s):

A P Iyer ◽

R Gunn ◽

H Sillars

Keyword(s):

Quality Of Life ◽

Confidence Interval ◽

Vestibular Schwannoma ◽

Hearing Preservation ◽

Middle Fossa ◽

Cross Sectional Survey ◽

Glasgow Benefit Inventory ◽

Sf 36 ◽

Significant Difference

AbstractObjective:Surgery for vestibular schwannoma may reduce patients' quality of life, but the effect of hearing preservation on this process is not fully understood. Our aim was to determine whether hearing preservation makes a difference to patients' quality of life in this clinical setting.Study design:Retrospective questionnaire and cross-sectional survey.Methods:The study included 104 consecutive patients who had undergone surgery for vestibular schwannoma between 1998 and 2004. Surgery was via a middle cranial fossa route in 24 patients and a translabyrinthine route in 79. Quality of life was assessed using the SF-36 questionnaire and the Glasgow Benefit Inventory.Results:Quality of life was reduced in both patient groups, with a mean Glasgow Benefit Inventory score of −7.5 (confidence interval (CI) −13 to −2.5) in the translabyrinthine patients and −4 (confidence interval −13.5 to 5.5) in the middle fossa patients. The SF-36 scores did not show any statistically significant difference between the two groups, except for social function (p = 0.01).Conclusions:Surgery for vestibular schwannoma reduces patients' quality of life, and the preservation of hearing, achieved by using a middle fossa surgical approach, does not significantly alter this result.

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Retrosigmoid Approach for Vestibular Schwannoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1673703 ◽

2018 ◽

Vol 80 (S 03) ◽

pp. S271-S271

Author(s):

Mohammed Aref ◽

Katherine Kunigelis ◽

Stephen P. Cass ◽

A. Samy Youssef

Keyword(s):

Vestibular Schwannoma ◽

Tumor Resection ◽

Internal Auditory Canal ◽

Hearing Preservation ◽

Neck Surgery ◽

Cochlear Nerve ◽

Management Options ◽

Suppurative Otitis Media ◽

History Of ◽

The Right

Vestibular schwannoma is a benign tumor that affects 3% of the population, but accounts for 85% of tumors occurring at the cerebellopontine angle (CPA). In this case, we present a 48-year-old female with history of cholesteatoma on the right and chronic suppurative otitis media on the left who presented with an 18 month history of bilateral hearing loss, worse on the right. Investigations revealed a right sided vestibular schwannoma measuring 1.6 cm in diameter. Audiogram revealed an AAO–HNS (American Academy of Otolaryngology–Head and Neck Surgery) class C hearing on the right and class B on the left. There are several management options for this size of vestibular schwannoma including observation and radiosurgery. However, preserving cochlear nerve function remains a challenging enterprise. Furthermore, the ideal management that confers the highest chance of hearing preservation remains heavily debated. Given the patient's young age, the goal of hearing preservation and the tumor size/extension into the CPA, surgery was decided through a right retrosigmoid transmeatal approach for tumor resection with intraoperative brain auditory evoked responses monitoring. For hearing preservation, we emphasize few important dissection techniques: tumor debulking from the top first to avoid early manipulation of the cochlear nerve at the bottom of the tumor, sharp dissection from medial to lateral off the vestibular nerve which is kept intact as a tension band to minimize cochlear nerve manipulations, and limit the drilling of the posterolateral wall of the internal auditory canal (IAC) medial to the labyrinth and endolymphatic apparatus. Postoperatively, the patient was discharged home within 2 days, with imaging showing a gross total resection. Follow-up audiogram shows unchanged pure tone thresholds.The link to the Video can be found at: https://youtu.be/Z5ftkpJN5k8.

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