1,720,994 research outputs found
Intralabyrinthine schwannoma: Surgical management and cochlear lumen preservation
No full text: The present video reports the surgical removal of an intralabyrinthine schwannoma. The video contains patient's medical history, preoperative radiological evaluations and detailed description of surgical steps of the procedure, consisting in labyrinthectomy, cochleostomy and insertion of a dummy electrode in the preserved cochlear lumen within the context of a subtotal petrosectomy
Lipomas of the internal auditory canal and cerebellopontine angle
No full textObjectives: Lipomas of the internal auditory canal (IAC) and cerebellopontine angle (CPA) are exceedingly rare lesions. The purpose of this report was to describe our experience with lipomas of the IAC and CPA and perform a review of the literature. Methods: We report 8 cases of lipomas involving the IAC and/or the CPA that were managed at Gruppo Otologico between April 1987 and October 2012. Results: Four cases of entirely intracanalicular lipomas were radiologically misinterpreted as vestibular schwannomas and underwent tumor removal by a translabyrinthine approach. Two of these patients experienced postoperative facial nerve palsy. Lipomas were suspected in 4 patients on the basis of imaging findings and were managed conservatively. Of these 4 cases, 3 did not show any growth after an average period of 28 months, and 1 case demonstrated tumor growth on follow-up imaging. Conclusions: Neuroimaging represents an extremely important tool for this diagnosis. Attempts to achieve complete resection may result in severe neurologic sequelae, especially in large lesions. Observation with repeated imaging in order to detect growth of the lesion is usually recommended. Debulking of the tumor, mainly aimed at brain stem and cranial nerve decompression, should be considered in cases of disabling and uncontrolled neurologic symptoms and signs. © The Author(s) 2014
Selection of the appropriate Limberg flap in the reconstruction of post-excisional nasal defects
No full textTreatment of superficial cutaneous neoplasias involving the nasal pyramid is frequent in plastic surgery. In this article the authors report their experience in the reconstruction of post-excisional nasal defects employing the local rhomboid flap, initially popularized by Alexander Limberg. From 1995 to 2000, 115 patients underwent exeresis for basalioma of the nasal pyramid at the Campus Bio-Medico University in Rome; in 98 cases the Limberg flap was the reconstructive procedure of choice. In spite of its simplicity, the flap requires accurate planning according to the location. The flap is designed for the repair of equilateral rhomboid defects and is marked extending the short diagonal of the defect in either direction for a distance equal to its own length. Two sides of the flap are thus obtained; the third side is designed at an angle of 60°, always with the same length. The fundamental principle for the application of this technique is that the flap has to be rotated and advanced along the lines of maximum extensibility which are perpendicular to the relaxed skin tension lines. Thus the short diagonal part of the flap has to be parallel to the lines of maximum extensibility; only by this careful planning is it possible to easily close the donor site where the major degree of cutaneous tension occurs. At the level of the nasal pyramid the relaxed skin tension lines are placed transversely; the lines of maximum estensibility, which are perpendicular to them, are oriented vertically, thus the rhomboid flap has to be rotated and advanced vertically in the direction of the caudal cranium. The different aesthetic nasal subunits are disthinguished and some guidelines are suggested according to the location. The simplicity of the execution and the minor trauma with respect to the other procedure, as well as the excellent aesthetic results in both young and elderly patients, make the Limberg flap a valid reconstructive procedure for nasal defects
Reconstruction of outer attic wall defects using bone patè: long term clinical and histological evaluation.
No full textEur Arch Otorhinolaryngol. 2006 Nov;263(11):983-7. Epub 2006 Jun 28.
Reconstruction of outer attic wall defects using bone paté: Long-term clinical and histological evaluation.
Bacciu A, Pasanisi E, Vincenti V, Di Lella F, Bacciu S.
SourceDepartment of Otolaryngology, University of Parma, Via Gramsci 14, 43100 Parma, Italy. [email protected]
Abstract
The objective was to evaluate the long-term clinical outcome of the bony outer attic wall reconstruction (scutumplasty) by using autogenous bone paté in a series of patients who underwent canal wall up (CWU) mastoidectomy for middle ear cholesteatoma. In addition, an histological analysis of bone paté graft specimens taken during the second-look procedure 12 months after the first surgery, was carried out. A series of 134 ears from 128 patients with cholesteatoma who underwent staged CWU mastoidectomy and attic reconstruction with bone paté, between 1995 and 2000 inclusive, was retrospectively analyzed. In ten randomly selected ears, biopsies from the newly built outer attic wall were taken during the second-look operation and were microscopically analyzed. At the second stage operation, the bone paté graft was found normal in 64.9% of cases. In 39 (29.1%) patients there was a remarkable hypertrophy of the bone paté which was subsequently thinned out by using a diamond burr. A partial resorption of the bone paté was observed in 4.4% of ears and a total resorption in 1.4%. Residual cholesteatoma was found in 13.4% of ears. At the last follow-up visit, recurrent cholesteatoma was observed in 5.2% of ears. Self cleaning attic retraction pocket occurred in 4.4% of ears. Twelve months after implantation, histologic examination on the newly built bone showed a well-structured bony tissue. In particular, osteoblasts lined bone trabeculae with signs of an active tissue remodeling. In conclusion, the reconstruction of the outer attic wall should be considered a fundamental step when performing a CWU procedure in order to prevent attic retractions and recurrences of cholesteatoma. In our experience, autogenous bone paté graft has demonstrated good long-term results in outer attic wall reconstruction being adaptable, well tolerated, stable and of low cost
Successful cochlear implantation in two profoundly deafened patients with neurofibromatosis type 1: further evidence to support a cochlear site of lesion
No full textObjective: To investigate the usefulness of cochlear implantation and to examine the evidence for a cochlear or retrocochlear site of lesion for deafness in Neurofibromatosis Type 1 (NF1).
Patients: Two profoundly deafened NF1 patients who underwent cochlear implantation.
Interventions: Preoperative electrophysiologic and audiologic evaluation including pure-tone audiometry, auditory brainstem response, speech audiometry, otoacoustic emission, and promontory stimulation test. Intraoperative electrophysiologic tests were also performed.
Main outcome measures: Results of preoperative diagnostic workup. Cochlear implant performances were evaluated in the auditory-only condition in both closed-set and open-set formats.
Results: Preoperative diagnostic assessment suggested cochlear impairment with preserved auditory pathway at the basis of the sensorineural hearing loss in both patients. Intraoperative electrically evoked auditory nerve and brainstem responses confirmed the integrity of the neural population all along the length of the cochlea. To date, with a follow-up of 2 and 10 years, both patients gained excellent open-set, auditory-only, speech understanding and were able to converse on the telephone without a code.
Conclusion: Cochlear impairment with preserved auditory pathways can be responsible for sensorineural hearing loss in NF1 patients. When their hearing deficit meets criteria for cochlear implantation, this type of auditory rehabilitation can restore social hearing in these patients while dramatically improving their quality of life
Long-term clinical outcomes of cochlear implantation in children with symptomatic epilepsy
No full textObjectives: To describe long-term clinical outcomes of cochlear implantation in deaf children with symptomatic epilepsy. Materials and methods: A retrospective data analysis review of patients implanted at the Cochlear Implant Center of the University of Parma, Italy, was performed, searching for implanted children with a confirmed diagnosis of symptomatic epilepsy. Clinical data, imaging findings, pre- and post-operative epilepsy pattern and EEG traces were analyzed; communicative skills were assessed using the Profile of Actual Linguistic Skills. Results: Search retrieved two patients affected by profound bilateral sensorineural hearing loss and symptomatic epilepsy (associated respectively with methylmalonic acidemia and cerebral palsy). After careful parental counselling both patients were offered and underwent cochlear implantation. Activation and use of cochlear implant did not determine substantial changes of pre-existing seizure pattern and EEG traces. Both patients showed substantial development of their communicative abilities. Conclusions: Cochlear implantation in children with symptomatic epilepsy did not determine variations in seizure pattern or EEG traces. Both patients experienced substantial benefit from cochlear implantation
Intracanalicular Meningioma: Clinical Features, Radiologic Findings and Surgical Management
No full textOtol Neurotol. 2007 Apr;28(3):391-9.
Intracanalicular meningioma: clinical features, radiologic findings, and surgical management.
Bacciu A, Piazza P, Di Lella F, Sanna M.
SourceDepartments of Otolaryngology,, University of Parma, Parma, Italy.
Abstract
OBJECTIVE: Intracanalicular meningiomas are extremely rare, and only 36 cases have been reported to date. The aim of this study is to describe the clinical, radiologic, and histopathologic features of 13 intracanalicular meningiomas highlighting important aspects of tumor diagnosis and treatment.
STUDY DESIGN: Retrospective study.
SETTING: Quaternary referral otology and cranial base private center.
PATIENTS: Thirteen consecutive patients with pathologically confirmed intracanalicular meningioma surgically treated between December 1988 and July 2006. The follow-up of the series ranged from 13 to 60 months.
INTERVENTIONS: Nine patients with unserviceable hearing were operated on through the translabyrinthine approach. Four patients underwent enlarged middle cranial fossa approach with the intention of preserving their hearing.
RESULTS: Total tumor removal was achieved in all cases. The postoperative facial nerve function was either excellent or good (House-Brackmann Grade I or II) in 10 cases (77%) and acceptable (Grade III) in one case. Two patients with preoperative facial paresis showed no improvement in their facial nerve function. In patients who underwent surgery via the enlarged middle cranial fossa, hearing was preserved at the preoperative level in two cases, but serviceable hearing was lost in the remaining two.
CONCLUSION: Primary meningiomas of the internal auditory canal are extremely rare. On account of a lack of specific symptoms and the limited diagnostic findings, preoperative diagnosis of intracanalicular meningioma still represents a diagnostic challenge. Intraoperative findings may help in differentiating meningiomas from other intracanalicular lesions
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