1,721,005 research outputs found

    Exclusive surgical treatment for vestibular schwannoma regrowth or recurrence: A meta-analysis of the literature

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    Vestibular schwannomas can be treated in different ways, but for symptomatic or growing tumors, the gold standard is surgical removal of the lesion. In order to preserve neurovascular structures, partial removal is often performed, leaving a residual that may grow in subsequent years. To date, there is no consensus with regard to surgical treatment of vestibular schwannoma residuals, and so this review focuses on this topic. A structured search was performed on PubMed searching for all articles discussing vestibular schwannoma residuals and recurrences. Only articles discussing surgical treatment were included, focusing on studies which also examined facial nerve outcomes. A total of 51 articles were eligible for review and these included 375 patients. Statistical analysis was performed by correlating the following parameters: patients' gender and age at first surgery, surgical approach adopted at first and subsequent surgeries, tumor and residual size, and extent of resection (gross total, near total, subtotal or others) at first and subsequent surgical procedures. Facial nerve function was also analyzed focusing on its performance when correlated with the different surgical approaches. The data were analyzed by linear regression but there were no correlations between any of the parameters chosen. There was a statistically significant difference between the first approach used (mainly the retrosigmoid route) compared with subsequent approaches (mainly the translabyrinthine route). In total, 8.5 % of patients needed further treatment due to residual regrowth. Facial nerve outcome was independent of the parameters chosen. Exclusive surgical treatment for vestibular schwannoma residuals had a very low failure rate in terms of requiring further treatment. The approach usually chosen for second surgery was the translabyrinthine technique, and this may be explained by the location of the residual, rather than its size. The choice of a particular surgical approach rather than another had no influence on facial nerve function. Complications rates are comparable to Gamma Knife Radiosurgery's as reported in the literature

    Facial Nerve Neurophysiologic Assessment in Vestibular Schwannoma Removal with Transcanal Approach: A Pilot Clinical Study.

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    Background: The transcanal transpromontorial approach has been introduced to remove vestibular schwannomas. As with other techniques, preservation of the facial nerve (FN) is challenging. This pilot study described FN outcomes of patients preoperatively and postoperatively assessed with electromyography (EMG) and blink reflex (BR). Methods: Between September 2017 and December 2018, 10 patients (5 men; 5 women; mean age, 59.8 years; age range, 25-77 years) underwent removal of vestibular schwannoma via the transcanal transpromontorial approach. FN assessment using EMG/BR and clinical evaluation with the House-Brackmann (HB) grading scale was performed preoperatively and 2 months postoperatively. If facial impairment was present postoperatively, further analysis was performed 6 months after surgery. Results: All 10 patients had normal FN function on preoperative EMG/BR. After 2 months, 4 patients had normal FN function on EMG/BR, 4 patients showed a slight delay of FN responses, 1 patient had moderate dysfunction, and 1 patient had consistent damage. After 6 months, among the 6 patients with a pathologic neurophysiologic study, consistent EMG/BR improvement was shown, with complete recovery in 3 cases. At the last follow-up, 8 patients had HB grade I, 1 patient had HB grade II, and 1 patient had HB grade III in 1, showing progression toward healing in 9 of 10 cases. Conclusions: The transcanal transpromontorial approach is an effective procedure for vestibular schwannoma removal. EMG/BR represents an objective evaluation method to verify FN recovery after surgery and confirms the low impact of this surgical procedure on the FN

    Does pregnancy have an influence on otosclerosis?

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    OBJECTIVE: Otosclerosis affects women twice as often as men, especially during fertile age. A role of female hormones has been claimed, but controversy still exists regarding the influence of pregnancy. The purpose of this research was to analyse the role of pregnancy on the course of otosclerosis. METHOD: PubMed was searched in May 2019 using the terms 'otosclerosis AND pregnancy', 'otosclerosis AND pregnant', 'otosclerosis AND parous', 'otosclerosis AND parity', and 'otosclerosis AND puerperium'. Age at diagnosis, number of pregnancies and the temporal relationship of the disease with childbearing were considered. RESULTS: From 65 articles, 11 were chosen for review. They described 2323 women affected by otosclerosis: 1805 had at least 1 pregnancy, while 518 did not. During childbearing, otosclerosis began in 1 per cent of pregnant women, worsened in 21 per cent and worsened during puerperium in 4 per cent. Often, the authors reported hearing change with pregnancy without details, so a further group has been considered composed of women belonging to any of the groups just mentioned or to another group of women not further characterised. Overall, hearing change occurred during pregnancy in 44 per cent. A statistically significant correlation emerged between hearing change and number of pregnancies (p = 0.003). CONCLUSION: Because of wide data heterogeneity and the difficulty in analysing a single factor, absolute statements could not be formulated. According to this review, pregnancy seems to have a worsening effect on the course of otosclerosis

    Going Beyond Counting First Authors in Author Co-citation Analysis

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    The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed

    Variations on the Author

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    “Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship

    Endoscopic Endonasal Surgery of Clival Chordomas: Preliminary Results

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    Chordomas are rare malignant tumors, often affecting the clival region. Traditionally, they are removed via craniotomic approach but the introduction of the endoscopic endonasal technique (EEA) allowed to control this area. This article shows a series of patients affected by clival chordomas treated with endoscopic approach. Patients who underwent EEA or transoral approach (TO) for clival chordomas at our Skull Base Referral Center, have been retrospectively examined. Clinical symptoms, preoperative neuroradiological evaluation, surgical approach, complications and postoperative results were evaluated. Nine patients (4 females and 5 males; age range 45-82 years, mean 61 years) were included. Chordomas involved upper clivus in 4/9 cases, with (2) or without (2) extension to the middle clivus, middle clivus alone in 2/9, lower clivus in 2/9, and the whole clivus in 1/9. Tumors were totally (4/9) or subtotally (5/9) removed. Skull base reconstruction was performed with a multilayer technique (6/9) or a gasket-seal closure (1/9), using pedicled nasoseptal flaps, middle turbinate and mucoperichondrial grafts, fascia lata and synthetic fascia. No reconstruction was performed in 2 cases. Recurrence occurred in 4 cases, who underwent a new operation. All the other patients underwent proton-beam radiotherapy with no documented tumor growth at the last follow-up (median: 24.9 months; range: 7-36 months). EEA and TO resulted to be safe procedures for treatment of clival chordomas. These approaches may be used as an alternative to the traditional approaches, according to the extension of the pathology

    Appropriate Similarity Measures for Author Cocitation Analysis

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    We provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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