[Predictive factors of facial palsy of the acoustic neurinoma after retrosigmoid surgery: 230 cases]. / Facteurs prédictifs de la survenue des paralysies faciales du neurinome de l'acoustique opéré par voie rétro-sigmoïde. A propos de 230 cas.

OBJECTIVES: To determine predictive factors influencing postoperative facial palsy during retro sigmoid approach in vestibular schwannoma surgery. MATERIAL AND METHODS: Retrospective study over 230 patients with vestibular schwannoma, mostly stade I and II, operated by retro sigmoid approach, by the same oto neuro chirurgical team between 1993 and 2004. Pre and post operative parameters taken into consideration: quantitative: age and sex, audiometric parameters, duration of clinical symptoms; qualitative: tumor anatomic factors and facial nerve function according to House Brackmann classification. RESULTS: 8 days after surgery, 92% of patients have a normal or subnormal facial nerve function, 5% a facial paresis and 3% a paralysis. After one year, only 4% of patients still have a grade III to VI paralysis. Latency of vertigo with facial nerve paralysis is 4.33 vs. 1.97 year in absence of paralysis. Hearing conservation is 85% without facial nerve paralysis vs. 58% with facial nerve paralysis; Wave III latency (PEAP) with facial nerve paralysis is 4.54 vs. 4.28 ms if not. CONCLUSION: Significant predictive factors of facial nerve palsy outcome are: age, post surgery hearing conservation, wave III latency, difficulty in tumor dissection, vertigo latency.

Acuteness of preoperative factors to predict hearing preservation in acoustic neuroma surgery.

OBJECTIVES: To determine in patients with acoustic neuromas the predictive factors of hearing preservation according to clinical, radiological, and electrophysiological parameters and to evaluate, for each of these predictive factors, the percentage of patients with preserved hearing. STUDY DESIGN: The study involved 107 candidates for hearing preservation attempt. Mean age was 49.7 +/- 11.4 years. Quantitative and qualitative parameters were prospectively studied. Quantitative parameters were age, duration of functional complaints, hearing loss assessed by pure tone and speech audiometry, and auditory brainstem responses (ABRs). Qualitative parameters (expressed in percentage of presence) were sex, functional complaints, vestibular deficit revealed by vestibular testings, well-shaped ABRs, wave I, III, or V of ABRs, and transient evoked otoacoustic emissions (TEOAEs). METHODS: Patients were divided into two groups according to whether their hearing was preserved (52.3%) or not preserved (47.7%). First, quantitative and qualitative factors were compared between both groups to identify predictive factors. Second, all patients were considered together and the percentage of hearing preservation was determined according to the presence of each predictive factor. RESULTS: The results confirmed the predictive value of classic parameters such as preoperative hearing level, radiological data, and trace of ABRs. They also emphasized the predictive role of other parameters such as short duration of hearing loss, presence of wave III in ABRs, and presence of TEOAEs. CONCLUSIONS: The size of the tumor and the preoperative hearing levels are longstanding predictive factors of hearing preservation in acoustic neuroma surgery, and candidates for hearing preservation are therefore now selected according to these factors. This study added more recent predictive factors and, among the 10 factors identified as predictive, the most relevant to hearing preservation were the presence of TEOAEs (69.7%), short duration of hearing loss (66.7%), and presence of wave III in ABRs (66.7%).

[Effects of buflomedil and naftidrofuryl on the human cochlear microcirculation measured by laser-Doppler]. / Les effets du Buflomedil et du Naftidrofuryl sur la microcirculation cochléaire humaine mesurée par laser-Doppler.

The aim of this study was to assess the effects on cochlear blood flow measured by laser-Doppler of two vasoactive agents known for their supposed effectiveness in the presbyacousy treatment (buflomedil, naftidrofuryl), 16 patients undergoing acoustic neurinoma surgery were studied. Cochlear blood flow (CBF) was continuously recorded after the head of the probe was inserted into the internal ear through the round window. Systolic arterial pressure (SAP) and heart rate (HR) were continuously recorded via an arterial cannula. Hemodynamic variations due to buflomedil (400 mg in bolus) and to naftidrofuryl (200 mg in bolus) were compared with those of sodium nitroprusside (500 micrograms in bolus) in each case with anova. Buflomedil did not alter CBF (0%), SAP (+0.14 +/- 1.7%), HR (+3.4 +/- 3.4%). Naftidrofuryl provoked a significant decrease (P < 0.05) of CBF (-14.5 +/- 7.55%), SAP (-13.7 +/- 4%), and a significant increase (P < 0.05) of HR (+8.5 +/- 3.5%); there is a relationship between CBF and SAP (r = 0.88 P < 0.05). NPS provoked a significant decrease (P < 0.01) of CBF (-34.7 +/- 7.7%) SAP (-26.8 +/- 5.4%) and a significant increase (P < 0.01) of HR(+14.7 +/- 7.3%) in the same way of naftidrofuryl (P < 0.01). In conclusion, human cochlear microcirculation depends upon pharmacological hemodynamic variations such as animal models or middle ear microcirculation. If buflomedil did not alter it, naftidrofuryl provoked a reduction by a direct vasodilator effect inducing hypotension like sodium nitroprusside.

[Otosclerosis: stapedectomy or stapedotomy. A long-term comparative study. Apropos of 1279 cases]. / Otospongiose: platinectomie ou platinotomie. Etude comparative a long terme. A propos de 1279 cas.

The authors report 1279 surgical operations of otosclerosis performed between 1980 and 1992 in 959 operated patients. They chose the autegenous vein or perichondrium interposition TeflonR piston; however this technique has improved over the past few years. The size of the stapedectomy has been diminishing; from total, then partial stapedectomy, at last to 0.8 mm across stapedotomy. The graft has become exclusively from venous origin and the diameter of the piston has been reduced from 0.8 to 0.6 then to 0.4 mm. Seven groups of patients have been examined according to the size of the incision for stapedotomy or stapedectomy and the size of the piston. The audiometric study was realized after one month, one year, three years, fine or even ten years after surgery. Comparative tests were made considering the sex and the age of the patient, the thinness of the graft, and surgical revisions. The audiometric study lied not only upon the audiometric Rinne's closing but also upon the bone conduction variation (postoperative bc-preoperative bc) in the course of time. The evolution of tinnitus, of vertigo has been, as well, the subject of a careful study in time according to the surgical techniques. The study shows that the audiometric results (Rinne's closing, bc evolution) are statically much better with total stapedectomy, then with partial stapedectomy, at last with stapedotomy in the first three postoperative years. The best audiometric results are obtained with wider pistons (0.8 mm diameter) and venous approach. The results regarding tinnitus and vertigos are dissimilar especially during the first operative year. After three years of evolution, the significant audiometric differences tend to reduce and the audiometric results become the same (no significant difference) whatever the surgical technique may be. After three years, simple, calibrated stapedotomy without interposition statically gives similar results in literature. However, each surgical technique may, though rather infrequently, produce some incidents or complications that undoubtedly influence the operator as for the choice of the surgical technique to use.

[Value of oto-endoscopy in the follow-up treatment of cholesteatoma of the middle ear]. / Intérêt de l'oto-endoscopie dans le traitement des 2ème temps de cholestéatome de l'oreille moyenne.

The endoscopic approach to the middle ear in eradication of cholesteatoma is now very frequently realised as in the control of the cavities of the middle ear in second stage of cholesteatomas for revision. The improvement of eradication will help to prevent recurrent cholesteatoma and to manage ossiculoplasty. Retraction pockets must also lead to endoscopic control and management.

[Preservation of the stapedial muscle in the treatment of otospongiosis, apropos of 48 cases]. / Conservation du muscle de l'étrier dans le traitement de l'otospongiose, á propos de 48 cas.

The surgical management of otosclerosis, using drilling of the foot plate with a 8 mm diamond burr, 4 mm diameter, teflon prosthesis and vein graft, seems to be in our experience the safest procedure. However, we have tried to keep the function of the stapedial muscle in 48 patients to study the effects on hearing improvement, the stapedial reflex conservation, the protection of inner ear during the six months after surgery. The original technique and results are reported. After surgery, we have not observed any case of painful amplified hearing or of resonance. The audition is reestablished like with the usual techniques.