[Comparative study using AAO-HNS guidelines for conductive hearing loss and Glasgow Benefit Plot to evaluate results of stapes surgery for otosclerosis: results of 129 cases]. / Evaluation de la chirurgie stapédienne pour otospongiose par le score de bénéfice de Glasgow compare aux critères de l'AAO-HNS : résultats sur 129 cas.

AIM OF THE STUDY: For surgery of otosclerosis, broughting to the fore interest of crossing informations achieved by using AAO-HNS guidelines for conductive hearing loss and Glasgow Benefit Plot (GBP). Secondary aim: compare stapedotomy with and without veinous interposition. INSTITUTIONS: Referential otologic center in semi-country-side general hospital and private institution in urban zone. MATERIALS AND METHOD: retrospective bi-centric study comparing 129 cases of primary surgery for otosclerosis between 1998 and 2004. 3 groups: stapedotomy without veinous interposition (92 cases), stapedotomy with veinous interposition (27 cases), stapedectomy (10 cases). Results given following AAO-HNS guidelines and GBP. STATISTICAL ANALYSIS USED: variance analysis test and t-Student test (p < 0,05), graphic analysis of inter-aural difference before and after surgery. RESULTS: Main benefit in air conduction (AC) threshold is 23 to 25 dB, no statistical difference between both techniques of stapedotomy. Stapedotomy gives better results than stapedectomy in this serie. Stereophony is achieved in 75% of overall cases with stapedotomy but normal hearing is achieved in only 53% of unilateral pre operative hearing loss. COMMENTS: Stapedotomy is a more effective technique in this serie. Crossing informations achieved using AAO-HNS guidelines and GBP leads to give a more realistic and comprehensive understanding to patients who will undergo surgery for otosclerosis.

Idiopathic temporal encephalocele: report of two cases.

BACKGROUND: Idiopathic brain herniation into the middle ear is a rare condition that represents diagnostic and therapeutic challenges. OBJECTIVE: The authors present here two new cases of idiopathic brain herniation with special clinical presentation and emphasis on radiographic studies, particularly computed tomographic scan and magnetic resonance imaging, which allowed the authors to detect the malformation. RESULTS: The two patients underwent surgical treatment with infratemporal approach and recovered perfectly.

Time series analysis of alcohol consumption and suicide mortality in the United States, 1934-1987.

OBJECTIVE: The objective is to analyze time series data on per capita alcohol consumption and suicide mortality between 1934 and 1987. Specifically, the aim is to test the hypothesis that increases in per capita consumption are associated with increases in suicide mortality overall and in gender and age subgroups. This study also examines whether the effect of per capita consumption on subsequent rates of suicide is influenced by other aggregate factors, particularly unemployment rates, per capita income and divorce rates. METHOD: This analysis examines the temporal structure of suicide mortality, alcohol consumption and covariate time series data in the United States, 1934-1987, using the Box-Jenkins method. RESULTS: Bivariate associations between alcohol consumption and suicide rates were not significant. However, when unemployment was included in the model, increases in per capita alcohol consumption were significantly related to increases in suicide overall, for men and women, and for the young (under age 40) and middle-aged (40 to 59 years), but not for those over age 60. CONCLUSIONS: The use in modeling of other known covariates of suicide rates, particularly unemployment, affects the magnitude of the relationship between alcohol consumption and suicide. Consistent with other studies, unemployment was significantly related to suicide and was shown to confound the relationship between alcohol and suicide. The effects of changes in alcohol consumption on changes in suicide rates differ by gender and age group, which demonstrates that focusing on the total population alone can mask divergent effects that can cancel each other out when subgroups are combined.

[Polycystic disease of the salivary glands: report of an attack of the submaxillary glands]. / Maladie polykystique des glandes salivaires: description d'une atteinte des glandes sous-maxillaires.

Bilateral dysgenetic polycystic disease of parotid glands is an extremely rare pathologic condition in which salivary parenchyma is partially replaced by multiple epithelial-lined cysts arising from intercalated ducts. Review of the fourteen cases published in literature shows that it affects nearly exclusively women with an history of asymptomatic progressive enlargement of almost always both parotid glands. We report here the first case, to our knowledge, of a polycystic disease involving both submandibular salivary gland in a man.

[Fixed mallear head syndrome]. / Le syndrome de la tête du marteau fixée.

Fixed head malleus syndrome is a rare anatomoclinical entity first described by Goodhill in 1966. We present a series of 9 patients who underwent surgery between 1991 and 1997 and discuss the technical procedures used and functional outcome. Ossicular mobility can be re-established with two surgical methods. The more simple method consists in a classical incus transposition with malleus neck section. The more physiological method consists in drilling the synostosis fixing the malleus without disrupting the ossicular chain; stapedotomy is associated in certain cases (Type III).

Hemifacial spasm: endoscopic vascular decompression.

Sixty patients with primitive hemifacial spasm were treated by means of a minimally invasive retrosigmoid approach in which endoscopic and microsurgical procedures were combined. Intraoperative endoscopic examination of the cerebellopontine angle showed that for 56 of the patients vessel-nerve conflict was the cause of hemifacial spasm. The most common offending vessel was the posterior inferior cerebellar artery (39 patients), next was the vertebral artery (23 patients), and last was the anterior inferior cerebellar artery (16 patients). Nineteen of the patients had multiple offending vascular loops. In one patient, another cause of hemifacial spasm was an epidermoid tumor of the cerebellopontine angle. For three patients, it was not possible to determine the exact cause of the facial disorder. Follow-up information was reviewed for 54 of 60 patients; the mean follow-up period was 14 months. Fifty of the patients were in the vessel-nerve conflict group. Forty of the 50 were free of symptoms, and four had marked improvement. The overall success rate was 88%, and there was minimal morbidity (no facial palsy, two cases of severe hearing loss).

Three-dimensional MRI of hemifacial spasm with surgical correlation.

MRI was used to investigate 100 patients with hemifacial spasm, using 3D-FT T2-weighted (CISS) and contrast-enhanced 3D-FT T1-weighted (turbo-FLASH) sequences in all cases. MR angiography was performed in 54 patients, using 3D-MT FISP images. Decompression of the facial nerve through a retromastoid craniotomy was performed in all patients. Hemifacial spasm caused by tumours in the cerebellopontine angle was not included. Vascular contact with the facial nerve root-exit zone or at the internal auditory canal was present in 96 of 100 patients with hemifacial spasm. The vessel responsible was the vertebral artery (VA) in 18 cases, the posterior inferior cerebellar artery (PICA) in 23, the anterior inferior cerebellar artery (AICA) in 22, the VA and PICA in 24, VA and AICA in 3, PICA and AICA in 1, VA, PICA and AICA in 4, and a vein in 1 case. CISS images showed compressive vascular loops better than contrast-enhanced turbo-FLASH images alone. The sensitivity of MRI was high, since only one false-negative case was found among the 100 patients who underwent surgery.

[Results of treatment of hemifacial spasm by surgical and endoscopic neurovascular decompression. Analysis of 60 records]. / Résultats du traitement du spasme de l'hémiface par décompression neuro-vasculaire chirurgicale et endoscopique. Analyse de 60 dossiers.

The notion of a neurovascular conflict in the pathogenesis of hemifacial spasm is now well accepted based on evidence obtained from pre-operative imaging and per-operative videoendoscopy of the pontocerebellous angle. We operated 60 patients, 47 women and 13 men, age range 28-79 years, who had hemifacial spasms for 2 months to 30 years. Neurovascular decompression of the facial nerve via the retrosigmoid access was performed using a minimal invasive technique: limited access of short duration, microsurgery, endoscopic and electrophysiologic techniques, positioning of Teflon microsponges between the nerve and the vessels involved. Surgery led to 90% good long-term results with minimal morbidity limited to auditive sequellae in 3.3% of the cases. The site of compression was at the point where the facial nerve emerged in 95% of the cases. Arteries involved were the posteroinferior cerebellous artery (39 cases), the vertebral artery (23 cases) and the anteroinferior cerebellous artery (16 cases). In a third of the cases, the vascular conflict involved more than one vessel. The facial nerve should be isolated from any nociceptive contact to obtain definitive cure.

[Neurinomas of the cochlear nerve]. / Neurinomes du nerf cochléaire.

Usually, schwannomas of the eight nerve arise from the vestibular nerve. Yet, the authors have operated from September 1993 to September 1995 three neuromas whose origin is certainly the cochlear nerve. Surgery was performed by retro-sigmoid approach magnified by endoscopic procedure of the cerebello-pontine angle before and after removing the tumor. We report here the cases and the literature is documented. Similar cases of observing cochlear neuromas at the moment of the procedure are exceptional. Because of more and more early diagnosis of these tumors, advances of microsurgery in ponto-cerebellar angle and endoscopic improvements in this area, observation of this kind of pathology could be more and more frequent.

[Neuro-vascular decompression in hemifacial spasm: anatomical, electrophysiological and therapeutic results apropos of 100 cases]. / Décompression neuro-vasculaire dans le spasme de l'hémiface: résultats anatomiques, électrophysiologiques et thérapeutiques à propos de 100 cas.

Hemifacial spasm is a neurological disorder due to abnormal hyperactivity of the facial nerve. The most common cause of hemifacial spasm is a neuro-vascular conflict in the cerebellopontine angle between a vascular loop and the root of the facial nerve (96% of cases). Tumors are the cause of hemifacial spasm in only 1% of cases). The authors present their results in 100 patients who underwent microvascular decompression for essential hemifacial spasm between 1990 and 1995. They used microsurgical and endoscopic procedures by a minimal retrosigmoid approach in all cases. The most common offending vessels were the posterior inferior cerebellar artery (70%), the vertebral artery (41%) and the anterior inferior cerebellar artery (28%). An aberrant vein was found in 2 cases. There were 38% of multiple artery-nerve conflicts. Physiopathology of hemifacial spasm is explained by two principal theories: in the ephaptic theory, hyperactivity and an abnormal nervous impulse pathway are due to a short demyelinated area on the nerve trunk caused by the offending vessel, inducing short circuiting between adjacent nerve fibers. In the nuclear theory, hyperactivity of the facial nerve is due to an abnormal and automatic activity of the facial nerve nucleus itself, induced by the vessel. The authors used pre and postoperative electromyographic tests and intraoperative electromyographic tests. Their results tend to prove the nuclear theory. Ninety per cent of the patients had a good result, with a mean follow-up time of 30 months in 60 cases. In 82% of the cases, there was a total recovery after a single procedure. There was no mortality and no facial palsy. Hearing loss occurred in less than 5%.

Endoscopy of the cerebellopontine angle.

The authors present their experience of 191 patients from June 1990 to December 1993 with endoscopy of the cerbellopontine angle using a limited retrosigmoid approach. The advantages of endoscopy of the cerebellopontine angle are the simplicity and efficiency of the procedure, and less invasive surgery. The authors emphasize the importance of the endoscopic procedure: first in acoustic neuroma surgery to get more accurate information about the relationship between the tumour and the adjacent structures, and to control the lateral end of the internal auditory canal; second in hemifacial spasm or facial neuralgia surgery, intraoperative endoscopy is the key point giving a sure and safe way to recognize the offending vessels.

[Current imaging of vasculo-neural conflicts in the cerebellopontine angle]. / L'imagerie actuelle des conflits vasculo-nerveux de l'angle ponto-cérébelleux.

UNLABELLED: To demonstrate the high sensitivity of high definition MRI and particularly "Constructive Interference in Steay State" (Ciss) imaging sequence, in depicting neurovascular conflicts in the CP angle cistern, cisternographic imaging and high definition T1 weighed (Turbo flash), contrast enhanced imaging were used to investigate hemifacial spasm (72 patients) and tinnitus with abnormal BER (5 patients). The study was complemented with Angio MR in 25 patients. The results were compared with findings in a control group of 200 patients, and with the surgical observations in 57 operated cases. In hemifacial spasm, the morphology of the neurovascular conflict was determined, as well as the site of compression (lateral medullary fossa 38 cases; nerve 9; both 15 cases), and the vessel involved (VA 25 cases; PICA 16 cases; AICA 10 cases; VA and PICA 8 cases; VA and AICA 3 cases; lateral medullary vein 1 case). In tinnitus (5 cases), the AICA was involved in every case in the IAM. Among 57 operated cases, only one false negative was observed. In the asymptomatic control group, a nerovascular conflict was observed in 3, 5% of the cases only. CONCLUSION: CISS imaging is the single most efficient technique, but the combined used of the 3 types of imaging brings the highest diagnostic efficiency, for identifying a neurovascular conflict in the CPA cistern.

[Role of endoscopy and vascular decompression in the treatment of hemifacial spasm]. / Place de l'endoscopie et de la décompression vasculaire dans le traitement du spasme de l'hémiface.

Although it has long been hypothesized that hemifacial spasm could arise from a conflict between the nerve and the artery, it is very difficult to distinguish between a normal arterial loop and a pathological conflict leading to facial symptoms. Several new elements would help in the definition of the cause and allow less traumatic treatment of idiopathic hemifacial spasm. They include magnetic resonance imagery with CISS sequences, limited retrosigmoid approach, endoscopy of the cerebellopontine angle and monitoring the facial nerve. In our experience with 20 cases, retrosigmoid approach with a combined surgical and endoscopic procedure has led to total involution of the spasms in 80% of the cases.

[Contribution of endoscopy of the cerebellopontine angle by retrosigmoid approach. Neuroma and vasculo-nervous compression]. / Apport de l'endoscopie de l'angle ponto-cérébelleux par voie rétro-sigmoïde. Neurinomes et conflits vasculo-nerveux.

An endoscopic approach to the cerebellopontine angle has been suggested by several authors over the last 20 years but it is only recently that the technical and operative conditions for successful endoscopy could be met. The retrosigmoid approach provides simple and direct access to the cerebellopontine zone. The endoscope, with its distal light source, provides excellent illumination of a wide visual field within an anatomical site particularly rich in neurovascular structures. Endoscopic and microsurgical techniques may be combined for the surgical management of acoustic neuroma with the advantage of assuring better exposure of structures adjacent to the tumor and better control of the quality of dissection of the fundus of the internal auditory canal. The addition of endoscopic techniques, during surgery for trigeminal neuralgia or unilateral facial spasm, makes it possible to accurately locate the site of neurovascular compression without either retraction of the cerebellum or unnecessary dissection.