ABSTRACT
The authors report the first case of extensive craniocervical pneumocranium causing mass effect, without any associated extradural pneumatocele. The patient presented with frontal headaches and unusual sensations in his left ear. He was found to have large pneumocranium involving his left frontal, temporal, parietal, and occipital bones as well as the atlas. He underwent a craniectomy with replacement of the pneumatized bone with titanium mesh, and mastoidectomy with obliteration of the mastoid air cells. This case is discussed in the context of the literature to date. A review of the literature shows that trauma is not a common cause of pneumocranium, with most cases occurring spontaneously. The authors believe that a combined neurosurgical-otological approach is beneficial in such cases.
Subject(s)
Pneumocephalus/diagnostic imaging , Pneumocephalus/surgery , Skull Fractures/complications , Skull/diagnostic imaging , Skull/surgery , Craniotomy , Humans , Male , Middle Aged , Pneumocephalus/etiology , Radiography , Surgical Mesh , Treatment OutcomeABSTRACT
OBJECTIVE: The main aim of this study was to examine differences in quality of life (QoL) among acoustic neuroma patients across the management options of microsurgery, radiation, and observation. Additional aims were to describe QoL and investigate management, medical, and demographic factors that predicted QoL in this patient group. STUDY DESIGN: Cross-sectional design, using a postal questionnaire. SETTING: Tertiary referral centers. PATIENTS: Participants included 180 adults diagnosed with, or treated for, a unilateral acoustic neuroma within 5 years of questionnaire distribution. The mean age of participants was 56.5 years, and 107 (59.4%) were female. INTERVENTION(S): Patients' acoustic neuromas were managed with microsurgery, radiation, or observation. MAIN OUTCOME MEASURE(S): Current QoL was measured using the Short Form 12 Version 2 (SF-12), and postmanagement changes in QoL were assessed with the Glasgow Benefit Inventory (GBI). RESULTS: No significant differences in SF-12 scores were found across microsurgery, radiation, and observation patients. However, microsurgery patients reported more deterioration on the GBI general well-being subscale than radiation patients and more improvement in the GBI social support scale than observation patients. Number of symptoms was a consistent predictor of SF-12 and GBI scores. CONCLUSION: This is only the second study to use multivariate statistical techniques and a large sample to examine QoL across the acoustic neuroma management options of microsurgery, radiation, and observation. There were few differences in QoL outcomes across management groups. Number of symptoms was an important factor in current QoL and postmanagement changes in QoL.
Subject(s)
Cranial Nerve Neoplasms/psychology , Neuroma, Acoustic/psychology , Otologic Surgical Procedures , Quality of Life , Adult , Aged , Cranial Nerve Neoplasms/radiotherapy , Cranial Nerve Neoplasms/surgery , Disease Progression , Female , Glasgow Outcome Scale , Humans , Logistic Models , Male , Microsurgery , Middle Aged , Neuroma, Acoustic/radiotherapy , Neuroma, Acoustic/surgery , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: General practitioners are usually the first point of contact for patients with hearing loss. Asymmetrical sensorineural hearing loss can be a symptom of a wide range of diseases. A correct diagnosis is essential for appropriate treatment and limitation of the progression of hearing loss. OBJECTIVE: This article provides an outline for an approach to a patient presenting with asymmetrical sensorineural hearing loss, and also provides a brief summary of four disease processes which may present with asymmetrical hearing loss. DISCUSSION: Asymmetrical sensorineural hearing loss may be secondary to the process of aging or simply be related to excessive noise exposure. It can however, be the only presenting symptom of a vestibular schwannoma or an intracranial tumour. A high level of clinical suspicion is required to ensure that these pathologies are not missed.