ABSTRACT
Fifty-eight patients underwent vestibular neurotomy via the posterior fossa approach between September 1992 and December 1998 at the ENT department of Legnano. All patients presented a history of disabling unilateral Menière's disease and underwent complete neuro-otologic evaluation following the 1985 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. All patients underwent MRI imaging, ABR and electronystagmographic testing before surgery. Objective analysis of results is reported using the criteria published by the Committee on Hearing and Equilibrium of the AAO-HNS in 1985. According to the AAO formula, 52 patients obtained a score of 0, indicating complete control of major vertigo spells, while four were classified within the 'substantial control' group. Immediate hearing results indicated that 93 per cent of the patients maintained a level within 10 dB from the pre-operative level. Only one patient experienced a subtotal hearing loss yet retained measurable hearing. No major complications were reported. We conclude that a retrosigmoid approach to vestibular neurotomy can be considered a safe and effective procedure in relieving medically refractory vertigo in Menière's disease while preserving the hearing. Tinnitus and long-term hearing deterioration are not influenced by the procedure.
Subject(s)
Meniere Disease/surgery , Vestibular Nerve/surgery , Adult , Aged , Female , Hearing Loss/surgery , Humans , Male , Middle Aged , Retrospective Studies , Tinnitus/surgery , Treatment Outcome , Vertigo/surgeryABSTRACT
The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current "enlarged" approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano.
Subject(s)
Cochlear Nerve/surgery , Ear, Inner/surgery , Neuroma, Acoustic/surgery , Otologic Surgical Procedures/methods , Adolescent , Adult , Aged , Cochlear Nerve/pathology , Facial Nerve Diseases/etiology , Facial Nerve Diseases/physiopathology , Female , Humans , Male , Middle Aged , Neuroma, Acoustic/pathology , Postoperative Complications , Severity of Illness IndexABSTRACT
El abordaje translaberíntico clásico para la exéresis de neurinomas del acústico fue introducido por William House en 1964. En el curso de los años el abordaje translaberíntico original ha sido progresivamente modificado hacia el actual abordaje "ampliado", extendiendo el área de resección ósea. Esta modificación permite la exéresis de tumores prácticamente de cualquier tamaño del ángulo pontocerebeloso. Se presentan los resultados de 71 neurinomas del nervio acústico grandes (52) o gigantes (19) operados entre los años 1993-1998 por abordaje translaberíntico en el Servicio de Otorrinolaringología del Hospital de Legnano. (AU)
The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current «enlarged» approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Aged , Male , Female , Humans , Otologic Surgical Procedures/methods , Neuroma, Acoustic/surgery , Cochlear Nerve/surgery , Ear, Inner/surgery , Postoperative Complications , Facial Nerve Diseases , Severity of Illness IndexABSTRACT
Petrous bone cholesteatoma is a rare pathology which grows slowly and is often asymptomatic. This work presents a series of 25 cases of Petrous bone cholesteatoma and discusses the diagnostic impact, the surgical approach, the results and the complications. Currently our surgical orientation favors translabyrinthine and transcochlear approaches which, better than other ones, allow both radical excision of the lesion and preservation of the main neuro-vascular structures. Out of the 25 patients undergoing surgery, 22 were treated with the translabyrinthine (6 cases) or transcochlear (16 cases) approaches, in 1 case an infratemporal type A approach was used while the remaining 2 were treated with a median cranial fossa approach. Paralysis of the facial nerve is the most dreaded complication, particularly when a deficit is already present prior to surgery. In just a few cases did the hearing justify an attempt at preservation but in no case should this compromise radical removal of the cholesteatoma.
