ABSTRACT
Non-chromaffin paragangliomas are very rare tumours. They arise from chemoreceptor cells at multiple sites throughout the body. They are usually very vascular and most arise in intimate contact with vital structures making their excision a surgical challenge. We describe in this paper four cases of paragangliomas in the carotid body and the jugular bulb. Their presentation was unusual. Two cases underwent excisional surgery and two had radiation treatment because they were not fit for surgery. We had to use a temporary pacemaker for preoperative preparation of the carotid body because of an associated hypersensitive carotid sinus syndrome. The clinical presentation and the surgical management will be described in this paper.
Subject(s)
Cardiac Pacing, Artificial , Carotid Body Tumor/surgery , Glomus Jugulare Tumor/surgery , Preoperative Care/methods , Adult , Aged , Carotid Body Tumor/complications , Carotid Body Tumor/diagnostic imaging , Female , Glomus Jugulare Tumor/diagnostic imaging , Humans , Male , Middle Aged , Paraneoplastic Syndromes/etiology , Paraneoplastic Syndromes/therapy , Patient Care Team , Radiography , Syncope, Vasovagal/etiology , Syncope, Vasovagal/therapyABSTRACT
Among 186 patients with preoperative hearing, a total of 189 acoustic neurinomas were removed through a lateral suboccipital approach with anatomical preservation of the cochlear nerve. Functional hearing was preserved in 92 (49%) of these patients; despite anatomical preservation of the cochlear nerve, deafness was the result in 51% of the series. Many factors have been considered to cause hearing loss in patients whose cochlear nerve was intact after surgery; these include nerve retraction, nerve or cochlear ischemia, overheating and vibration damage to the nerve, and opening of the labyrinth. To evaluate the significance of injury to the labyrinth in postoperative hearing loss, a prospective study was undertaken. High-resolution computerized tomography studies through the inner ear with bone algorithm were performed pre- and postoperatively. The postoperative status of the labyrinth was classified into three patterns: intact, fenestrated, and widely opened. Injury to the labyrinth occurred in 30% of the cases. The most frequently injured labyrinth structures were the crus commune of the posterior and superior semicircular canals (52%), the posterior semicircular canal (23%), the vestibule (21%), and the superior semicircular canal (4%). A statistically significant relationship was found between injury to the labyrinth and deafness, elevated thresholds, and lower discrimination values at pure-tone audiograms and speech audiometry (p < 0.0001). The degree of the injury (comparison between fenestration and wide opening of the labyrinth) was also significantly related to postoperative deafness (p < 0.0001). Disturbance of the inner-ear fluids was considered to be the cause of the hearing loss. In 12 patients labyrinth injury was not associated with deafness. This finding may support the existence of mechanisms of cochlear protection. The homeostatic function of the endolymphatic sac was considered to play an important role in recovery of damaged hearing in these 12 cases.
Subject(s)
Ear, Inner/surgery , Hearing Loss, Functional/etiology , Neuroma, Acoustic/surgery , Postoperative Complications , Surgical Procedures, Operative/methods , Adolescent , Adult , Aged , Ear, Inner/diagnostic imaging , Female , Hearing Tests , Humans , Male , Middle Aged , Neuroma, Acoustic/diagnostic imaging , Postoperative Complications/prevention & control , Tomography, X-Ray ComputedABSTRACT
The authors report eight cases of chronic epidural hematoma, classified according to macroscopical operative findings and histological studies of the hematomas. Clinical, radiological, and pathological findings are described. A review of 63 cases of the literature is presented, and the accepted concepts for classification and management of these lesions are discussed.
