CT-guided core needle biopsies of head and neck tumors: a comprehensive monocenter analysis of safety and outcomes.

BACKGROUND: Although core needle biopsy is an important tool in minimally invasive tissue sampling and diagnostics for head and neck masses, comprehensive data about safety and outcomes is lacking. PURPOSE: To retrospectively evaluate the diagnostic performance and safety of computed tomography (CT)-guided percutaneous core needle biopsy of head and neck masses. MATERIAL AND METHODS: This retrospective single-center study included patients from 04/2007 to 12/2021, and a total of 156 core needle biopsies were evaluated. The initial histopathological results were compared with the long-term final diagnosis to evaluate the diagnostic yield of CT-guided core needle biopsies. The patients' age, sex, and history of malignancy, as well as procedural complications and radiation exposure were collected. RESULTS: A total of 156 biopsies of 150 patients (mean age 56 years ± 17; 89 men) were evaluated. 57.3% (86/150) of patients had a history of malignancy. 55.1% (86/156) of the lesions were accessed by an infrahyoid needle approach. 92.9% (145/156) of biopsies yielded conclusive results. There were no false positives and 4 false negatives, resulting in a total false negative rate of 2.7% (4/145) and a total diagnostic yield of 90.4% (141/156). There were nine puncture-related complications (9/156-5.7%). None of the complications required further reintervention. The average dose length product was 311.3 mGy × cm. CONCLUSION: CT-guided core needle biopsies of head and neck masses showed excellent results with high diagnostic yield and clinical safety. CLINICAL RELEVANCE STATEMENT: General anesthesia for open biopsy carries a higher risk for elderly patients, and fine needle aspiration has a poor reputation in terms of its diagnostic yield. This study focuses on safety and diagnostic yield of CT-guided core needle biopsies. KEY POINTS: • CT-guided core needle biopsy in head and neck tumors was a reliable and safe procedure. • The most common cause for an inconclusive biopsy result was a shortage of tissue collected during the biopsy. • During our study period of nearly 15 years, the radiation exposure of head and neck biopsies decreased.

The Advanced Bionics High Resolution Mode: stimulation rates up to 5000 pps.

CONCLUSION: The technology of stimulation rates between 1500 and 5000 pulses per second per channel (pps/ch) brings a benefit for all users. However, the fastest possible rate does not necessarily lead to best hearing performance in each individual subject. Individual optimization of stimulation rate is recommended. OBJECTIVES: The aim of this study was to investigate the effect of high stimulation rates on speech perception ability. SUBJECTS AND METHODS: Thirteen subjects with at least 3 months of experience with conventional Clarion speech coding strategies were recruited into cross-over studies. The first study investigated stimulation rates of 1500, 2000 and 3000 pps/ch, the second study investigated rates of 2500 and 5000 pps/ch. Speech perception data were collected for testing in quiet and in competing noise. RESULTS: On average, speech perception performance increased significantly when changing from conventional speech coding strategies to High Resolution Mode. Subjects who preferred continous interleaved sampling (CIS) in standard mode appeared to obtain better results with rates of 2500 or 3000 pps/ch than with 5000 pps/ch. The stimulation rate that led to best performance provided the highest stimulation current efficiency in the majority of subjects.

Investigation of pitch discrimination and the effect of learning for virtual channels realized by current steering.

CONCLUSION: As virtual channels could be perceived by the majority of implant users, they promise potential for advanced speech coding strategies, providing enhanced spectral resolution. An improvement in resolution was found from first stimulation up to 6 months afterwards. OBJECTIVE: Independent current sources allow distribution of the current between adjacent electrode contacts in a defined ratio, thus steering the current. The goal of our study was to investigate a) whether all users were able to distinguish between adjacent physical channels, b) how many users could perceive a distinct pitch as the current was steered between two adjacent contacts and c) whether a learning effect was observed. SUBJECTS AND METHODS: A pitch ranking measurement was performed during an acute test session for a group of 39 cochlear implant users. The results were analysed with respect to the implanted electrode system. The learning process during the first 6 months after implantation was investigated for a selected subgroup. RESULTS: About half of the study participants were able to perceive intermediate channels; 5% were able to discriminate more than eight intermediate channels, which correspond to half of the physical channels. A wide variation was found across the array.

A case of unilateral hypoglossus nerve palsy associated with chordoma in the region of clivus.

We had a rare case of 50-year-old woman with a unilateral hypoglossus nerve palsy as a sign of clival chordoma. A computed tomography (CT) scan of the skull base showed bone destruction at the anterior part of the foramen magnum and CT scan of the neck reveals asymmetrical area at the base of the tongue. Magnetic resonance imaging showed a mass at the skull base in the region of the clivus with bone destruction in the middle and right side of the clivus. The tumor was biopsied through transnasal biopsy from the region of the clivus using a navigation system and microscopical surgical technique. Postoperatively, the patient received radiotherapy. Surgery is the most effective treatment of chordomas. An endoscopic approach provides easy, rapid and direct access to the clivus. A postoperative radiation therapy is recommended. A carbon ion radiotherapy is an effective treatment for chordomas of the skull base with minimal side effects. Close interdisciplinary collaboration between ORL, neuroradiology, pathology and oncology is desirable for effective therapy.

Differential fine-tuning of cochlear implant material-cell interactions by femtosecond laser microstructuring.

Cochlear implants (CIs) can restore hearing in deaf patients by electrical stimulation of the auditory nerve. To optimize the electrical stimulation, the number of independent channels must be increased by reduction of connective tissue growth on the electrode surface and selective neuronal cell contact. The femtosecond laser microstructuring of the electrode surfaces was performed to investigate the effect of fibroblast growth on the implant material. A cell culture model system was established to evaluate cell-material interactions on these microstructured CI-electrode materials. Fibroblasts were used as a cell culture model for connective tissue formation, and differentiating neuronal-like cells were employed to represent neuronal cells. For nondestructive microscopic examination of living cells on the structured surfaces, the cells were genetically modified to express green fluorescent protein. To investigate the special interaction between the electrode material and the tissue we used electrode material which is originally used for manufacturing CI for human applications, namely platinum (contact material) and silicone carrier material (LSR 30, HCRP 50). Microstructures of various dimensions (groove width 1-10 microm) were generated by using femtosecond laser ablation. The highest fibroblast growth rate was observed on platinum, but cell growth rates on the silicone carrier material were lower. Microstructuring reduced fibroblast cell growth on platinum significantly. On the microstructured silicone, a trend to lower cell growth rates was observed. In addition, microgrooves on platinum surfaces can direct neurite outgrowth parallel to the grooves. The implications of the results are discussed with respect to the design of a microstructured CI surface.

Comparison of a paired or sequential stimulation paradigm with advanced bionics' high-resolution mode.

OBJECTIVE: Simultaneous stimulation on two channels was investigated with respect to fully sequential stimulation while controlling for the number of channels and the stimulation rate used. STUDY DESIGN: Only subjects having at least 6 months' experience with conventional Clarion speech coding strategies (CIS, PPS, or SAS) were included. A counterbalanced cross-over design was used to compare the paired stimulation paradigm to the sequential stimulation paradigm. SETTING: The investigation was a prospective, within-subject, repeated-measures experiment. PATIENTS: The study group consisted of 13 postlingually deafened adult subjects. INTERVENTIONS: The following programs were evaluated: 1) 16-channel paired stimulation with 5000 pps per channel; 2) 16-channel sequential stimulation with 2500 pps per channel; and 3) 8-channel sequential stimulation with 5000 pps per channel. MAIN OUTCOME MEASURES: Speech perception tests in quiet and noise, Quality Assessment Questionnaire. RESULTS: On average, both sequential stimulation programs showed comparable results, whereas the program with paired stimulation, on average, provided poorer performance. Several subjects showed a remarkable drop in performance when changing from sequential to paired mode. Although a few subjects showed better performance in quiet when using paired stimulation, they still had poorer performance in noise. A weak trend was found linking the difference between program levels in paired or in sequential stimulation paradigm to the difference in performance with these two settings. CONCLUSION: Results indicate that for all subjects in this group sequential stimulation is more appropriate than paired stimulation. Subjective reports, as well as formal speech perception testing, show that the difference between the two paradigms is pronounced, especially when evaluating in the presence of background noise, the test condition more representative of everyday listening.