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  • 1
    Online Resource
    Online Resource
    Hypercoagulability in Vestibular Schwannoma Surgery
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Otology & Neurotology Vol. 42, No. 2 ( 2021-02), p. e222-e226
    Details
    In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 2 ( 2021-02), p. e222-e226
    Abstract: Patients with vestibular schwannoma who harbor a genetic predisposition for venous thromboembolism require special consideration when determining optimal therapeutic management. The primary objective of the current study was to provide recommendations on treatment of hypercoagulable patients with vestibular schwannoma through a case series and review of the literature. Patients: Two patients who underwent resection of vestibular schwannomas. Intervention(s): Surgical resection and diagnostic testing. Main Outcome Measure(s): Postoperative venous thromboses. Results: One patient who underwent resection of vestibular schwannoma and suffered several postoperative thrombotic complications consistent with a clinical thrombophilia. One patient with known Factor V Leiden deficiency who underwent resection of vestibular schwannoma followed by postoperative chemoprophylaxis with a direct factor Xa inhibitor and experienced an uneventful postoperative course. Conclusions: In patients with a known propensity for venous thromboembolism, the skull base surgeon should consider nonsurgical management. If the patient undergoes surgical resection, we recommend careful effort to minimize trauma to the sigmoid sinus. In addition, the surgeon may consider retrosigmoid or middle fossa approaches. Best practice recommendations include the use of pneumatic compression devices, early ambulation, and consideration of postoperative prophylactic anticoagulation in patients with a known genetic predisposition.
    Type of Medium: Online Resource
    ISSN: 1531-7129 , 1537-4505
    URL: Article
    DOI: 10.1097/MAO.0000000000002934
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2058738-7
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  • 2
    Online Resource
    Online Resource
    Hypofractionated Robotic Stereotactic Radiosurgery for Vagal Paragangliomas: A Novel Treatment Strategy for Cranial Nerve Preservation
    Wiley ; 2020
    In:  Otolaryngology–Head and Neck Surgery Vol. 162, No. 6 ( 2020-06), p. 897-904
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 162, No. 6 ( 2020-06), p. 897-904
    Abstract: To provide the first description of hypofractionated stereotactic radiosurgery (SRS) and evaluate tumor control and safety for vagal paragangliomas (VPs), which begin at the skull base but often have significant extracranial extension. Study Design Retrospective chart review. Setting Tertiary‐referral neurotology and neurosurgery practice. Subjects and Methods Five VPs in 4 patients (all male, ages 15‐56 years) underwent SRS between 2010 and 2018. Outcome measures included tumor dimensions on serial imaging, cranial nerve function, and radiation side effects. Results CyberKnife hypofractionated SRS was performed. The prescription dose was 24 or 27 Gy (maximum dose 33.4 Gy; range, 29.3‐35.5 Gy) delivered in 3 equal fractions. The mean isodose line was 79% (range, 76%‐82%). Four VPs were treated primarily, and 1 tumor underwent SRS to treat regrowth 2 years after microsurgical subtotal resection via the modified infratemporal fossa approach. The treatment volume ranged from 8.81 to 86.3 cm 3 (mean, 35.7 cm 3 ). All demonstrated stable size (n = 3) or regression (n = 2) at last follow‐up, 63 to 85 months after SRS (mean, 76 months). One patient had stable premorbid vocal fold paralysis from a prior ipsilateral glomus jugulare tumor resection. All others demonstrated normal vagal function following SRS. Treatment‐related side effects, including dysgeusia (n = 1), mucositis (n = 1), and neck soft‐tissue edema (n = 2), were self‐limited. Conclusions Hypofractionated SRS appears to be both safe and effective for treating VPs, including large‐volume and predominantly extracranial tumors, while preserving vagal function. SRS should be considered as a cranial nerve preservation option, especially in settings of contralateral lower cranial nerve deficits or in those with multiple paragangliomas risking both vagal nerves.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599820910150
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2008453-5
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  • 3
    Online Resource
    Online Resource
    Predictors of hearing functional outcome following surgery for cerebellopontine angle meningioma
    Springer Science and Business Media LLC ; 2022
    In:  Journal of Neuro-Oncology Vol. 157, No. 1 ( 2022-03), p. 165-176
    Details
    In: Journal of Neuro-Oncology, Springer Science and Business Media LLC, Vol. 157, No. 1 ( 2022-03), p. 165-176
    Type of Medium: Online Resource
    ISSN: 0167-594X , 1573-7373
    URL: Article
    DOI: 10.1007/s11060-022-03958-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2007293-4
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  • 4
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    Online Resource
    Radiation-Induced Malignant Peripheral Nerve Sheath Tumor of the Vagus Nerve Following Radiation Treatment of Cervical Paraganglioma
    Georg Thieme Verlag KG ; 2020
    In:  Journal of Neurological Surgery Reports Vol. 81, No. 04 ( 2020-10), p. e66-e70
    Details
    In: Journal of Neurological Surgery Reports, Georg Thieme Verlag KG, Vol. 81, No. 04 ( 2020-10), p. e66-e70
    Abstract: Radiation-induced sarcoma is a known but rare complication of radiation treatment for skull base paraganglioma. We present the cases of a female patient with multiple paraganglioma syndrome treated with external beam radiation treatment who presented 4 years later with a malignant peripheral nerve sheath tumor of the vagus nerve.
    Type of Medium: Online Resource
    ISSN: 2193-6358 , 2193-6366
    URL: Article
    DOI: 10.1055/s-0040-1718408
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 2677885-3
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  • 5
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    Online Resource
    Bilateral Auditory Brainstem Implants in Patients With Neurofibromatosis 2
    Wiley ; 2021
    In:  Otolaryngology–Head and Neck Surgery Vol. 165, No. 2 ( 2021-08), p. 339-343
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 165, No. 2 ( 2021-08), p. 339-343
    Abstract: To discuss indications for bilateral auditory brainstem implants (ABIs), compare audiometric outcomes of unilateral vs bilateral ABIs, and determine if patients have improved outcomes with addition of a second‐side implant. Study Design Retrospective review of 24 patients with neurofibromatosis 2 (NF2) who underwent sequential placement of ABIs from 1989 to 2019. Setting Tertiary referral center. Methods Charts were reviewed for indication for second‐side surgery, use of implants, and audiometric outcomes. Implants placed in the past 30 years were included in the study. Northwestern University Children’s Perception of Speech (NU‐CHIPS) and/or City University of New York (CUNY) sentence scores were compared in unilateral and bilateral conditions. Results Indications for a second‐side implant included first‐side implants with severe nonauditory symptoms (11), marginal audiometric results (9), outdated technology (2), or deterioration of first side (2). Seven patients are bilateral users and 1 patient discontinued bilateral use after a year due to no significant improvement over unilateral use. One patient with initial bilateral use was lost to follow‐up. Thirteen patients are unilateral users due to nonaudiometric side effects or poor audiometric outcomes with the first side. Two patients are complete nonusers. Seventy‐five percent had improved audiometric outcomes after the second‐side implant, and 20% had stable findings. Conclusions Second‐side ABIs should be consider in patients with poor performance from a first‐side implant. Most patients demonstrate subjective improvement with the second ABI. More research is needed for better objective assessments of improvements.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599820977420
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008453-5
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  • 6
    Online Resource
    Online Resource
    Anatomic Assessment of the Limits of an Endoscopically Assisted Retrolabyrinthine Approach to the Internal Auditory Canal
    Georg Thieme Verlag KG ; 2021
    In:  Journal of Neurological Surgery Part B: Skull Base Vol. 82, No. S 03 ( 2021-07), p. e184-e189
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 82, No. S 03 ( 2021-07), p. e184-e189
    Abstract: Objective Data regarding the surgical advantages and anatomic constraints of a hearing-preserving endoscopic-assisted retrolabyrinthine approach to the IAC are scarce. This study aimed to define the minimum amount of retrosigmoid dural exposure necessary for endoscopic exposure of the IAC and the surgical freedom of motion afforded by this approach. Methods Presigmoid retrolabyrinthine approaches were performed on fresh cadaveric heads. The IAC was exposed under endoscopic guidance. The retrosigmoid posterior fossa dura was decompressed until the fundus of the IAC was exposed. Surgical freedom of motion at the fundus was calculated after both retrolabyrinthine and translabyrinthine approaches. Results The IAC was entirely exposed in nine specimens with a median length of 12 mm (range: 10–13 mm). Complete IAC exposure could be achieved with 1 cm of retrosigmoid dural exposure in eight of nine mastoids. For the retrolabyrinthine approach, the median anterior–posterior surgical freedom was 13 degrees (range: 6–23 degrees) compared with 46 degrees (range: 36–53 degrees) for the translabyrinthine approach (p = 0.014). For the retrolabyrinthine approach, the median superior–inferior surgical freedom was 40 degrees (range 33–46 degrees) compared with 47 degrees (range: 42–51 degrees) for the translabyrinthine approach (p = 0.022). Conclusion Using endoscopic assistance, the retrolabyrinthine approach can expose the entire IAC. We recommend at least 1.5 cm of retrosigmoid posterior fossa dura exposure for this approach. Although this strategy provides significantly less instrument freedom of motion in both the horizontal and vertical axes than the translabyrinthine approach, it may be appropriate for carefully selected patients with intact hearing and small-to–medium sized tumors involving the IAC.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/s-0040-1712180
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
    detail.hit.zdb_id: 2653367-4
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  • 7
    Online Resource
    Online Resource
    Translabyrinthine resection of neurofibromatosis type 2 associated vestibular and facial schwannomas, repair of facial nerve, and placement of auditory brainstem implant
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2014
    In:  Neurosurgical Focus Vol. 36, No. v1supplement ( 2014-01), p. 1-
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 36, No. v1supplement ( 2014-01), p. 1-
    Abstract: We present video of gross-total resection of a large cerebellopontine angle tumor consisting of both vestibular and facial schwannoma components via the translabyrinthine route in a patient with neurofibromatosis type 2. The facial nerve is reconstructed using a greater auricular nerve graft, and an auditory brainstem implant is placed. Prior to surgery the patient had no facial nerve function on the operative side and had lost useful hearing. He also had usable vision only on the ipsilateral side and had contralateral vocal cord paralysis. The video can be found here: http://youtu.be/IOkEND-0vhI .
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/2014.V1.FOCUS13429
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2014
    detail.hit.zdb_id: 2026589-X
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  • 8
    Online Resource
    Online Resource
    Effect of Vestibular Schwannoma Size and Nerve of Origin on Posterior External Auditory Canal Sensation: A Prospective Observational Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Otology & Neurotology Vol. 41, No. 9 ( 2020-10), p. e1145-e1148
    Details
    In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 9 ( 2020-10), p. e1145-e1148
    Abstract: Posterior external auditory canal (EAC) hypesthesia (Hitselberger's sign) has been previously described to occur in all vestibular schwannomas (1966) but has not been studied since. We hypothesized that sensory loss may be related to tumor size and sought to determine if this clinical sign could predict preoperative characteristics of vestibular schwannomas, intraoperative findings, and/or surgical outcomes. Study Design: Prospective observational study. Setting: Tertiary referral center. Patients: Twenty-five consecutive patients who underwent surgery for vestibular schwannoma. Intervention: Patients were tested for the presence of EAC hypesthesia or anesthesia. Main Outcome Measures: Preoperative, intraoperative, and postoperative findings were recorded, including facial nerve function, hearing function, tumor size, tumor nerve of origin, and extent of resection. Results: Twelve patients (48%) demonstrated either posterior EAC hypesthesia (11 patients) or anesthesia (1 patient). Sensory loss was a significant predictor of size (tumor maximal diameter) ( p  = 0.004). Median tumor diameter was 1.7 cm in the cohort with intact sensation versus 2.9 cm in the cohort with sensory loss. Patients with sensory loss were also significantly more likely to be associated with a superior vestibular nerve origin tumor ( p  = 0.01). Preoperative sensory loss did not significantly predict postoperative facial outcome ( p  = 0.10). Conclusion: Neurological exam findings may be overlooked in the workup of brain tumors. Posterior EAC hypesthesia is a predictor of tumor size and superior vestibular nerve origin. These findings may have implications for patient selection, particularly with the middle cranial fossa approach. Furthermore, given this relationship with tumor size, this clinical biomarker should be studied as a potential predictor of tumor growth.
    Type of Medium: Online Resource
    ISSN: 1531-7129 , 1537-4505
    URL: Article
    DOI: 10.1097/MAO.0000000000002738
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2058738-7
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