Predictors of hearing functional outcome following surgery for cerebellopontine angle meningioma.

Objective: Cerebellopontine angle (CPA) meningiomas can affect hearing function and require expeditious treatment to prevent permanent hearing loss. The authors sought to determine the factors associated with functional hearing outcome in CPA meningioma patients treated with surgery and/or radiation therapy in the form of either stereotactic radiosurgery or stereotactic radiation therapy.

Methods: Consecutive patients with CPA meningiomas who had presented at our hospital from 2008 to 2018 were identified through retrospective chart review.

Safety of 3 Tesla Magnetic Resonance Imaging in Patients With Auditory Brainstem Implants.

Objective: To evaluate the safety of 3 Tesla (T) magnetic resonance imaging (MRI) in patients with auditory brainstem implants (ABI) with the magnet removed at implantation and report incidence of complications.

Study Design: Retrospective chart review.

Setting: Tertiary neurotology ambulatory practice.

Anatomic Assessment of the Limits of an Endoscopically Assisted Retrolabyrinthine Approach to the Internal Auditory Canal.

 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.  Presigmoid retrolabyrinthine approaches were performed on fresh cadaveric heads.

Working Toward Consensus on Sporadic Vestibular Schwannoma Care: A Modified Delphi Study.

Objective: To address variance in clinical care surrounding sporadic vestibular schwannoma, a modified Delphi study was performed to establish a general framework to approach vestibular schwannoma care. A multidisciplinary panel of experts was established with deliberate representation from key stakeholder societies. External validity of the final statements was assessed through an online survey of registered attendees of the 8th Quadrennial International Conference on Vestibular Schwannoma.

Skull Base Training and Mentorship.

Objective: To review teaching and mentoring techniques of experienced skull base surgeons and educators STUDY DESIGN:: Expert commentary.

Setting: 8th Quadrennial International Conference on vestibular schwannoma and other CPA tumors, panel on teaching, and mentoring.

Main Outcome Measures: Experiences and opinions of experienced skull base surgeons, both neurosurgeons and neurotologists, presented and discussed at the conference.

Radiation-Induced Malignant Peripheral Nerve Sheath Tumor of the Vagus Nerve Following Radiation Treatment of Cervical Paraganglioma.

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.

Bilateral Auditory Brainstem Implants in Patients With Neurofibromatosis 2.

Objective: 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.

Hypercoagulability in Vestibular Schwannoma Surgery.

Objective: 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.

Effect of Vestibular Schwannoma Size and Nerve of Origin on Posterior External Auditory Canal Sensation: A Prospective Observational Study.

Objective: 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.

Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study.

Background: Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined.

Objective: To analyze the effect of facial nerve segment involvement on functional outcome for these tumors.

Hypofractionated Robotic Stereotactic Radiosurgery for Vagal Paragangliomas: A Novel Treatment Strategy for Cranial Nerve Preservation.

Objective: 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.

Temporal bone resection for lateral skull-base malignancies.

Introduction: Malignancies involving the temporal bone are increasingly common and require specialized multi-disciplinary care. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. In this review we discuss general principles for temporal bone resection, as well as alternative and complementary surgical approaches that should be considered in the management of patients with temporal bone cancer.

Congenital Cholesteatoma of the Sphenoid, Occipital, and Temporal Bones: 54-Year Follow Up.

Objective: To provide long-term follow up of a unique patient with history of massive petrous apex congenital cholesteatoma.

Patient: 75-year-old man who presented at age 18 with left Gradenigo-like syndrome.

Intervention: Staged left radical mastoidectomy and open transsphenoidal marsupialization.

Cochlear implantation and auditory brainstem implantation in neurofibromatosis type 2.

Objectives/hypothesis: To report a series of patients with neurofibromatosis type 2 (NF2), where each patient underwent both cochlear implantation and auditory brainstem implantation for hearing rehabilitation, and to discuss factors influencing respective implant success.

Study Design: Retrospective case series.

Methods: Ten NF2 patients with both cochlear implantations and auditory brainstem implantations were retrospectively reviewed.

Tinnitus Suppression After Auditory Brainstem Implantation in Patients With Neurofibromatosis Type-2.

Objective: To evaluate whether an auditory brainstem implant (ABI) can impact levels of tinnitus in neurofibromatosis type-2 (NF2) patients who have undergone translabyrinthine craniotomy for vestibular schwannoma (VS) removal and to evaluate the burden of tinnitus in these patients.

Study Design: A retrospective case series and patient survey.

Setting: Tertiary neurotologic referral center.

Nerve crush but not displacement-induced stretch of the intra-arachnoidal facial nerve promotes facial palsy after cerebellopontine angle surgery.

Little is known about the reasons for occurrence of facial nerve palsy after removal of cerebellopontine angle tumors. Since the intra-arachnoidal portion of the facial nerve is considered to be so vulnerable that even the slightest tension or pinch may result in ruptured axons, we tested whether a graded stretch or controlled crush would affect the postoperative motor performance of the facial (vibrissal) muscle in rats. Thirty Wistar rats, divided into five groups (one with intact controls and four with facial nerve lesions), were used.

Historical perspective on evolution in management of lateral skull base tumors.

This article gives a history of the major advances that have contributed to the current management of lateral skull base lesions. These advances include changes in surgical technique, better understanding of the natural history of these lesions, and the advent of stereotactic radiosurgery. An understanding of how treatment has evolved over time improves understanding of how the current treatment methods have been developed.

Stereotactic radiosurgery for facial nerve schwannomas: meta-analysis and clinical review.

Objective: Although several small individual series on stereotactic radiosurgery (SRS) for facial nerve schwannomas (FNSs) have been published, we aim to systematically aggregate data from the literature as well as from our institution to better understand the safety and efficacy of SRS for FNS.

Data Sources: PubMed English language search for keywords "facial nerve schwannoma" AND "radiation therapy" published from January 1995 to 2014. Data from our institution were also included in the analysis.

Bone-anchored hearing device placement with translabyrinthine tumor removal.

Objective: Translabyrinthine resection of intracranial tumors results in single-sided deafness, which can be treated by surgical and nonsurgical means. Here we describe the first series examining complication and device usage rates among patients receiving a surgically implanted bone-anchored hearing device (BAHD) at the time of translabyrinthine tumor removal.

Study Design: Case series with chart review.

Cerebellopontine angle and intracanalicular masses mimicking vestibular schwannomas.

Objective: To describe the clinical and radiographic characteristics in a series of patients with non-vestibular schwannoma cerebellopontine angle (CPA) and intracanalicular (IAC) masses, who underwent microsurgery for presumed vestibular schwannoma (VS).

Study Design: Retrospective case series.

Setting: Tertiary neurotologic referral center.

Conservative management of vestibular schwannoma: expectations based on the length of the observation period.

Objective: Evaluate long-term prevalence of tumor growth and need for further treatment in patients with a vestibular schwannoma treated with conservative management.

Study Design: Retrospective chart review.

Setting: Private neurotologic tertiary referral center.

Surgical management of endolymphatic sac tumors.

Objective To review the cumulative experience of surgical management of endolymphatic sac tumors (ELSTs) in the literature. To review the experience with ELST management at a tertiary referral-based otology-neurotology practice and present our approach to management. Study Design Retrospective patient review at a referral-based otology-neurotology practice.

Translabyrinthine resection of neurofibromatosis type 2 associated vestibular and facial schwannomas, repair of facial nerve, and placement of auditory brainstem implant.

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.

Total ossiculoplasty: short- and long-term results using a titanium prosthesis with footplate shoe.

Objectives: Review experience using a titanium TORP with a footplate shoe; compare early and long-term hearing results and complications with those obtained using a TORP alone.

Study Design: Retrospective chart review.

Setting: Tertiary referral neurotologic private practice.