Abstract Otology 2000 D13-1

Olivier Sterkers MD, A. Rey MD, M. Kalamarides MD, D. Bouccara MD

Service d'ORL, Hôpital Beaujon Faculté Xavier Bichat Université Paris 7 F-Clichy

The management of small vestibular schwannomas (VS), either intracanalar (stage I) or with a small extension of less than 2 cm in CPA (stage II) is still under debate including surgery, observation and stereotactic irradiation. From 1987 to 1997, among 343 VS referred to our department, 202 were small VS (79 stage I and 123 stage II). Initially, 72 patients were observed mainly because of the age of the patients (more than 60 y), 127 patients were operated on, and 3 were irradiated for medical reasons. Among observed patients (72 patients) tumor growth was noticed in 15 cases who were operated on in 14 cases and irradiated in 1 case for medical reasons. This concerned 7 and 8 among 55 stage I and 17 stage II, respectivelly. Thus 57 untreated VS (28 %) and 4 irradiated ones (2 %) are still under yearly MRI follow up, and 142 VS (70 %) were operated on. VS (142 cases)were operated through transpetrosal approaches : (64 % translabyrinthine, 21 % middle fossa (MFa), 15 % retrosigmoid (RSa). These was no mortality. Post-operative complications include 11 CSF leakages with reoperation (5 %). Post-operative facial function was good (Gr. I and II, HB) in 93 % of either stage I or stage II tumors. Hearing preservation was attempted in 51 selected cases (PTA < 50 dB, SDS 100 %) with a success rate of 55 % (53 % and 57 % through MFa and RSa, respectively). In conclusion, surgery is indicated for small VS, except for intracanalar tumors in elderly.

Abstract Otology 2000 D13-2

Dominik Brors MD (1), Bernhard Schick MD (1), Oliver Koch (1), Maria Schäfers MD (2), Gabriele Kahle MD (3), Wolfgang Draf MD, PhD, FRCS (1)

(1) Department of ENT-Diseases, Head, Neck and Facial Plastic Surgery D-Fulda
(2) Department of Neurology University Hospital Würzburg D-Würzburg
(3) Institute of Radiology Academic Teaching Hospital D-Fulda

Objectives: In acoustic neuroma diagnosis and postoperative follow-up MRI represents the radiological technique of choice. The value of MRI in diagnosis of acoustic neuromas is well-established, but the various MRI findings in postoperative follow-up were only cursoryly considered in literature. Differentiation of normal postoperative changes and graft materials (e.g. abdominal fat, muscle) in opposite to findings suggesting residual tumor or complications are still diagnostic problems. Material and Methods: In a retrospective study of 86 cases the postoperative MRI findings of 70 patients (mean age 54,1 years), who had undergone surgery for acoustic neuroma between 1987 and 1998 via a transtemporal (48) and translabyrinthine (22) approach by the use of fat-graft were reviewed. The signal intensity of the fat-grafts were subdivided into 4 levels: I. 0-25%, II. 25-50%, III 50-75% and 75-100% in order to describe the changes over the time. Additionally, manifestation of postsurgical temporal lobe gliosis was evaluated. Results: In 7 out 70 patients residual tumors were detected by MRI. In further 23 cases with localized enhancement in the internal auditory meatus residual tumor could be excluded only by decreased enhancement over the time. After transtemporal tumor resection MRI depicted 15 cases of different degree temporal lobe gliosis. During the first year of follow-up the signal intensity of the abdominal fat grafts decreased from level 4 to level 1 or 2 in most cases. Conclusion: Differentiation between residual tumor and granulation tissue may only be achieved over a long observation period. Thus, follow-up examinations at the same institution are highly desirable in order to provide best facilities in early diagnosis of residual tumor. Even abdominal fat has been proved clinically to support prevention of CSF-leakage, the study indicates graft fibrosis. Detection of temporal lobe gliosis requires analysis of the individual surgical technique to improve outcome in transtemporal surgery.

Abstract Otology 2000 D13-3

V.B. Pothula F.R.C.S, Vel Nandapalan F.R.C.S, Tristram H.J. Lesser MD, C. Mallucci F.R.C.S, P. May F.R.C.S, F.R.C.P, P. Foy F.R.C.S

University Hospital GB-Liverpool

Sporadic unilateral acoustic neuromas are very rare in childhood. We report three children under 16 years of age bringing the in the world literature to 39. These tumours are more common in boys and they tend to present late with raised intracranial pressure, cerebellar symptoms or multiple cranial nerve palsies. These surprisingly are often large tumours. Eventhough, none of the three children in our series presented with otological symptoms the literature review showed only 59% of the children had deafness and tinnitus as presenting symptoms. These tumours can be vascular, difficult to remove and are associated with significant postoerative neurological deficits. It should be borne in mind that acoustic neuroma may be the first manifestation of neurofibromatosis type 2 and we recommend follow up with serial Magnetic Resonance Imaging (MRI) to detect the appearance of other lesions.

Abstract Otology 2000 D13-4

Derald E. Brackmann MD, Jose N. Fayad MD, William Hitselberger MD

House Ear Clinic Inc. USA-Los Angeles CA

Introduction: The management of patients with neurofibromatosis type II (NF2) has always posed a challenging problem for neurosurgeons and neurotologists. Guidelines for appropriate management of this devastating disease are controversial. Methods: A retrospective study of 24 patients with neurofibromatosis type II who underwent 34 middle fossa craniotomies for excision of their acoustic tumors is reported. Ten patients underwent bilateral procedures. The study focused on hearing preservation and facial nerve results in this group of patients. Results: There were 13 males and 11 females. Age at the time of surgery ranged between 10 and 70 years. The size of the tumor ranged between 0.5 cm and 2.5 cm with the majority of the tumors being between 1 and 2 cm. The hearing was preserved in 24 ears (77.42%), lost in 7 ears (22.58%). Three recently operated patients did not have a follow-up at this time. In the immediate postoperative period 28 cases (82.35%) had a grade I House-Brackmann. Three cases had a grade II (8.82%). One case had a grade III. One case had a grade V, and one had a grade VI. Long-term facial nerve results will be reported. Discussion and Conclusions: Based upon these data, we conclude that early surgical treatment of acoustic tumors in NF2 patients is the treatment of choice.

Abstract Otology 2000 D13-5

Daqing Li MD (1), Ugo Fisch MD (2)

(1) ORL - Head & Neck Surgery Univ. of Maryland School of Medicin USA-Baltimore
(2) ORL-Klinik Universitätsspital CH-Zürich

The transotic approach developed by senior author (U.F.) provides extensive lateral exposure of cerebellopintine angle (CPA) and is ideally suited for the removal of large tumor (up to 2.5 cm in medial-lateral diameter) extending from the CPA. The purpose of this study is to present a strategy of using transotic approach for 1-stage removal of cochlear-involved intracanalicular and cerebellopontine angle tumors. Two typical cases are described in the present study. One case was with multicentric acoustic tumor arising separately from the left cochlea and internal auditory canal whereas another one had an intracanalicular meningioma with intracochlear involvement. In both cases, tumors were completely removed in 1-stage and facial nerve function remained in normal condition. In addtion, there was no postoperative cerebrospinal fluid leak. The patients are being followed routinely and, when last seen 3 years after there initial surgery, were free of the tumor. The present study indicates that transotic approach can be well-applied not only in large CPA tumors but also in cochlear-involved intracanalicular and CPA tumors.

Abstract Otology 2000 D13-6

Sudhakar B. Ogale MD, N.S. Gaidward MD, K.B. Sandu MD

Dept. of Otolaryngology K.E.M. Hospital Parel IND-Bombay

Hemifacial spasms - HFS -(Syn: Clonic Facial Spasms) is a cosmetically disabling, socially embarrassing disorder with an erratic behavior. At our institution we have treated 21 cases of idiopathic HFS after investigating them by a battery of audiological, vestibular and electrophylogical tests. The age group variies between 26-55 years and females were predominant. Our standard procedure of transtympanic facial nerve needling was performed on all these patients. Out of 21 patients, 18 had 100% relief of spasms, 2 patients had 60% improvement and only one patient had no relief at all. The 3 unrelieved patients were subjected to transmastoid needling to obtain 100% relief of spasms. Results of the above procedure were very enterprising. 3 patients had a recurrence of spasms after a period of 12-36 months. A repeated needling of the facial nerve proved beneficial in 2 patients, one of them was lost of follow up.

Abstract Otology 2000 D13-7

Vel Nandapalan F.R.C.S, V.B. Pothula F.R.C.S, Tristram H.J. Lesser MD

University Hospital Aintree GB-Liverpool

For many years vestibular testing has relied on measurements of the vestibulo-ocular reflex. Recently quantified assessment of balance using fixed or moving force platforms and magnetometry have been applied to clinical research. These are objective attempts to quantify the vestibulo-spinal reflex. This study evaluates whether the Sway Weigh, a simple device which measures lateral body sway can provide an objective assessment of balance dysfunction. 35 patients with peripheral vestibular balance disorder and 33 age matched subjects with normal balance were tested with eyes opened and eyes closed whilst they were standing on a flat surface and then on air bed to reduce the limb proprioception. The lateral sway in patients with a balance disorder was compared to that in the normal subjects and highly significant differences (p<0.0001) were observed. The Sway Weigh balance platform is a simple, portable, economical and user friendly device which objectively measures balance dysfunction.