Objective:To report a rare case of otogenic tension pneumocephalus as a complication of a diffuse leptomeningeal glioneuronal tumor in a patient with a ventriculoperitoneal(V.P.)shunt.Patients:Twenty-three-year-old ma...Objective:To report a rare case of otogenic tension pneumocephalus as a complication of a diffuse leptomeningeal glioneuronal tumor in a patient with a ventriculoperitoneal(V.P.)shunt.Patients:Twenty-three-year-old man with a confirmed diffuse leptomeningeal glioneuronal tumor diagnosis was treated for temporal bone defect and considerable pneumocephalus one year after V.P.shunt.Intervention(s):The patient underwent a Transmastoid,retrolabyrinthine approach.The defect was closed with temporalis facia graft and conchal cartilage as a double-layer closure,and then DuraSeal®was placed over the repaired area.Main outcome measure(s):Resolution of the pneumocephalus.Results:There was a significant reduction in the pneumocephalus on the first day post-operatively.Conclusions:Spontaneous or secondary pneumocephalus development should be considered in patients with brain tumors,hydrocephalus,and patients who undergo V.P.shunt insertion.展开更多
There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends ...There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends and applications of the endoscope in the field of otology and neurotology.Advantages of the endoscope include excellent ergonomics,compatibility with pediatric anatomy,and improved access to the middle ear through the external auditory canal.Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma,tympanic membrane perforations,and otosclerosis as compared to microscopic approaches,while utilizing less invasive surgical corridors and reducing the need for postauricular incisions.When a postauricular approach is required,the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma.The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors,meningiomas,and vestibular schwannomas.Outside of the operating room,the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities.For these reasons,the endoscope is currently poised to transform the field of otology and neurotology.展开更多
The auditory brainstem implant(ABI)was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2(NF2).Recent studies of the ABI have investigated outcomes in non-NF2 c...The auditory brainstem implant(ABI)was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2(NF2).Recent studies of the ABI have investigated outcomes in non-NF2 cohorts,such as patients with cochlear nerve aplasia or cochlear ossification and more recently,intractable tinnitus.New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects.Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future,enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry.These advances will improve surgical planning and ultimately improve patients1 audiological capabilities.ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve.Herein,we aim to characterize ongoing clinical,basic science,and bioengineering advances in ABIs and discuss future directions of this technology.展开更多
Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-...Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.展开更多
This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recom...This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.展开更多
文摘Objective:To report a rare case of otogenic tension pneumocephalus as a complication of a diffuse leptomeningeal glioneuronal tumor in a patient with a ventriculoperitoneal(V.P.)shunt.Patients:Twenty-three-year-old man with a confirmed diffuse leptomeningeal glioneuronal tumor diagnosis was treated for temporal bone defect and considerable pneumocephalus one year after V.P.shunt.Intervention(s):The patient underwent a Transmastoid,retrolabyrinthine approach.The defect was closed with temporalis facia graft and conchal cartilage as a double-layer closure,and then DuraSeal®was placed over the repaired area.Main outcome measure(s):Resolution of the pneumocephalus.Results:There was a significant reduction in the pneumocephalus on the first day post-operatively.Conclusions:Spontaneous or secondary pneumocephalus development should be considered in patients with brain tumors,hydrocephalus,and patients who undergo V.P.shunt insertion.
文摘There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends and applications of the endoscope in the field of otology and neurotology.Advantages of the endoscope include excellent ergonomics,compatibility with pediatric anatomy,and improved access to the middle ear through the external auditory canal.Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma,tympanic membrane perforations,and otosclerosis as compared to microscopic approaches,while utilizing less invasive surgical corridors and reducing the need for postauricular incisions.When a postauricular approach is required,the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma.The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors,meningiomas,and vestibular schwannomas.Outside of the operating room,the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities.For these reasons,the endoscope is currently poised to transform the field of otology and neurotology.
基金Swiss National Science Foundation,Grant numbers:W81XWH-17-NFRP-IIRASinergia Neuroprosthetic Platform for Personalized and Impantable Systems,US Department of Defense Grant numbers:W81XWH-17-NFRP-IIRA.
文摘The auditory brainstem implant(ABI)was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2(NF2).Recent studies of the ABI have investigated outcomes in non-NF2 cohorts,such as patients with cochlear nerve aplasia or cochlear ossification and more recently,intractable tinnitus.New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects.Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future,enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry.These advances will improve surgical planning and ultimately improve patients1 audiological capabilities.ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve.Herein,we aim to characterize ongoing clinical,basic science,and bioengineering advances in ABIs and discuss future directions of this technology.
文摘Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.
文摘This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.
