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IX Surgical treatment

Combined petrosal approaches in the management of temporal bone meningiomas. Oto. Neurotol. 2007 Feb;28(2):236-239. Baugh A, Hillman TA, Shelton C University of Utah School of Medicine, Salt Lake City, Utah, USA.

Objectives: To evaluate the indications and outcomes of the combined petrosal approaches in the surgi- cal management of temporal bone meningiomas. Study design: Retrospective chart review. Setting: University teaching hospital. Patients: Adults with temporal bone meningiomas. Intervention(s): Meningioma removal using a combined petrosal approach. Main outcome messure(s): Cranial nerve outcomes, complications, completeness of resection, and recurrence rates. Results: Forty-nine patients underwent surgical excision of a temporal bone meningioma between 1996 and 2004 at our institution. Nineteen of these patients required a combined petrosal approach for exci- sion. The most common presenting complaints were balance disturbance, 11 (58%); hearing loss, 10 (53%); headache, 10 (53%); and tinnitus, 9 (47%). The most common tumor origin was of the petrous ridge (14; 74%). Average tumor size was 3.1 cm. Complete resection was possible in 17 (89%) patients. Upper cranial nerve (III-VI) function was improved in two (11%) patients and worsened in three (16%) pa- tients. Lower cranial nerve (IX-XII) function improved in one (5%) patient and was worsened in one (5%) patient. Postoperative facial nerve function was Grades I to II in 16 (84%) patients and Grades III to IV in 1 (5%) patient at last follow-up. Hearing data were available in 14 patients. Of those patients, 11 (85%) had serviceable hearing after surgery. The most common surgical complication was a cerebrospinal fluid leak, with three (16%) incidences. There were no reported incidents of stroke, death, or meningitis in the cohort. Conclusion: The use of the combined petrosal approach for temporal bone meningioma resection results in favorable outcomes for the patient. The incidence of complications is acceptably low, and cure rates are high.

How does stapes surgery influence severe disabling tinnitus in otosclerosis patients? Adv Otorhinolaryngol. 2007;65:343-347. Oliveira CA Department of Otolaryngology, Brasilia University Medical School, Brasilia, Brazil. cacpoliveira@brturbo. com.br

Tinnitus is a common symptom in otosclerosis patients. Many papers have been written about tinnitus outcome after stapes surgery. However, none has attempted to quantify the intensity of the symptom pre- and postoperatively in order to evaluate the influence of surgery on the degree of annoyance caused by tinnitus. Severe disabling tinnitus (SDT) is defined by Shulman as a symptom severe enough to disrupt the patient‘s routine and to prevent him from performing his daily tasks. We have studied 48 consecutive otosclerosis patients by means of a visual analogue scale measuring tinnitus intensity before and after stapes surgery. We have accepted tinnitus as severe and disabling when the symptom score was 7 or above in a visual analogue scale from 1 to 10. Of 19 patients with preoperative SDT, 10 reported com- plete remission and 7 reported significant improvement. Two patients had no change and none reported worsening of tinnitus after stapes surgery. We conclude that stapes surgery can improve SDT significant- ly in 90% of otosclerosis patients and is very unlikely to make the symptom worse.

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