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Biomedical subjects

D E Brackmann

Publications and source records attributed to D E Brackmann.

At least 55 records · Page 3Linked to original sources
PubMed1996

Acoustic neuroma recurrence after suboccipital resection: management with translabyrinthine resection.

Thirty-five patients with recurrent acoustic tumors have been studied before, during, and after revision surgery. Each had their original surgery via a suboccipital approach. Six patients had undergone multiple suboccipital surgeries. Revision surgery was accomplished using a translabyrinthine approach in all patients. Total tumor removal was possible in 33 patients. No second recurrences have occurred to date among the patients with total tumor removal. Anatomic facial nerve integrity was maintained in 24 patients. All recurrent tumors were present in the lateral internal auditory canal. Direct tumor access in this area is not possible with the suboccipital approach without entering the vestibular labyrinth. The suboccipital approach to acoustic neuromas is contraindicated if tumor extends to the fundus of the internal auditory canal. Translabyrinthine resection is the treatment of choice for recurrence of acoustic neuroma after primary suboccipital resection.

Adult↗
PubMed1996

Acoustic neuroma update.

We have described refinements and alternative techniques in the management of acoustic neuromas. The outcome for patients with both unilateral and bilateral tumors continues to improve.

Craniotomy↗
PubMed1996

Evaluation of MRI compatibility of the modified nucleus multichannel auditory brainstem and cochlear implants.

Magnetic resonance imaging (MRI) has been contraindicated for users of cochlear implants because of the internal magnet and other possible interactions. Users of the Nucleus Mini-22 Cochlear Implant (CI) or the experimental Multichannel Auditory Brainstem Implant (ABI) may have other disorders that are best diagnosed by MRI. The CI and ABI were modified by replacing the internal magnet and integrated circuit lid with nonmagnetic material. Tests were conducted in a 1.5-T MRI machine. Safety tests for force, heating, induced current, unintentional implant output, and implant damage were conducted by using various phantom models. Image distortion was evaluated in two subjects with implants. The maximum force measured was 2,818 dynes. There was < 0.1 degree C temperature increase in the vicinity of the implant. The maximum induced charge was > or = 667 times less than the minimum charge for auditory stimulation. There was no unintentional output during MRI scans and no change in implant function after 10 repeated scans. Image distortion consisted primarily of darkening and was worst in the axial plane, where it extended 1-2 cm medially and inferiorly from the receiver/stimulator. Compatibility-test results were acceptable, with a large margin of safety. Image distortion is limited to darkening in the immediate vicinity of the implant.

Adult↗
PubMed1996

Skull base osteomyelitis. Malignant external otitis.

Aggressive medical therapy is warranted to prevent morbidity and mortality that has long been associated with skull base osteomyelitis. Outcomes are now improved because of a better understanding of the pathophysiology of the disease process, improved diagnostic tests, and more effective antipseudomonal therapy.

Aminoglycosides↗
PubMed1995

The long-term follow-up of drainage procedures for petrous apex cholesterol granulomas.

OBJECTIVE: To determine the long-term effectiveness of various approaches to surgical drainage of petrous apex cholesterol granulomas. DESIGN: A retrospective cohort study in which patients treated by surgical drainage for petrous apex cholesterol granulomas were followed up for a minimum of 1 year (mean, 4.6 years). SETTING: House Ear Clinic, an otologic tertiary care center in Los Angeles, Calif. PATIENTS: A total of 25 patients who underwent either transcanal infracochlear, infralabyrinthine, middle fossa, or translabyrinthine drainage and who had at least 1 year of clinical and, in some cases, radiologic postoperative follow-up. MAIN OUTCOME MEASURES: Relief or recurrence of symptoms, need for revision surgery, postoperative hearing, appearance on postoperative imaging studies. RESULTS: Twenty-three patients had improvement or complete resolution of preoperative noncranial nerve VIII nerve dysfunction. Hearing was preserved in cases of middle fossa, infralabyrinthine, and infracochlear approaches with serviceable preoperative hearing. Hearing did not improve in cases of total preoperative hearing loss. Of the patients who underwent postoperative imaging, over three fourths had reduction in lesion size and one third developed aeration of the petrous apex. Revision surgery was required in three patients. Recently developed, the infracochlear approach has shown excellent early results. Lesion size was reduced in five of five patients, and the petrous apex contained air in three of five patients who underwent the infracochlear approach. CONCLUSION: Drainage via the infracochlear and infralabyrinthine approaches offers effective long-term decompression of petrous apex cholesterol granulomas, while preserving hearing.

Adolescent↗
PubMed1995

Metastatic melanoma to the cerebellopontine angle. Clinical and imaging characteristics.

OBJECTIVE: To describe the clinical and imaging features of metastatic melanoma to the cerebellopontine angle (CPA). DESIGN: A case series study with world literature review. SETTING: House Ear Clinic and St Vincent's Hospital, Los Angeles, Calif. PATIENTS: Three cases of metastatic CPA tumors operated on at the House Ear Clinic. INTERVENTIONS: All patients underwent surgical removal of CPA metastatic melanoma. MAIN OUTCOME MEASURE: Survival and duration of disease-free interval are reported. RESULTS: Two patients died of melanoma within 5 months of diagnosis and resection of CPA melanoma metastases. One patient survived for 5 years after undergoing total resection of an isolated CPA melanoma metastasis. Magnetic resonance imaging features were not uniform. CONCLUSIONS: Metastatic melanoma to the CPA should be suspected in patients with a history of melanoma and a rapid progression of audiovestibular or facial nerve symptoms. Surgical removal of solitary metastases to the CPA may be valuable in patients without other melanoma focus; however, the long-term prognosis for patients with CPA melanoma is grim.

Adult↗
PubMed1995

Acute postoperative hydrocephalus following translabyrinthine craniotomy for acoustic neuroma resection.

Acute mental status changes following craniotomy for acoustic tumors demand prompt evaluation and treatment to avoid serious morbidity and mortality. Two cases of acute obstructive hydrocephalus complicating the postoperative period following translabyrinthine craniotomy are presented. Diagnosis is made with noncontrast computed tomography scanning. Treatment is rendered at the bedside with placement of a ventriculostomy. Diagnosis and management implications for acoustic tumor patients are discussed.

Journal Article↗
PubMed1995

Utility of auditory brainstem response audiometry in diagnosis of acoustic neuromas.

Auditory brainstem response (ABR) audiometry is said to be 90% sensitive in the diagnosis of acoustic neuromas. Since gadolinium-DTPA was introduced, magnetic resonance imaging (MRI) is capable of detecting acoustic neuromas as small as 3 mm. Early diagnosis is important, because hearing can frequently be preserved with resection of tumors smaller than 2 cm. At the same time, cost-containment has become a pressing issue in medicine. Auditory brainstem response, although considerably less expensive than MRI, may not be as sensitive as previously thought, particularly for small tumors. Of 753 acoustic neuromas treated at the House Ear Clinic from January 1988 through March 1993, 197 had ABR data available. The 98 males and 99 females ranged in age from 13 to 78 years with a mean of 48 years. The overall sensitivity of ABR was 92.3% using an interaural latency difference for wave V of more than 0.2 ms, and was 81.6% using waveform morphology. There was a statistically significant difference in sensitivity with respect to tumor size. Auditory brainstem response interaural latency difference sensitivity ranged from 100% in tumors larger than 3.0 cm to 83.1% in tumors 1.0 cm or smaller. Waveform morphology was abnormal in 100% of tumors larger than 2.0 cm but in only 76.5% of tumors 1.0 cm or smaller.

Adolescent↗
PubMed1995

Results of surgery following stereotactic irradiation for acoustic neuromas.

Stereotactic irradiation has been proposed as an alternative to surgical intervention for the treatment of acoustic neuromas. The authors present their experience with five patients previously treated with stereotactic irradiation who had progression of symptoms due to tumor enlargement. Intraoperatively, the tumors were severely scarred to the facial nerve. Histopathologic examination demonstrated viable cells typical of schwannomas. Two patients received auditory brainstem implants; neither received benefit from the implant. Three of the patients had House-Brackmann grade VI facial nerve function preoperatively, and all four patients with greater than 1 year follow-up had a grade VI postoperatively. It is concluded that, with stereotactic irradiation, surgical morbidity is increased, brainstem implant results are poor, and viable tumor persists.

Adolescent↗
PubMed1995

Preservation of auditory and vestibular function after surgical removal of bilateral vestibular schwannomas in a patient with neurofibromatosis type 2.

The outcome of acoustic neuroma (vestibular schwannoma) surgery continues to improve rapidly. Advances can be attributed to several fields, but the most important contributions have arisen from the identification of the genes responsible for the dominant inheritance of neurofibromatosis types 1 (NF1) and 2 (NF2) and the development of magnetic resonance imaging with gadolinium enhancement for the early anatomic confirmation of the pathognomonic, bilateral vestibular schwannomas in NF2. These advances enable early diagnosis and treatment when the tumors are small in virtually all subjects at risk for NF2. The authors suggest that advising young NF2 patients to wait until complications develop, especially hearing loss, before diagnosing and operating for bilateral eighth nerve schwannomas may not always be in the best interest of the patient. To the authors' knowledge, this is the first reported case of preservation of both auditory and vestibular function in a patient after bilateral vestibular schwannoma excision.

Adult↗
PubMed1994

Osteoma of the internal auditory canal. A case report.

Osteomas of the petrous temporal bone are rare and seldom symptomatic. This report describes an osteoma of the internal auditory canal, causing compression of the eighth nerve, leading to auditory and vestibular complaints. The symptoms were abolished by surgical decompression of the internal auditory canal and removal of the osteoma.

Adult↗
PubMed1994

Comprehensive management of bilateral acoustic neuromas. Current perspectives.

Bilateral acoustic neuromas are pathognomonic for neurofibromatosis 2. Patients with neurofibromatosis 2 present complex and challenging management problems, because growth or surgical removal of the acoustic neuroma may result in total hearing loss. Early diagnosis with gadolinium-enhanced magnetic resonance imaging and refinements in hearing preservation surgery have improved our ability to prevent total hearing loss. For patients with larger tumors or no useful hearing, the auditory brain-stem implant allows restoration of some auditory function when the tumor is removed. We describe our management strategy for patients with bilateral acoustic neuromas, and present case reports to show their diversity. We also discuss the newly identified neurofibromatosis 2 tumor suppressor gene.

Adolescent↗
PubMed1994

Intralabyrinthine schwannomas.

Intralabyrinthine schwannomas are unusual tumors of the vestibule, cochlea, semicircular canals, or some combination of these three, which in the past have been reported as incidental findings at autopsy or surgery. We summarize eight cases of intralabyrinthine schwannomas diagnosed by magnetic resonance imaging at the House Ear Clinic during the past 3 years. We discuss the typical clinical presentation and treatment of cochlear vs. vestibular intralabyrinthine schwannomas.

Adolescent↗
PubMed1994

Surgical management of iatrogenic facial nerve injuries.

Surgical management of an iatrogenic facial nerve injury represents a significant challenge for the otologic surgeon. The decision to perform facial nerve grafting is a difficult one and is based on the extent of injury to the nerve. We conducted a review of 22 patients who had sustained iatrogenic facial nerve injuries during otologic surgery that required surgical exploration. The facial nerve was transected more than half its diameter in 13 of the patients. All of these patients' nerves were repaired either with direct reanastomosis of the facial nerve or with a cable nerve graft. The transection was less than 50% in nine of the patients in the study group. Eight of these patients underwent only decompression of the facial nerve. No patient with a neural repair (direct anastomosis or cable graft) had better than a House grade III result. All of the patients undergoing direct anastomosis of the nerve obtained a House grade III result. The most common result in patients undergoing cable nerve grafting was a House grade IV. The only patients with normal or near-normal facial nerve function (House grade I or II) had only decompression of the facial nerve. Five of the eight patients undergoing decompression had results similar to those undergoing cable nerve grafts. We conclude that acceptable results can be obtained when the facial nerve is repaired by direct anastomosis or a cable nerve graft. These results are comparable with those of patients treated with decompression only. When in doubt as to the extent of injury, it is preferable to repair the facial nerve, because the extent of injury may be underestimated.

Adolescent↗
PubMed1994

Surgical management of previously untreated glomus jugulare tumors.

The treatment of glomus jugulare tumors is controversial. Changes in the surgical treatment of glomus jugulare tumors at The House Ear Clinic have allowed complete resection in 85% of patients with minimal morbidity and no surgical mortalities. Our experience with 52 previously untreated patients with glomus jugulare tumors is reviewed. Two primary surgical techniques were used. The mastoid/neck approach was used in 9 patients with small tumors limited to the jugular bulb. The infratemporal fossa approach was used in the remaining 43 tumors. Lower cranial nerve preservation was possible in the majority of patients with normal preoperative function. Modifications in the management of the facial nerve during the infratemporal fossa approach have resulted in good recovery of facial function (House grade I/VI or II/VI) in 95% of patients. Most patients (85%) were able to fully resume all preoperative activities. Our results suggest that surgical management is the treatment of choice in younger patients with glomus jugulare tumors.

Adult↗
PubMed1994

Iatrogenic facial nerve injury during otologic surgery.

Perhaps the most devastating complication in otologic surgery is that of inadvertent injury to the facial nerve. A review of 22 patients who had sustained an iatrogenic facial nerve injury was conducted. Although the most common procedure being performed during the injury was mastoidectomy (55%), a surprising number of patients had injury during tympanoplasty (14%) or during removal of exostoses (14%). The most common area of injury to the facial nerve in this series was in the tympanic segment. In 79% of the patients, the facial nerve injury was not detected at the time of surgery. All patients underwent surgical exploration of the facial nerve. Otologic surgeons are cautioned to be familiar with the normal course of the facial nerve and to be aware of the potential for facial nerve injury when performing transcanal surgery.

Adolescent↗