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Biomedical subjects

D E Brackmann

Publications and source records attributed to D E Brackmann.

At least 73 records · Page 4Linked to original sources
PubMed1994

Technical modifications to the middle fossa craniotomy approach in removal of acoustic neuromas.

With the increased use of gadolinium-enhanced magnetic resonance imaging studies to detect acoustic neuromas, smaller tumors are discovered more frequently. The middle fossa craniotomy approach for removal of small tumors is ideal for hearing preservation. The authors report hearing preserved at or near the preoperative levels in 71 percent of a series of 24 consecutive patients in whom the middle fossa craniotomy approach was employed. Several technical modifications, including more extensive bony exposure medially, tumor dissection in a medial-to-lateral direction, and topical application of papaverine to the cochlear nerve at the modiolus, have enhanced the ability to preserve hearing.

Adolescent↗
PubMed1994

Surgical treatment of difficult cerebrospinal fluid otorhinorrhea.

Cerebrospinal fluid (CSF) otorhinorrhea may be a result of infection, congenital abnormality, trauma, or it may be iatrogenic. Despite its etiology, most cases of CSF otorhinorrhea resolve spontaneously or with conservative management. For those instances where the leak does not resolve, a large variety of drainage, packing, and obliteration procedures have been developed in an attempt to stop the CSF drainage and prevent the development of meningitis. Seven cases are reviewed that resulted in complete control of the leak with minimal morbidity. The authors' approach to difficult cerebrospinal fluid otorhinorrhea is presented and described in detail.

Aged↗
PubMed1993

The middle fossa transpetrous approach for petroclival meningiomas.

Seventeen patients with petroclival meningioma were operated on through a middle fossa transpetrous approach. This approach exposes the anterior cerebellopontine angle through a middle fossa craniotomy with removal of the petrous apex medial to the cochlea and petrous carotid artery. This approach may be enlarged by transection of the superior petrosal sinus and tentorium. The surgical technique and application of the middle fossa transpetrous approach for petroclival meningiomas is presented.

Journal Article↗
PubMed1993

Endolymphatic sac tumors: radiologic appearance.

PURPOSE: To evaluate the radiologic appearance of endolymphatic sac tumors (ELSTs). MATERIALS AND METHODS: Four patients with ELST underwent computed tomography (CT), and two of the four also underwent magnetic resonance (MR) imaging. Their radiologic studies were reviewed for characteristic findings of ELST. RESULTS: Retrolabyrinthine bone destruction was centered at the external aperture of the vestibular aqueduct in all four patients. CT showed irregular bone margins and prominent intratumoral bone in all four patients. At MR imaging, one tumor was almost homogeneous and isointense to gray matter with T1 weighting, and the other was heterogeneous and contained hyper-, hypo-, and isointense foci with T1 and T2 weighting. CONCLUSION: These radiologic changes may help distinguish ELSTs from other tumors of the temporal bone and posterior fossa.

Adenocarcinoma↗
PubMed1993

Auditory brainstem implant: I. Issues in surgical implantation.

Most patients with neurofibromatosis type 2 (NF2) are totally deaf after removal of their bilateral acoustic neuromas. Twenty-five patients with neurofibromatosis type 2 have been implanted with a brainstem electrode during surgery to remove an acoustic neuroma. The electrode is positioned in the lateral recess of the fourth ventricle, adjacent to the cochlear nuclei. The present electrode consists of three platinum plates mounted on a Dacron mesh backing, a design that has been demonstrated to be biocompatible and positionally stable in an animal model. Correct electrode placement depends on accurate identification of anatomic landmarks from the translabyrinthine surgical approach and also on intrasurgical electrophysiologic monitoring. Some tumors and their removal can result in significant distortion of the brainstem and surrounding structures. Even in the absence of identifiable anatomic landmarks, electrode location can be adjusted during surgical placement to find the location that maximizes the auditory evoked response and minimizes activation of other monitored cranial nerves. Stimulation of the electrodes produces auditory sensations in most patients, with results similar to those of single-channel cochlear implants. A coordinated multidisciplinary team is essential for successful application of an auditory brainstem implant.

Brain Stem↗
PubMed1993

Reclassification of aggressive adenomatous mastoid neoplasms as endolymphatic sac tumors.

The emerging concept that aggressive adenomatous tumors of the temporal bone arise from the endolymphatic sac and constitute a distinct clinicopathologic entity merits wider recognition. These tumors share a common clinical pattern and exhibit consistent imaging and histopathologic features. Endolymphatic sac tumors (ELSTs) have been mistaken for other neoplasms such as paragangliomas, adenomatous tumors of mixed histology, ceruminomas, and choroid plexus papillomas. A review of the literature shows similarities among case studies of these aggressive adenomatous lesions. An analysis of the data supports the endolymphatic sac as an origin for these tumors. This report also presents an additional case of a less differentiated variant of this rare but important clinicopathologic entity.

Adenoma↗
PubMed1993

Tympanoplasty with mastoidectomy: canal wall up procedures.

Management of the mastoid in cases of chronic otitis media with cholesteatoma remains controversial. Whether to leave the canal wall up or perform a cavity technique continues to be debated. The author reviewed his personal cases of surgery for chronic otitis media over a 5-year period and studied 108 cases without prior surgery who required tympanoplasty with mastoidectomy for cholesteatoma. Thirty-two percent of the cases were in children 15 years of age and under. Over two thirds of the procedures were canal wall up, and the remainder of patients underwent a canal wall down technique with obliteration. There was little difference in the results between children and adults, with the exception of there being a tendency for a greater degree of ossicular destruction in the children and a greater incidence of residual disease at second stage surgery. There was a 3 percent incidence of recurrent cholesteatoma. It appears that the intact canal wall technique is preferable in both children and adults, when circumstances are favorable.

Acute Disease↗
PubMed1992

Middle fossa vestibular neurectomy in retrolabyrinthine neurectomy failures.

Retrolabyrinthine vestibular nerve section is an important treatment option in patients with refractory, incapacitating vertigo. However, an indistinct cleavage plane between the cochlear and vestibular portions of the eighth cranial nerve may result in incomplete sectioning of the superior and inferior vestibular nerve fibers. We describe 11 patients in whom middle fossa vestibular neurectomy was performed following failure of a retrolabyrinthine vestibular neurectomy. A successful postoperative outcome from this revision surgery was obtained in six of 11 patients on follow-up evaluation. Patients in whom infrared video electronystagmography showed persistent function of the inferior vestibular nerve following retrolabyrinthine vestibular nerve section had a better response to middle fossa vestibular neurectomy than those with no measurable residual vestibular function. Because it provides access to the vestibular nerves where there is separation from the cochlear nerves distal to the previous section, we feel that the middle fossa vestibular neurectomy is the procedure of choice in selected patients who fail retrolabyrinthine neurectomy.

Adult↗
PubMed1992

Selection of surgical approaches for meningiomas affecting the temporal bone.

The varied locations of meningiomas within the temporal bone require a wide array of neurotologic approaches to accomplish complete resection with minimal morbidity. We reviewed 56 consecutive patients with temporal bone meningiomas. The six surgical approaches are described with regard to site of lesion, morbidity of procedure, and long-term patient outcome. Recommendations are made for selection of surgical approach. Hearing preservation was attempted in 25%. Middle fossa tumor removal was performed in nine patients (16%), retrosigmoid (suboccipital) in five patients (9%), translabyrinthine in 24 patients (43%), transcochlear in 15 patients (27%), infratemporal fossa in two patients (4%), and retrolabyrinthine in one patient (2%). Overall, meningioma surgery has higher morbidity, poorer facial nerve outcome, and higher recurrence rates than acoustic neuroma surgery. Thirteen percent of patients were unable to resume full preoperative activities after their surgery. Facial nerve transection occurred in 9% of the cases, and 83% of cases with more than 1 year followup had satisfactory or intermediate facial function (grades I to IV). Meningiomas of the temporal bone are insidious and aggressive lesions. Particular care is required to select the surgical approach appropriate for location, level of hearing, and the anatomic structures involved. Patients must be realistically counseled about the surgical morbidity and long-term outcome associated with each approach.

Facial Nerve↗
PubMed1992

Meningiomas of the jugular foramen.

Meningiomas of the jugular foramen manifest the same signs and symptoms as glomus jugulare tumors. They arise from arachnoid cells lining the jugular bulb and grow slowly, infiltrating the temporal bone and posterior fossa. These lesions, however, are more clinically treacherous than glomus tumors. Meningiomas infiltrate surrounding bone and nerve tissue and require wide margins of resection to prevent recurrence. Eight of these lesions have been managed in the past 5 years at the House Ear Clinic using modern imaging and skull base techniques. Two have recurred after "total" microsurgical removal. Presentation, radiologic evaluation, and management guidelines are reviewed.

Adult↗
PubMed1992

Lipoma of internal auditory canal.

Lipoma of the internal auditory canal is a rare tumor. Clinically, it presents like an acoustic tumor. The diagnosis can be made with the use of a magnetic resonance imaging showing a high intensity on T1- and low intensity on T2-weighted image with no enhancement. Pathologically, this is a soft, smooth, yellow tumor with some fat in it that can resemble grossly any acoustic tumor. The lipoma is intermixed with the eighth nerve and can be adherent to adjacent structures. The growth of a lipoma can be slower than an acoustic tumor. A patient diagnosed with lipoma of the internal auditory canal can often have quite good hearing. As an alternative to surgical removal, another therapeutic option is to watch the growth of the lipoma with periodic magnetic resonance imaging, probably on a yearly basis initially.

Adult↗
PubMed1992

Retrolabyrinthine vestibular nerve section: evaluation of technical modification in 143 cases.

Selective vestibular nerve section is effective in relieving intractable vertigo while preserving hearing. Histologic study demonstrated overlap of the cochlear and vestibular fibers at the cochleovestibular cleavage plane within the posterior fossa. In the hopes of improving surgical results by sectioning these overlapping vestibular fibers, the technique of sectioning the vestibular division of the eighth nerve was modified to include a small portion of the cochlear division. We have evaluated 143 cases of retrolabyrinthine vestibular nerve section in which this technical modification was employed. A patient questionnaire was used to examine control of vertigo as well as changes in tinnitus, unsteadiness, and disability. Hearing preservation and incidence of complications were also reviewed. Resolution or improvement of vertigo occurred in 93 percent of Menièré's cases and 74 percent of non-Menièré's cases as compared to 97 percent and 68 percent, respectively, in the pre-1986 series.

Adult↗
PubMed1992

Facial nerve repair techniques in cerebellopontine angle tumor surgery.

This study reviewed the technique and outcome of facial nerve repair in cases of cerebellopontine angle (CPA) tumor that resulted in transection of the facial nerve. Between January 1982 and December 1989, the facial nerve was preserved in over 97.7 percent of 1110 cases of CPA tumor resection. Facial nerve repair was performed in 23 patients. The nerve repair was accomplished with either suture anastomosis or support with microfibrillar collagen. In the cases repaired with sutures, reanastomosis to a proximal facial nerve stump at the brain stem was performed with a single suture, while stabilizing the nerve with a fenestrated suction. Direct facial nerve neurorrhaphy or anastomosis with a greater auricular nerve interposition graft was successful in restoring tone and some degree of voluntary motion in 18 of the 21 patients with follow-up available (86%) and acceptable function (grade IV/VI or better) in 12 of 21 (57%). The degree of recovery of facial function was significantly better in patients without preoperative facial nerve symptoms and patients in whom the tumor did not arise from the facial nerve itself. We conclude that in cases of facial nerve transection in the CPA, good results are obtained by immediately reestablishing anatomic continuity of the nerve with direct reanastomosis or with a greater auricular nerve graft.

Adult↗