Biomedical subjects

Enrico Piccirillo

Publications and source records attributed to Enrico Piccirillo.

8 recordsLinked to original sources

PubMed2006

Petrous bone cholesteatoma: management and outcomes.

OBJECTIVE: Cholesteatoma of the petrous bone is a rare pathology that grows slowly and is often asymptomatic. High clinical suspect is recommended for its diagnosis. With the advancement of imaging, clinical diagnosis is confirmed and follow up is assured. The present study is presented to state our experience in management of petrous bone cholesteatoma (PBC) and an overview of the outcome results. METHODS: This study was a retrospective case review conducted at a private quaternary referral center. From January 1984 to October 2004, 93 of 2,739 patients with chronic otitis media with cholesteatoma were treated surgically for PBC with varying location types. RESULTS: The mean age in this study was 46 years. Ninety-four percent of patients presented with hearing loss. Facial paralysis constituted 55% of the presented manifestations and grade VI palsy was the most common. A massive type of PBC was found to affect 45% of patients and it was mainly the acquired pathology. The surgical approaches varied according to the class type of PBC. Postoperative complications were minimal, and follow up was carried out after 1 year from the surgery date. CONCLUSION: Petrous bone cholesteatoma presents difficulties in its diagnosis and treatment. Adequate history-taking, high clinical suspicious, with the advancement of imaging techniques made its diagnosis more feasible. Improvement of the lateral skull base approaches rendered possible safe, adequate, and complete removal of the pathology.

Adolescent↗

PubMed2006

Preoperative predictive factors for hearing preservation in vestibular schwannoma surgery.

OBJECTIVES: We performed a retrospective chart review to evaluate the various predictive factors for postoperative hearing preservation in the surgical management of vestibular schwannoma. METHODS: Of 792 patients operated on for vestibular schwannoma between April 1987 and July 2002, 107 were candidates for hearing preservation surgery. These patients were divided into group 1 (hearing preserved) and group 2 (hearing not preserved), and both of these groups were evaluated for age, sex, pure tone average, sound discrimination score, tumor size, and auditory brain stem response parameters. A corrected chi2 test and a corrected t-test were used for statistical analysis. Multiple regression analysis was further done to evaluate independent predictive factors, either alone or in combination. The results were evaluated by use of the modified Sanna classification and the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). RESULTS: Preoperative pure tone average and tumor size were the 2 predictive factors in our study. A Pearson correlation test showed that there was no multicollinearity between the factors. On multiple regression analysis by backward elimination of nonsignificant factors, we found that tumor size is an independent predictive factor for postoperative hearing. According to the modified Sanna classification, postoperative hearing was preserved in 11.2% of patients (equivalent to class A of AAO-HNS guidelines). CONCLUSIONS: In our series, preoperative pure tone average and tumor size were found to be predictors of postoperative hearing levels.

Adolescent↗

PubMed2004

Hearing preservation surgery in vestibular schwannoma: the hidden truth.

To compare the results of hearing preservation surgeries using different approaches--the enlarged middle cranial fossa approach and the retrosigmoid approach--and different classification systems, stressing the importance of preserving "normal hearing," we performed a retrospective case review in a tertiary care medical center. The charts of 107 patients with vestibular schwannoma who underwent tumor resection were reviewed. Hearing preservation was reported according to 2 different classification systems: the modified Sanna classification and the classification of the American Academy of Otolaryngology-Head and Neck Surgery. The facial nerve results were graded according to the House-Brackmann scale. The hearing preservation rates differed markedly depending on the classification used. We conclude that hearing preservation in acoustic neuroma is a more difficult proposition than most surgeons appreciate, especially in terms of serviceable hearing.

Adolescent↗

PubMed2004

Management of temporal bone hemangiomas.

Temporal bone hemangiomas are rare tumors that require a high degree of clinical suspicion on the part of the otolaryngologist to be diagnosed early. The purpose of this report is to present 10 histologically confirmed cases of hemangiomas located within the temporal bone treated at the Gruppo Otologico of Piacenza-Rome, Italy. A short review of the literature is also presented. The symptomatology of these extraneural vascular tumors depends on their location. Tumors located within the internal auditory canal present mainly with hearing loss, while a facial nerve deficit is the predominant symptom in geniculate ganglion tumors. The treatment modality is also dependent on the location of the tumor, as well as the clinical features and tumor size. The final facial nerve outcome is directly affected by the duration of the facial nerve deficit, and so the treatment should not be delayed once the diagnosis is made.

Adult↗

PubMed2003

Anterior and Posterior Facial Nerve Rerouting: A Comparative Study.

The infratemporal fossa type A (IFT-A) and the modified transcochlear approach are used to remove glomus jugular tumors type C and petroclival tumors extending to the prepontine cistern, respectively. Anterior rerouting is a key step in IFT-A, whereas the modified transcochlear approach involves posterior rerouting. The aim of this study was to analyze facial nerve function after application of the two procedures. One year after surgery, anterior rerouting was associated with excellent to good outcomes (grade I to III) in 94 % of the cases, while posterior rerouting was associated with good outcomes (grade III) in 70 % of the cases.

Journal Article↗

PubMed2003

Facial nerve grafting.

OBJECTIVE: To evaluate the results of facial nerve reconstruction by means of grafting and to determine the influence of different variables on final functional recovery. STUDY DESIGN: Retrospective case review. SETTING: Tertiary otologic and skull base referral center. PATIENTS: Sixty nine patients underwent facial nerve grafting. Facial nerve tumors (24) or vestibular schwannomas (18) affected most of them. Preoperatively, 47 patients had a clinical facial nerve deficit lasting from 1 to 120 months, with a mean of 20.2 months. MAIN OUTCOME MEASURES: Final facial nerve motor function. RESULTS: Among the 56 patients with a follow-up time equal to or longer than 1 year, 26 recovered to a Grade III (46.4%), 14 to a Grade IV (25%), while 16 remained at Grade V or Grade VI according to the House-Brackmann scale. Patients with a preoperative facial nerve deficit for more than 1 year showed the lowest rate of recovery, with only 3 cases (19%) reaching Grade III. CONCLUSIONS: Duration of the preoperative facial nerve deficit emerged as the most important factor influencing final results. According to the authors' data, the 1-year period after the occurrence of the preoperative clinical deficit seemed to be the cutoff point in achieving a high rate of good postoperative recovery. Among the other factors that might have influenced the final outcome, only the underlying cause of the lesion played a significant role.

Adolescent↗

PubMed2002

Prediction of facial nerve outcome using electromyographic responses in acoustic neuroma surgery.

OBJECTIVE: To determine whether early and late postoperative facial nerve function can be predicted on the basis of electromyographic responses in acoustic neuroma surgery. SETTING: Prospective blinded study. DESIGN: Tertiary referral center. PATIENTS AND METHODS: Burst and train electromyographic responses were recorded intraoperatively during the last step of vestibular schwannoma removal. The responses were classified and compared with early and late postoperative facial function in 49 patients who underwent enlarged translabyrinthine acoustic neuroma surgery. RESULTS: In the early postoperative period, 20 of 22 patients with an irritable pattern and 10 of 13 patients with an ordinary pattern had Grade III or better facial nerve function, whereas all 3 patients with a stray pattern and 9 of 11 patients with a silent pattern had Grade V or VI. In the late postoperative period, on the other hand, Grade III or better facial nerve function was achieved in 37 of 38 patients with an irritable, stray, or ordinary pattern, but the facial nerve function remained at Grade V or VI in 2 patients with the silent pattern. CONCLUSION: Patients with mechanically evoked facial electromyographic responses to the last step of tumor dissection may not experience severe facial nerve dysfunction or show a remarkable improvement. However, patients with silent electromyographic responses during this step tend to experience severe facial nerve dysfunction early in the postoperative course, and some patients may not show any functional improvement.

Adult↗

PubMed2002

Treatment of residual vestibular schwannoma.

OBJECTIVE: To evaluate the results of the surgical removal of residual vestibular schwannomas and compare them with results obtained from the first operation. STUDY DESIGN: Retrospective case review. SETTING: Tertiary otologic and skull base referral center. PATIENTS Twenty-three patients with residual vestibular schwannoma from a total of 637 patients who underwent surgery during the same time (April 1987 to April 2001). Only 1 patient had previously been treated in the same center. All but 1 patient had previously undergone at least 1 retrosigmoid approach. The majority of patients experienced an extensive list of complications and additional treatments after the first operation. Only 2 patients experienced some measurable hearing preoperatively. Previous hospitalization averaged 34.9 days, with a minimum of 5 and a maximum of 150 days. INTERVENTIONS: 16 patients were treated through an enlarged translabyrinthine approach and 7 through a modified transcochlear approach. MAIN OUTCOME MEASURES: Total tumor removal, postoperative complications, hospital stay. RESULTS: All but 2 patients underwent a total removal. Complications recorded were 1 temporary hemiparesis and aphasia, 1 subcutaneous abdominal hematoma, and 2 transitory VIth cranial nerve palsies. No additional treatment was required. The postoperative hospital stays ranged from 3 to 22 days, with a mean of 6.9. CONCLUSIONS: Patients with vestibular schwannoma should be treated by an experienced team in a referral center to reduce postoperative morbidity and decrease the need to resort to only partial removal. Planned subtotal removal should be reserved for a few selected cases. The retrosigmoid approach is considered to have the highest risk that tumor remnants will unintentionally be left. In surgery of a residual vestibular schwannoma that has previously been treated through the retrosigmoid approach, the translabyrinthine approach offers some advantages with respect to performing another retrosigmoid procedure. In the presence of long-lasting facial palsy, the modified transcochlear approach represents the safest and most viable option available.

Adult↗