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Biomedical subjects

M Aristegui

Publications and source records attributed to M Aristegui.

13 recordsLinked to original sources
PubMed1997

Retrolabyrinthine vestibular nerve section: a current appraisal.

We report our experience (1987-1993) with Meniere's disease patients treated with a retrolabyrinthine vestibular neurectomy. The current literature was reviewed and our results have been compared with those of previous reports. The overall success rate for vertigo relief was 96.7%, with no serious or permanent complications resulting from the procedure. The technical elements of the operation, as they apply to our approach and those of others, have been analyzed, with special attention given to the anatomical features of the region and their influence on success or failure. We conclude that the retrolabyrinthine approach for vestibular nerve section remains a safe and highly successful technique which merits continued use.

Adult↗
PubMed1996

Normal hearing in acoustic neuroma patients: a critical evaluation.

A series of 128 acoustic neuromas (ANs) managed in our center in the last 6 years were evaluated. Sixteen cases (12.5%) were found to have normal pure tone audiograms. A comparatively younger age was an important characteristic of these patients. Tinnitus, dysequilibrium, and subjective hearing loss or distortion were their most common complaints. Pure tone audiometry showed a mean pure tone average of 14.5 dB. Speech discrimination score and performance intensity phonetically balanced index were very insensitive and showed very high false-negative results. Auditory brainstem responses proved to be a reliable test, being positive in 93.8% of cases. The mean tumor size did not show any significant difference when compared with acoustic neuroma cases with abnormal hearing. The combination of otologic and neurotologic symptoms in a young patient should prompt the clinician to investigation further even if hearing is within normal limits. A high index of suspicion is a prerequisite for the early diagnosis of such subtle lesions.

Adult↗
PubMed1996

[Vestibular neurectomy by retrolabyrinthine approach in cases of untreatable Meniere's disease].

We report on a series of 35 Ménière's disease patients, all of whom had undergone retrolabyrinthine vestibular neurectomy between 1987-1993. The overall success rate of vertigo relief was 96.7% with no serious or permanent complications resulting from the procedure. The current literature is reviewed and our results are compared with those of previous reports. The technical elements of the operation, regarding our approach and those of the others are analyzed with special attention given to the anatomical features of the region and their influence on success or failure. We conclude that the retrolabyrinthine approach for nerve section remains a safe and highly successful technique which continues to be widely used.

Adult↗
PubMed1996

[Glomus jugulare tumor: perioperative management].

Surgical treatment of glomus jugulare tumors yields high rates of perioperative morbidity and mortality for several reasons, among them neuroendocrine secretory activity, a high degree of vascularization, intracranial extension, duration of surgery and cranial nerve lesion. Secretory activity (e.g. catecholamines and serotonin) should be investigated before surgery and treated appropriately. Carotid arteriography (and ball occlusion) are useful to assess vascularization of the tumor and determine the need to clamp the carotid artery during the procedure. Potential complications such as hemodynamic alterations (bleeding or endocrine response), pulmonary embolism (air or thrombotic), hypothermia, facial nerve lesion, should be monitored for during surgery. After surgery cranial nerve involvement, which can lead to dysphagia and bronchoaspiration, must be looked for; the risk of cerebro-spinal fluid fistula is also high. We report the case of a woman who underwent surgery for a non secreting glomus jugulare tumor with extradural intracranial invasion. The main complications during surgery were bleeding with hemodynamic repercussions, pulmonary embolism, lesions in the VII, VIII and X cranial nerves, and opening of the dura mater (which required insertion of an intradural drain to prevent formation of a fistula). After surgery oral intake was delayed until intestinal function was established and glottic sphincter competence was verified by fiberoptic laryngoscopy. The only complication presenting at this time was cephalea, which disappeared upon removal of the drain on day 4. The patient was released on day 10.

Catheterization↗
PubMed1995

Lower skull base: anatomic study with surgical implications.

With advances in the lateral approaches to the skull base and the increasing success of the management of jugular foramen lesions, a thorough knowledge of the anatomy of this region is needed. The purpose of the present work is to study the detailed microsurgical anatomy of the lower skull base and the jugular foramen area as seen through the lateral approaches. Forty preserved skull base specimens and 5 fresh cadavers were dissected. The shape of the jugular bulb and its relationship to nearby structures were recorded. The different venous connections of the bulb were noted. The hypoglossal canal was identified and its contents were observed. The lower cranial nerves were studied at the level of the upper neck, at their exit from the inferior skull base, and in the jugular foramen. The results of the present study showed the complex and variable anatomy of this area. The classic compartments of the jugular foramen were not always present. Cranial nerves IX through XI followed different patterns while passing through the jugular foramen, being separated from the jugular bulb by bone, thick fibrous tissue, or thin connective tissue.

Cadaver↗
PubMed1995

[Meningoencephalic herniation into the middle ear].

Herniation of meningeal and/or encephalic tissue into the middle ear is a pathology which, even if rarely found by the otologist, can be life-threatening for the patient because of eventual infective intracranial complications. Four different etiological types are possible, infective, post-surgical, traumatic and spontaneous. From a pathogenic point of view, all types are characterized by a bony and dural defect localized in the tegmen through which meningeal and encephalic tissue can herniate. Symptomatology is often non-specific so that some cases are diagnosed during surgery. When there is strong suspicion of herniation neuroradiological assessment procedures must be carried out in order to make a correct pre-operative diagnosis, High Resolution Computed Tomography (HRCT) of the temporal bone in particular, can show the exact limits and location of the bone defect, while Magnetic Resonance Imaging (MRI) allows the nature of the tissue in the middle ear to be determined. Surgery is the only appropriate therapy. Different approaches have been described amongst which the transmastoid with or without temporal minicraniotomy and the middle cranial fossa (MCF) are the most frequently reported literature. From June 1982 to March 1994, 27 consecutive cases underwent surgery at the Gruppo Otologico, Piacenza. As a result of the occurrence of postoperative meningitis in one case, a new surgical technique through the MCF was standardized. The main step of this procedure consist in leaving the herniated tissue in situ so as to make a barrier between the middle ear and subdural space. The technique is indicated either in the case of large, multiple or very anteriorly located bony defects or when there is an infection in the middle ear.

Adolescent↗
PubMed1994

The enlarged translabyrinthine approach for removal of large vestibular schwannomas.

This study was carried out to validate the enlarged translabyrinthine approach for the surgical management of large vestibular schwannomas. A retrospective review of the charts of 53 patients with large tumours removed via the enlarged translabyrinthine approach at the Gruppo Otologico, Piacenza, Italy, during the last five years was carried out. The ability to control large tumours and the achievement of total removal with low morbidity and very few complications, demonstrate that tumour size does not influence the use of the enlarged translabyrinthine approach for managing large tumours.

Adult↗
PubMed1994

Revision stapes surgery: a critical evaluation.

Fifty-six revision stapes surgeries performed during the last 9 years were evaluated retrospectively for their preoperative symptoms, intraoperative findings, and postoperative results according to the causes of failure, at the Gruppo Otologico, Piacenza, Italy. The most frequent causes of failure were found to be prosthetic misalignments, a reaction to the surgical trauma in the form of excess fibrous tissue reaction or new bony regrowth at the oval window, and ossicular chain problems. The location of the pathology was found to be an important factor in the outcome. Sixty percent of cases resulted in 0- to 20-dB air-bone gap. The causes of these failures, management, and their prevention during primary surgeries are also discussed.

Adult↗
PubMed1994

Surgical anatomy of the petrous apex as it relates to the enlarged middle cranial fossa approaches.

This work was designed to study the surgical anatomy of the petrous apex as it relates to the enlarged middle cranial fossa approaches, on 25 temporal bones. In this study we suggest dividing the petrous apex into two topographic areas: an anterior triangular and a posterior quadrangular area with respect to the posterior border of the Gasserian ganglion. Anatomic descriptions endorsed by relevant measurements of these areas are provided in this study.

Humans↗
PubMed1994

Surgical management of epitympanic cholesteatoma with intact ossicular chain: the modified Bondy technique.

The results of 37 cases surgically treated with the modified Bondy technique during a 6-year period at the Gruppo Otologico-Piacenza, Italy, are reported. This technique, indicated in epitympanic cholesteatoma with good hearing and intact ossicular chain and pars tensa, provides a one-stage mastoid cavity exteriorization with radical removal of cholesteatoma while preserving the preoperative hearing levels. The technique, indications, results, and comparison with other current techniques are discussed in this article.

Adolescent↗
PubMed1994

Giant cell tumor of the lateral skull base: a case report.

Giant cell tumors of the temporal bone are very rare lesions. They should be differentiated from other giant cell lesions of bone, mainly reparative granulomas. A case with a very huge giant cell tumor of the temporal bone extending to the infratemporal fossa, temporomandibular joint, and greater wing of the sphenoid has been presented. Because of their tendency for recurrence, total removal is the treatment of choice for these tumors and was accomplished through the infratemporal fossa approach type B. A follow-up of 2 years and 9 months revealed no evidence of tumor recurrence.

Adult↗
PubMedDate not supplied

[Treatment of petrous bone cholesteatoma].

Cholesteatoma involving the petrous compartment of the temporal bone is rare and is a difficult surgical challenge for the neuro-otological surgeon. A series of 60 cases of petrous bone cholesteatoma is presented. The diagnosis, surgical treatment, results, and complications are discussed. Our present surgical attitude is based on closed obliterative procedures that allow a wide field exposure with radical removal excision, control and protection of vital structures, and management of problems related to the facial nerve. The treatment of dura mater involved by matrix is still unsolved. Regular follow-up with CT and MRI is mandatory.

Adolescent↗