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Mario Sanna

Publications and source records attributed to Mario Sanna.

30 records · Page 2Linked to original sources
PubMed2004

Transapical extension in difficult cerebellopontine angle tumors.

The transapical extension of the enlarged translabyrinthine approach is aimed at making the removal of certain tumors of the cerebellopontine angle simpler and with less morbidity. The extension is classified into 2 types--type I and type II--based on the extent of bone drilling around the internal auditory canal. Type I extension involves drilling for 300 degrees to 320 degrees around the canal and is indicated for large or giant vestibular schwannomas and vestibular schwannomas with significant extension anterior to the internal auditory canal. Type II extension entails complete removal of the bone around the canal for 360 degrees and is indicated for meningiomas of the posterior surface of the petrous bone extending anterior to the internal auditory canal. The extension allows better control over the anterior pole of the tumor, the displaced facial nerve, the prepontine cistern, and the venous vascularity of the cerebellopontine angle. The aim of this report is to present our experience with this extension.

Adult↗
PubMed2004

Total facial paralysis after vestibular schwannoma surgery: probability of regaining normal function.

The aim of the present study was to ascertain the precise fraction of vestibular schwannoma cases that recover to normal function after postoperative total facial nerve paralysis and to compare our results with those presented in the literature. This was a retrospective case review of 631 cases. Among the 132 cases with immediate postoperative facial nerve palsy (House Brackmann [HB] grade VI), only 2 (1.5%) recovered to normal function (HB grade I). In an attempt to compare our results with those of other series in the literature, we found a large variation in the incidence of recovery of this group of patients to grade I, ranging from 0% to 50%. Our analysis of the reported data revealed widely varying methods of data collection and presentation, making a scientifically valid comparison particularly difficult. According to our data, complete (HB grade I) or near-complete (HB grade II) facial nerve function recovery from an immediate postoperative grade VI palsy is extremely rare.

Facial Paralysis↗
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

Inner ear extension of vestibular schwannomas.

OBJECTIVE: Inner ear extension of vestibular schwannomas (VSs) is a rare finding but has important clinical implications. This report reviews the treatment options and presents the experience of the Gruppo Otologico, Piacenza, Italy, in this field. STUDY DESIGN: Case report and literature review. METHODS: Five cases of VSs with inner ear extension were surgically removed. In all of them, the cochlea was partially or completely invaded by the lesion. RESULTS: In 4 cases, the inner ear extension was preoperatively identified on magnetic resonance imaging, and the surgical removal was planned through a transotic approach. In the last case, the cochlear invasion was not detected preoperatively, and the lesion was removed during a second surgery performed to seal a cerebrospinal fluid fistula. CONCLUSIONS: VSs with inner ear extension should be distinguished from pure intralabyrinthine schwannomas because of differences in clinical significance. Cochlear involvement is more frequent than vestibular involvement and is often accompanied by a dead ear. Dead ear caused by small VSs should alert the surgeon to the possibility of a cochlear extension. The presence of an intracochlear involvement requires the adoption of an approach that allows control of the cochlear turns, and we found the transotic approach to be the most suitable. Undetected cochlear extensions that are left in place may grow with time.

Adult↗
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↗
PubMed2003

Facial nerve tumors.

OBJECTIVE: To evaluate the surgical results in primary facial nerve (FN) tumors. STUDY DESIGN: Retrospective case review. SETTING: Private neuro-otological and skull-base tertiary referral center. PATIENTS: Twenty eight consecutive patients affected by primary FN tumors that underwent surgery between December 1990 and February 2001. INTERVENTIONS: The lesions were removed through a variety of surgical approaches, depending on tumor location and extension, as well as preoperative hearing. In one case, partial removal was performed. MAIN OUTCOME MEASURES: Preoperative and postoperative FN function; preoperative and postoperative hearing level; and postoperative complications. RESULTS: Based on histologic examination, tumors were distributed as follows: 18 schwannomas, six hemangiomas, two meningiomas, and two neurofibromas. Tumor location varied, with lesions distributed along the entire length of the nerve. Facial dysfunction was the most frequently recorded symptom, followed by hearing loss. Only five patients presented a preoperative grade 1 facial function. In the remaining patients of the group, the facial deficit lasted from 2 to 120 months, with a mean of 31.2 months. Anatomic integrity of the nerve was preserved in 4 cases; all others required a nerve interruption followed by reconstruction using a sural nerve graft. The complications recorded were: one cerebrospinal fluid leak, one postoperative retraction pocket, and one external auditory canal wall resorption requiring a surgical revision. Preoperative hearing remained unchanged in 8 out of the 15 patients in whom a hearing preservation procedure was attempted. In 25 cases, a follow-up of equal to or longer than 1 year was available, with the FN functions: two grade 1, eight grade 3, nine grade 4, three grade 5, and three grade 6. Patients with a preoperative deficit lasting more than 1 year demonstrated the worst recovery. CONCLUSIONS: Primary FN tumors are rare lesions that include different histologic types. FN deficit represents the most common symptom, but it is not present in all cases. A conservative strategy is often adopted in presence of a normal preoperative facial function. When surgical management is selected, the decision on surgical approach to use depends on tumor size and location, as well as on preoperative hearing. FN integrity may be spared in rare occasions, but more frequently nerve reconstruction is required. Final facial function recovery is mainly dependent on the preoperative presence of FN deficit and its duration.

Adolescent↗
PubMed2003

Transapical extension in difficult cerebellopontine angle tumours: preliminary report.

Difficult cerebellopontine angle (CPA) tumours namely large/giant vestibular schwannomas, vestibular schwannomas with a significant anterior extension and meningiomas of the posterior surface of the petrous bone extending anterior to the internal auditory canal (IAC) have always posed a problem for the otoneurosurgeon. Modifications of the enlarged translabyrinthine approach (ETLA) specifically aimed at dealing with these tumours are not reported. The aim of this paper is to introduce the transapical extension of ETLA which involves increased circumferential drilling around the IAC beyond 270 degrees C. The extension allows enhanced surgical control over the tumour as well as the anterior aspect of the CPA including the prepontine cistern, the Vth and VIth cranial nerves. The extension is further classified into Type I and II depending upon the extent of drilling. Type I extension entails drilling around the IAC for 300-320 degrees and is indicated for large/giant vestibular schwannomas (large vestibular schwannoma extrameatal diameter 3-39 cm, giant vestibular schwannoma extrameatal diameter >or=4 cm) and vestibular schwannomas with significant anterior extension. Type II extension involves complete drilling around the canal for 360 degrees and is indicated for meningiomas of the posterior surface of the petrous bone extending anterior to the IAC.

Cerebellar Neoplasms↗
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↗