PubMed Health⌕ Search

Biomedical subjects

W Hitselberger

Publications and source records attributed to W Hitselberger.

5 recordsLinked to original sources
PubMed2001

The transcochlear approach revisited.

OBJECTIVE: To evaluate the indications for, techniques used in, and patient outcomes after surgery with the transcochlear approach in the treatment of petroclival tumors. METHODS: Retrospective review of 24 cases between 1985 and 1995 at the House Ear Clinic (Los Angeles, CA, U.S.A.). RESULTS: Meningioma was the most common tumor. Complete removal was achieved in 82% of tumors after one-or two-stage surgeries (average follow-up time, 36 months). The second-stage surgery was a middle fossa transpetrous approach. Most patients had some degree of facial nerve dysfunction immediately after surgery, and 12 of 20 patients subsequently improved to House-Brackmann Grade III or better. Fifty-nine percent of patients had permanent neurologic sequelae because of either the surgery or their disease. CONCLUSION: The transcochlear approach is best suited to treating petroclival intradural tumors that extend ventrally to the brainstem in patients without serviceable hearing. Temporary facial weakness is expected as a result of posterior facial nerve transposition.

Adult↗
PubMed1998

Hearing preservation in neurofibromatosis type 2.

OBJECTIVE: The aim of the study was to provide a clinical review of the middle fossa approach for hearing preservation in patients with neurofibromatosis type 2 (NF2). STUDY DESIGN: The study design was a prospective case review. SETTING: The study was conducted at a private practice tertiary neurotologic referral center. PATIENTS: Eighteen patients diagnosed with NF2 underwent 23 middle fossa procedures between 1992 and 1996 for removal of an acoustic neuroma. The nine males and nine females ranged in age from 11-73 years with a mean age of 28 years. Tumor size ranged from 0.5-2.5 cm with a mean of 1.1 cm. MAIN OUTCOME MEASURES: House-Brackmann facial nerve grade was measured. In addition, hearing level was classified both by the American Academy of Otolaryngology-Head and Neck Surgery criteria for reporting results of hearing preservation surgery and by comparison with preoperative level (15 dB/15%). RESULTS: Measurable hearing was preserved in 65%, 48% within 15 dB of preoperative pure-tone average (PTA) and within 15% of preoperative speech discrimination. Bilateral hearing preservation occurred in five patients. Excellent facial nerve function (House-Brackmann grades I-II) was obtained in all patients with normal preoperative facial nerve function. CONCLUSIONS: In this series of patients with NF2, outcomes in hearing and preservation of preoperative facial nerve function are similar to results seen in patients suffering a sporadic unilateral acoustic neuroma. However, early intervention is crucial in obtaining such favorable outcomes.

Adolescent↗
PubMed1997

Middle fossa approach for hearing preservation with acoustic neuromas.

OBJECTIVE: This study aimed to provide a clinical review of middle fossa approach for hearing preservation in acoustic neuroma surgery. STUDY DESIGN: This was a prospective case review. SETTING: The study was performed in a tertiary referral center of a private otologic practice. PATIENTS: One hundred fifty-one consecutive middle fossa approaches for removal of acoustic neuroma were used. The 91 males and 60 females ranged in age from 10-72 years with a mean age of 48 years. Tumor size ranged from 0.5-2.5 cm, with a mean of 1.2 cm. MAIN OUTCOME MEASURES: House-Brackmann facial nerve grade and hearing level classified both by the American Academy of Otolaryngology-Head and Neck Surgery criteria for reporting results of hearing preservation surgery and by comparison with preoperative level (15 dB/15%) were the main outcome measures. RESULT: Measurable hearing was preservation in 68%, with 52% within 15 dB and 15% discrimination. Excellent facial function (House-Brackmann grade I-II) was obtained in 95% of patients. CONCLUSION: The middle fossa craniotomy approach for acoustic neuroma is a reliable approach with a good hearing preservation rate and excellent facial nerve function outcome. Complications are minimal in this group of patients.

Adolescent↗
PubMed1993

Management of hydrocephalus resulting from acoustic neuromas.

Patients with large acoustic neuromas may have secondary obstructive hydrocephalus and occasionally significant neurologic deficit develops. At the House Ear Clinic, we have managed patients with hydrocephalus by translabyrinthine tumor removal without preoperative ventriculoperitoneal shunting. Forty-three patients with documented hydrocephalus who underwent acoustic neuroma removal have been reviewed. Six patients had neurologic deficit resulting from raised intracranial pressure before surgery. In each of these six cases, the deficit resolved after tumor removed without requiring shunting. Two patients had had ventriculoperitoneal shunts inserted because of neurologic deficit before referral for tumor removal. Two other patients underwent postoperative shunting for neurologic deficit --one at 2 weeks and one at 2 years. Cerebral or cerebellar herniation was not noted in any case. Cerebrospinal fluid leak occurred in five patients (11.6%) and culture-positive meningitis in two patients (4.6%). We conclude that decompression by translabyrinthine tumor removal is a safe method of management for patients with hydrocephalus resulting from large acoustic tumors.

Adult↗