Biomedical subjects

Wolf J Mann

Publications and source records attributed to Wolf J Mann.

At least 19 recordsLinked to original sources

PubMed2006

Technical Note: minimal access surgery for cochlear implantation with MED-EL devices.

BACKGROUND: Minimally invasive techniques have been described for cochlear implant surgery, but so far this had not been the case for Med-EL devices. OBJECTIVE: To describe a newly developed minimal access approach for the implantation of Med-EL devices and report our results after up to 1 year of follow-up in 52 patients. DISCUSSION: The use of a minimally invasive approach without raising a flap or extensive drilling of a bony well was feasible in all 52 patients of this series. It shortened the surgical time to an average of 45 min and there were no specific postoperative complications. The average follow-up of 8.4 months was uneventful with the implants well covered and fixed in their position. The described approach therefore appears to be a safe, time- and cost-effective alternative to the standard procedure in cochlear implant surgery using Med-EL devices.

Adolescent↗

PubMed2006

Gastroesophageal reflux disease (GERD), extraesophageal reflux (EER) and recurrent chronic rhinosinusitis.

Chronic polypoid rhinosinusitis (CRS) is a common disease, affecting approximately 16% of the adult population in the US every year. In addition to many well known predisposing factors, an association with reflux disease is hypothesized. Such an association might explain the recurrence of polyposis in the face of improved surgical techniques and postsurgical treatment of CRS. At present it is unclear whether extraesophageal reflux directly injures the sinus mucosa, whether gastroesophageal reflux leads to vagus-mediated neuroinflammatory changes, or whether both mechanisms occur separately or simultaneously. In patients suffering from recurrent CRS (n=20) and healthy volunteers (n=20), ambulatory 24 h two channel pH testing was performed. The number of reflux events, the fraction of the total time during which pH was below 4, and the reflux area index (RAI) were determined in the esophagus as well as in the hypopharynx. Patients with recurrent CRS had significantly more reflux events in the esophagus and the fraction of pH<4 and the RAI were increased up to 10-fold compared to healthy volunteers. In contrast to the esophagus, these differences were not observed in the hypopharynx. Recurrent CRS is often associated with GERD but not with EER. Recurrent disease or prolonged recovery after surgery should raise the suspicion of reflux disease as a possible triggering factor. Because GERD itself cannot be diagnosed by laryngoscopy, and because of the subjectivity of symptoms such as heartburn, the otolaryngologist should consider double-probe pH testing as the diagnostic procedure of choice.

Adult↗

PubMed2006

Evaluation of microsatellite amplifications at chromosomal locus 3q26 as surrogate marker for premalignant changes in mucosa surrounding head and neck squamous cell carcinoma.

We analyzed tumor and surrounding mucosal samples of head and neck squamous cell carcinoma by fragment analysis for gain of genomic material as a potential indicator for oncogenic transformation. Our aim was to evaluate the potential value of this fast and sensitive polymerase chain reaction (PCR)-based method for intra-operative detection of chromosomal aberrations as a surrogate marker for incomplete tumor resection. Biopsies of the primary tumors and adjacent macroscopically nonmalignant mucosa 1 and 2 cm away from the tumor margins were collected from 20 patients. DNA were isolated, and 11 microsatellite markers at loci 3q25.31 approximately 3q28 were amplified by PCR. Allelic losses or gains were analyzed by capillary electrophoresis. Imbalanced alleles were common in the samples evaluated. In the median gains of the informative loci were detected in 67% of the primary tumors, 22% of the samples taken at 1 cm and 15% of the samples taken at 2 cm distance. We observed gains of 3q at least in one microsatellite in all primary tumors, in 15 (1 cm) and 12 (2 cm) nonmalignant mucosa samples. Gain of genetic material is frequent in tumor-surrounding mucosa. Detection of small chromosomal aberrations is possible using the PCR-based, highly sensitive, and fast-to-perform fragment analysis technique. The value for the diagnosis and prognosis will have to be proven in follow-up studies.

Carcinoma, Squamous Cell↗

PubMed2005

COX-2 expression in the guinea pig cochlea is partly altered by moderate sound exposure.

The cyclooxygenase-2 isoform (COX-2) was found recently to be constitutively expressed in the guinea pig inner ear. To gain knowledge about its role in sound perception, alterations in the COX-2 level of moderate noise-stimulated cochleae were determined. Staining intensities were quantified in different regions using an immunohistochemical staining procedure and computer-assisted system. After 70 dB and 90 dB noise exposure for 1 h at 8000 Hz, COX-2 downregulation was observed in the organ of Corti, which was most prominent in Deiters' cells near Hensen cells and outer hair cells. In pillar cells, COX-2 levels were only slightly reduced after 70 dB but strongly diminished after 90 dB exposure. In Hensen cells, COX-2 was downregulated after 70 dB stimulation, revealing a decreasing COX-2 content from the third to the first turn of the cochlea and a homogeneously reduced enzyme expression in all three turns after 90 dB. The COX-2 content in inner hair cells was nearly identical to unexposed cochleae after 70 dB exposure but significantly reduced after 90 dB stimulation. In spiral ganglion cells, stria vascularis, spiral ligament and limbus, COX-2 expression was unchanged after 70 dB and 90 dB. We suggest that alterations in COX-2 expression might contribute to diminished sensitivity at the cochlea after noise exposure to reduce subsequent noise distress, termed sound conditioning.

Acoustic Stimulation↗

PubMed2005

Extraesophageal reflux and upper aerodigestive tract diseases.

Reflux disease can cause multiple disorders not only of the esophagus but also of the upper aerodigestive tract. In the last decade, an association between reflux disease and multiple head and neck diseases was described, including those of the larynx and pharynx as well as those of the nose, the sinuses and the middle ear. The present article summarizes these different diseases and possible pathomechanisms are explained. In particular, there is a need to differentiate between the classical gastroesophageal reflux disease (GERD) and the extraesophageal manifestation of the reflux disease, called extraesophageal reflux (EER). Both diseases are characterized by different symptoms and can cause different disorders. To differentiate between GERD and EER, double-probe pH monitoring is mandatory. At last, some aspects of reflux therapy are explained.

Cough↗

PubMed2005

Endothelial nitric oxide synthase upregulation in the cochlea of the guinea pig after intratympanic gentamicin injection.

Single-shot transtympanic gentamicin therapy has become a popular treatment modality for Meniere's disease despite the known possible ototoxic properties of this drug. It was shown recently that NO production and iNOS were upregulated after gentamicin application, which was interpreted as a possible effect of ototoxicity. In this study we analyzed the expression of eNOS after gentamicin application to determine a possible correlation of this enzyme with gentamicin-induced ototoxicity. We compared eNOS expression in gentamicin-treated and non-treated guinea pigs in the second turn of the cochlea, an area corresponding to speech perception in humans. Gentamicin (4 mg) was injected intratympanically into the middle ear of guinea pigs ( n =3) and the reduction of the hearing threshold level was determined by recording acoustic-evoked potentials (AEP) before and 5 days after gentamicin application. Morphological alterations in the organ of Corti were analyzed by light and electron microscopy. Gold-labeled anti-eNOS antibodies were counted in eight different cell areas for quantification of eNOS expression. Seven animals were analyzed as controls. After gentamicin application, a deterioration of hearing level was observed varying from 10 to 30 dB. A high degree of vacuolization was identified in the third row of outer hair cells. At the subcellular level, the subsurface cisterns in outer hair cells were dissociated from the basolateral cell membrane, and the mitochondrial membranes were frequently damaged. Statistically significant upregulation of eNOS was observed in all cell types analyzed. Depending on the various cell types the amount of gold-labeled eNOS antibodies was 2.5 to 5.7 times higher after gentamicin application. We observed significant eNOS upregulation after gentamicin application in the cochlea, in conjunction with cellular damages and decreased hearing.

Animals↗

PubMed2005

Vascular endothelial growth factor expression, vascularization and proliferation in paragangliomas.

OBJECTIVE/HYPOTHESIS: Paragangliomas are heavily vascularized tumors, and the expression of VEGF (vascular endothelial growth factor) has been reported. The aim of our study was to extend the available database of VEGF expression in paraganglioma, to add correlated data concerning vessel density and proliferative activity, and to draw conclusions concerning the mechanisms resulting in tumor vascularization and growth. STUDY DESIGN: Semiquantitative histopathologic examination of paraganglioma specimens obtained from surgical cases. METHODS: Paraffin-embedded paragangliomas were analyzed by immunohistochemistry. Fourteen consecutive samples were hybridized with VEGF-, CD31- and Ki67-specific antibodies, and visualized by diaminobenzidine staining. Vessel density was determined by counting CD31-positive vessels and proliferation by quantification of Ki67-positive cells. RESULTS: Ten out of 14 samples were positive for VEGF. In this group, vessel density was up to 5 times as high and proliferative activity was about twice as high as in the VEGF-negative group. CONCLUSIONS: We observed higher CD31 and Ki67 counts in VEGF-positive tumors, but statistical significance could not be assessed due to low sample numbers. These data might suggest a contribution of VEGF secreted by paragangliomas to tumor vascularization and possibly proliferation. The clinical impact of VEGF expression analysis has to be proven in future studies.

Adult↗

PubMed2005

Intratympanic gentamicin treatment after endolymphatic sac surgery.

CONCLUSIONS: Interval treatment with up to three intratympanic gentamicin injections once weekly effectively controlled vertigo while preserving hearing in patients with Ménière's disease and recurrent or resistant vertigo after saccotomy. OBJECTIVES: Recurrent or resistant incapacitating vertigo may occur after endolymphatic sac surgery (saccotomy) in patients with Ménière's disease. In these patients, revision saccotomy, vestibular nerve section or labyrinthectomy are the established treatment options. We advocate a once-weekly application of intratympanic gentamicin (12 mg) as an effective alternative in this group of patients. MATERIAL AND METHODS: Five patients (age range 39-65 years) with definite Ménière's disease according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria and incapacitating vertigo underwent gentamicin treatment after saccotomy. Control of vertigo and hearing preservation were the aims of treatment. The follow-up period ranged from 26 to 59 months. History and pure-tone audiometry were used to assess vertigo control and hearing, respectively. The frequency of vertigo in the 6-month period before gentamicin treatment ranged between 0.5 and four definitive episodes per month. Hearing stage (AAO-HNS criteria) before gentamicin treatment ranged between 2 and 4. Pre- and post-treatment pure-tone hearing thresholds at 0.5, 1, 2 and 3 kHz were compared by means of the Mann-Whitney U-test. RESULTS: Complete vertigo control (class A; AAO-HNS) and hearing preservation at 0.5, 1, 2 and 3 kHz were achieved.

Adult↗

PubMed2005

Role of fungus in eosinophilic sinusitis.

PURPOSE OF REVIEW: Chronic rhinosinusitis is characterized by a broad diagnostic and etiologic spectrum. It has been postulated that fungal organisms might represent the immunologic target initiating and maintaining the disease process in patients with chronic rhinosinusitis as a common denominator. This review analyzes the available data to describe the current understanding of the role of fungus in the pathophysiology of chronic rhinosinusitis. RECENT FINDINGS: Recent findings have demonstrated that using highly sensitive methods, the detection rate of fungi in nasal mucin can be increased to approximately 100% in patients and in healthy controls. If this ubiquitous fungal contamination were to be related to a causative mechanism in chronic rhinosinusitis, there would have to be an immunologic sensitization in patients in contrast with healthy individuals, which is yet not fully understood. However, studies were able to demonstrate cytokine production in blood-derived lymphocytes in the presence of fungi in patients, but not in healthy controls. Several questions arise. If this is a relevant finding, in what percentage of chronic rhinosinusitis patients could it be causative? Is chronic rhinosinusitis, then, a systemic disease? How is the extramucosal target in the mucin presented to the immune system? Is intranasal, topical antifungal treatment a successful option? SUMMARY: The role of fungal organisms in the etiology of eosinophilic rhinosinusitis is reviewed with respect to novel findings, and arising questions are discussed in the light of recent investigations.

Chronic Disease↗

PubMed2005

Epidural hematoma after cochlear implantation in a 2.5-year-old boy.

OBJECTIVE: Report a case of an epidural hematoma after cochlear implantation in a 2.5-year-old boy, the diagnostic and therapeutical emergency management, as well as the postinterventional course and rehabilitation of the child. STUDY DESIGN: Retrospective case review. PATIENT: Two and a half-year-old boy, suffering from early onset, profound sensorineural hearing loss had been diagnosed at an age of 1.5 years, which had been more severe on the right side initially, but had progressed to bilateral deafness. INTERVENTION AND COMPLICATION: Cochlear implantation on the left side, followed up by an extensive epidural hematoma, causing intracranial compression with a midline shift of 15 mm to the right side. This initial complication was followed up by arterial infarction not only of the middle but also the posterior as well as the anterior cerebral artery, most likely caused by incarceration through the tentorium. RESULTS: After immediate neurosurgical intervention and intensive care treatment including low-dose anticoagulation and high doses of corticosteroids, the child recuperated completely within 3 weeks without any remaining neurologic deficits. CONCLUSION: In cochlear implantation, especially if placement of the implant housing is associated with considerable bone work, epidural hematoma has to be considered as an extremely rare, but life-threatening, complication.

Child, Preschool↗

PubMed2005

Nasal provocation testing as an international standard for evaluation of allergic and nonallergic rhinitis.

Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, sneezing and, most importantly, nasal obstruction are assessed as well as ocular, bronchial, cutaneous, and systemic reactions. To achieve objective data on changes in nasal airflow and patency after the challenge, anterior rhinomanometry and acoustic rhinometry have been included in the standard protocol of NPT. By monitoring changes of nasal airflow on one hand and of nasal geometry on the other hand, these methods display nasal function in a graphic way just as speech and pure tone audiometry do for auditory function. Also, by their objective nature, these methods offer a clear and internationally comparable standard. This review outlines a protocol for NPT and discusses practical applications and clinical indications. The use of rhinomanometry and acoustic rhinometry as objective diagnostic tools is emphasized. For the diagnosis of allergic and occupational rhinitis, standardized NPT should be regarded as an international diagnostic standard.

Allergens↗

PubMed2005

Current concepts in therapy of chronic rhinosinusitis and nasal polyposis.

The exact pathophysiological mechanisms leading to chronic rhinosinusitis (CRS) still to a large extent remain obscure. However, recently there has been some progress in elucidating the etiology of nasal polyposis, especially regarding tissue eosinophilia as well as the role of aspirin intolerance and eicosanoid mediators. Endonasal sinus surgery has evolved to be the treatment of choice in CRS and nasal polyposis in all cases where conservative treatment has failed or resulted in only a partial or temporary relief. Today, state of the art in surgical technique includes the ability to combine microscopic and endoscopic procedures. Regardless of technical advances like powered instrumentation or computer-aided surgery, in a modern protocol, surgical therapy can offer only one option within a complex and individually tailored therapeutical concept. This review discusses current concepts and new developments in the diagnosis and treatment of CRS and nasal polyposis.

Anti-Bacterial Agents↗

PubMed2005

VEGF-subtype specific protection of SCC and HUVECs from radiation induced cell death.

The contribution of VEGF (vascular endothelial growth factor) to angiogenesis and tumor aggressiveness has been shown in several tumor types, but no comparative data regarding the impact of the VEGF-subtypes on endothelial and tumor cell protection are available. Therefore, we analysed the cytoprotective effects of the two major soluble VEGF-subtypes, VEGF-121 and -165, on HUVEC cell cultures (human umbilical vein endothelial cells) and squamous cell carcinoma (SCC) cell lines after ionizing radiation. We performed clonogenic analyses and proliferation assays for evaluation of cell survival and proliferative activity. Experiments were performed employing different intensities up to 8 Gy with or without added recombinant VEGF-121 or -165 and compared to non-irradiated cultures. To evaluate a possible contribution of the VEGF-receptors, we performed immunohistochemical stainings of VEGF-R1 (flt), -R2 (KDR,flk), and Neuropilin-1. In the SCC cell lines and HUVEC cultures, cell survival and proliferative activity were reduced in a dosage-dependent manner. The addition of VEGF-121 yielded a significant increase of resistance from 1.2 to 2.7 Gy (+125%) for killing 50% of subjected cells, while VEGF-165 was less effective in this regard (+83%). Conversely, in HUVEC cultures, 50%-survival was increased more strongly by VEGF-165 compared to VEGF-121 (+100% vs. +43%). Accordingly, proliferation was more intensely stimulated in HUVECs by VEGF-165 than by VEGF-121. VEGF-receptors were expressed in all cell cultures analysed at comparable levels. We conclude that the two VEGF-subtypes differentially increase the survival of tumor and endothelial cells after irradiation in vitro. We hypothesise, that the release of VEGF by the tumor protects tumor cells and endothelium resulting in increased radiation resistance.

Carcinoma, Squamous Cell↗

PubMed2005

Vascular endothelial growth factor and basic fibroblast growth factor are released by squamous cell carcinoma cells after irradiation and increase resistance to subsequent irradiation.

We analysed the release of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) from squamous cell carcinoma (SCC) after irradiation and their potential contribution to radiation resistance. Three SCC cell lines were irradiated, and VEGF- and bFGF-release was quantified by Elisa-assay. Conditioned media (CM) were used in clonogenic assays for analysis of tumor cell survival. To evaluate the effect of tumor released VEGF and bFGF on survival, experiments with neutralizing monoclonal anti-VEGF and anti-bFGF antibodies were conducted in parallel. Cell cultures were irradiated with 2 Gy to analyse the effects of CM on tumor cell escape from radiation-induced death. We observed a marked increase in VEGF- and bFGF-release after irradiation by the surviving cells. Using these conditioned media, subsequently we observed an up to 10-fold increase in colony formation. The addition of anti-VEGF- and anti-bFGF-antibodies reduced colony formation, indicating that irradiation stimulates the release of growth promoting substances including VEGF and bFGF by the surviving cells. Additionally, irradiation of cells cultured with CM decreased colony formation about 50%, however, it was still increased 5-fold compared to the cultures without CM. The addition of VEGF- and/or bFGF-antibodies led to an additional 20% reduction of this radioprotective effect of the CM. This means, bFGF and VEGF contribute to a significant proportion of the survival stimulating activity. We thus show that irradiation might result in autologous protection of tumor cells from irradiation-induced cell death by the release of growth factors. These observations suggest that radiation might lead to unsuspected and undesired effects in tumorous tissue with possible clinical impact.

Carcinoma, Squamous Cell↗

PubMed2004

Vessel density, proliferation, and immunolocalization of vascular endothelial growth factor in juvenile nasopharyngeal angiofibromas.

BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, highly vascularized neoplasm of the nasopharynx that affects boys and young men. The underlying dysregulated molecular mechanisms remain unclear. The participation of angiogenic growth factors has been suggested, but few studies have been published. OBJECTIVES: To evaluate the expression and localization of vascular endothelial growth factor (VEGF), proliferating cells, and vessel density in JNA. STUDY DESIGN: Immunohistochemical examination of 10 consecutive JNAs (8 primary tumors and 2 recurrent tumors). METHODS: Paraffin-embedded and cryopreserved JNA samples were included. VEGF-, CD31-, and Ki67-specific antibodies were applied and visualized using light microscopy. Vascularization was determined by counting CD31-positive vessels. Proliferating and VEGF-expressing vessels as well as stromal cells were quantified by the same method. Patients' age at the time of surgery and tumor stage were correlated with the immunohistochemical data. RESULTS: All tumors were heavily vascularized, but major differences were noted between the samples. About half of the vessels were proliferating (Ki67 positive) and half of the Ki67-positive cells were also VEGF positive. The tumor stroma was VEGF positive in 8 of 10 samples and proliferating in 5 of these 8. The 5 samples with both VEGF- and Ki67-positive stroma showed high vessel densities. No correlation was observed between age or tumor stage and vessel density, VEGF expression, or Ki67 expression. CONCLUSIONS: In JNA, VEGF is frequently expressed by stromal cells and vessels and is associated with proliferation and increased vessel density. We suggest the promotion of vascularization by VEGF, but the involvement of androgens in JNA angiogenesis still needs to be analyzed.

Adolescent↗

PubMed2004

Juvenile angiofibromas: changing surgical concept over the last 20 years.

OBJECTIVES: Nasopharyngeal angiofibroma is a rare tumor. Several surgical approaches have been established, including transpalatal, lateral rhinotomy, craniofacial, and midface degloving procedures. More recently, less invasive endonasal approaches have been used. In a retrospective study, we analyzed the outcome of surgical treatment for angiofibroma to determine whether an endonasal approach was as effective as other, more invasive techniques for removing the tumors. METHODS: Thirty patients with histologically confirmed angiofibromas were treated by surgical removal at two institutions during a 20-year period. Tumors were staged according to size and extension on the basis of imaging and surgical findings using the Fisch classification. Specific analysis of the operative approaches and recurrence rate by stage were included. Recurrent or residual disease was handled by surgical excision. RESULTS: The number of patients treated increased during the last 10 years in both institutions, but no major changes in distribution of tumor stages were observed. In the most recent years, the endonasal approach has been favored. All 30 patients remain alive and free of disease. CONCLUSIONS: During the last 12 years, we have undergone a marked shift toward endonasal procedures while the tumor stages of the patients treated remained the same. Our results demonstrate that angiofibromas may be managed successfully using less invasive techniques, thereby reducing morbidity, without increasing the chance of recurrence.

Adolescent↗

PubMed2004

Untreated chronic rhinosinusitis: a comparison of symptoms and mediator profiles.

OBJECTIVES/HYPOTHESIS: Since the early 1990s, the knowledge of inflammatory mediators involved in chronic rhinosinusitis has increased extensively. However, until the present no data on trends in mediator levels in the natural course of the exacerbation-free interval of chronic rhinosinusitis have been published. The purpose of the study was to examine how levels of inflammatory mediators and clinical findings in chronic rhinosinusitis relate over time in the absence of acute exacerbation. STUDY DESIGN: Prospective study. METHODS: The authors investigated 12 untreated patients with chronic rhinosinusitis and repeated clinical examinations and measurements of inflammatory mediators in the nasal mucosa (messenger RNA [mRNA]of interleukin-1beta; interleukins 3, 5, 6, and 8 [IL-3, IL-5, IL-6, and IL-8]; interferon gamma; tumor necrosis factor-alpha [TNF-alpha]; monocyte chemotactic proteins 1, 3, and 4 [MCP-1, MCP-3, and MCP-4]; and granulocyte-macrophage colony-stimulating factor [GM-CSF]), as well as measurements of peptido-leukotriene [PLT] and prostaglandin E2 [PGE2]) in nasal secretion over a period of 4 weeks. RESULTS: Clinically speaking, the symptom score significantly improved over the period of 4 weeks, whereas other clinical parameters (computed tomography score, endoscopy score, rhinomanometric values, saccharine transport time, ciliary beat frequency, and olfaction) varied insignificantly. Regarding proinflammatory and inflammatory mediators, only mRNA of IL-1beta, IL-6, IL-8, MCP-1, and TNF-alpha were detected in relevant amounts in nasal mucosa, and their levels decreased only insignificantly over the 4-week period. In nasal secretion, a slight decrease of PGE2 and PLT levels was observed over the same time period. CONCLUSION: Subjective symptoms may show a spontaneous improvement of approximately 25% in patients with so-called "stable" chronic rhinosinusitis over a 4-week period, whereas objective clinical parameters vary insignificantly. Messenger RNA of IL-1beta, IL-6, IL-8, MCP-1, and TNF-alpha, as well as PLT and PGE2 levels, are detectable and appear to play a role in the persistence of inflammation in chronic rhinosinusitis. Their levels decrease only insignificantly over time, even in the absence of acute exacerbation of disease, possibly rendering the mucosa more prone to recurrent acute episodes.

Adult↗

PubMed2004

Clinical and radiologic sequelae of the middle fossa approach to the internal auditory canal.

OBJECTIVE: This retrospective study aimed to characterize the postoperative nonneurotologic complications and radiologic findings after the middle fossa approach to the internal auditory canal (IAC). A grading system for computed tomography (CT) changes was developed. STUDY DESIGN: Sixty-two patients operated between 2000 and 2003 had CT scans of the head on the day after surgery. Their charts and films were reviewed. SETTING: R15 DK 54070-01A1: Tertiary referral center. RESULTS: Nine patients had complications, including seven with cerebrospinal fluid leakage, one with infection, and one with visual disturbances. Only three of these patients had CT changes. Alternatively, 14 patients had CT changes according to our grading system for edema, pneumatocephalus, and hematoma. Three of these patients had complications. The overall complication rate was low (15%), and there were no cases of serious damage to the temporal lobe. CONCLUSION: The middle fossa approach provides safe access to the IAC. With the use of flexible retractors, serious damage to the temporal lobe can be avoided. The CT scan on the first day after surgery is useful for detecting dangerous hematomas but should be correlated to the patient's condition because of non-specific radiologic changes and the potential for complications to be present even in the absence of CT findings.

Adolescent↗