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Acoustic neuroma has always been reported to accompany neurofibromatosis in patients with enlargement of the internal auditory canal. The authors describe a case in which the internal auditory canal was enlarged but there was no tumor. This may represent a normal variant or a manifestation of the bony dysplasia of neurofibromatosis.
The minimal size of acoustic neuromas detectable by computered tomography (CT) is, according to the available literature, 1.5 to 2 cm. The new otoneurosurgical technic using the transtemporal and translabyrinthine approach necessitates an early diagnosis of neuromas protruding 1 cm or less into the cerebellopontine angle cistern. This seemed impossible with the available CT equipment. Eight proven acoustic neuromas 1 cm or less in diameter, detected with CT, are reported. Diagnostic criteria are elaborated. The study shows that small cerebellopontine angle tumors can be detected by use of CT machines of the newer generation which perform scanning with thin and overlapping slices.
Eleven patients with verified acoustic neuroma had critical band estimation performed by the method of loudness summation using noise bands centered around 1 kHz. The normal loudness difference between broad band noise and narrow band noise was reduced at all levels except the highest. Judged as single individuals, 9 of the 11 patients had a normal critical band. The pooled data indicated a normal critical band, both in patients with hearing loss less than 50 dB HL and in patients with hearing loss greater than or equal to 50 dB HL. The results are similar to those obtained in patients with Ménière's disease (Bonding, 1978c) and thus CB-measurements cannot be utilized for differentiating between cochlear and retrocochlear lesions. However, at the highest test levels applied the loudness difference between broad band noise and narrow band noise appeared to have some correlation to the presence or absence of recruitment.
The records of 225 patients with surgically documented acoustic neuromas seen at the Mayo Clinic between 1966 and 1976 were studied. Included in this group were 4 patients who had von Recklinghausen's disease with bilateral ear involvement, 7 patients with recurrence of acoustic neuroma, and 8 patients who were referred because of recurrent acoustic neuroma. Symptoms, clinical findings, and results of audiologic, vestibular, and roentgenographic studies were analyzed. Nine patients had a history of sudden onset of hearing loss, and 11 had a history of vertigo. A correlation between the size of the lesion and the symptoms, physical findings, and roentgenographic accuracy was made in an attempt to gain further knowledge of the natural course of the pathologic processes involved.
After removal of an acoustic neuroma by the suboccipital route cerebrospinal fluid rhinorrhea was observed. This procedure was complicated by meningitis and pneumatocephalus. Finally, after one neurosurgical and four otosurgical interventions, the cerebrospinal fluid leak was identified in the membrane of the round window. It was plugged with a fascial graft.
Since the introduction of the translabyrinthine approach in the treatment of acoustic neuromas in Denmark. 47 patients have been operated on, the series containing 2% small, 60% medium and 38% large tumours. This distribution differs significantly from previously published tumour series, where the large tumours dominated. The paper describes the various diagnostic procedures applied in the present active search for acoustic neuromas, and the reduction in tumour size is ascribed to information on the improved surgical results obtained by the translabyrinthine approach.
BACKGROUND: Patients undergoing acoustic neuroma (AN) surgery often experience postoperative negative emotions, including anxiety, depression, and immune function suppression. This trial evaluated whether perioperative sub-anesthetic esketamine improves early postoperative negative emotions and immune function. METHODS: In this single-center, double-blind, randomized trial, 84 patients scheduled for AN surgery were assigned to esketamine (n = 42) or placebo (n = 42). The esketamine cohort received a continuous intravenous infusion of esketamine at 0.2 mg·kg-1·h-1 during anesthesia, followed by 1 mg·kg-1 esketamine as an adjuvant in patient-controlled intravenous analgesia (PCIA). The placebo group received saline. The primary outcome was the incidence of depression on postoperative day (POD1), defined as a Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) score > 7. RESULTS: Seventy-seven patients completed the study (39 in the esketamine group, 38 in the placebo group). Esketamine significantly reduced the incidence of depression at POD1 (7.7% versus 31.6%; relative risk 0.24, 95% CI: 0.08-0.80, p = 0.008) and POD3 (0.0% versus 15.8%, relative risk 0.00, 95% CI: 0.00-0.47, p = 0.031) compared with placebo. The incidences of anxiety on POD1 and 3 and sleep disturbances on POD1 were also significantly reduced (p < 0.05). Notably, no significant differences were observed between the two groups in terms of immune function, postoperative pain scores, or intraoperative morphine equivalent. Adverse events did not differ between the groups. CONCLUSION: Perioperative sub-anesthetic esketamine reduced postoperative depression and anxiety, and improve sleep quality after AN surgery, without significant effects on early immune function or acute postoperative analgesia. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400084537.
Forty-three patients with a surgically confirmed unilateral acoustic neuroma were studied preoperatively with both alternate and simultaneous binaural bithermal caloric tests using horizontal lead electronystagmography. Twenty-four patients had a significant reduced vestibular response on the side of the tumor utilizing the alternate binaural bithermal calorization of Fitzgerald-Hallpike. The addition of the simultaneous binaural bithermal stimulus improved the diagnostic accuracy of caloric testing from 56% to 86%. The simultaneous test was of particular accuracy in diagnosing the inferior vestibular nerve neuroma. The simultaneous stimulus, which adds only six and one-half minutes to overall testing time, is felt to be a valuable adjunct to the alternate test of Fitzgerald-Hallpike.
Forty-seven patients with 48 unoperated acoustic neuromas have been studied by computed tomography (CT) with respect to bone changes. CT and conventional X-ray examination of the skull were compared. The importance of using a small collimator, proper selection of the plane of the CT section and changing of the window level is stressed. CT detects porus changes as accurately as conventional X-ray methods.
Five patients with signs and symptoms of acoustic neuroma had a filling defect on positive contrast posterior fossa myelography. At surgical exploration they were found to have a vascular loop accounting for the space occupying lesion.
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The records of 10 patients, who underwent removal of small vestibular schwannomas by the middle cranial fossa approach at the University of Iowa Department of Otolaryngology and Maxillofacial Surgery between October 1974 and November 1977, are reviewed. The principal deviation from previously described operative techniques is that after identification of appropriate landmarks, the internal auditory canal is first unroofed in its medial portion near the porus rather than following the facial nerve to the fundus of the canal. There were no intraoperative complications, but one patient died after a postoperative brain stem vascular accident. Another patient developed a cerebrospinal fluid leak and, subsequently, meningitis. Auditory function was preserved postoperatively in 8 of 10 patients, but only 6 retained auditory function after discharge from the hospital. Facial nerve function was normal immediately after surgery in 6 of the 10 patients, but return was incomplete in 2 patients more than 1 year after surgery. Postoperative routine and special audiometric studies are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.