RESUMO
OBJECTIVES/HYPOTHESIS: To investigate the cochleovestibular apparatus bilaterally in children with isolated unilateral bony cochlear nerve canal (bCNC) stenosis. STUDY DESIGN: Retrospective review. METHODS: Imaging studies of children with unilateral bCNC stenosis (<1.0 mm) on computed tomography imaging (N = 36) were compared with controls imaged due to trauma without temporal bone injury (N = 32). Twenty-six measurements were obtained in each ear, assessing the bony internal auditory canal (IAC), cochlea, and vestibular end-organs, and were analyzed using one-way analysis of variance for intersubject comparisons and paired t tests for intrasubject comparisons with a Bonferroni adjustment for multiple comparisons (P = .0006). RESULTS: Patients with bCNC stenosis had a smaller IAC (P < .000) and cochlea (P < .000) on the stenotic side as compared with controls. Although the vestibular end-organ was also smaller in bCNC ears, this difference was not significant. The contralateral ear also had a smaller bCNC (P < .000) and cochlea (P < .000) as compared with controls, although to a lesser degree than the stenotic side. CONCLUSIONS: Children with unilateral bCNC stenosis have abnormal biometry of both the cochlea and the vestibular end-organ in the affected and the normal contralateral ear as compared with controls. LEVEL OF EVIDENCE: 3b Laryngoscope, 129:2403-2408, 2019.
Assuntos
Cóclea/anormalidades , Nervo Coclear/patologia , Tomografia Computadorizada por Raios X , Vestíbulo do Labirinto/anormalidades , Doenças do Nervo Vestibulococlear/patologia , Criança , Pré-Escolar , Cóclea/diagnóstico por imagem , Nervo Coclear/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Vestíbulo do Labirinto/diagnóstico por imagem , Doenças do Nervo Vestibulococlear/congênito , Doenças do Nervo Vestibulococlear/diagnóstico por imagemRESUMO
OBJECTIVES: To report a case of multifocal fibrosclerosis with a nine-year follow up, and to discuss this disease's radiological appearance and management. The disease is a rare systemic disorder of unknown cause characterised by fibrous proliferation involving multiple anatomical sites. CASE REPORT: A 50-year-old woman presented with histological findings characterised by similar inflammatory processes involving the meninges, pituitary gland, peritoneum, retroperitoneum and orbits, prompting a search for a common pathophysiology. A diagnosis of multifocal fibrosclerosis was postulated. Symptom improvement was noted after treatment with prednisone and azathioprine. CONCLUSION: This is the first documented case of involvement of the cochleovestibular nerve in a patient with multifocal fibrosclerosis. The rare association between fibrotic diseases and masses showing various clinical patterns should be kept in mind by otolaryngologists, and imaging performed to investigate for multifocal fibrosclerosis. However, diagnosis can only be confirmed with tissue biopsy and histopathological examination.
Assuntos
Meningite/patologia , Fibrose Retroperitoneal/congênito , Transtornos de Sensação/complicações , Doenças do Nervo Vestibulococlear/patologia , Azatioprina/uso terapêutico , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Meningite/complicações , Meningite/diagnóstico , Pessoa de Meia-Idade , Doenças Orbitárias/complicações , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/patologia , Prednisona/uso terapêutico , Radiografia , Recidiva , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/patologia , Fibrose Retroperitoneal/terapia , Convulsões/complicações , Transtornos de Sensação/patologia , Sinusite/complicações , Doenças do Nervo Vestibulococlear/complicaçõesRESUMO
OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.
Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Craniotomia/normas , Neuroma Acústico/cirurgia , Decúbito Dorsal , Doenças do Nervo Vestibulococlear/cirurgia , Nervo Vestibulococlear/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Craniotomia/métodos , Dura-Máter/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Microcirurgia/normas , Neuroma Acústico/patologia , Retalhos Cirúrgicos/patologia , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento , Nervo Vestibulococlear/patologia , Doenças do Nervo Vestibulococlear/patologiaRESUMO
OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99 percent of the cases, with a mortality of 1.6 percent. The facial nerve function was preserved in 85 percent of cases and hearing in 40 percent of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8 percent and meningitis 2.9 percent. Venous air embolism was registered in 3 percent of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.
OBJETIVO: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). MÉTODO: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. RESULTADOS: A exérese foi completa em 99 por cento dos casos, com mortalidade de 1,6 por cento. Houve preservação da função do nervo facial em 85 por cento dos casos e da audição em 40 por cento dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8 por cento e meningite 2,9 por cento. Embolia gasosa foi registrada em 3 por cento dos casos, não associada à mortalidade. CONCLUSÃO: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade.