Biomedical subjects

A Taibah

Publications and source records attributed to A Taibah.

At least 37 records · Page 2Linked to original sources

PubMed1998

Myringoplasty in children: factors influencing surgical outcome.

Age, size, and site of perforation, condition of the ear, status of the contralateral ear, grafting materials, and more are considered factors influencing the success rates in myringoplasties in children. The ambivalence in results is mainly due to nonhomogeneous patient groups. In an effort to compose groups as homogeneous as possible for analysis of influencing factors, a retrospective study of 51 pediatric myringoplasty cases (51 ears) was undertaken. All patients had perforations caused by simple chronic otitis media. The overall surgical success rate was 82.3% at 18 months, and for young (5 to 10 years) and older (11 to 16 years) children it was 77.2% and 86.2%, respectively. Anterior, central, and total perforations healed without significant differences. Outcome in unilateral perforations was better than bilateral: 96.9% and 55%, respectively (p < 0.01). Discharging ears (100%) healed better compared with dry ears (75%) (p < 0.05). Analysis of the literature also revealed significant difference in success rates of discharging and dry ears: 92.5% and 80.6%, respectively (p < 0.01). We conclude that, contrary to comments in the literature, discharging ears in children favor good outcome and they should be operated on regardless of age and site of perforation. However, in bilateral perforations results may not be so rewarding.

Adolescent↗

PubMed1998

The system of the modified transcochlear approach: a lateral avenue to the central skull base.

OBJECTIVE: This study aimed to update the authors' experience with the modified transcochlear approach for the management of lesions of the central skull base. The surgical technique, classification, indications, and results also are presented. STUDY DESIGN: A retrospective review of the charts of 66 consecutive patients treated in our centers by the modified transcochlear approach was conducted. SETTING: The study was performed in two tertiary referral centers. PATIENTS: All patients treated by the modified transcochlear approach were included. Thirty-five patients had extradural lesions, whereas 31 lesions were intradural. INTERVENTION: All patients were treated surgically using the modified transcochlear approach either in its basic form (type A) or with its extensions (types B, C, and D). MAIN OUTCOME MEASURES: The outcome of surgery is evaluated with particular emphasis on the incidence of morbidity, mortality, and the degree of total tumor removal. RESULTS: Total tumor removal was accomplished in 58 cases either in single or staged procedures. A second-stage procedure for total tumor removal is planned in five other patients. Subtotal tumor removal was performed in three patients. Mortality occurred in two cases. Ipsilateral hearing loss and immediate facial nerve palsy constituted the major drawbacks of this approach. However, 67.5% recovered to grade III facial function or better 1 year after surgery. CONCLUSIONS: The modified transcochlear approach provides a relatively safe, wide, and versatile access to large lesions of the central skull base.

Adolescent↗

PubMed1998

[Cerebrospinal fluid leak after translabyrinthine approach in acoustic neuroma excision].

Cerebrospinal fluid (CSF) leak is one of the most dangerous complications that can arise in cases of acoustic neuroma removal. It increases the risk of meningitis, requires longer postoperative recovery and often requires revision surgery. A retrospective analysis was performed on all cases of acoustic neuromas which had undergone translabyrinthine surgery at the Gruppo Otologico, Piacenza, Italy, between April 1987 and December 1997, in the aim of finding the causes of postoperative CSF leaks. The causes found were high pneumatization of the temporal bone and improper execution of some surgical steps. The technique has presently been modified on the basis of the experience gained from cases of CSF leaks. By scrupulously applying these modifications, from July 1994 to December 1997, a total of 160 patients were consecutively treated using the translabyrinthine approach without a single case of postoperative CSF leak. Routine use of this modified technique can and must lower the percentage of CSF leaks after a translabyrinthine surgery to nearly 0%.

Adolescent↗

PubMed1997

Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: is it necessary?

Chronic suppurative otitis media (CSOM) without cholesteatoma, the surgical treatment of which is still controversial, is a common diagnosis in otologic practice. A retrospective analysis of 323 patients who underwent surgery for noncholesteatomatous chronic otitis media in the Gruppo Otologica, Piacenza, Italy, between April 1983 and December 1993 is presented. Cases were separated into three groups according to different surgical treatment modalities and conditions of the ears at the time of operation. Group I (n = 53) consisted of cases of CSOM treated by tympanoplasty without mastoidectomy (TLWOM). Group II (n = 28) included cases of CSOM treated by tympanoplasty with mastoidectomy (TLWM). Intact canal wall technique was used in these cases. The ears in both these groups were discharging severely at the time of surgery. Group III (n = 242) included patients whose ears were dry at the time of surgery but who had had previous recurrent episodes of suppuration and who were treated by TLWOM. At the last follow-up, graft success rates for groups I, II, and III were 90.5%, 85.7%, and 89.2%, respectively, and mean residual gaps were 17.2 dB, 20.1 dB, and 19.4 dB, respectively. There was no statistically significant difference between the three groups either on graft success rates (p > 0.05) or on final functional hearing outcome (p > 0.05). TLWM is the preferable treatment modality for most surgeons in noncholesteatomatous CSOM. Nevertheless, in our experience TLWOM yields comparable results for this group of patients. In addition, we could not find any significant difference in results of graft success and final functional hearing rates between dry and discharging ears (p > 0.05).

Adolescent↗

PubMed1997

Clinical observations on coexistence of sudden hearing loss and vestibular schwannoma.

It has long been recognized that sudden hearing loss (SHL) may be a harbinger of vestibular schwannoma (VS). Among 192 VS patients who underwent operation in the Gruppo Otologico, Piacenza, Italy, from April 1987 to October 1995, the charts of 14 (7.3%) cases with a history of SHL were examined. SHL was the first symptom in 8 (4.2%) patients. Eight (57.1%) of 14 VS cases with SHL anamnesis had reported recovery of their previous hearing either totally or partially before establishment of tumor diagnosis. Five (35.7%) cases had recurrent bouts of SHL. SHL was observed less frequently in cases with large tumors (>3 cm). However, the frequency of SHL in patients with small tumors did not differ from that of medium-sized tumors. Awareness about coexistence of SHL and VS, as well as concomitant use of auditory brain stem response and magnetic resonance imaging, is crucial to rule out the diagnosis of VS in a patient with SHL.

Adult↗

PubMed1997

Anatomical considerations of high jugular bulb in lateral skull base surgery.

In order to study high jugular bulb management in lateral skull base surgery, an anatomical study was conducted on 30 temporal bones by examining the relationship between the internal auditory canal (IAC) and the jugular bulb. The following parameters were measured: 1) Height of the jugular bulb (H)... distance between the level of jugular bulb dome and the line passing through the confluence of the sigmoid sinus with the jugular bulb (SS-JB), 2) Mastoid length (ML)... distance between the mastoid process and middle cranial fossa dura, 3) Distance between the most inferior part of the porus acousticus and jugular bulb dome (A), 4) Distance between the porus acousticus and SS-JB (B). The jugular bulb was defined as high when it occupied more than two thirds of (B). The incidence of a high jugular bulb was 23 per cent in this study. When the jugular bulb was high, the mean (H) and (A) were 9.4 +/- 1.9 mm and 2.7 +/- 0.5 mm, respectively. (H) was higher on the right side than on the left side. No statistically significant difference was found between small and large mastoids (t-test: p > 0.05). It was concluded that when a high jugular bulb was encountered during lateral skull base surgery, the jugular bulb position allows a very small working area inferior to the IAC. In these cases, a 3 or 4 mm depression of the jugular bulb is necessary in order to expose the lower cranial nerves. This can be accomplished by lowering the jugular bulb with the technique already described.

Humans↗

PubMed1997

[Modified Body technique in the treatment of epithympanic cholesteatoma. Otologic group, Piacenza].

The Bondy technique is a particular radical, yet conservative, treatment where the intact tympanic-ossicular system is preserved during the operation. This technique was initially introduced by Gustave Bondy in 1910 and has been used at the authors' center since December 1983 with a few modifications. In the twelve years from December 1983 to December 1995 69 cases (66 patients) were treated with this technique: 5.6% of all chronic cholesteatomatose otitis surgically treated during that period. The following indications were applied: purely epitymapnic cholesteatoma, average transmission gap equal to or lower than 25 dB and intact bone chain. During the follow-up no signs of recurrent cholestatoma were found. The average post-operative transmission gap was greater than 25 dB in only 5 of the 54 cases with at least one year of follow-up. When used in selected cases, the modified Bondy technique can be considered an excellent option in the treatment of epitympanic cholesteatoma, making it possible to maintain the good pre-operative hearing without requiring a second operation.

Adult↗

PubMed1997

[Lateral approaches to the clivus].

Thanks to ongoing development in microsurgical techniques to treat the skull base some clivus lesions, considered inoperable until a few years ago, can now be removed with relatively low mortality and morbidity. The approaches available for the treatment of lesions in this anatomical area can be broken down into anterior and lateral. The latter offer the surgeon several important advantages such as better control over the main vascular structures and the possibility of opening the intradural space without coming into communication with the pharynx. By virtue of their extreme versatility, the lateral approaches may be used in combination in a single operation or can be performed as staged procedures. Each of the lateral routes, however, has its own advantages and drawbacks. These are presented during a brief description of each technique. The main factor in selection of approach is the anatomical limits of the approach itself. Generally speaking, the largest surgical field is offered by the most destructive approaches. Although they do cause such deficits as unilateral hearing loss, these approaches permit greatly improved control over the vital structures. Nevertheless, when such deficits exist prior to surgery, the morbidity of such approaches is negligible. The histological nature of the disease, the variable relationships with the dura, the main neurovascular structures and other factors should all be considered when deciding how to manage each case. The surgeon must, however, have the range of skills required to perform the diversity of approaches to the lateral skull base so as to provide the patient with the best possible care.

Adult↗

PubMed1996

Anatomical relationship between position of the sigmoid sinus and regional mastoid pneumatization.

In order to examine the relationship between the location of the sigmoid sinus (SS) and mastoid pneumatization, 25 adult temporal bones were dissected. Pneumatization was evaluated according to findings during dissections of three separate regions of the mastoid: i.e., the sinodural angle (SDA) area, inter-sinofacial area and mastoid apex. In addition, the SDA and distance between the SS and vertical portion of the facial nerve, were measured at the second genu (G) of the facial nerve, the junction (J) of the nerve and digastric ridge and the midpoint between G and J.A good correlation was observed between pneumatization of the cells surrounding the SDA and the distance between the SS and facial nerve at the mid-point of its vertical segment. However, pneumatization of the inter-sinofacial air cell tract could not be correlated with this distance. A significant decrease in the values of the SDA was found when the air cells surrounding the SDA were poorly pneumatized. This study indicated a correlation between the position of the SS and pneumatization of the mastoid in the area of the SDA.

Adult↗

PubMed1996

Vestibular schwannoma and the only hearing ear.

With the recent advances in the management of vestibular schwannomas, it is possible not only to save the facial nerve function but also preserve hearing in a small percentage of cases. Difficulties arise while managing patients with vestibular schwannoma in their only hearing ear. In this article we summarize our experience in managing seven of these patients. We recommended a watch and wait policy with a regular follow-up with audiometric testing and gadolinium-enhanced magnetic resonance imaging (MRI). Gamma knife radiosurgery is advised in cases with deterioration of hearing or increase in tumour size. Surgery is usually avoided unless there are brainstem compression symptoms.

Adult↗

PubMed1996

[Vestibular neurectomy by retrolabyrinthine approach in cases of untreatable Meniere's disease].

We report on a series of 35 Ménière's disease patients, all of whom had undergone retrolabyrinthine vestibular neurectomy between 1987-1993. The overall success rate of vertigo relief was 96.7% with no serious or permanent complications resulting from the procedure. The current literature is reviewed and our results are compared with those of previous reports. The technical elements of the operation, regarding our approach and those of the others are analyzed with special attention given to the anatomical features of the region and their influence on success or failure. We conclude that the retrolabyrinthine approach for nerve section remains a safe and highly successful technique which continues to be widely used.

Adult↗

PubMed1995

Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery.

Cerebrospinal fluid leakage is the most common complication of translabyrinthine acoustic neuroma surgery. This retrospective study reviews patients who had translabyrinthine acoustic neuroma surgery at the Gruppo Otologico, Piacenza, Italy, and ENT Department of Bergamo General Hospital, Bergamo, Italy, during the last 6 years. The incidence of postoperative cerebrospinal fluid leakage was 6.2%, and 75% of these patients underwent another surgery to control the cerebrospinal fluid leakage. A modification of translabyrinthine approach was used in patients with highly pneumatized temporal bones to prevent cerebrospinal fluid leakage in these high-risk patients.

Adolescent↗

PubMed1995

Benign osteoblastoma of the mastoid part of the temporal bone: case report.

Osteoblastoma is a benign bone lesion that mainly affects the long bones and rarely the temporal bones. Very few cases have been reported in the literature. This paper reviews the literature, discusses the differential diagnosis, clinical presentation, and CT scan findings of such a condition and details our experience with a young patient who had a temporal bone (mastoid process) osteoblastoma.

Adolescent↗

PubMed1995

Canal wall down mastoidectomy: causes of failure, pitfalls and their management.

Managing patients with failed canal wall down mastoidectomy, requires a meticulous approach to control the disease and restore hearing. The present article reviews the causes of failure of the primary procedure and pitfalls encountered in 105 patients referred to our centre for revision canal wall down mastoidectomy. At post-revision surgery there were no cases with residual or recurrent cholesteatoma. The failures in our revision procedure were due to tympanic membrane perforation which occurred in five per cent (n = 4) and intermittent otorrhoea in two per cent (n = 2). A dry cavity with adequate middle ear space allowed for optimum audiological function even in revision canal wall down procedures.

Adolescent↗

PubMed1995

Intratemporal hemangiomas involving the facial nerve: diagnosis and management.

Intratemporal vascular tumors involving the facial nerve are rare benign lesions. Because of their variable clinical features, they are often misdiagnosed preoperatively. This study presents a series of 21 patients with such lesions managed from 1977 to 1994. Facial nerve dysfunction was the most common complaint, present in 60% of the cases, followed by hearing loss, present in 40% of cases. High-resolution computed tomography, magnetic resonance imaging with gadolinium, and a high index of clinical suspicion is required for preoperative diagnosis of these lesions. Early surgical resection of these tumors permits acceptable return of facial nerve function in many patients.

Journal Article↗

PubMed1995

An easy, cost-effective and time-conserving method of studying the vascular anatomy of the base of the skull.

In this work we present a simple, rapid, cost-effective and time-conserving method of studying the vascular anatomy of the base of the skull. This method is based on the injection of the arteries and veins with an appropriate coloring solution that possesses the property of rapid solidification. This technique of preparation of the coloring solution and the method of injection is described in detail. The advantages and disadvantages of this technique are also discussed.

Journal Article↗

PubMed1995

Cholesteatoma surgery: the individualized technique.

A retrospective analysis of 433 cholesteatoma cases, surgically treated at the Gruppo Otologico, Piacenza, Italy, over a 7-year period, is reported. The purpose of this study was to delineate actual indications for individualizing open and closed procedures and to compare their results as regards residual or recurrent disease and hearing. The total incidences of residual and recurrent cholesteatoma in the open cavity procedures were 10% and 2.38%, respectively, while the closed procedures showed higher incidences of residual and recurrent cholesteatoma: 31.22% and 11.16%, respectively. The problem of a persistently discharging cavity was encountered in only 1 case of an open procedure, while 2 patients had persistent otorrhea among the closed cavity cases. The hearing results, although slightly better in the closed procedures, were not significantly different from those in the open procedures.

Adolescent↗

PubMed1995

Meningoencephalic herniation into the middle ear: a report of 27 cases.

Meningoencephalic herniation into the middle ear is a rare and potentially life-threatening condition that may require prompt surgical intervention. Preoperative diagnosis is based on a high index of suspicion. Sometimes, however, meningoencephalic herniation is discovered during surgery. High-resolution computed tomography and magnetic resonance imaging should be performed to confirm the diagnosis and to evaluate the extension of the herniated tissue. This article discusses the diagnostic approach, management strategy, and surgical technique used in 27 patients with meningoencephalic herniation. In an attempt to avoid infective complications, the authors used the middle cranial approach in patients with large herniations.

Adult↗