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D Bouccara

Publications and source records attributed to D Bouccara.

54 records · Page 3Linked to original sources
PubMed1998

[Intra-labyrinthine schwannomas: a report of two cases].

Intralabyrinthine schwannomas are rare tumors of vestibule, cochlea, semicircular canals, or some combination of these three. In the past, they have been found at autopsy or as incidental finding at surgery. Since the advent of magnetic resonance imaging (MRI) with intravenous gadolinium contrast, the preoperative diagnosis is possible. We report two cases of intralabyrinthine schwannoma: one case of intralabyrinthine schwannoma extended into the internal auditory canal (IAC), a second case of tumor restricted to the vestibule. No characteristic clinical presentation of this tumor is reported in the literature. In patients with vestibular weakness (vertigo and no response of caloric testing), MRI with gadolinium contrast can make the diagnosis of intravestibular tumor. In patients with the more common IAC acoustic neuromas, MRI can demonstrate extension of tumor into the labyrinth; diagnosing this extension preoperatively is important to plan surgical treatment.

Adult↗
PubMed1998

[Treatments of idiopathic sudden sensorineural hearing loss: retrospective study of 144 cases].

In this report of a retrospective study of 144 cases of idiopathic sudden hearing loss, two important prognostic indicators appear: the elapsed time since the onset of symptoms and the degree of hearing loss. According to these indicators, the authors define three group of patients with a recovery rate of 65%: patients with a threshold hearing level of less than 40 dB, treated within two months of the onset of their hearing loss, patients with a threshold hearing level between 40 and 70 dB treated within one month and patients with a threshold hearing level of more than 70 dB treated within 7 days. Patients with a threshold hearing level of more than 70 dB, treated between 7 and 30 days, have only a partial recovery in 40%. The evaluation of efficacy of various treatment demonstrates a slight improvement of the hearing loss using steroids associated to vasodilatators, even if no significant difference is found between the different therapies. The normovolemic hemodilution and the treatment included mannitol seem to be ineffectual.

Adult↗
PubMed1998

[Management of intracanalicular acoustic neurinoma].

Between 1991 and 1996, 35 patients had an intracanalicular tumor: 26 patients were operated via middle cranial fossa approach (MFA: 23 cases) or translabyrinthine approach (TL: 3 cases), 9 cases were supervised by audiovestibular testing and MRI. For the operated patients through MFA the functional hearing (pure tone loss < 50 dB and 100% vocal discrimination) was preserved in 47.8% of cases, facial function was grade I and II in 83% of cases and grade III in 17% of cases. One recurrence was noted and reoperated by TL. For the TL operated patients, the postoperative facial function was normal (grade I) in all cases. Among the 9 supervised cases for reasons of age (more than 60 years), or the tumoral size (< than 5 mm): the tumor in 3 cases did not increase in size, 5 cases increased by 1 mm/year and 1 case increased 1 cm/year (and must be operated). These results show the importance of the middle cranial fossa approach for excision of intracanalicular neuromas and supervising patients with the same tumor according to age, and tumoral size.

Adolescent↗
PubMed1997

[Intratemporal surgery of the facial nerve. Apropos of 34 cases].

The results of facial nerve surgery in the temporal bone have been evaluated in a review of 34 cases (19 decompressions and 15 reparations). Decompressions of immediate and complete facial paralysis by fracture of the temporal bone that have achieved a good motor recovery resulted from early surgery before the 21st day (50% of grades I and II, 50% of grades III). After this delay, facial recovery did not reach grades I and II any longer. In case of nervous interruption of traumatic origin or after tumoral ablation, direct restoration of continuity by an intermediary grafting fixed with fibrin glue enabled the recovery of a facial function of grade III in 87.5% of the cases. These results point out the importance of an early exploration of traumatic facial paralysis before the end of the third week, and the interest of using a cable graft fixed with fibrin glue to repair directly the facial nerve.

Adolescent↗
PubMed1997

[Chondroblastoma of the temporal bone. Apropos of a case].

A case of temporal bone chrondroblastoma is reported. The presenting symptom was a serious otitis. The finding on physical examination was partial facial palsy. The tumor was removed through a middle fossa approach. Chondroblastoma is a rare tumor that represents 1% of all primary bone tumors. In the temporal bone only 34 cases have been reported. The histologic diagnostic should be difficult. Radical excision is suggested regarding its tendency to recur.

Adult↗
PubMed1997

[Trans-petrous surgery in acoustic neuroma. Value of preoperative audiovestibular and facial investigation in the risk evaluation of facial nerve function].

Between 1987 and february 1994, 162 consecutive patients with acoustic neuroma were operated on by an otoneurosurgery team, using transpetrous approaches (89% translabyrinthine, 8% middle fossa and 3% retrosigmoid). The relationship between the clinical, audiometric and vestibulographic characteristics and the post-operative facial nerve function were evaluated. In acoustic neuromas with cerebello-pontine component inferior to 3 cm without central neurologic signs (ic: central controlateral auditory and/or ipsilateral vestibular pathway alteration), good post-operative facial nerve function was achieved in 80% of cases. In acoustic neuromas superior to 3 cm with alteration of the central vestibular and auditory pathways, a good result was obtained in only 30% of cases which correlated negatively with preoperative facial dysfunction. These results underline the value of preoperative facial and audiovestibular examinations in predicting the postoperative facial nerve function following surgery for acoustic neuroma.

Adolescent↗
PubMed1996

[Sudden deafness disclosing acoustic neuroma. Apropos of 16 cases].

We performed a retrospective review of the audiologic, radiologic and clinical data on 239 patients operated on for acoustic neuroma from 1987 to 1995 at Beaujon Hospital. In 16 patients or 6.6% of the total group, we identified as having experienced sudden hearing loss by history. The 16 tumors involved were 1 stade I; 8 stade II, 5 stade III and 2 stade IV. In 14 cases, the tumor was removed by translabyrinthine approach, 1 case by masto-retrosigmoid approach and 1 case by middle fossa approach. The hearing was preserved in the two latter cases. The purpose of this study is to illustrate and reaffirm the importance of a thorough neurotologic evaluation and to discuss the diagnostic methods in this select patient population.

Adult↗
PubMed1995

[Surgical treatment of vertigo induced by jugular bulb diverticulum].

The position of the jugular bulb is extremely variable. A high jugular fossa with a diverticulum of the jugular bulb can alter the inner ear function with sensorineural hearing loss, vertigo and tinnitus. Nine cases of jugular bulb diverticulum with vertigo mimicking Menière's disease were operated on and followed up from 3 months to 4 years. Eight patients were treated surgically. The jugular bulb was approached through a mastoïdectomy and the diverticulum was compressed downwards using bone wax. The vertigo disappeared after surgery in all cases. These observations suggest that an abnormally of the jugular bulb should be considered as a possible symptom of Ménière's disease and that vertigo can be cured by downward compression of the diverticulum.

Aged↗
PubMed1995

[Malignant tumors of the petrous bone. Apropos of 25 cases].

Twenty five cases of malignant tumors of the petrous bone are presented. Prognosis depends on the histology and on the local invasion which dictate the possibility of curative surgery. Squamous cell carcinoma of the middle ear and other invasive tumors have a bad prognosis, and in spite of the progress of modern image technology, the peripetrous extension of the tumors are often underestimated. Actuarial two years survival for squamous cell carcinoma was 38%. Total excision needs at least a subtotal petrous resection with, in some cases meningal and internal carotid resection. In all cases, surgery was followed by radiation. Low grade malignant tumors had a better prognosis and required a more limited resection. In these cases, when necessary, facial nerve can be repaired by a cable graft at the time of initial surgery.

Adolescent↗
PubMed1993

[Jugular bulb diverticulum mimicking Menière's disease. Surgical treatment].

The position of the jugular bulb is extremely variable. A high jugular fossa with a diverticulum of the jugular bulb can alter the inner ear function with neurosensory hearing loss, vertigo and tinnitus. Six cases of jugular bulb diverticulum with vertigo mimicking Meniere's disease were operated on and followed up from 6 months to 4 years. The jugular bulb was approached through a mastoidectomy and the diverticulum was decompressed downward using bone wax. The vertigo disappeared after surgery in all the cases. These observations suggest that an abnormality of the jugular bulb should be considered as a possible origin of Meniere's disease and that vertigo can be cured by downward decompression of the diverticulum.

Adult↗
PubMed1991

[Diagnostic strategy of acoustic neuroma. Evaluation of efficacy of auditory evoked potentials. Apropos of a series of 50 neuroma cases].

The authors carry out a retrospective study of the diagnostic procedures used in a series of 50 acoustic neuromas. AEP were performed for thirty-four neuromas at some stage of their history. The findings were perfectly normal for eight of them, which represents a sensitivity level of 76%. Various elements likely to account for this are put forward, then the role of AEP and MRI in the diagnostic strategy for neuroma is discussed in the light of this study. Finally, the authors emphasize the necessity to regularly evaluate the diagnostic methods in order to guarantee their quality and reliability.

Evoked Potentials, Auditory↗
PubMed1989

[Complete tumor remission after chemotherapy. What should be done?].

When confronted with complete chemotherapy-induced histological/clinical regression of a tumor, should the initial therapeutical strategy be modified? Such situations occur more and more frequently. Additional treatment must be carried out in all instances. Indeed, a correlation between complete clinical and histological regression was demonstrated in 66% of cases by histological examination of surgical specimens. It is doubtless recommended to avoid mutilating surgery and to continue chemotherapy for another year. However, whenever partial surgery had been programmed initially, the same indications and excision limits should be maintained. Combination chemical and surgical treatments yield better local results. Nonetheless, this is not always the case and the patient's tolerance to chemotherapy and background should influence the final decision. Radiotherapy then constitutes a choice alternative.

Adult↗
PubMed1989

[The Chinese flap in reconstructing the posterior pharyngolaryngeal wall, mouth cavity and in reoperation after failure of pedicled digestive transfer].

The Chinese flap has already been recommended in the context of circular pharyngolaryngectomy. The authors studied its vascularization from an anatomy-focusing project carried out on 40 dissection cases. They broaden the applications of this material to posterior reconstructive pharyngectomy, for which they specify the methods and routes of access. Other applications are proposed: this flap may represent an alternative for reconstitution of the oral cavity, or even as a second-intent surgical procedure where other technics have failed.

Adult↗
PubMedDate not supplied

Inner ear pressure in Menière's disease and fluctuating hearing loss determined by tympanic membrane displacement analysis.

Menière's disease and fluctuating hearing loss are related to labyrinthine fluid pressure variations. The development of a new indirect method of analysis of the tympanic membrane displacement during the stapedial reflex, using the Marchbanks Measurements System (MMS 10), allows us to study inner ear fluid pressure during these pathological conditions. In this study, measurements with this method were made in four groups of patients: a control group with normal hearing (n=7), stable sensorineural hearing loss (n=9), fluctuating hearing loss (n=8), and Menière's disease (n=25). Results show, first, a good relationship between the recording of negative curves, suggesting a high pressure, and the acute episodes of fluctuating hearing loss; and, secondly, in the case of Menière's disease two types of situation: positive and negative curves suggesting normal and high pressures, respectively.

Adult↗
PubMedDate not supplied

Nucleus 21-channel auditory brainstem implant in patients with previous tumour removal.

Three patients with neurofibromatosis type 2 who had undergone previous cochlear nerve tumour removal were implanted with the Nucleus 21-channel auditory brainstem implant (ABI). The time intervals between tumour removal and implantation were 4, 5, and 7 years, respectively. Total bilateral deafness was confirmed before implantation. One patient was also blind after acute intracranial hypertension. The translabyrinthine approach was used in all cases. The choice of side for implantation depended on pre-operative magnetic resonance imaging study, the facial nerve function, the presence of recurrent and/or other lesions, and the patient's preference. Although the scarring of prior surgical procedure largely changed the anatomical structures in the cerebello-pontine angle, various landmarks could be found to locate the foramen of Luschka, where the ABI electrode was inserted into the lateral recess of the fourth ventricle. During surgery, the electrically evoked auditory brainstem responses were recorded to confirm that the ABI stimulation activated the auditory system; the electromyogram of the 7th and 9th nerves was helpful in finding the landmarks and minimising the triggering of the cranial nerves with ABI stimulation. The number of active electrodes was 21, 7, and 4 in the three patients. All obtained meaningful pitch scaling and useful auditory sensations. One patient, with 21 activated electrodes, has achieved functional open-set speech understanding. The second patient, with 7 activated electrodes, has benefited from environmental sound awareness and improved lipreading. The last, blind, patient, with 4 electrodes activated, achieved only perception of environmental sounds.

Adult↗