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Biomedical subjects

D E Brackmann

Publications and source records attributed to D E Brackmann.

At least 91 records · Page 5Linked to original sources
PubMed1992

Translabyrinthine approach for acoustic tumor removal.

The translabyrinthine approach is the most direct route to the cerebellopontine angle. It is the preferred approach for removal of all tumors in patients with poor hearing and for large tumors when the likelihood of hearing preservation is slight. This approach offers the advantages of minimum cerebellar retraction, identification of the facial nerve proximally and medially, and the ability to repair immediately the facial nerve if it is severed during acoustic tumor removal. This approach has the lowest morbidity with regard to spinal fluid leaks and also postoperative headaches.

Contraindications↗
PubMed1991

Cochleosacculotomy revisited. Long-term results poorer than expected.

Cochleosacculotomy has been described as a simple, efficacious treatment for relief of vertigo in patients with Meniere's disease in whom medical therapy has failed. We reviewed records of 11 elderly patients with good vestibular function who were thought to be ideal candidates for this procedure. Average follow-up was 17 months. Contrary to previous reports, long-term control of vertigo was poor, and more than 80% of the patients suffered a significant hearing loss from this procedure. Four of 11 patients required a second surgical procedure to control their vertigo. Audiometric measures revealed statistically significant postoperative increases in puretone thresholds at all frequencies and speech reception threshold, and a decrease in discrimination scores. Based on the results of this study, we no longer plan to use cochleosacculotomy for the treatment of elderly patients with Meniere's disease.

Adult↗
PubMed1991

Transcanal infracochlear approach to the petrous apex.

Computerized tomography and magnetic resonance imaging have now made it possible to reliably differentiate cholesteatoma from cholesterol granuloma of the petrous apex. The treatment for cholesteatoma is complete surgical excision when possible, whereas cholesterol granuloma needs only adequate drainage for control. A new transcanal infracochlear approach for drainage of cholesterol granuloma involving the anterior petrous apex is described. Absolute measurements from 10 cadaveric temporal bones were obtained to determine the distances between the cochlea, jugular bulb, carotid artery, and facial nerve. In all specimens the petrous apex was entered without invading the cochlea, carotid, or jugular bulb. Advantages of this technique include a more direct route to the petrous apex, dependent drainage, and preservation of the normal hearing mechanism, including the tympanic membrane. Clinical indications for this technique include failure of other treatment approaches and a high jugular bulb obstructing an infralabyrinthine approach. Experience to date shows that patients experience little difficulty from the procedure.

Adolescent↗
PubMed1991

Intratemporal facial nerve hemangiomas.

Facial nerve hemangiomas are benign vascular tumors that arise within the temporal bone and have a histologic appearance similar to both cavernous hemangiomas and vascular malformations. In contrast to facial nerve schwannomas, these are extraneural tumors that cause symptoms by compression and tend to produce deficits when very small in size. We report our experience at the House Ear Clinic with 34 patients having these nonglomus intratemporal vascular tumors. Hemangiomas arising in the internal auditory canal tend to produce a progressive sensorineural hearing loss and are demonstrated with magnetic resonance imaging (MRI), whereas those at the geniculate ganglion are usually first seen with facial nerve symptoms and may require high-resolution computerized tomography (CT) for detection. Facial electromyography is helpful in establishing the diagnosis. Because of their extraneural nature, early diagnosis can permit removal of the tumor with preservation of facial nerves in some patients.

Adult↗
PubMed1991

Intraoperative facial nerve monitoring: prognostic aspects during acoustic tumor removal.

Intraoperative facial nerve monitoring with electrical stimulation (IFNMES) has become an integral part of acoustic tumor surgery. We reviewed the records of fifty-six patients who underwent translabyrinthine acoustic tumor removal with IFNMES. There was excellent correlation between intraoperative facial nerve activity and immediate postoperative facial nerve function (24 hours after surgery and at hospital discharge). Our data would suggest that patients who exhibit less than 500 microvolts of ongoing EMG activity during surgery, and who yield at least a 500-microvolt contraction when stimulated with 0.05 milliamps at the brainstem after tumor removal, can expect an excellent immediate facial nerve result (grade I or II).

Ear Neoplasms↗
PubMed1991

Lipomas of the internal auditory canal.

Intracranial lipomas are rare tumors which may occur in the cerebellopontine angle (CPA) or internal auditory canal (IAC). Although seemingly innocuous in other parts of the body, lipomas within the CPA and IAC often involve the surrounding cranial nerves, making attempts at hearing conservation largely unsuccessful. In an attempt to differentiate the IAC lipoma from the more commonly found acoustic schwannoma, the preoperative imaging studies (magnetic resonance and computerized tomography) on five previously unreported cases of IAC lipomas were evaluated. Based on these studies, features were determined that may allow the surgeon to diagnose IAC lipomas preoperatively. These features will be discussed, as well as the surgical and pathological findings.

Adult↗
PubMed1991

Glomus tympanicum tumors: a clinical perspective.

Since Guild first discovered glomus bodies in the middle ear, the diagnostic evaluation and therapy of glomus tympanicum tumors have remained challenging. This study describes 73 cases diagnosed as glomus tympanicum tumors over the past 30 years. During this period, imaging techniques have markedly improved, and surgical approaches have evolved and been refined. These 73 cases were reviewed from a clinical perspective involving presentation, diagnostic evaluation, and therapeutic management. Pulsatile tinnitus was the primary symptom in over half the patients, followed by hearing loss in one third. The physical exam rarely revealed a circumferential view of the lesion, emphasizing the necessity of further diagnostic evaluation. High-resolution computerized tomography (CT) is currently the radiographic study of choice. A transmastoid surgical approach with extended facial recess was most commonly employed. Extension to the jugular bulb or internal carotid was rare, and no intraoperative complications of catecholamine secretion were noted. Postoperative complications were few, and the overall residual/recurrence rate was less than 5%. Additional clinical insights may assist in the management of these rare but fascinating tumors.

Adult↗
PubMed1991

Acoustic neuroma: surgical approaches and complications.

Acoustic neuroma is the commonly used term for benign schwannomas arising from the vestibular divisions of the eighth cranial nerve. They are relatively common lesions and present a therapeutic challenge. Three approaches are used for removal of acoustic neuromas: middle fossa, retrosigmoid, and translabyrinthine. Each approach has advantages and disadvantages. The advantage of the middle fossa and retrosigmoid approaches is the possibility of preserving hearing. Both require more brain retraction and have greater risk to the facial nerve than the translabyrinthine approach. The translabyrinthine approach sacrifices hearing but has lower incidence for all other complications. The details of each of these surgical approaches are described. The advantages and disadvantages of each approach are detailed, and then the complications which are common to the procedures are described.

Female↗
PubMed1991

Differential diagnosis of primary petrous apex lesions.

Accurate preoperative diagnosis of petrous apex lesions is critical because the surgical approaches used for this region are different depending upon the specific disease process involved. While CT and MRI have each improved the accuracy of preoperative diagnosis of petrous apex pathology, these imaging studies are most helpful when used in conjunction with one another. When systematically applied, the combination of CT with contrast and MRI (with and without gadolinium) permits accurate differential diagnosis of primary petrous apex lesions. This review presents the imaging approach employed at the House Ear Clinic for the differential diagnosis of primary lesions of the petrous apex.

Bone Diseases↗
PubMed1990

Auditory brain stem implant: effect of tumor size and preoperative hearing level on function.

The auditory brain stem implant is an investigational device designed to provide hearing sensations to patients without functioning auditory nerves. We analyzed results from 17 implants in 15 patients to determine if tumor size or preoperative hearing level might be related to proper device function. We found no significant correlation between preoperative hearing level or tumor size and device function. We also found no significant correlation between preoperative hearing level and tumor size in these 15 patients.

Adolescent↗
PubMed1990

Hearing preservation after acoustic tumor removal: long-term results.

This report examines the durability of preserved postoperative hearing in 25 middle fossa acoustic tumor patients with a minimum follow-up of 3 years. The mean follow-up time for this group was more than 8 years, with a maximum of almost 20 years. The initial postoperative audiogram was compared to the most recent audiogram for each patient, with change in the nonoperated ear serving as the control. Fourteen of the patients (56%) had a significant loss of the preserved hearing in the operated ear over time. The mean loss of speech discrimination was 25%, and the mean loss of speech reception threshold was 12 dB. Only one of the 14 patients had a similar loss in the contralateral ear. No recurrent tumors were identified. Good preoperative hearing is an obvious criterion for selection of candidates for hearing preservation surgery. Results of this study emphasize that a good initial postoperative hearing level is necessary to offset the potential deterioration of hearing that may occur over time.

Adolescent↗
PubMed1990

Middle fossa decompression of the internal auditory canal in acoustic neuroma surgery: a therapeutic alternative.

Unilateral acoustic neuromas in only-hearing ears and bilateral acoustic neuromas (NF-2) are separate entities, but both pose a common problem because surgical removal has the potential to leave the patient totally deafened. A middle fossa decompression of the internal auditory canal (IAC) was performed in 8 patients (5 with NF-2 tumors and 3 with neuromas in an only-hearing ear). In 5 of the 8, the speech discrimination scores at the 6-month follow-up were better than preoperative scores. After 6 months, however, hearing regressed at variable rates. Although not a definitive therapeutic treatment, decompression of the IAC appears to improve and perhaps prolong useful hearing, which gains valuable time for rehabilitation. Rigid follow-up by computed tomography scans or magnetic resonance imaging is essential.

Adult↗
PubMed1990

A review of acoustic tumors: 1983-1988.

This is a review of the English literature relative to acoustic tumors from 1983 through 1988. In January of 1984, a similar article was published in this journal which reviewed the literature from 1979 through 1982. We have selected what we consider the most important articles from the hundreds that were published on this subject. Many other significant papers are not discussed. The material is presented in 11 categories: diagnosis, histopathology, treatment, hearing preservation, facial nerve preservation and repair, von Recklinghausen's disease and bilateral tumors, nonacoustic cerebellopontine angle tumors, instrumentation, basic research, complications of surgery, and miscellaneous topics. In each section the articles are briefly reviewed, and sometimes our personal point of view is expressed.

Cranial Nerve Neoplasms↗
PubMed1989

Acoustic tumor surgery. Prognostic factors in hearing conversation.

Preoperative selection criteria for hearing conservation surgery in patients with acoustic tumors continues to be unresolved. The level of hearing that is worth saving is still debatable. However, most acoustic tumor surgeons agree that hearing preservation is less likely the larger the tumor. We reviewed the results of 106 middle fossa acoustic tumor removals with attempted hearing preservation. Measurable postoperative hearing remained in 59% of 97 cases analyzed for postoperative hearing results. Tumor size, preoperative auditory brain-stem response, and preoperative electronystagmography were found to be useful in predicting successful postoperative hearing preservation. We found no correlation between the level of preoperative hearing and our ability to preserve measurable postoperative hearing. A new classification system is proposed for reporting hearing results after acoustic tumor surgery. It is based on functional hearing results and we believe it is simpler than previously proposed systems.

Audiometry↗
PubMed1989

Metastasis from an unknown primary presenting as a tumor in the internal auditory meatus.

A 40-year-old male presented with a 2-month history of sudden hearing loss and tinnitus in his left ear. Mild vertigo was present initially but disappeared spontaneously without treatment. Facial nerve paralysis and retroauricular pain appeared 3 months after the onset of hearing loss on the same side. Computerized tomography and magnetic resonance imaging demonstrated a 1-cm mass in the left internal auditory canal. Translabyrinthine removal of tumor revealed metastatic adenocarcinoma. The patient died 3 months postoperatively from multiple metastatic deposits. A primary tumor was never found. The course of illness in this patient differs significantly from the typical course of other conditions involving the internal auditory canal. A metastatic work-up should be considered for patients with a similar history before a craniotomy is performed.

Adenocarcinoma↗
PubMed1989

Intratemporal vascular tumors: detection with CT and MR imaging.

The diagnostic contributions of computed tomography (CT) and magnetic resonance (MR) imaging were compared in 12 patients with benign intratemporal vascular tumors (hemangioma or vascular malformation). The tumors included six in the internal acoustic canal and six in the geniculate ganglion region. Clinical and histologic correlations were made. Two of the six patients with tumors in the internal acoustic canal underwent CT, and both required gas cisternography to show the tumor. Five patients in that group underwent MR imaging, and all five studies showed the tumor. All six patients with geniculate ganglion tumors underwent CT. Results in one study were questionable, and five showed the tumor. Five patients in this group underwent MR imaging, but the MR findings were positive in only two cases. MR imaging should therefore be performed before CT in the evaluation of facial nerve dysfunction, as it demonstrated all tumors in the internal acoustic canal and some in the geniculate ganglion region. If MR findings are negative, CT should then be performed to rule out a possible geniculate ganglion lesion.

Adult↗