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Biomedical subjects

D E Brackmann

Publications and source records attributed to D E Brackmann.

At least 145 records · Page 8Linked to original sources
PubMed1984

Retrolabyrinthine vestibular nerve section: a viable alternative to the middle fossa approach.

Vestibular nerve section, whether by the middle fossa or retrolabyrinthine approach, is effective in relieving intractable vertigo while preserving hearing. However, the potential morbidity and technical difficulty of the middle fossa approach have limited its usefulness. In an attempt to determine if the two approaches produce comparable results, we evaluated 52 patients who underwent retrolabyrinthine vestibular neurectomy between April 1981 and March 1983 at the Otologic Medical Group. We compared their audiometric data and questionnaire responses with published data on patients who had a middle fossa vestibular neurectomy. Although differences between the two procedures do exist, the retrolabyrinthine method, with its 93% success rate in improving or resolving vertigo and its zero incidence of total sensorineural hearing loss, offers the surgeon a strong alternative to the middle fossa approach.

Adult↗
PubMed1984

Retrolabyrinthine section of the vestibular nerve.

When symptoms of dizziness and episodic vertigo cannot be controlled through medical management or drainage procedures such as endolymphatic subarachnoid shunt operations, selective vestibular nerve section may be necessary. In the 1920s eighth cranial nerve sections were performed by neurosurgeons through the suboccipital approach but were frequently associated with hearing loss and facial paralysis. The middle fossa approach has been popularized by Dr. William House and others as a method of selectively sectioning the vestibular nerve and preserving facial and cochlear function. More recently the suboccipital retrolabyrinthine approach has been described as a method of selectively sectioning the vestibular nerve. We have reviewed 42 cases of suboccipital retrolabyrinthine selective section of the vestibular nerve performed at the Otologic Medical Group over the past 2 years. The shortest follow-up on these patients has been 6 months. Thirty-two patients had preoperative diagnosis of Meniere's disease, and of these patients 25 had had previous endolymphatic subarachnoid shunt surgery. Eighty-five percent (27 patients) experienced complete relief of vertigo following surgery, while 6% (two patients) stated they were improved. Three patients reported no relief. There were 10 patients with dizziness who had a diagnosis other than Meniere's disease. In this diverse group three experienced complete relief of vertigo, five were improved, and two reported no improvement of vertigo following surgery. None of the patients lost his hearing as a result of the surgery and there was no facial weakness. One patient had postoperative CSF rhinorrhea and another had meningitis.

Dizziness↗
PubMed1984

Fibrous dysplasia of the temporal bone: the use of computerized tomography.

Fibrous dysplasia of the temporal bone is a rare condition characterized histologically by proliferation of fibrous tissue with scattered trabeculae of immature bone. Eighteen cases of monostotic fibrous dysplasia of the temporal bone have been reported in the literature. The clinical course of temporal bone fibrous dysplasia is unpredictable. Potential complications include cholesteatoma, recurrence, and malignant transformation. Surgery has been the recommended treatment, but the indications, approach, and extent have not been clearly established. The introduction of computerized tomography with high-resolution bone reconstruction is a significant advance in the therapeutic approach to temporal bone fibrous dysplasia. It accurately defines the extent of the disease within the temporal bone, and periodic scanning will reveal any progression. This information can be used to resolve many surgical dilemmas and to minimize secondary complications. This article includes a comprehensive review of the literature on temporal bone fibrous dysplasia and summarizes a case in which computerized tomography was used.

Adolescent↗
PubMed1984

Facial paralysis in longitudinal temporal bone fractures: a review of 26 cases.

The management of facial nerve injury resulting from temporal bone fracture continues to be a topic of discussion. The indications for surgery as well as the proper timing and extent of surgical exploration are the principal questions debated. This study reviews a large series of patients (26), treated for facial paralysis following a longitudinal temporal bone fracture. The most frequent site of injury was the area of the geniculate ganglion. The injury to the facial nerve was often severe. We recommend early exploration in these cases when electrical studies indicate a severe injury. In most cases a combined mastoid and middle fossa approach is required.

Adolescent↗
PubMed1984

A review of acoustic tumors: 1979-1982.

This is a review of the English literature relative to acoustic tumors from 1979 through 1982. I have selected what I consider the most important articles. Many other significant papers are not discussed. The material is presented in ten categories: diagnosis, histopathology, surgical approaches, 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 a personal point of view is presented.

Audiometry, Evoked Response↗
PubMed1984

Facial nerve anastomosis in the cerebellopontine angle: a review of 24 cases.

Facial nerve repair during translabyrinthine tumor surgery was performed in twenty-four patients. Nineteen patients (79 percent) had return of facial function. Different techniques of facial nerve anastomosis were evaluated. Suture anastomosis was more reliable than other anastomotic methods, especially if cable nerve grafts were used. Facial function began to return within twelve months in all patients whose function returned.

Brain Neoplasms↗
PubMed1982

Cholesterol granuloma of the cerebellopontine angle.

Two unusual cases of cholesterol granuloma of the temporal bone manifested as cerebellopontine angle tumors. To our knowledge, cerebellopontine angle extension of this lesion has not previously been reported. Obstruction of ventilation and drainage of any air complex in the temporal bone may produce cholesterol granuloma. Asymptomatic involvement of the mastoid air cell system is common in chronic otitis media. Surgical management of cholesterol granuloma with cerebellopontine angle extension is recommended. Total excision of the lesion is preferred; marsupialization into the mastoid air cell system is an alternative if excision would produce a major neurologic deficit.

Adult↗
PubMed1982

Facial nerve abnormalities after acoustic tumor removal. Morphological and clinical study of seven patients with postoperative facial paralysis.

Operative specimens of the tympanic segment of the facial nerve obtained from seven patients during hypoglossal-facial anastomosis surgery were studied under light and electron microscopy. All patients previously underwent acoustic tumor removal during which the facial nerve was left anatomically intact but attenuated; immediate postoperative facial paralysis was present and persisted. In all specimens, the fascicular area of the nerve had two differing zones: a smaller one with normal-looking populations of myelinated nerve fibers, and a large one with severe reduction of myelinated nerve fibers and an increase of the deposition of endoneurial collagen. The changes indicate that in all cases, the motor fibers have undergone degeneration with subsequent regeneration. However, regeneration has remained incomplete with total lack of normal-sized (7 to 10 micrometers) motor fibers. Incomplete regeneration explains the lack of functional improvement. The structural features of the distal stump of the facial nerve with numerous Schwann's cell tubes were evaluated to provide favorable preconditions for reinnervation through anastomosis. Clinical follow-up of all patients showed varying degrees of functional restoration indicating regeneration.

Adult↗
PubMed1981

Computed cranial tomography in acoustic tumor diagnosis.

With the development of computed cranial tomography (CCT), many physicians have come to rely on this technique as their sole means of excluding a diagnosis of acoustic neurinoma. In our series of 237 patients with acoustic tumors, 29% of tumors were not detected by CCT. New thin-section scanners improve this detection rate. Tumors within the internal auditory canal, however, will not be detected without special techniques. We recommend that contrast studies of the posterior fossa be employed to exclude definitely the diagnosis of acoustic tumor when one is suspected.

Cerebellopontine Angle↗
PubMed1981

Tinnitus: surgical treatment.

Surgical treatment of tinnitus includes destructive procedures, neurectomies, stapedectomies and tympanosympathectomies. Translabyrinthine procedures for the removal of acoustic neuromas and sectioning of the eighth nerve to eliminate vertigo are analogous to cutting the eighth nerve as a surgical intervention for tinnitus. After surgical removal of acoustic tumours with excision of the auditory nerve in 414 patients, only 40% reported improvement in their tinnitus. Of 68 patients undergoing translabyrinthine eighth nerve section, 60 (80%) had tinnitus preoperatively. Improvement occurred in 45%, while 55% reported the condition to be the same or worse. In patients undergoing middle cranial fossa section of the vestibular nerve for vertigo or dizziness, most reported the tinnitus to be the same but a significant number felt that it was worse. Stapedectomy improves hearing in most patients but improves the symptom of tinnitus in only about half of the patients. Cochlear implant patients report an improvement in their tinnitus with use of the stimulator and implant. Implant procedures might therefore be used in patients who suffer from severe tinnitus. Surgical management of tinnitus, although successful in some cases, does not provide a valid and reliable mode of treatment for subjective tinnitus.

Cochlear Implants↗
PubMed1981

Management of intratemporal vascular tumors.

Vascular tumors (vascular malformations and hemangiomas) of the temporal bone are uncommon, and guidelines for their management have not been published. In an effort to develop an approach to their management, the present study examined the pathological, clinical, and surgical experience with ten of these lesions treated at the Otologic Medical Group, Inc., and St. Vincent Medical Center in Los Angeles from 1960 to 1980. Intratemporal vascular tumors occurred most frequently at two sites, the internal auditory canal and the geniculate ganglion. Histological features and clinical behavior did not correlate. Both vascular malformations and hemangiomata invaded the facial nerve. Surgical excision in these cases required severence and repair of the involved facial nerve. Complete surgical excision is the treatment of choice of vascular lesions of the temporal bone.

Adult↗
PubMed1980

Neurotologic manifestations of the osteopetroses.

Facial nerve paralysis or symptoms of audiovestibular nerve dysfunction may be the first indication of one of the group of bone diseases known as the osteopetroses. We describe three such patients. The pathophysiology of these diseases and the treatment of the resulting symptoms of facial and audiovestibular nerve dysfunction are discussed.

Adult↗
PubMed1980

Bilateral acoustic tumors. A diagnostic and surgical challenge.

Bilateral acoustic tumors present problems not only in diagnosis but in surgical correction as well. The usual auditory findings associated with acoustic tumors occur late in the development of these lesions. Although vertigo usually is not a complaint, electronystagmographic caloric vestibular tests often show reduced or absent responses bilaterally. In contrast to unilateral-type tumors, bilateral tumors are invasive. Thus, total removal often is not accomplished. However, it is our suspicion that the interruption of the blood supply to the residual tumor causes it to remain dormant.

Adolescent↗
PubMed1980

Ménière's disease: results of treatment with the endolymphatic subarachnoid shunt.

Every otolaryngologist confronts the problem of therapy for Ménière's disease. Although the classic triadic symptoms of episodic vertigo, tinnitus and fluctuating sensorineural hearing loss are well known, an effective and permanent method of relief from these disabling attacks is not known. Medical and particularly surgical treatments of Ménière's disease are controversial. This chapter discusses the senior author's experience with surgical treatment of 125 patients with Ménière's disease. In-depth case analyses are presented in an attempt to identify factors that may account for success or failure of the endolymphatic subarachnoid shunt operation.

Adolescent↗