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Biomedical subjects

D G Hardy

Publications and source records attributed to D G Hardy.

At least 55 records · Page 3Linked to original sources
PubMed1992

Bilateral optic nerve sheath meningiomas in a patient with neurofibromatosis type 2.

A 34-year-old woman who presented with hearing loss and tinnitus was found to have reduced vision bilaterally. Computed tomography scan revealed bilateral acoustic neuromas and bilateral optic nerve sheath meningiomas. The presence of bilateral acoustic neuromas fulfils the criteria for the diagnosis of central neurofibromatosis (neurofibromatosis type 2). Although this is the first report of bilateral optic nerve sheath meningioma in neurofibromatosis type 2, meningiomas are commoner in this dominantly inherited disorder, than in its absence and both forms of central nervous system tumour may be caused by loss of tumour suppressor genes on chromosome 22.

Adult↗
PubMed1992

Petrous apex cholesteatoma: diagnostic and treatment dilemmas.

The diagnosis and treatment of petrous apex cholesteatoma is a difficult surgical challenge. This study is a review of 14 cases of cholesteatoma involving the petrous apex. These cholesteatomas originated as a congenital primary lesion or secondary to an acquired lesion. The cases were evaluated according to the clinical features, the intraoperative findings, the radiological findings, and the surgical approaches. In this series, 83% of the patients presented with hearing loss and 50% presented with facial nerve weakness or paralysis (House grade II to VI). Intraoperative and radiological features revealed frequent direct labyrinthine and supralabyrinthine cell spread. The transpetrous surgical approach was used in all cases. The main factors affecting the surgical approach to be adopted are the inaccessible nature of the petrous apex, the extent of disease, the degree of facial nerve function, and the need for the prevention of cerebrospinal fluid leaks and the recurrence of the lesion.

Adult↗
PubMed1991

Posterior fossa vestibular neurectomy.

Many procedures have been devised to deal with intractable vertigo and conserve hearing, but despite this selective vestibular nerve section remains by far the most effective treatment. A series of 14 patients who underwent posterior fossa vestibular neurectomy is reported. The results are reported for vertigo control, hearing and tinnitus. All of the patients achieved vertigo control according to the AAOO (1972) reporting system. A simple and reliable system for the classification of the disability in these patients has yet to be devised. This problem is addressed and a disability grading system proposed, and discussed.

Disability Evaluation↗
PubMed1989

Strategy and benefits of acoustic neuroma searching.

Advances in audiological, radiological and microsurgical techniques have enabled otologists to diagnose and excise very small acoustic tumours with a low morbidity and mortality. Is this cost effective? In an attempt to answer this question, an analysis of 66 cases of surgically treated acoustic neuromas is presented. This represents part of a series of skull base procedures carried out at Addenbrooke's Hospital over the last five years. As a result of this work an investigative protocol is suggested. By studying the relative morbidity of early and late surgical intervention in these cases, and by costing the exercise, the justification for early diagnosis and treatment is presented both in financial and human terms.

Adult↗
PubMed1989

Role of post-operative electroneuronography in predicting facial nerve recovery after acoustic neuroma removal: a pilot study.

Complete clinical facial paralysis immediately after acoustic neuroma removal occurs in between 40 to 90 per cent of patients despite the fact that the facial nerve has been preserved anatomically. Some of these patients improve rapidly with adequate cosmetic and functional recovery. Others however, have incomplete or no return of useful function. A pilot study to assess the prognostic value of electroneuronography (ENOG) in 14 patients following acoustic neuroma removal was performed. The results suggest that post operative ENOG is of value in dividing those patients with anatomically intact facial nerves yet complete clinical paralysis post-operatively into groups: one with rapid improvement to an acceptable functional and cosmetic result and one with prolonged paralysis with incomplete or no recovery. Electroneuronography may thus be used to predict the initial recovery profile in patients with complete facial paralysis after surgery.

Adult↗
PubMed1989

Facial nerve recovery after acoustic neuroma removal.

A retrospective analysis of 76 patients who underwent acoustic neuroma removal is reported. Facial nerve function prior to surgery and tumour size are assessed with respect to final facial nerve recovery and the need for surgical rehabilitation. Both pre-operative facial weakness and tumour size greater than 2.5 cm. are shown to be predictive factors of poor facial nerve recovery. Multiple surgical rehabilitative procedures are often required when inadequate function and/or cosmetic results are obtained. Primary nerve repair and facial-hypoglossal anastomosis give better rehabilitative results than dynamic and static procedures. The association of tumour size greater than 2.5 cm. with increased risk of poor facial recovery re-emphasizes the need to detect and remove acoustic neuromas at an early stage.

Adolescent↗
PubMed1989

Contralateral auditory brainstem response abnormalities in acoustic neuroma.

Contralateral Auditory Brainstem Response (ABR) findings in a series of 79 patients with unilateral acoustic neuroma are presented. Sixty-four patients (81 per cent) had a normal contralateral ABR, thirteen (16.4 per cent) had latency abnormalities contralaterally and in two patients (2.6 per cent) no consistent responses could be recorded despite good hearing. Abnormalities in the contralateral ABR were analysed and five patients had abnormal III-V interwave intervals, in seven patients the I-III intervals were abnormal and in one patient, only the fifth wave was present and of abnormal latency. The tumour size was assessed by computed axial tomography (CT) and the relationship between tumour size and contralateral ABR findings established. Large tumours (greater than 2.5 cm.) were associated with contralateral ABR abnormalities in 25.6 per cent of the patients, medium tumours (1.0-2.5 cm.) with ABR abnormalities in 14 per cent and there were no abnormalities in the small group (intracanalicular). The implications for interpretation of ABR recordings contralateral to an acoustic neuroma are discussed in relation to brainstem compression and its effect on the wave generator sites.

Brain Stem↗
PubMed1989

Mastoid ache in acoustic neuroma.

In a series of 100 patients with unilateral acoustic neuroma the incidence of mastoid aching was found to be 25 per cent, though none of the patients reported this as their principal symptom. Mastoid ache was not related to tumour size, hydrocephalus, or duration of symptoms. However, there was a significantly higher incidence of facial numbness and diminished facial sensation, but not facial weakness, compared with the whole series. Since motor fibres are more resistant to pressure than sensory fibres, mastoid ache may signify the pressure of an expanding cerebellopontine angle tumour.

Face↗
PubMed1989

Surgical management of large glomus jugulare tumours: infra- and trans-temporal approach.

Surgery may have to be considered in the management of large glomus tumours since other modalities of treatment are not curative. The judicious use of surgical intervention is imperative since a neurological deficit involving the last four cranial nerves may ensue and consideration of the quality of life of the patient in the post-operative period is of paramount importance. A brief description of the historical aspects and pathology of these tumours is followed by an analysis of the clinical presentation, investigation and assessment of a series of 10 patients. Six patients underwent surgery and their tumours were removed by the infra- and trans-temporal approach. This is described and illustrated in detail and the surgical results presented.

Adult↗
PubMed1989

Early diagnosis and surgical management of acoustic neuroma: is it cost effective?

Audiological and radiological advances and refinement of microsurgical techniques have facilitated the diagnosis and excision of very small acoustic nerve tumours with a low morbidity and mortality. Is this cost effective? In an attempt to answer this question, an analysis of 66 cases of surgically treated acoustic neuromas is presented. This represents a part of a series of otoneurosurgical procedures carried out at Addenbrooke's Hospital over the last five years. By studying the relative morbidity of early and late surgical intervention in these cases, and by costing the exercise, the justification for early diagnosis and treatment is presented both in financial and human terms.

Adult↗
PubMed1989

Facial nerve recovery following acoustic neuroma surgery.

A series of 76 consecutive patients undergoing unilateral acoustic neuroma excision is reported. Preoperative facial weaknesses and a tumour larger than 2.5 cm were predictive factors of poor facial nerve recovery, re-emphasising the need to detect and remove these tumours at an early stage. Electroneuronography performed around one week after surgery appears to be a good indicator of the likelihood of recovery in facial nerves which are anatomically intact, but which show no function at that stage. Multiple rehabilitative procedures are often required when inadequate function or poor cosmetic results are obtained. Primary nerve repair or facial-hypoglossal anastomosis provide better rehabilitative results than dynamic and static procedures.

Adolescent↗
PubMed1989

Surgery for acoustic neurinoma. An analysis of 100 translabyrinthine operations.

A consecutive series of 100 translabyrinthine operations for removal of acoustic neurinoma is reported. Complete tumor removal was achieved in 97% of cases. There were three perioperative deaths, and the postoperative morbidity rate was low. The facial nerve was preserved anatomically in 82% of patients. Preoperative facial weakness and tumor size larger than 2.5 cm were predictive of poor facial recovery. In patients with an intact nerve but complete facial palsy 1 week after surgery, electroneuronography was a good predictor of the final facial outcome and may influence the timing of rehabilitative procedures. With the exception of patients who have small tumors and good speech discrimination (where a suboccipital approach may preserve hearing acuity), the translabyrinthine operation is the procedure of choice for removal of acoustic neurinomas in patients who have normal hearing in the contralateral ear.

Adult↗
PubMed1989

Unterberger's stepping test in acoustic neuroma.

A prospective study of 100 patients with a unilateral, subsequently histologically proven, acoustic neuroma seen in the Department of Otoneurosurgery at Addenbrooke's Hospital between 1983 and 1988, demonstrated that Unterberger's Stepping test achieved a higher sensitivity (71 per cent) than the Romberg test (39 per cent). The discrepancy between tests is at a maximum for small acoustic neuromas, and therefore the Stepping test may help in the earlier detection of vestibular abnormalities.

Humans↗
PubMed1988

Diffuse cerebrospinal gliomatosis: clinical and radiological findings.

Diffuse cerebrospinal gliomatosis is extremely rare. We report the case of a 47-year-old man who presented with clinical features of intracranial hypertension. He developed ascending paraplegia and died. This latter clinical feature has not previously been reported. Clinical features and diagnostic difficulties are discussed.

Brain Neoplasms↗
PubMed1983

Osteogenic sarcoma of the skull complicating Paget's disease: case report.

A case of osteogenic sarcoma of the skull in a patient with a long-standing Paget's disease is reported. Osteogenic sarcoma arising within the skull is rare in Paget's disease, although the recent literature emphasizes that it is more common than was realized previously. Intraparenchymal brain invasion, which is rare and present usually only as a preterminal event, was found in this patient who presented initially with minimal neurological findings. Rapid neurological deterioration in this patient was due to macroscopic hemorrhage into tumor. Although microscopic hemorrhage is characteristic of this tumor, gross hemorrhage into osteosarcoma of the skull as a cause of sudden neurological deterioration has not been reported previously. Radical resection is the treatment of choice, although the prognosis for this tumor remains dismal.

Aged↗
PubMed1983

Large intramedullary neurofibroma of the conus medullaris: case report.

A case of a very large intramedullary neurofibroma of the conus medullaris extending over 3 1/2 segments is reported. The tumor was successfully treated by midline myelotomy and radical excision with no exacerbation of the preoperative neurological deficit. Intramedullary neurofibroma is extremely rare, accounting for less than 1% of spinal neurofibromas. Myelotomy and radical excision under the operating microscope are recommended in such cases.

Adult↗
PubMed1983

The penetration of misonidazole and desmethylmisonidazole into brain tumours and other central nervous system tissues in man.

The concentration of drug after oral administration of 1 g misonidazole to patients undergoing neurosurgery has been studied in samples taken from intracerebral tumours, normal brain, cerebrospinal fluid and brain tumour cyst fluid. A total of 31 patients yielded samples at various times 2-8 h after drug administration. Results show a considerable range of tumour/plasma percentages but from about 2-5 h after drug administration this averaged between 65-80%. Normal brain and CSF showed similar good penetration but drug entry into cyst fluid was lower (30-50%). A further study with desmethylmisonidazole given to 11 additional patients showed a similar range of tumour penetration but lower concentrations in CSF and cyst fluid (10-20%). Low values were also seen in some but not all of the normal brain tissue samples. Necrotic tumour also had much lower concentrations than macroscopically viable tissue. These results are discussed in terms of their clinical relevance to sensitiser studies on patients with brain tumours with drugs of different lipophilicities.

Adolescent↗