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Biomedical subjects

U Fisch

Publications and source records attributed to U Fisch.

At least 37 records · Page 2Linked to original sources
PubMed1997

Comparative value of facial nerve grading systems.

The Fisch Detailed Evaluation of Facial Symmetry (DEFS) and House-Brackmann grading system (HBGS) were compared by statistical examination for their reliability and interobserver variability. Furthermore, the correlation and agreement with a standard global evaluation were compared. Therefore 47 patients with facial palsy of different cause have been evaluated with the two systems, and the global overall evaluation was done by five otolaryngologists familiar with facial palsy. The DEFS showed a high reliability of 0.93 compared with a reliability of 0.77 with the HBGS (international standard requires a reliability of at least 0.8). The mean interobserver variability is 5.24% (SD = 3.2%) with the DEFS and 9.26% (SD = 5.0%) with the HBGS; with a confidence interval of 95%, it is 11.6% and 19.26%. The correlation of both gradings with the global evaluation was high, with r = 0.98 and r = 0.97. The DEFS shows an excellent agreement with the global overall evaluation in 41 (87%) of 47 cases and the HBGS in 32 (66%) of 47 cases.

Facial Paralysis↗
PubMed1997

Meningiomas intrinsic to the geniculate ganglion.

OBJECTIVE: To present the clinical, surgical and histopathological manifestations of meningioma intrinsic to the geniculate ganglion. STUDY DESIGN: Retrospective study of outcome. SETTING: Three private tertiary and one university (otology/neurotology) referral centers. PATIENTS: Six patients with cranial nerve VII paresis underwent magnetic resonance imaging and/or high-resolution computed tomography for subsequently histologically proven intrinsic meningioma of the geniculate ganglion. An additional six cases were identified in the literature. Most patients were female and ranged in age from 5 to 40 years. INTERVENTION: Total tumor removal via middle fossa and mastoid exposures followed by cable graft VII-VII neuroanastomosis. MAIN OUTCOME MEASURE: Meningioma can occur intrinsic to the geniculate ganglion and produces gradual VIIth nerve paresis as its first symptom. Other sites of predilection may occur extrinsically within the temporal bone or along intracranial venous sinuses at sites of arachnoid villi. RESULTS: Hearing was maintained in each patient, and postoperative House-Brackmann grade III-V facial nerve function was achieved. CONCLUSIONS: Intrinsic meningiomas of the geniculate ganglion rarely occur. However, this entity should be included in the differential diagnosis of a slowly progressive VIIth nerve paresis, especially in young females. Surgical removal and cable graft VII-VII neuroanastomosis is the treatment of choice. Long-term follow-up should be maintained because of the potential for von Recklinghausen's disease.

Adolescent↗
PubMed1997

Cochlear implantation in a bilateral Mondini dysplasia.

We report the speech perception progress and programming procedures of a case of congenital profound deafness and bilateral Mondini dysplasia implanted with a Nucleus 20 + 2 cochlear implant at the age of six. Unclear relations between electrodes array and cochlear partition made implant programming difficult and non-standard procedures were set. Cochlear implantation may give excellent rehabilitative results also in cochleae with malformation.

Child↗
PubMed1997

Results from a pilot study using the nucleus CI24M/SP5 cochlear implant system.

OBJECTIVE: To conduct a pilot study in adults with the Nucleus CI24M/SP5 cochlear implant system. PATIENTS AND METHODS: Eight postlingually deafened adults who had received little or no benefit from conventional hearing aids, equipped with the Nucleus CI24M/SP5 cochlear implant system. RESULTS AND CONCLUSIONS: The results indicate that most of the subjects were able to perform well in speech recognition tests. The test performances appeared to be strongly affected by the duration of deafness. The speech processor's four user-selectable program memories have been extremely useful for the subjects to evaluate variations to the speech coding strategies in ordinary surroundings outside of the laboratory. The telemetry functions of the new implant provide a set of useful clinical and research tools for gathering greater insights into the in-situ operation of the implant.

Adult↗
PubMed1996

Transtemporal supralabyrinthine (middle cranial fossa) vestibular neurectomy: a review of the last 100 cases.

The outcome of 100 consecutive transtemporal supralabyrinthine vestibular neurectomies performed between 1982 and 1992 was analyzed retrospectively and compared with that of the first 100 operations (1969 to 1975) in order to analyze the effects of the learning curve on immediate postoperative complications. A total sensorineural hearing loss, which occurred in 2% of the cases initially, could be totally avoided by (1) opening the tegmen tympani for better identification of the superior ampulla and (2) preserving the saccular branch of the inferior division of the vestibular nerve when the identification of the cochlear nerve was difficult because of a narrow anatomic space. As in the first series of patients, no immediate or delayed total loss of facial function was observed. However, a slightly higher number of delayed, temporary facial weaknesses (7% vs 3%) were recorded. The impairment of facial function was limited mostly to an asymmetric eyelid closure, unnoticed by the majority of the patients, which disappeared within 10 days. The number of postoperative temporary CSF leaks (through the wound or nose) resolving spontaneously remained the same (12%). There was no instance of postoperative meningitis. Due to the minimal dural elevation involved in transtemporal, supralabyrinthine vestibular neurectomy, no temporal lobe complications (particularly seizures) have been observed. In patients over 65 years of age, the operation lasted, on average, 10 minutes longer and the hospitalization was 3 days longer. There was no difference in the duration of the acute subjective vertigo (3 days) in patients younger than 65 versus older patients. Transtemporal, supralabyrinthine vestibular neurectomy offers an effective cure for disabling vertigo while preserving hearing in Menière's disease. The complications are acceptable even in patients over 65 years of age if the operation is carried out with limited elevation of the middle cranial fossa dura by a sufficiently trained and experienced skull base surgeon.

Journal Article↗
PubMed1996

Catecholamine-secreting paragangliomas at the skull base.

Paragangliomas (glomus tumors) comprise 15% of all neoplasms at the skull base. Despite extensive growth, these tumors usually do not secrete active biogenic substances into the circulation in sufficient quantities to produce symptoms. When they do secrete large amounts of catecholamines, they will cause symptoms that mimic a pheochromocytoma. The still confusing nomenclature of paragangliomas is reviewed, and the clinical work-up, surgical treatment, and follow-up of five patients with catecholamine-secreting paragangliomas of temporal bone (3), infratemporal fossa (1), and nasopharynx (1) are presented and discussed.

Journal Article↗
PubMed1996

Intratemporal facial nerve perineurioma.

Forty-two cases of perineurioma have been reported in the literature. This report adds the first intratemporal facial nerve perineurioma to the literature and reviews the others. Unlike schwannoma and neurofibroma, the histological features of perineurioma demonstrate onion bulb-like structures with a strong positive immunoreactivity for epithelial membrane antigen. The clinical history of gradual facial nerve paresis was 15 years in the case presentation and the clinical diagnosis of tumor was overlooked.

Adult↗
PubMed1996

Correlation of MRI, clinical, and electroneuronographic findings in acute facial nerve palsy.

Intratemporal enhancement of (Gd-DTPA) was investigated by an interleaved-overlapping magnetic resonance imaging (MRI) technique in 35 cases of acute facial palsy. In a reference group (normal facial function), enhancement was localized from the ganglion geniculi to the stylomastoid foramen. In cases of acute palsy, the facial nerve enhanced in the meatal fundus independent of etiology (idiopathic, herpetic, or traumatic). In 70% of those with Ramsay-Hunt syndrome, the vestibular and cochlear nerves, the labyrinth, and the sheets of the internal and external auditory canal additionally enhanced. No correlation was found between intensity, extension, and duration of the enhancement and the clinical, intraoperative, or electroneuronographic degree of the facial palsy. The pathogenesis of the Gd-DTPA enhancement of the facial nerve appears to be closely connected with the vascular supply of the fallopian canal and the permeability of the neural sheets.

Adolescent↗
PubMed1995

Clinical pathophysiology of vestibular neurectomy.

This study attempts to characterize the residual vestibular function remaining after incomplete supralabyrinthine vestibular neurectomy performed for disabling vertigo. Patients with bilateral vestibular neurectomy had preserved horizontal vestibulo-ocular reflexes in response to high angular accelerations with gain enhancement over time. A torsional down-beating spontaneous nystagmus and an important tilt of the subjective vertical were observed when the remaining eighth nerve was sectioned after homolateral incomplete supralabyrinthine vestibular neurectomy. These findings suggest that a reorganization of vestibular reflexes may occur after incomplete supralabyrinthine vestibular neurectomy if afferents of the inferior vestibular branch are partially spared. The vestibular function after incomplete supralabyrinthine vestibular neurectomy does not affect the postoperative control of vertiginous attacks and may have positive effects in case of deterioration of the contralateral inner ear.

Adult↗
PubMed1995

Parapharyngeal space tumors: the infratemporal fossa approach.

Tumors of the parapharyngeal space, although mostly benign in their histopathology, present a challenge to the surgeon due to the limited access. Multiple approaches have been described in the literature for the extirpation of these tumors. The usual anatomic division of the parapharyngeal space into prestyloid and poststyloid spaces does not help the clinician determine which approach to use for a specific tumor. We have reviewed our 10-year experience at the University of Zurich. The usual presentation of the patients and the histopathologic characteristics of their tumors are compared. The radiological evaluation of these patients, their perioperative course, and complications are analyzed. The different surgical techniques used to treat the 72 patients in our series are described, with a special emphasis on the infratemporal fossa approach. Furthermore, a clinical division of the parapharyngeal space in the superior-inferior axis is established. The usefulness of this classification in helping the surgeon to decide which surgical approach is the most suitable for a particular lesion is discussed.

Journal Article↗
PubMed1995

Are papillary adenomas endolymphatic sac tumors?

Papillary adenomas of the temporal bone have been considered as originating from the endolymphatic sac. The radiologic, surgical, and pathologic findings in a patient suffering from von Hippel-Lindau disease with bilateral papillary adenomas of the temporal bone cast some doubt on this site of origin. Radiologically, the center of tumor growth was at the top of the jugular bulb. Intraoperatively, the tumor was found to have reached the lateral wall of the endolymphatic sac, but the lumen was tumor-free. Both ciliated and nonciliated tumor cells were found in the resected tumor, resembling the ultrastructure of normal epithelial lining in the human mastoid. A strong positive immunohistochemical reaction for keratin and negative reactions for vimentin, glial fibrillary acidic protein, and S-100 protein in the tumor tissue of this patient are typical for middle ear mucosa. Therefore, the described papillary adenoma originated from the mucosa of the pneumatic spaces surrounding the jugular bulb, and the theory that the endolymphatic sac is the origin of all papillary-cystic tumors (adenocarcinomas) should be questioned.

Adenoma↗
PubMed1995

Magnetic resonance imaging and intraoperative frozen sections in intratemporal facial schwannomas.

Seven cases of intratemporal facial schwannoma were assessed by preoperative magnetic resonance imaging (MRI) and intraoperative frozen sections to determine tumor boundaries. These results were then analyzed with respect to gross tumor appearance, under the operating microscope, and final histopathologic diagnosis, with immunostains. Gadolinium-enhanced MRI was helpful in planning the surgical and approach and in defining the extent of tumor involvement relative to the facial nerve. Frozen sections on the other hand were often unreliable in confirming the completeness of resection, frequently overestimating tumor infiltration. Ultimately, tumor-nerve interface, especially in the proximal facial segments, is best judged by its gross intraoperative appearance under high magnification, with the aid of MRI. The difficulty in establishing tumor infiltration in the presence of organized neutral fibers and artifacts is emphasized. Immunohistochemical assays are essential in this regard. Complete tumor removal was achieved in all seven cases, with acceptable functional outcome in those with sufficiently long follow-up.

Adolescent↗
PubMed1995

Carotid occlusion without reconstruction: a safe surgical option in selected patients.

Complete resection of extensive skull base tumors can be difficult when the disease involves or is closely related to the carotid artery. Detachable balloons have been used effectively to permanently occlude the carotid artery prior to anticipated surgical resection, but their use involves risk of significant cerebral complications. To better define the risks and benefits of this procedure, 52 patients who underwent balloon occlusion of the carotid artery followed by surgery with resection of a portion of the carotid artery were retrospectively reviewed. Pathologic findings are presented demonstrating the infiltrative nature of many of these tumors and the difficulty in separating histologically benign tumors from the carotid artery when they are closely related to it. Although vascular reconstruction can be considered whenever carotid occlusion or resection is planned, balloon occlusion without reconstruction can be safely performed in selected patients, avoiding unnecessary and hazardous additional surgery.

Brain Neoplasms↗
PubMed1994

Faciohypoglossal anastomosis: does the morphology of the facial nerve affect the functional result?

We report the results of a histological study of facial nerve specimens obtained at the time of faciohypoglossal anastomosis. We examined sections from 24 patients using light and electron microscopy in order to determine the extent of the degenerative process with time and its relationship to the functional results of the anastomosis. We graded the histological features associated with degeneration, regeneration, and fibrosis on an ordered nominal scale from 0 to 3 and correlated them with duration of facial palsy and postoperative facial function. There was no histological evidence of increasing collagenosis or fibrosis with duration of facial palsy, and endoneural fibrosis was a very infrequent finding. There was no evidence that the relative numbers of endoneural fibrocytes or the degree of collagenosis had any bearing on the functional result. The presence of large numbers of endoneural tubes, containing nonmyelinated axons, showed a positive correlation with the postoperative facial function, whereas the presence of active axon degeneration showed a negative correlation.

Journal Article↗
PubMed1994

Trigeminal nerve tumors of the lateral skull base.

A retrospective review of 8 trigeminal nerve tumors centered in the lateral skull base was carried out. Clinical manifestations, radiographic features, and outcome of management are detailed. Six patients in this series presented for primary surgery, and 2 patients had prior surgical interventions with incomplete resections.Surgical exposure via the infratemporal fossa (ITF) approaches resulted in complete tumor extirpation in all but I of the reoperated cases. Limited postoperative cranial neuropathies and the lack of intracranial complications are particularly notable in this series.A mean follow-up of 3 years revealed no evidence of recurrent disease. In the case of incomplete resection, there appears to be no appreciable growth of the small tumor remnant in the region of the cavernous sinus after 5 years.Trigeminal tumors of the lateral skull base with intracranial components below the level of the posterior clinoid process are ideally suited for the ITF techniques. The importance of securing the petrous carotid artery through a wide exposure is emphasized.

Journal Article↗
PubMed1994

Inflammatory pseudotumors of the skull base.

Inflammatory pseudotumor is a rare affliction of the skull base with a propensity for locally aggressive growth. Frequently, the location of involvement does not lend itself to conventional biopsy techniques, resulting in diagnostic and treatment dilemma. A retrospective review of three unusual cases of skull base inflammatory pseudotumors is reported. These lesions illustrate the difficulty of management by virtue of their histopathology and behavior. They are clinically and radiographically indistinguishable from invasive neoplasms. One involved the petrous apex with bony erosion; a second case presented with pain and trigeminal paresthesia secondary to an infiltrative lesion in the clivus and the sphenoid sinus; and the third case involved peritubal soft tissues of the infratemporal fossa, with mandibular paresthesia and middle ear effusion. All three lesions were resected via lateral skull base approaches with no evidence of recurrence. Because of the inherent nature of this lesion and its rarity, inflammatory pseudotumor should remain a diagnosis of exclusion. When suspected, surgical approaches should be designed to allow complete extirpation with limited morbidity.

Journal Article↗
PubMed1994

Management of petrous bone fractures in children: analysis of 127 cases.

Petrous bone fractures (PBF) in children are relatively frequent. They are mostly diagnosed after collisions and falls. The complications typically associated with PBF were different types of hearing disorders in 69.1% of the patients who had audiometry, liquorrhea in 16.5%, palsy of cranial nerves in 10.8% (facial nerve palsy in 9.4%), bacterial meningitis, stenosis of the external ear canal, and posttraumatic cholesteatoma in 0.7% of the fractures each. Most complications were transient; 8.6% of the patients underwent surgery because of PBF-related complications and 9.4% suffered from severe, irreversible sequelae. Management of PBF in children requires an interdisciplinary approach between pediatric surgeons and pediatric ear, nose, and throat (ENT) specialists. It basically includes daily examination for cranial nerve palsy, liquorrhea, and meningitis during hospitalization as well as routine audiometric examination and antibiotic prophylaxis. Routine vaccination against Streptococcus pneumoniae as a new standard procedure and subtotal petrosectomy after transverse fracture as a new surgical modality are strongly recommended in order to lower the incidence of posttraumatic meningitis. Severe complications such as persistent hearing loss, persistent liquorrhea, cranial nerve palsy, and posttraumatic meningitis require aggressive diagnostic and therapeutic measures in order to minimize further morbidity and irreversible deficits.

Adolescent↗