Search PubMed⌕ Search

Biomedical subjects

W E Hitselberger

Publications and source records attributed to W E Hitselberger.

At least 55 records · Page 3Linked to original sources
PubMed1989

Middle fossa acoustic tumor surgery: results in 106 cases.

Although the middle cranial fossa approach has been used less frequently in recent years than in the past, it continues to be a useful technique for the removal of small acoustic tumors with possible hearing preservation. The approach provides complete exposure of the contents of the internal auditory canal, thus allowing positive facial nerve identification and facilitating total tumor removal. This paper reports the results of 106 middle fossa acoustic tumor removals over a 25-year period. Measurable postoperative hearing remained in 59% of cases. In 89% of cases, normal or near-normal postoperative facial nerve function was obtained. Total tumor removal was achieved in 98% of cases. Preoperative selection criteria are discussed, and postoperative complications are reported.

Adult↗
PubMed1988

Retrolabyrinthine vestibular neurectomy: a reevaluation.

Selective vestibular neurectomy is considered an effective means of relieving intractable vertigo while preserving hearing. In order to determine the effectiveness of the retrolabyrinthine approach to selective vestibular neurectomy, we evaluated 161 patients who underwent vestibular neurectomy between April 1981 and September 1985. Questionnaire responses indicated that 97% of the Meniere's disease patients and 68% of the non-Meniere's disease patients experienced a substantial improvement or resolution of their vertiginous symptoms. Hearing was maintained within 10 dB of the preoperative level in the majority of the patients. Neurological complications were limited to 2 cases of meningitis which resolved with medical therapy, 7 cases of cerebral spinal fluid leaks, and 3 cases of complete sensorineural hearing loss. Based on this review, we concluded that retrolabyrinthine vestibular neurectomy continues to be a safe and effective approach to relieve ear-related vertigo.

Adult↗
PubMed1988

Vertigo caused by basilar artery compression of the eighth nerve.

Vascular compression syndromes in the posterior cranial fossa have become well described clinical entities, especially for the fifth and seventh cranial nerves. Jannetta has proposed vascular compression of the eighth nerve as the etiology of hearing loss, tinnitus, and vertigo in some patients. The case that follows illustrates a clear-cut example of vestibular symptoms arising from vascular compression of the eighth nerve. The patient involved had disabling peripheral vertigo refractory to medical management. Magnetic resonance imaging documented a tortuous basilar artery compressing the eighth nerve on the involved side. This was confirmed at surgery, and a selective section of the vestibular nerve provided complete relief of disabling symptoms and preservation of hearing. The authors describe the details of this case and the enigma of eighth nerve symptoms due to vascular compression.

Basilar Artery↗
PubMed1987

Surgical accessibility of the cochlear nuclear complex in man: surgical landmarks.

Patients deafened by bilateral acoustic tumors or by transections of both cochlear nerves are excluded as candidates for cochlear implantation. These patients require more proximal stimulation of the auditory pathway. One potential area for such stimulation is the cochlear nuclear complex (CNC) in the lateral recess of the fourth ventricle. If animal studies establish the safety and efficacy of such stimulation, electrical stimulation of the human cochlear nuclear complex may become an accepted treatment modality for this select group of patients. Such implantation requires that the surgeon accurately locate the cochlear nuclear complex without destruction of vital surrounding neural and vascular structures. With ten fresh human brains, oriented for a translabyrinthine approach, we determined key anatomical landmarks to the exposed surface of the CNC on both sides of each brain. Using a combination of anatomical landmarks--including the flocculus, eighth nerve root, choroid plexus, and taenia--we located the cochlear nuclear complex (without disruption of surrounding neural or vascular structures) and marked it with colloidal carbon. Access to the CNC was obtained in all 20 specimens, and histologic sections confirmed the carbon marker in the CNC in 19 of 20 specimens.

Cochlea↗
PubMed1987

Acoustic tumor management in senior citizens.

We reviewed records of 116 consecutive acoustic tumor surgery patients aged 65 and older during the 10 years ending in 1984. One hundred six had total removal. Ninety-four (81%) had no intraoperative complications and 66 (57%) had no postoperative complications. Only one patient, who had previously undergone partial removal elsewhere, died. Because tumors grow at 2 mm per year, and because elderly patients can expect to live up to 18 more years, we recommend planned total removal of an acoustic tumor as the management of choice for senior citizens in good health. We feel that the advantages of immediate surgery outweigh the risks of delayed surgery when age is advanced, the tumor is enlarged, and general health may be declining.

Age Factors↗
PubMed1987

Early detection of small bilateral acoustic tumors.

Bilateral acoustic tumors are one of the most difficult problems in acoustic tumor surgery. Total tumor removal with preservation of hearing has seldom been achieved in the past. Recently, hearing has been successfully preserved if the tumors are small when removed. We present the case of a child with a family history of von Recklinghausen's disease associated with bilateral acoustic tumors. A high index of suspicion of bilateral tumors and a thorough work-up resulted in the early diagnosis of small tumors. The tumors were removed with preservation of normal hearing.

Adolescent↗
PubMed1987

Surgical approaches to the human cochlear nuclear complex.

Patients with bilateral neural deafness may be candidates for rehabilitation with a device that provides direct electrical stimulation of the central nervous system. The cochlear nuclear complex at the pons-medulla junction is a logical site to implant because it is in the surgical field exposed for acoustic tumor surgery. In this study we compared four surgical approaches commonly used to reach the cerebellopontine angle for ease of access to the cochlear nuclear complex. We found the translabyrinthine approach to be the most satisfactory because the anterior approach facilitates identification of key landmarks, such as the tenia of the choroid plexus and the lateral recess of the fourth ventricle. The suboccipital, or retrosigmoid, approach would be satisfactory after removal of a large acoutic tumor; however, the amount of cerebellar retraction necessary may preclude its use in nontumor cases.

Cochlea↗
PubMed1987

Vestibular nerve section in patients with chronic otitis media.

Retrolabyrinthine vestibular neurectomy preserves hearing and relieves intractable vertigo emanating from the inner ear. However, this approach must be modified in patients with prior "canal-wall-down" procedures. Traversing an exteriorized mastoid cavity risks bacterial contamination of the subarachnoid space. Three patients seen at the Otologic Medical Group with prior canal-wall-down procedures required vestibular neurectomy for persistent vertigo. Using the retrosigmoid approach, the vestibular nerve was sectioned without sacrificing hearing and without traversing a potentially infected mastoid cavity. It is recommended that this approach be considered in patients with intractable vertigo, serviceable hearing, and exteriorized mastoid cavities.

Aged↗
PubMed1986

Chondrosarcoma of the skull base.

Chondrosarcoma of the skull base is an uncommon neoplasm that comprises 0.15% of all intracranial tumors and 6% of skull base lesions. Compression of vital neurologic structures by tumor expansion as well as the histologic characteristics contribute to the malignant potential of these neoplasms. Tumor recurrence has been associated with incomplete resection in this traditionally surgically inaccessible region. This review of five cases of chondrosarcoma of the skull base examines the surgical approaches to resection in a chronologic fashion to emphasize that total gross resection of these lesions has become possible through the evolution of lateral skull base techniques. The difficulty in pathologic diagnosis and the efficacy of postoperative radiotherapy in enhancing survival are also addressed.

Adult↗
PubMed1986

The middle fossa transpetrous approach to the anterior-superior cerebellopontine angle.

We present a new approach to the skull base, medial and superior to the internal auditory canal, for tumors involving the anterior-superior cerebellopontine angle, petrous apex, and clivus. This approach is accomplished through a middle fossa craniotomy and involves removal of the bone anterior and medial to the internal auditory canal and medial to the cochlea and carotid artery. It combines the advantages of complete tumor removal, low mortality rate, and hearing preservation.

Cerebellar Neoplasms↗
PubMed1985

Electrical stimulation of cochlear nucleus in man.

Auditory percepts can be produced by electrical stimulation of the cochlear nucleus in man. The ability to locate accurately and stimulate selectively the cochlear nucleus after removal of an acoustic schwannoma was confirmed in this patient. The surgical approach, electrode design, and a discussion of the results and concerns of electrical stimulation are reviewed.

Auditory Perception↗
PubMed1985

The neuro-otologist's view of the surgical management of acoustic neuromas.

The experience of our group in the management of 1667 patients with the diagnosis of an acoustic neuroma has been reviewed. Certain features of the operation have been discussed. It is our feeling at this time that with the techniques available to the neuro-otologist for the management of patients harboring acoustic neuromas, the goals of surgery should be total removal of the tumor with preservation of the facial nerve and avoidance of injury to the adjacent important brain structures. Our patients, at this time, should reasonably expect this type of result from their surgery. Hearing preservation in the above framework continues to be frustrating and difficult to consistently attain, and obviously remains the next barrier in acoustic tumor surgery.

Arteries↗
PubMed1985

Schwannomas of the jugular foramen.

Schwannomas of the jugular foramen are relatively uncommon tumors. The growth and initial presentation of these tumors are variable and may not be associated with neuropathies of cranial nerves IX, X and XI. Seven patients with jugular fossa schwannomas are presented. Auditory brain stem response, electronystagmogram, computed cranial tomography, and carotid angiography are helpful in diagnosis and preoperative evaluation. The surgical approach should be individualized to the lesion and may include transmastoid with extended facial recess, translabyrinthine, retrolabyrinthine, and infratemporal/cervical approaches.

Accessory Nerve↗
PubMed1985

Recurrence rate of partially resected acoustic tumors.

Thirty-three (16.5%) of the first 200 patients who presented to the Otologic Medical Group with acoustic tumors underwent surgery for their subtotal removal. These 33 patients, operated on between 1964 and 1967, were followed for clinical evidence of recurrent tumor for a period ranging from 2 to 20 years. Twelve patients required further surgery for recurrent tumor and three of these repeat surgery patients died as a result of their tumors. Case reports of six patients who underwent partial resection are presented with recent computed cranial tomographic follow-up.

Adult↗
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

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↗