Five-Year Experience In Surgical Treatment Of Temporal Bone Paragangliomas

The article describes our five-year experience in the surgical treatment of temporal bone paragangliomas. Considering our experience, the surgical treatment of patients with different types of paragangliomas based on a detailed study of the CT scan and MRI data using the preoperative selective embolization of tumor-feeding vessels and the navigation system intraoperatively as well as the endoscopy assistance allows total removing of the tumor with minimal damaging of the vital structures of the lateral skull base

Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

Introduction. Petrous temporal bone (PTB) cholesteatoma is an epidermal cyst, which is the result of uncontrolled growth of keratinizing squamous epithelium in the petrous part of the temporal bone. Cholesteatoma is classified into congenital, acquired, and iatrogenic.Objective. To discuss the classification of infralabyrinthine petrous bone cholesteatoma (PBC), add modified classificationand to propose adequate differential surgical management.Methods. The setting was a National Medical Scientific Center of Otorhinolaryngology FMBA (Russia). The data of 14 patients who underwent surgery for different variations of infralabyrinthine PBC from 2017 till 2020 were analyzed and included into the study (with respect to localization type of the approach used, complications, recurrences and outcome). The follow-up period ranged from 6 to 34 months with a median of 18 months.Results. Based on preoperative CT scans and intraoperative findings a Scale of Cholesteatoma extension CLIF(APO) and Modified classification of infralabyrinthine cholesteatoma (in relation to mastoid segment of the facial nerve) are proposed. The scale includes the main anatomical structures of the temporal bone and the adjacent parts of the occipital and sphenoid bones, which may be involved in the cholesteatoma process: cochlea, vestibule and semicircular canals, internal auditory canal, jugular foramen, bony chanal of the internal carotid artery, petrous apex, occipital condyle. Based on the modified classification and scale we present an algorithm for decision making and surgical approach choosing.Conclusion. The implementation of the Scale of Cholesteatoma Extension in Otology and Radiology practice will allow to preoperatively diagnose the extension of PBC, unify the data of the localization of cholesteatoma; allows standardization in reporting and continuity at all stages of treatment. The modified classification proposed by us in this article facilitate the algorithm for selecting the type of surgical approach and determine whether to perform less aggressive combined microscopic approaches with endoscopic control

Infralabyrinthine petrous bone cholesteatoma (literature review)

A literature review on the infralabyrinthine petrous bone cholesteatoma (PBC) was presented in this article. Attention is paid to etiology and clinical symptoms of the disease, classifications. All modern classifications divide cholesteatoma with localization under the labyrinth into two big groups: infralabyrinthine and infralabyrinthine apical. This is not enough to determine the algorithm of surgical tactic of these patients. The most used approaches to the infrlabyrinyhine area and lateral skull base were analyzed (infralabyrinthine and infracochlear, subtotal petrosectomy, transotic approach, group of transcochlear approaches, infratemporal and translabyrinthine approaches). Possible variants of the surgery ending are described (tympanoplasty or “cul-de-sac” closure). Comparison of the results of different authors, starting from 1990, in which the infralabyrinthine cholesteatoma was distinguished as a separate class was carried out. 16 publications were analyzed based on the type of used classification, the total number of cases with infralabyrinthine cholesteatoma, the type of surgical approach, the complications and recurrence rate. The total number of patients was 141, 84 with infralabyrinthine (59,6%), 57 (40,4%) with infralabyrinthine apical PBC. The most common type of surgery were subtotal petrosectomy, transcochlear approach in different variations and transotic approach. The recurrence rate ranged from 0 to 29%. This paper identifies unresolved issues, the necessity of new classification and algorithm of surgical management based on it

Results of Surgical Treatment of Patients with Congenital Auditory Canal Atresia and Microtia

Purpose: Creation and implementation effective methods of complex anatomical, functional and aesthetic rehabilitation for different categories of patients with atresia of the external auditory canal (AEAC) and microtia.Methods: Fourty seven patients (n = 47) with congenital atresia of external auditory canal and microtia of different grade underwent surgery on the base of ear diseases department of Federal Scientific and Clinical Center of Otorhinolaryngology (FSCCO) of Federal Medico-Biological Agency of Russian Federation. All patients were divided into three groups. The first group included patients with EACA and 1 grade microtia. The second group included patients with EACA and 2-3 grade microtia. The third group included patients with AECA and 2-3 grade microtia who underwent different types of surgeries previously, had unsufficient development of local tissue, history of trauma, radiation or auricular cancer. To all of them one of three surgical approaches was performed due to individual features and indications: formation of an EAC, tympanoplasty with ossicular chain reconstruction (n = 23) to the 1st group of patient; formation of an EAC, tympanolasty with ossicular chain reconstruction and concomitant reconstruction of an auricle by use of MEDPORto the 2nd group of patients (n = 9) or fixation of cranial osseointegrated implants (COI) to the 3rd group of patients (n = 15).Results: During the observation period which covered on average 3.2 years (+/- 9 months) achieved stable anatomical result. The air-bone gap was on the average 17,0±3.2 dB. Medpor reconstruction provided reliable aesthetic results. The removable auricural prosthesis completely covered up a congenital defect and was a reflection of a healthy ear.Conclusion: The application of the method of lining the formed bone walls of the external auditory canal with a skin pedicled flapand free skin grafts makes it possible to achieve stable anatomical result. Ossiculoplasty with titanium prostheses and tympanoplasty with auto-fascia graft provide a significant hearing improvement in patients with congenital atresia of the external auditory canal. Simultaneous surgical interventions with atresia repair; tympanoplasty and Medpor implantation or setting of ectoprosthetic on COI can be successfully used to improve hearing, replace abnormal ear in different categories of patients according to indications and return them to the social life

Surgical Treatment of Intratemporal Facial Nerve Tumors

Purpose: To report the management, surgical procedure and outcomes from a case series of intratemporal facialnerve tumors. The management of patients with intratemporal tumors of the facial nerve has progressively evolved from performing microsurgical excision with restoration of the facial nerve to more conservative techniques aiming at preserving the integrity of the facial nerve. Methods: Sixteen patients with facial nerve tumors underwent surgery. The surgical approach was proposedafter a first phase of expectant management with careful observation of symptoms evolution. After tumor removal, a facio-facial nerve suture was performed in three cases. For the other cases, an intermediate graft from the great auricular nerve or the sural nerve was used. Results: A direct neurorrhaphy and plastics with intermediate graft allowed improvement of the facial functionby one grade on the House-Brackmann scale. During the observation period, which covered on average 10 months (+/- 5 months), tumor recurrence was not detected in any of the 16 patients. This was confirmed by post-surgical MRI examination. Conclusions: In spite of the fact that this pathology is quite rare, it is a priority disease because of its importantsocial and functional meaning. Paresis and mimic muscles paralysis is a great tragedy for a patient, and in this case the priority is to safe facial nerve functions. The efficiency of surgical treatment of facial nerve’s tumor and its functions’ restoration directly depends on its timely definition based on modern radiologic examination, prevalence rate of tumor’s stage and time duration of paresis

Difficult cases of cochlear implantation

Background: In the recent  years, there  is a tendency to extend  the  indications  to cochlear implantation in patients  with inner and middle ear malformations, cochlea  ossificans and  Meniere's disease. In otosurgical practice, the cases are not uncommon when  cochlear  implantation is difficult after previous canal wall down mastoidectomy due to chronic suppurative otitis media. Aim: To improve postoperative auditory performance of patients  with profound  sensorineural  hearing loss (deafness), complicated  by the inner or middle ear disorders, through the optimization of cochlear implantation surgical technique. Materials and methods: We analyzed 42 patients  with profound  sensorineural  hearing  loss who underwent  cochlear  implantation, 12 of them  having cochlea  ossification  after  meningitis  (group  1), 19,  with  inner  ear  malformations   (group  2),  9, had underwent canal wall down mastoidectomy (group 3) and 2, with Meniere's disease (group 4). Surgical  techniques  varied  depending  on  the type of disorder. In all patients, implant  telemetry and  evoked  stapes  reflex registration  (if stapedium muscle was present) were performed. Postoperatively the mastoid cavity was controlled by  otomicroscopy. Results: Stapes  reflex were obtained in 8 patients  from group  1. Number of from group 3 in whom of the proposed cochlear implantation technique was used, no long-term relapses of chronic suppurative otitis media were observed, the mastoid cavity could be visualized very well and graft survival was excellent. No cases of electrode array extrusion or protrusion were registered. Patients  with  Meniere's  disease  and bilateral  sensorineural  hearing  loss who  underwent  simultaneous  operations  (endolymphatic sac drainage  and cochlear implantation)  showed satisfactory results of audioverbal  rehabilitation and a marked reduction  of vestibular symptoms. Conclusion: Surgical techniques proposed in this study  allow for insertion  of maximal  electrode numbers  into the spiral canal of a malformed and ossified cochlea. Formation  of bone  tunnels  for the active electrode  in the burred  cavity and its covering with autocartilage helps to prevent  any protrusion  and displacement of the electrode  in patients   who  had  previously  underwent canal wall down mastoidectomy. Simultaneous cochlear implantation and endolymphatic sac drainage is also considered  to be an adequate approach  to treatment of patients  with late  stage  Meniere's disease with profound bilateral sensorineural hearing loss

Management and surgical outcomes in patients with chronic suppurative otitis media

Background: Reconstruction of the ossicular chain is performed in 70-90% of tympanoplastic interventions. A cholesteatoma in chronic suppurative otitis media is diagnosed in 24-63% cases, irrespective of localization of the eardrum perforation. Persistently good outcomes after radical mastoidectomy is obtained only in 65 to 66% of patients, and the proportion of unsatisfactory results remains to be rather high (10 to 15%). Aim: To analyze the effectiveness of surgical treatment of patients with chronic suppurative otitis media, operated in a single clinical center from 2014 to 2016. Materials and methods: A total of 212 patients (233 ears) with chronic suppurative otitis media patients, who underwent surgery, were included in this study. The effectiveness of surgical interventions were assessed as short-term (up to 3 months post-operatively) and long-term (6 to 12 months) anatomical and functional outcomes. The anatomical results were considered satisfactory if there was a well-formed mobile neotympanic membrane, air tympanic cavity and dry postoperative cavity. Pure tone audiograms were analyzed to evaluate the functional results. Results: Satisfactory anatomical results were obtained in 93.5% of patients with the safe type suppurative otitis, 88.9% of patients with the unsafe type and 91.2% of patients after a revision surgery. Displacement of total ossicular prosthe-ses was the main cause of poor functional results. The most common causes of unsatisfactory anatomical results were perforation (14 cases), cholesteatoma recurrence (2 cases) and lateralization of the neotympanic membrane (2 cases). Discussion and conclusion: Formation of a reliable sound conducting system with ossicular prostheses allows for persistent improvement of hearing. Various surgical techniques, such as extended posterior tympanotomy, endoscopic assistance, provide a good effect with the removal of non-aggressive cholesteatoma while preserving the bone structures, which are not involved in the disease. A complete removal of an advanced aggressive cholesteatoma with the opening of the temporal bone cell system ensures good functional and anatomical outcomes, makes it possible to prevent the spread of the pathological process and development of intracranial complications