The Experts below are selected from a list of 3096 Experts worldwide ranked by ideXlab platform
Christian Scheller - One of the best experts on this subject based on the ideXlab platform.
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the influence of prophylactic vasoactive treatment on cochlear and facial nerve functions after Vestibular Schwannoma surgery a prospective and open label randomized pilot study
Neurosurgery, 2007Co-Authors: Christian Scheller, H P Richter, Martin Engelhardt, Ralph W Koenig, Gregor AntoniadisAbstract:OBJECTIVE: Facial nerve paresis and hearing loss are common complications after Vestibular Schwannoma surgery. Experiments with facial nerves of the rat and retrospectively analyzed clinical studies showed a beneficial effect of vasoactive treatment on the preservation of facial and cochlear nerve functions. This prospective and open-label randomized pilot study is the first study of a prophylactic vasoactive treatment in Vestibular Schwannoma surgery. METHODS: Thirty patients were randomized before surgery. One group (n = 14) received a vasoactive prophylaxis consisting of nimodipine and hydroxyethylstarch which was started the day before surgery and was continued until the seventh postoperative day. The other group (n = 16) did not receive preoperative medication. Intraoperative monitoring, including acoustic evoked potentials and continuous facial electromyelograms, was applied to all patients. However, when electrophysiological signs of a deterioration of facial or cochlear nerve function were detected in the group of patients without medication, vasoactive treatment was started immediately. Cochlear and facial nerve function were documented preoperatively, during the first 7 days postoperatively, and again after long-term observation. RESULTS: Despite the limited number of patients, our results were significant using the Fisher's exact test (small no. of patients) for a better outcome after Vestibular Schwannoma surgery for both hearing (P = 0.041) and facial nerve (P = 0.045) preservation in the group of patients who received a prophylactic vasoactive treatment. CONCLUSION: Prophylactic vasoactive treatment consisting of nimodipine and hydroxyethylstarch shows significantly better results concerning preservation of the facial and cochlear nerve function in Vestibular Schwannoma surgery. The prophylactic use is also superior to intraoperative vasoactive treatment.
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preservation of facial nerve function after postoperative vasoactive treatment in Vestibular Schwannoma surgery
Neurosurgery, 2006Co-Authors: Christian Strauss, Stefan Rampp, J Romstock, Rudolf Fahlbusch, Christian SchellerAbstract:OBJECTIVE: Facial nerve paresis and hearing loss are common complications after Vestibular Schwannoma surgery. Experimental and clinical studies point to a beneficial effect of nimodipine and hydroxyethyl starch for preservation of cochlear nerve function. A retrospective analysis was undertaken to evaluate the effect of vasoactive treatment on facial nerve outcome. PATIENTS AND METHODS: Forty-five patients with Vestibular Schwannoma removal, intraoperative electromyographic monitoring, and postoperative deterioration of facial nerve function were evaluated. Twenty-five patients underwent vasoactive treatment consisting of nimodipine and hydroxyethyl starch for improvement of hearing outcome. Twenty patients did not receive such treatment. Facial nerve function was evaluated before and after surgery, as well as 1 year after the surgical procedure. Patients were comparable regarding age, tumor size, and preoperative facial nerve function. RESULTS: Long-term results of facial nerve function were significantly improved in those patients who experienced severe postoperative deterioration of facial nerve function and received vasoactive treatment as compared with patients who did not receive nimodipine and hydroxyethyl starch after surgery. Treated patients showed a significantly higher rate of complete recovery compared with patients without treatment. CONCLUSION: The study points to a potential effect of vasoactive treatment for facial nerve function after Vestibular Schwannoma surgery. In particular, patients with postoperative disfiguring facial nerve palsy clearly benefit from intravenous hydroxyethyl starch and nimodipine with respect to a long-term socially acceptable facial nerve function.
Christine G Gourin - One of the best experts on this subject based on the ideXlab platform.
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national prevalence and impact of perioperative vagus nerve injury in Vestibular Schwannoma
Laryngoscope, 2012Co-Authors: Bryan K Ward, Howard W Francis, Simon R Best, Heather M Starmer, Lee M Akst, Christine G GourinAbstract:Objectives/hypothesis Lower cranial nerve injury may be an under-reported complication of Vestibular Schwannoma surgery. This study aims to characterize the prevalence of complications associated with vagus nerve injury following Vestibular Schwannoma surgery and the impact of these complications on patient care. Study design Retrospective cross-sectional study. Methods Discharge data from the Nationwide Inpatient Sample for 17,281 patients with Vestibular Schwannoma who underwent surgery in 2003-2008 were analyzed using cross-tabulations and multivariate regression modeling. Results Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P Conclusions Although infrequently reported in this national inpatient sample, vagus nerve injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.
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national prevalence and impact of perioperative vagus nerve injury in Vestibular Schwannoma
Laryngoscope, 2012Co-Authors: Bryan K Ward, Howard W Francis, Simon R Best, Heather M Starmer, Lee M Akst, Christine G GourinAbstract:Objectives/Hypothesis: Lower cranial nerve injury may be an under-reported complication of Vestibular Schwannoma surgery. This study aims to characterize the prevalence of complications associated with vagus nerve injury following Vestibular Schwannoma surgery and the impact of these complications on patient care. Study Design: Retrospective cross-sectional study. Methods: Discharge data from the Nationwide Inpatient Sample for 17,281 patients with Vestibular Schwannoma who underwent surgery in 2003–2008 were analyzed using cross-tabulations and multivariate regression modeling. Results: Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P < .001). Tracheostomy (3.4% vs. 0.8%) and gastrostomy tube placement (20.9% vs. 0.5%) were significantly more likely in patients with dysphagia (P < .0001). After adjusting for other variables, dysphagia, aspiration pneumonia, and tracheostomy were significantly associated with increased length of hospitalization and hospital-related costs. Conclusions: Although infrequently reported in this national inpatient sample, vagus nerve injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.
Robert G. Ojemann - One of the best experts on this subject based on the ideXlab platform.
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retrosigmoid approach to acoustic neuroma Vestibular Schwannoma
Neurosurgery, 2001Co-Authors: Robert G. OjemannAbstract:Abstract The retrosigmoid approach for the microsurgical removal of an acoustic neuroma (Vestibular Schwannoma) is described, and perioperative medical management of the patient is discussed. The techniques for monitoring facial and cochlear nerve function are presented. The supine-oblique position, skin incision, bone removal, dural opening, and initial exposure are outlined. Important points in the technique for removing acoustic neuromas and preserving hearing, when possible, are described and illustrated.
Bryan K Ward - One of the best experts on this subject based on the ideXlab platform.
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national prevalence and impact of perioperative vagus nerve injury in Vestibular Schwannoma
Laryngoscope, 2012Co-Authors: Bryan K Ward, Howard W Francis, Simon R Best, Heather M Starmer, Lee M Akst, Christine G GourinAbstract:Objectives/hypothesis Lower cranial nerve injury may be an under-reported complication of Vestibular Schwannoma surgery. This study aims to characterize the prevalence of complications associated with vagus nerve injury following Vestibular Schwannoma surgery and the impact of these complications on patient care. Study design Retrospective cross-sectional study. Methods Discharge data from the Nationwide Inpatient Sample for 17,281 patients with Vestibular Schwannoma who underwent surgery in 2003-2008 were analyzed using cross-tabulations and multivariate regression modeling. Results Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P Conclusions Although infrequently reported in this national inpatient sample, vagus nerve injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.
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national prevalence and impact of perioperative vagus nerve injury in Vestibular Schwannoma
Laryngoscope, 2012Co-Authors: Bryan K Ward, Howard W Francis, Simon R Best, Heather M Starmer, Lee M Akst, Christine G GourinAbstract:Objectives/Hypothesis: Lower cranial nerve injury may be an under-reported complication of Vestibular Schwannoma surgery. This study aims to characterize the prevalence of complications associated with vagus nerve injury following Vestibular Schwannoma surgery and the impact of these complications on patient care. Study Design: Retrospective cross-sectional study. Methods: Discharge data from the Nationwide Inpatient Sample for 17,281 patients with Vestibular Schwannoma who underwent surgery in 2003–2008 were analyzed using cross-tabulations and multivariate regression modeling. Results: Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P < .001). Tracheostomy (3.4% vs. 0.8%) and gastrostomy tube placement (20.9% vs. 0.5%) were significantly more likely in patients with dysphagia (P < .0001). After adjusting for other variables, dysphagia, aspiration pneumonia, and tracheostomy were significantly associated with increased length of hospitalization and hospital-related costs. Conclusions: Although infrequently reported in this national inpatient sample, vagus nerve injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.
Andrew T Parsa - One of the best experts on this subject based on the ideXlab platform.
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beyond audiofacial morbidity after Vestibular Schwannoma surgery
Journal of Neurosurgery, 2011Co-Authors: Michael E Sughrue, Isaac Yang, Shanna Fang, Derick Aranda, Steven W Cheung, Martin J Rutkowski, Andrew T ParsaAbstract:Object Outcomes following Vestibular Schwannoma (VS) surgery have been extensively described; however, complication rates reported in the literature vary markedly. In addition, the majority of reports have focused on outcomes related to cranial nerves (CNs) VII and VIII. The objective of this study was to analyze reported morbidity unrelated to CNs VII and VIII following the resection of VS. Methods The authors performed a comprehensive search of the English language literature, identifying and aggregating morbidity and death data from patients who had undergone microsurgical removal of VSs. A subgroup analysis based on surgical approach and tumor size was performed to compare rates of CSF leakage, vascular injury, neurological deficit, and postoperative infection. Results One hundred articles met the inclusion criteria, providing data for 32,870 patients. The overall mortality rate was 0.2% (95% CI 0.1–0.3%). Twenty-two percent of patients (95% CI 21–23%) experienced at least 1 surgically attributable co...
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a comprehensive analysis of hearing preservation after radiosurgery for Vestibular Schwannoma
Journal of Neurosurgery, 2010Co-Authors: Isaac Yang, Michael E Sughrue, Seunggu J Han, Derick Aranda, Steven W Cheung, Lawrence H Pitts, Andrew T ParsaAbstract:Object Gamma Knife surgery (GKS) has evolved into a practical alternative to open microsurgical resection in the treatment of patients with Vestibular Schwannoma (VS). Hearing preservation rates in GKS series suggest very favorable outcomes without the possible acute morbidity associated with open microsurgery. To mitigate institutional and practitioner bias, the authors performed an analytical review of the published literature on the GKS treatment of Vestibular Schwannoma patients. Their aim was to objectively characterize the prognostic factors that contribute to hearing preservation after GKS, as well as methodically summarize the reported literature describing hearing preservation after GKS for VS. Methods A comprehensive search of the English-language literature revealed a total of 254 published studies reporting assessable and quantifiable outcome data obtained in patients who underwent radiosurgery for VSs. Inclusion criteria for articles were 4-fold: 1) hearing preservation rates reported specifi...
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facial nerve preservation after Vestibular Schwannoma gamma knife radiosurgery
Journal of Neuro-oncology, 2009Co-Authors: Isaac Yang, Michael E Sughrue, Seunggu J Han, Shanna Fang, Derick Aranda, Steven W Cheung, Lawrence H Pitts, Andrew T ParsaAbstract:Objective Facial nerve preservation is a critical measure of clinical outcome after Vestibular Schwannoma treatment. Gamma Knife radiosurgery has evolved into a practical treatment modality for Vestibular Schwannoma patients, with several reported series from a variety of centers. In this study, we report the results of an objective analysis of reported facial nerve outcomes after the treatment of Vestibular Schwannomas with Gamma Knife radiosurgery. Materials and methods A Boolean Pub Med search of the English language literature revealed a total of 23 published studies reporting assessable and quantifiable outcome data regarding facial nerve function in 2,204 patients who were treated with Gamma Knife radiosurgery for Vestibular Schwannoma. Inclusion criteria for articles were: (1) Facial nerve preservation rates were reported specifically for Vestibular Schwannoma, (2) Facial nerve functional outcome was reported using the House–Brackmann classification (HBC) for facial nerve function, (3) Tumor size was documented, and (4) Gamma Knife radiosurgery was the only radiosurgical modality used in the report. The data were then aggregated and analyzed based on radiation doses delivered, tumor volume, and patient age. Results An overall facial nerve preservation rate of 96.2% was found after Gamma Knife radiosurgery for Vestibular Schwannoma in our analysis. Patients receiving less than or equal to 13 Gy of radiation at the marginal dose had a better facial nerve preservation rate than those who received higher doses (≤13 Gy = 98.5% vs. >13 Gy = 94.7%, P 1.5 cm3 95.5%, P < 0.0001). Superior facial nerve preservation was also noted in patients younger than or equal to 60 years of age (96.8 vs. 89.4%, P < 0.0001). The average reported follow up duration in this systematic review was 54.1 ± 31.3 months. Conclusion Our analysis of case series data aggregated from multiple centers suggests that a facial nerve preservation rate of 96.2% can be expected after Gamma knife radiosurgery for Vestibular Schwannoma. Younger patients with smaller tumors less than 1.5 cm3 and treated with lower doses of radiation less than 13 Gy will likely have better facial nerve preservation rates after Gamma Knife radiosurgery for Vestibular Schwannoma.
