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Mercy George

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Mercy George, MBBS,MS.DLOCHUV | Centre hospitalier universitaire vaudoisService d'Oto-rhino-laryngologie et de Chirurgie Cervico-FacialeRue du Bugnon 46 | BH/12 /5001011 Lausanne | SuisseT. 41 79 556 31 68

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David Carson Berry

University of Cincinnati

Sorbonne University

University of Music and Performing Arts Graz (Austria)

Eric S . Kim (UBC)

University of British Columbia

Kansas State University

Tel Aviv University

University of Oslo

University of Rochester

Daniel K . S . Walden

Yale University

Western University Canada

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Papers by Mercy George

Combined petrosal approach: a systematic review and meta-analysis of surgical complications

Neurosurgical Review, Jul 13, 2023

Transpetrosal approaches are known to be associated with a significant risk of complications, inc... more Transpetrosal approaches are known to be associated with a significant risk of complications, including CSF leak, facial palsy, hearing impairment, venous injury, and/or temporal lobe injury. We aimed to evaluate the morbidity of the standard combined petrosal approach (CPA), defined as a combination of the posterior (retrolabyrinthine) and the anterior petrosal approach. We performed a systematic review and meta-analysis of articles reporting on clinical series of patients operated on for petroclival meningiomas through CPA. Studies that used the terminology "combined petrosal approach" without matching the aforementioned definition were excluded as well as clinical series that included less than 5 patients. A total of 8 studies were included involving 160 patients. The pooled complication rates were 3% (95% CI, 0.5-5.6) for CSF leak, 8.6% (95% CI, 4.1-13.2%) for facial palsy, 8.2% (95% CI, 3.9-12.6%) for hearing impairment, 2.8% (95% CI, 0.9-6.5%) for venous complications, and finally 4.8% (95%, 1.2-8.4%) for temporal lobe injury. Contrary to the general belief, CPA is associated with an acceptable rate of complications, especially when compared to alternative approaches to the petroclival area. In view of the major advantages like shorter trajectory, multiple angles of surgical attack, and early tumor devascularization, CPA remains an important tool in the armamentarium of the skull base surgeon.

Long-term outcomes following functional endoscopic sinus surgery in Samter's triad

The Journal of laryngology and otology, 2015

This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samte... more This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy. Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland. A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2-20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endo...

Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach

Neurosurgical Focus, Mar 1, 2018

T he treatment of large vestibular schwannomas (VSs) has traditionally focused primarily on achie... more T he treatment of large vestibular schwannomas (VSs) has traditionally focused primarily on achieving total excision of the tumor. This strategy has been associated with a significant rate of facial and cochlear nerve deficits directly related to the surgery. 1,21,45 Over the last decade, there has been a progressive shift of focus from tumor excision to nerve preservation as the primary objective, and this has been achieved by the use of a combination of subtotal resection (STR) and subsequent stereotactic radiosurgery (SRS). 4 The goal of this strategy is to perform an intracapsular debulking focusing on reducing tumor size to render the tumor volume compatible for treatment with SRS. With increasing interest generated in this strategy at several centers worldwide, this article attempts to analyze the existing literature through a systematic review of this novel trend in the treatment of large VSs. Experience with this treatment paradigm is limited, and therefore functional and surgical outcomes should be updated through a meta-analysis approach of published data. Methods Search Strategy and Selection Criteria Following PRISMA guidelines and recommendations, 29 we conducted a systematic search using the PubMed, Embase, and Cochrane databases. All studies published before September 2017 were screened. There was no backward date limit. The following medical subject headings (MeSH) and

Impact of the Mean Cochlear Biologically Effective Dose on Hearing Preservation After Stereotactic Radiosurgery for Vestibular Schwannoma: A Retrospective Longitudinal Analysis

Neurosurgery, Jul 11, 2023

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) is a useful alternative for small- to ... more BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) is a useful alternative for small- to medium-sized vestibular schwannoma. To evaluate whether biologically effective dose (BEDGy2.47), calculated for mean (BEDGy2.47 mean) and maximal (BEDGy2.47 max) cochlear dose, is relevant for hearing preservation. METHODS: This is a retrospective longitudinal single-center study. Were analyzed 213 patients with useful baseline hearing. Risk of hearing decline was assessed for Gardner–Robertson classes and pure tone average (PTA) loss. The mean follow-up period was 39 months (median 36, 6-84). RESULTS: Hearing decline (Gardner–Robertson class) 3 years after SRS was associated with higher cochlear BEDGy2.47 mean (odds ratio [OR] 1.39, P = .009). Moreover, BEDGy2.47 mean was more relevant as compared with BEDGy2.47 max (OR 1.13, P = .04). Risk of PTA loss (continuous outcome, follow-up minus baseline) was significantly corelated with BEDGy2.47 mean at 24 (beta coefficient 1.55, P = .002) and 36 (beta coefficient 2.01, P = .004) months after SRS. Risk of PTA loss (&gt;20 dB vs ≤) was associated with higher BEDGy2.47 mean at 6 (OR 1.36, P = .002), 12 (OR 1.36, P = .007), and 36 (OR 1.37, P = .02) months. Risk of hearing decline at 36 months for the BEDGy2.47 mean of 7–8, 10, and 12 Gy2.47 was 28%, 57%, and 85%, respectively. CONCLUSION: Cochlear BEDGy2.47 mean is relevant for hearing decline after SRS and more relevant as compared with BEDGy2.47 max. Three years after SRS, this was sustained for all hearing decline evaluation modalities. Our data suggest the BEDGy2.47 mean cut-off of ≤8 Gy2.47 for better hearing preservation rates.

Combined Approach for Large Vestibular Schwannomas: Planned Subtotal Resection Followed by Gamma Knife Surgery: An Update on a Series of 40 Consecutive Cases

Journal of neurological surgery, Jun 1, 2017

Proton beam radiation therapy for vestibular schwannomas-tumor control and hearing preservation rates: a systematic review and meta-analysis

Neurosurgical Review

Objective Proton beam therapy is considered, by some authors, as having the advantage of deliveri... more Objective Proton beam therapy is considered, by some authors, as having the advantage of delivering dose distributions more conformal to target compared with stereotactic radiosurgery (SRS). Here, we performed a systematic review and meta-analysis of proton beam for VSs, evaluating tumor control and cranial nerve preservation rates, particularly with regard to facial and hearing preservation. Methods We reviewed, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) articles published between 1968 and September 30, 2022. We retained 8 studies reporting 587 patients. Results Overall rate of tumor control (both stability and decrease in volume) was 95.4% (range 93.5–97.2%, p heterogeneity= 0.77, p<0.001). Overall rate of tumor progression was 4.6% (range 2.8–6.5%, p heterogeneity < 0.77, p<0.001). Overall rate of trigeminal nerve preservation (absence of numbness) was 95.6% (range 93.5–97.7%, I2 = 11.44%, p heterogeneity= 0.34, p<0.001). Ove...

The Relevance of Biologically Effective Dose for Hearing Preservation After Stereotactic Radiosurgery for Vestibular Schwannomas: A Retrospective Longitudinal Study

Neurosurgery

A systematic review of the primary squamous cell carcinoma of the external auditory canal: survival outcome based on T-staging and proposal of a new classification

The Journal of Laryngology & Otology, 2021

ObjectiveThis study aimed to provide a systematic review on survival outcome based on Pittsburgh ... more ObjectiveThis study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell carcinoma.MethodThis study was a systematic review in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed until January 2018; pertinent studies were screened. Quality of evidence was assessed using the grading of recommendation, assessment, development and evaluation working group system.ResultsEight articles were chosen that reported on 437 patients with external auditory carcinoma. The 5-year overall survival rate was 53.0 per cent. The pooled proportion of survivors at 5 years for T1tumours was 88.4 per cent and for T2tumours was 88.6 per cent. For the combined population of T1and T2cancer patients, it was 84.5 per cent. For T3and T4tumours, it was 53.3 per cent and 26.8 per cent, respectively, whereas for T3and T4tumours combined, it was 40.4 per cent. Individ...

Surdité brusque : diagnostic et prise en charge en 2021

Revue Médicale Suisse, 2021

Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

Neurosurgical Review, 2021

Vestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing fr... more Vestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing from the vestibular part of the eight cranial nerves. Stereotactic radiosurgery (SRS) has now a long-term scientific track record as first intention treatment for small- to medium-sized VS. Though its success rate is very high, SRS for VS might fail to control tumor growth in some cases. However, the literature on repeat SRS after previously failed SRS remains scarce and reported in a low number of series with a limited number of cases. Here, we aimed at performing a systematic review and meta-analysis of the literature on repeat SRS for VS. Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2020 and referenced in PubMed. Tumor control and cranial nerve outcomes were evaluated with separate meta-analyses. Eight studies comprising 194 patients were included. The overall rate of patients treated in repeat SRS series as per overall series with first SR...

Proposal of a timing strategy for cholesteatoma surgery during the COVID-19 pandemic

European Archives of Oto-Rhino-Laryngology, 2020

Purpose The COVID-19 infection is an aggressive viral illness with high risk of transmission duri... more Purpose The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold's abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? Methods Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. Results Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 subgroups based on disease severity. Conclusions Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic.

Letter: Residual Tumor Volume and Location Predict Progression After Primary Subtotal Resection of Sporadic Vestibular Schwannomas: A Retrospective Volumetric Study

Neurosurgery, 2019

New Frontiers in Managing Clival Tumors — The Extended Endoscopic Endonasal Approach

Endoscopy - Innovative Uses and Emerging Technologies, 2015

Clival lesions still represent a challenge for neurosurgeons. A variety of expansive process, eit... more Clival lesions still represent a challenge for neurosurgeons. A variety of expansive process, either benign or malignant, may be identified in the clival and paraclival region. Surgery of this region with classical open approaches is associated with a significant rate of complication, and the treatment is risky despite technological progress. The acceptance and utilization of endoscopic techniques on a regular basis in transsphenoidal surgery have allowed its application to regions far beyond the sella turcica, such as to reach the clival and paraclival region. Long-term follow-up studies show how the extent of oncological resection is related to long-term prognosis for the most common clival malignancies. Gross total removal is therefore mandatory, and the selection of the best surgical approach is essential for the achievement of this goal. The choice of the surgical approach depends on the location and the extent of the lesion. Through a complete overview of surgical anatomy, we propose a surgical classification with three corridors in the sagittal plane and three zones in the coronal plane. We finally summarize the indications and the limits for the endoscopic technique. In selected cases, endoscopic approaches allow similar oncological outcomes as classical open approaches with a lower rate of complications.

Direct cochlear nerve stimulation monitoring through evoked muscle responses during retrosigmoid vestibular schwannoma resection surgery: technical note

Journal of Neurosurgery

OBJECTIVE Cochlear nerve preservation during surgery for vestibular schwannoma (VS) may be challe... more OBJECTIVE Cochlear nerve preservation during surgery for vestibular schwannoma (VS) may be challenging. Brainstem auditory evoked potentials and cochlear compound nerve action potentials have clearly shown their limitations in surgeries for large VSs. In this paper, the authors report their preliminary results after direct electrical intraoperative cochlear nerve stimulation and recording of the postauricular muscle response (PAMR) during resection of large VSs. METHODS The details for the electrode setup, stimulation, and recording parameters are provided. Data of patients for whom PAMR was recorded during surgery were prospectively collected and analyzed. RESULTS PAMRs were recorded in all patients at the ipsilateral vertex-earlobe scalp electrode, and in 90% of the patients they were also observed in the contralateral electrode. The optimal stimulation intensity was found to be 1 mA at 1 Hz, with a good cochlear response and an absent response from other nerves. At that intensity...

Erratum to: Endoscopic endonasal trans-sphenoidal approach for pituitary adenomas: Is one nostril enough?

Acta Neurochirurgica, 2013

Should Koos I vestibular schwannomas be treated early with Gamma Knife surgery

17th Reunion of the Leksell Gamma Knife Society, 2014

Traitement de la surdité unilatérale par l’implant cochléaire

Revue Médicale Suisse, 2021

La surdité unilatérale diminue la compréhension dans le bruit et la capacité de localiser les sou... more La surdité unilatérale diminue la compréhension dans le bruit et la capacité de localiser les sources sonores affectant ainsi globalement la performance auditive. De plus, la qualité de vie est souvent impactée par la présence d'un acouphène dérangeant. Les patients ont le choix de s'adapter à la situation sans traitement ou de reconstituer une pseudo-stéréophonie à l'aide d'un appareillage qui transmet l'information auditive arrivant sur l'oreille sourde à l'oreille saine (Contralateral Routing of Signals (CROS)). L'implant cochléaire est une alternative récente qui permet de « réactiver » l'oreille atteinte et de redonner ainsi une audition binaurale. Les différentes options de réhabilitation auditive en cas de surdité unilatérale en mettant l'accent sur l'implant cochléaire sont discutées à l'aide d'un cas clinique. = Single sided deafness diminishes speech understanding in noise and sound localization and thereby globally auditory performance. Most patients also suffer from tinnitus and indicate reduced quality of life. Patients have the choice to adapt to the new situation without treatment, to restore pseudostereophonic hearing by contralateral routing of signal (CROS) hearing aids or to restore binaural hearing using a cochlear implant in the deaf ear. This article summarizes the physiological base of binaural hearing and treatment options for single sided deafness with a special emphasis on the cochlear implant.

[Treatment of single-sided deafness by cochlear implantation]

Revue medicale suisse, 2021

Single sided deafness diminishes speech understanding in noise and sound localization and thereby... more Single sided deafness diminishes speech understanding in noise and sound localization and thereby globally auditory performance. Most patients also suffer from tinnitus and indicate reduced quality of life. Patients have the choice to adapt to the new situation without treatment, to restore pseudostereophonic hearing by contralateral routing of signal (CROS) hearing aids or to restore binaural hearing using a cochlear implant in the deaf ear. This article summarizes the physiological base of binaural hearing and treatment options for single sided deafness with a special emphasis on the cochlear implant.

Management of Otogenic Sigmoid Sinus Thrombosis

Otology & Neurotology, 2011

Objectives: To analyze the demographics, presenting symptoms, diagnosis, and management of otogen... more Objectives: To analyze the demographics, presenting symptoms, diagnosis, and management of otogenic sigmoid sinus thrombosis and to propose an algorithm in diagnosis and treatment. Methods: A retrospective chart review was performed. Six patients who were treated at the ENT University Hospital Graz between 2005 and 2010 were included. Results: The mean age of the patients was 11.7 years. Patients were experiencing symptoms for 9.8 days on average. Presenting symptoms were headache, neck stiffness, fever, otalgia, postauricular pain, and erythema. One patient presented with sixth nerve palsy. The otoscopic findings were abnormal in all cases. Computed tomography with contrast enhancement was performed in all patients. It was possible to detect the thrombosis in all cases with computed tomographic scans after contrast administration. An additional magnetic resonance imaging was performed in 3 patients. One patient was treated completely conservatively. All other patients underwent surgical treatment

[Sudden sensorineural hearing loss : Diagnosis and management in 2021]

This article proposes, through a literature review, an updated summary of the initial evaluation,... more This article proposes, through a literature review, an updated summary of the initial evaluation, treatment and follow-up of sudden sensorineural hearing loss (SSNHL) based on current guidelines. SSNHL occurs within 72h with at least 30dBHL loss over 3 consecutive frequencies. Diagnosis is medical in the emergency setting, the etiological workup aims at treating known causes, while different pathophysiological hypotheses exist for idiopathic SSNHL. Controversy exists regarding optimal management due to frequent spontaneous recovery. However, corticotherapy remains widely accepted. Prognosis depends on initial severity, age, associated vertigo and shape of the audiometric curve. Hearing rehabilitation in proposed for significant residual hearing loss.

Combined petrosal approach: a systematic review and meta-analysis of surgical complications

Neurosurgical Review, Jul 13, 2023

Transpetrosal approaches are known to be associated with a significant risk of complications, inc... more Transpetrosal approaches are known to be associated with a significant risk of complications, including CSF leak, facial palsy, hearing impairment, venous injury, and/or temporal lobe injury. We aimed to evaluate the morbidity of the standard combined petrosal approach (CPA), defined as a combination of the posterior (retrolabyrinthine) and the anterior petrosal approach. We performed a systematic review and meta-analysis of articles reporting on clinical series of patients operated on for petroclival meningiomas through CPA. Studies that used the terminology "combined petrosal approach" without matching the aforementioned definition were excluded as well as clinical series that included less than 5 patients. A total of 8 studies were included involving 160 patients. The pooled complication rates were 3% (95% CI, 0.5-5.6) for CSF leak, 8.6% (95% CI, 4.1-13.2%) for facial palsy, 8.2% (95% CI, 3.9-12.6%) for hearing impairment, 2.8% (95% CI, 0.9-6.5%) for venous complications, and finally 4.8% (95%, 1.2-8.4%) for temporal lobe injury. Contrary to the general belief, CPA is associated with an acceptable rate of complications, especially when compared to alternative approaches to the petroclival area. In view of the major advantages like shorter trajectory, multiple angles of surgical attack, and early tumor devascularization, CPA remains an important tool in the armamentarium of the skull base surgeon.

Long-term outcomes following functional endoscopic sinus surgery in Samter's triad

The Journal of laryngology and otology, 2015

This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samte... more This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy. Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland. A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2-20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endo...

Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach

Neurosurgical Focus, Mar 1, 2018

T he treatment of large vestibular schwannomas (VSs) has traditionally focused primarily on achie... more T he treatment of large vestibular schwannomas (VSs) has traditionally focused primarily on achieving total excision of the tumor. This strategy has been associated with a significant rate of facial and cochlear nerve deficits directly related to the surgery. 1,21,45 Over the last decade, there has been a progressive shift of focus from tumor excision to nerve preservation as the primary objective, and this has been achieved by the use of a combination of subtotal resection (STR) and subsequent stereotactic radiosurgery (SRS). 4 The goal of this strategy is to perform an intracapsular debulking focusing on reducing tumor size to render the tumor volume compatible for treatment with SRS. With increasing interest generated in this strategy at several centers worldwide, this article attempts to analyze the existing literature through a systematic review of this novel trend in the treatment of large VSs. Experience with this treatment paradigm is limited, and therefore functional and surgical outcomes should be updated through a meta-analysis approach of published data. Methods Search Strategy and Selection Criteria Following PRISMA guidelines and recommendations, 29 we conducted a systematic search using the PubMed, Embase, and Cochrane databases. All studies published before September 2017 were screened. There was no backward date limit. The following medical subject headings (MeSH) and

Impact of the Mean Cochlear Biologically Effective Dose on Hearing Preservation After Stereotactic Radiosurgery for Vestibular Schwannoma: A Retrospective Longitudinal Analysis

Neurosurgery, Jul 11, 2023

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) is a useful alternative for small- to ... more BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) is a useful alternative for small- to medium-sized vestibular schwannoma. To evaluate whether biologically effective dose (BEDGy2.47), calculated for mean (BEDGy2.47 mean) and maximal (BEDGy2.47 max) cochlear dose, is relevant for hearing preservation. METHODS: This is a retrospective longitudinal single-center study. Were analyzed 213 patients with useful baseline hearing. Risk of hearing decline was assessed for Gardner–Robertson classes and pure tone average (PTA) loss. The mean follow-up period was 39 months (median 36, 6-84). RESULTS: Hearing decline (Gardner–Robertson class) 3 years after SRS was associated with higher cochlear BEDGy2.47 mean (odds ratio [OR] 1.39, P = .009). Moreover, BEDGy2.47 mean was more relevant as compared with BEDGy2.47 max (OR 1.13, P = .04). Risk of PTA loss (continuous outcome, follow-up minus baseline) was significantly corelated with BEDGy2.47 mean at 24 (beta coefficient 1.55, P = .002) and 36 (beta coefficient 2.01, P = .004) months after SRS. Risk of PTA loss (&gt;20 dB vs ≤) was associated with higher BEDGy2.47 mean at 6 (OR 1.36, P = .002), 12 (OR 1.36, P = .007), and 36 (OR 1.37, P = .02) months. Risk of hearing decline at 36 months for the BEDGy2.47 mean of 7–8, 10, and 12 Gy2.47 was 28%, 57%, and 85%, respectively. CONCLUSION: Cochlear BEDGy2.47 mean is relevant for hearing decline after SRS and more relevant as compared with BEDGy2.47 max. Three years after SRS, this was sustained for all hearing decline evaluation modalities. Our data suggest the BEDGy2.47 mean cut-off of ≤8 Gy2.47 for better hearing preservation rates.

Combined Approach for Large Vestibular Schwannomas: Planned Subtotal Resection Followed by Gamma Knife Surgery: An Update on a Series of 40 Consecutive Cases

Journal of neurological surgery, Jun 1, 2017

Proton beam radiation therapy for vestibular schwannomas-tumor control and hearing preservation rates: a systematic review and meta-analysis

Neurosurgical Review

Objective Proton beam therapy is considered, by some authors, as having the advantage of deliveri... more Objective Proton beam therapy is considered, by some authors, as having the advantage of delivering dose distributions more conformal to target compared with stereotactic radiosurgery (SRS). Here, we performed a systematic review and meta-analysis of proton beam for VSs, evaluating tumor control and cranial nerve preservation rates, particularly with regard to facial and hearing preservation. Methods We reviewed, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) articles published between 1968 and September 30, 2022. We retained 8 studies reporting 587 patients. Results Overall rate of tumor control (both stability and decrease in volume) was 95.4% (range 93.5–97.2%, p heterogeneity= 0.77, p<0.001). Overall rate of tumor progression was 4.6% (range 2.8–6.5%, p heterogeneity < 0.77, p<0.001). Overall rate of trigeminal nerve preservation (absence of numbness) was 95.6% (range 93.5–97.7%, I2 = 11.44%, p heterogeneity= 0.34, p<0.001). Ove...

The Relevance of Biologically Effective Dose for Hearing Preservation After Stereotactic Radiosurgery for Vestibular Schwannomas: A Retrospective Longitudinal Study

Neurosurgery

A systematic review of the primary squamous cell carcinoma of the external auditory canal: survival outcome based on T-staging and proposal of a new classification

The Journal of Laryngology & Otology, 2021

ObjectiveThis study aimed to provide a systematic review on survival outcome based on Pittsburgh ... more ObjectiveThis study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell carcinoma.MethodThis study was a systematic review in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed until January 2018; pertinent studies were screened. Quality of evidence was assessed using the grading of recommendation, assessment, development and evaluation working group system.ResultsEight articles were chosen that reported on 437 patients with external auditory carcinoma. The 5-year overall survival rate was 53.0 per cent. The pooled proportion of survivors at 5 years for T1tumours was 88.4 per cent and for T2tumours was 88.6 per cent. For the combined population of T1and T2cancer patients, it was 84.5 per cent. For T3and T4tumours, it was 53.3 per cent and 26.8 per cent, respectively, whereas for T3and T4tumours combined, it was 40.4 per cent. Individ...

Surdité brusque : diagnostic et prise en charge en 2021

Revue Médicale Suisse, 2021

Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

Neurosurgical Review, 2021

Vestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing fr... more Vestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing from the vestibular part of the eight cranial nerves. Stereotactic radiosurgery (SRS) has now a long-term scientific track record as first intention treatment for small- to medium-sized VS. Though its success rate is very high, SRS for VS might fail to control tumor growth in some cases. However, the literature on repeat SRS after previously failed SRS remains scarce and reported in a low number of series with a limited number of cases. Here, we aimed at performing a systematic review and meta-analysis of the literature on repeat SRS for VS. Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2020 and referenced in PubMed. Tumor control and cranial nerve outcomes were evaluated with separate meta-analyses. Eight studies comprising 194 patients were included. The overall rate of patients treated in repeat SRS series as per overall series with first SR...

Proposal of a timing strategy for cholesteatoma surgery during the COVID-19 pandemic

European Archives of Oto-Rhino-Laryngology, 2020

Purpose The COVID-19 infection is an aggressive viral illness with high risk of transmission duri... more Purpose The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold's abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? Methods Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. Results Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 subgroups based on disease severity. Conclusions Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic.

Letter: Residual Tumor Volume and Location Predict Progression After Primary Subtotal Resection of Sporadic Vestibular Schwannomas: A Retrospective Volumetric Study

Neurosurgery, 2019

New Frontiers in Managing Clival Tumors — The Extended Endoscopic Endonasal Approach

Endoscopy - Innovative Uses and Emerging Technologies, 2015

Clival lesions still represent a challenge for neurosurgeons. A variety of expansive process, eit... more Clival lesions still represent a challenge for neurosurgeons. A variety of expansive process, either benign or malignant, may be identified in the clival and paraclival region. Surgery of this region with classical open approaches is associated with a significant rate of complication, and the treatment is risky despite technological progress. The acceptance and utilization of endoscopic techniques on a regular basis in transsphenoidal surgery have allowed its application to regions far beyond the sella turcica, such as to reach the clival and paraclival region. Long-term follow-up studies show how the extent of oncological resection is related to long-term prognosis for the most common clival malignancies. Gross total removal is therefore mandatory, and the selection of the best surgical approach is essential for the achievement of this goal. The choice of the surgical approach depends on the location and the extent of the lesion. Through a complete overview of surgical anatomy, we propose a surgical classification with three corridors in the sagittal plane and three zones in the coronal plane. We finally summarize the indications and the limits for the endoscopic technique. In selected cases, endoscopic approaches allow similar oncological outcomes as classical open approaches with a lower rate of complications.

Direct cochlear nerve stimulation monitoring through evoked muscle responses during retrosigmoid vestibular schwannoma resection surgery: technical note

Journal of Neurosurgery

OBJECTIVE Cochlear nerve preservation during surgery for vestibular schwannoma (VS) may be challe... more OBJECTIVE Cochlear nerve preservation during surgery for vestibular schwannoma (VS) may be challenging. Brainstem auditory evoked potentials and cochlear compound nerve action potentials have clearly shown their limitations in surgeries for large VSs. In this paper, the authors report their preliminary results after direct electrical intraoperative cochlear nerve stimulation and recording of the postauricular muscle response (PAMR) during resection of large VSs. METHODS The details for the electrode setup, stimulation, and recording parameters are provided. Data of patients for whom PAMR was recorded during surgery were prospectively collected and analyzed. RESULTS PAMRs were recorded in all patients at the ipsilateral vertex-earlobe scalp electrode, and in 90% of the patients they were also observed in the contralateral electrode. The optimal stimulation intensity was found to be 1 mA at 1 Hz, with a good cochlear response and an absent response from other nerves. At that intensity...

Erratum to: Endoscopic endonasal trans-sphenoidal approach for pituitary adenomas: Is one nostril enough?

Acta Neurochirurgica, 2013

Should Koos I vestibular schwannomas be treated early with Gamma Knife surgery

17th Reunion of the Leksell Gamma Knife Society, 2014

Traitement de la surdité unilatérale par l’implant cochléaire

Revue Médicale Suisse, 2021

La surdité unilatérale diminue la compréhension dans le bruit et la capacité de localiser les sou... more La surdité unilatérale diminue la compréhension dans le bruit et la capacité de localiser les sources sonores affectant ainsi globalement la performance auditive. De plus, la qualité de vie est souvent impactée par la présence d'un acouphène dérangeant. Les patients ont le choix de s'adapter à la situation sans traitement ou de reconstituer une pseudo-stéréophonie à l'aide d'un appareillage qui transmet l'information auditive arrivant sur l'oreille sourde à l'oreille saine (Contralateral Routing of Signals (CROS)). L'implant cochléaire est une alternative récente qui permet de « réactiver » l'oreille atteinte et de redonner ainsi une audition binaurale. Les différentes options de réhabilitation auditive en cas de surdité unilatérale en mettant l'accent sur l'implant cochléaire sont discutées à l'aide d'un cas clinique. = Single sided deafness diminishes speech understanding in noise and sound localization and thereby globally auditory performance. Most patients also suffer from tinnitus and indicate reduced quality of life. Patients have the choice to adapt to the new situation without treatment, to restore pseudostereophonic hearing by contralateral routing of signal (CROS) hearing aids or to restore binaural hearing using a cochlear implant in the deaf ear. This article summarizes the physiological base of binaural hearing and treatment options for single sided deafness with a special emphasis on the cochlear implant.

[Treatment of single-sided deafness by cochlear implantation]

Revue medicale suisse, 2021

Single sided deafness diminishes speech understanding in noise and sound localization and thereby... more Single sided deafness diminishes speech understanding in noise and sound localization and thereby globally auditory performance. Most patients also suffer from tinnitus and indicate reduced quality of life. Patients have the choice to adapt to the new situation without treatment, to restore pseudostereophonic hearing by contralateral routing of signal (CROS) hearing aids or to restore binaural hearing using a cochlear implant in the deaf ear. This article summarizes the physiological base of binaural hearing and treatment options for single sided deafness with a special emphasis on the cochlear implant.

Management of Otogenic Sigmoid Sinus Thrombosis

Otology & Neurotology, 2011

Objectives: To analyze the demographics, presenting symptoms, diagnosis, and management of otogen... more Objectives: To analyze the demographics, presenting symptoms, diagnosis, and management of otogenic sigmoid sinus thrombosis and to propose an algorithm in diagnosis and treatment. Methods: A retrospective chart review was performed. Six patients who were treated at the ENT University Hospital Graz between 2005 and 2010 were included. Results: The mean age of the patients was 11.7 years. Patients were experiencing symptoms for 9.8 days on average. Presenting symptoms were headache, neck stiffness, fever, otalgia, postauricular pain, and erythema. One patient presented with sixth nerve palsy. The otoscopic findings were abnormal in all cases. Computed tomography with contrast enhancement was performed in all patients. It was possible to detect the thrombosis in all cases with computed tomographic scans after contrast administration. An additional magnetic resonance imaging was performed in 3 patients. One patient was treated completely conservatively. All other patients underwent surgical treatment

[Sudden sensorineural hearing loss : Diagnosis and management in 2021]

This article proposes, through a literature review, an updated summary of the initial evaluation,... more This article proposes, through a literature review, an updated summary of the initial evaluation, treatment and follow-up of sudden sensorineural hearing loss (SSNHL) based on current guidelines. SSNHL occurs within 72h with at least 30dBHL loss over 3 consecutive frequencies. Diagnosis is medical in the emergency setting, the etiological workup aims at treating known causes, while different pathophysiological hypotheses exist for idiopathic SSNHL. Controversy exists regarding optimal management due to frequent spontaneous recovery. However, corticotherapy remains widely accepted. Prognosis depends on initial severity, age, associated vertigo and shape of the audiometric curve. Hearing rehabilitation in proposed for significant residual hearing loss.