A 49-year-old woman with a direct posttraumatic carotid cavernous fistula (CCF) was treated with ... more A 49-year-old woman with a direct posttraumatic carotid cavernous fistula (CCF) was treated with detachable balloons via a transcarotid route. After the procedure, her intracranial bruit, conjunctival injection, and orbital congestion were cured, but the preexistent sixth nerve palsy deteriorated.
The treatment of deaf and hearing-impaired children with cochlear implants has been established f... more The treatment of deaf and hearing-impaired children with cochlear implants has been established for several years. Nonetheless, no long-term results exist for studies of a representatively large number of children in the German-speaking area. These are necessary in order to formulate prognoses regarding the development and results of children undergoing implantation at various ages. In a retrospective study, we assessed the data of 156 children with various implantation ages and a minimum follow-up period of 5 years for whom speech and audiological data (Oldenburg Sentence Test, Freiburg words/numbers test) were available. Our findings confirm the assumption that early-implanted children (<2 years) achieve the best speech-comprehension results. For this reason, support for a sufficient universal neonate hearing screen should be emphatically given so that implantation, after a hearing test phase, can be targeted in the first year of life. The surgical, anesthesiological, and rehabilitation conditions must be fulfilled, and surgical experience is required for operation on infants and small children.
Otology Neurotology Official Publication of the American Otological Society American Neurotology Society and European Academy of Otology and Neurotology, 2001
To evaluate the auditory brainstem response (ABR) findings in cerebellopontine angle (CPA) tumors... more To evaluate the auditory brainstem response (ABR) findings in cerebellopontine angle (CPA) tumors and focus on those with normal ABR results. This was a retrospective evaluation of ABR findings. All subjects with diagnosed CPA tumors who were referred for treatment were included. All 309 patients with radiographically confirmed (computed tomography or magnetic resonance imaging [MRI]) CPA tumors (153 before 1993 and 156 after 1993). All patients underwent complete audiologic examination, electronystagmography, ABR testing, and ipsilateral transtympanic electrocochleography. All tumors were histologically confirmed. The patients were categorized according to ABR results (normal or pathologic findings or no response); according to histology (vestibular schwannomas or meningiomas); and according to tumor size by MRI (small, up to 15 mm; medium, 16-25 mm; large, 26-40 mm; and very large, over 40 mm). Normal ABR results were found in 18.4%; pathologic ABR results in 31.4%; and no response in 50.2%. Small vestibular schwannomas (under 15 mm) showed a higher incidence of normal ABR results (41.7%). CPA tumors with normal ABR results (n = 57) caused no hearing loss (n = 12), symmetrical hearing loss (n = 11), or ipsilateral hearing loss with Short Increment Sensitivity Index 100% and normal acoustic reflex (cochlear deafness, n = 34). Caloric response was normal in 59.7% of these tumors. Because validation of ABR as screening for acoustic tumors is based on diagnosed tumors, and because MRI allows detection of very small tumors, the incidence of normal ABR increases and its sensitivity would be expected to decrease. ABR is not sufficient for early detection of small CPA tumors.
The radiologic evaluation of the temporal bone in cochlear implant candidates can detect malforma... more The radiologic evaluation of the temporal bone in cochlear implant candidates can detect malformations of the inner ear in up to 20% of cases. The aim of our study was to analyze and classify malformations of the inner ear in patients with cochlear implants carried out from 2001 to 2009. Malformations of the inner ear, including malformations of the internal auditory canal were detected in 12.7% of children and 3.4% of adults. Mondini dysplasia was most common and occurred in 45% of cases. The surgical procedure had to be adapted according to the individual malformation. Modification of surgical access, management of intraoperative CSF gusher, choice of electrode array, intraoperative imaging and the use of navigation were the most important factors. Rehabilitation results were generally very positive and corresponded to the expectation depending on the duration of deafness, if no additional handicaps were present.
ZusammenfassungHintergrundLimitierend für eine optimale funktionelle Intigrität von Kochleaimplan... more ZusammenfassungHintergrundLimitierend für eine optimale funktionelle Intigrität von Kochleaimplantaten sind der richtige Sitz und die Position der Elektrode, welche maßgeblich von der Kochleostomie beeinflusst werden. Lokalisation und Form des Bohrkanals werden bislang ausschließlich vom Operateur bestimmt, wobei häufig intraoperativ nachkorrigiert werden muss.Material und MethodenIn einer Kadaverstudie haben wir untersucht, inwieweit durch Einsatz der computerassistierten Chirurgie der in der Computertomographie festgelegte Zielpunkt auch reproduzierbar erreicht wird. Für die Referenzierung haben wir Titanschraubmarker als derzeitigen Goldstandard gewählt. ErgebnisseAm Zielpunkt wurde eine reale Abweichung von 1,6 mm festgestellt. Bei einer Kochleostomie von 0,5 mm Durchmesser wird damit jedoch der Zielpunkt nicht eindeutig reproduzierbar erreicht. Andererseits wird bei dieser Abweichung ein Zielfeld von 2,56 mm 2 umschrieben.SchlussfolgerungenEin solches navigiert angesteuertes Zielfeld ist jedoch hinsichtlich Reproduzierbarkeit und Genauigkeit besser als ohne Einsatz der Navigation. Bei Weiterentwicklung der Technik ist eine navigierte Kochleostomie grundsätzlich möglich.
A 49-year-old woman with a direct posttraumatic carotid cavernous fistula (CCF) was treated with ... more A 49-year-old woman with a direct posttraumatic carotid cavernous fistula (CCF) was treated with detachable balloons via a transcarotid route. After the procedure, her intracranial bruit, conjunctival injection, and orbital congestion were cured, but the preexistent sixth nerve palsy deteriorated.
The treatment of deaf and hearing-impaired children with cochlear implants has been established f... more The treatment of deaf and hearing-impaired children with cochlear implants has been established for several years. Nonetheless, no long-term results exist for studies of a representatively large number of children in the German-speaking area. These are necessary in order to formulate prognoses regarding the development and results of children undergoing implantation at various ages. In a retrospective study, we assessed the data of 156 children with various implantation ages and a minimum follow-up period of 5 years for whom speech and audiological data (Oldenburg Sentence Test, Freiburg words/numbers test) were available. Our findings confirm the assumption that early-implanted children (<2 years) achieve the best speech-comprehension results. For this reason, support for a sufficient universal neonate hearing screen should be emphatically given so that implantation, after a hearing test phase, can be targeted in the first year of life. The surgical, anesthesiological, and rehabilitation conditions must be fulfilled, and surgical experience is required for operation on infants and small children.
Otology Neurotology Official Publication of the American Otological Society American Neurotology Society and European Academy of Otology and Neurotology, 2001
To evaluate the auditory brainstem response (ABR) findings in cerebellopontine angle (CPA) tumors... more To evaluate the auditory brainstem response (ABR) findings in cerebellopontine angle (CPA) tumors and focus on those with normal ABR results. This was a retrospective evaluation of ABR findings. All subjects with diagnosed CPA tumors who were referred for treatment were included. All 309 patients with radiographically confirmed (computed tomography or magnetic resonance imaging [MRI]) CPA tumors (153 before 1993 and 156 after 1993). All patients underwent complete audiologic examination, electronystagmography, ABR testing, and ipsilateral transtympanic electrocochleography. All tumors were histologically confirmed. The patients were categorized according to ABR results (normal or pathologic findings or no response); according to histology (vestibular schwannomas or meningiomas); and according to tumor size by MRI (small, up to 15 mm; medium, 16-25 mm; large, 26-40 mm; and very large, over 40 mm). Normal ABR results were found in 18.4%; pathologic ABR results in 31.4%; and no response in 50.2%. Small vestibular schwannomas (under 15 mm) showed a higher incidence of normal ABR results (41.7%). CPA tumors with normal ABR results (n = 57) caused no hearing loss (n = 12), symmetrical hearing loss (n = 11), or ipsilateral hearing loss with Short Increment Sensitivity Index 100% and normal acoustic reflex (cochlear deafness, n = 34). Caloric response was normal in 59.7% of these tumors. Because validation of ABR as screening for acoustic tumors is based on diagnosed tumors, and because MRI allows detection of very small tumors, the incidence of normal ABR increases and its sensitivity would be expected to decrease. ABR is not sufficient for early detection of small CPA tumors.
The radiologic evaluation of the temporal bone in cochlear implant candidates can detect malforma... more The radiologic evaluation of the temporal bone in cochlear implant candidates can detect malformations of the inner ear in up to 20% of cases. The aim of our study was to analyze and classify malformations of the inner ear in patients with cochlear implants carried out from 2001 to 2009. Malformations of the inner ear, including malformations of the internal auditory canal were detected in 12.7% of children and 3.4% of adults. Mondini dysplasia was most common and occurred in 45% of cases. The surgical procedure had to be adapted according to the individual malformation. Modification of surgical access, management of intraoperative CSF gusher, choice of electrode array, intraoperative imaging and the use of navigation were the most important factors. Rehabilitation results were generally very positive and corresponded to the expectation depending on the duration of deafness, if no additional handicaps were present.
ZusammenfassungHintergrundLimitierend für eine optimale funktionelle Intigrität von Kochleaimplan... more ZusammenfassungHintergrundLimitierend für eine optimale funktionelle Intigrität von Kochleaimplantaten sind der richtige Sitz und die Position der Elektrode, welche maßgeblich von der Kochleostomie beeinflusst werden. Lokalisation und Form des Bohrkanals werden bislang ausschließlich vom Operateur bestimmt, wobei häufig intraoperativ nachkorrigiert werden muss.Material und MethodenIn einer Kadaverstudie haben wir untersucht, inwieweit durch Einsatz der computerassistierten Chirurgie der in der Computertomographie festgelegte Zielpunkt auch reproduzierbar erreicht wird. Für die Referenzierung haben wir Titanschraubmarker als derzeitigen Goldstandard gewählt. ErgebnisseAm Zielpunkt wurde eine reale Abweichung von 1,6 mm festgestellt. Bei einer Kochleostomie von 0,5 mm Durchmesser wird damit jedoch der Zielpunkt nicht eindeutig reproduzierbar erreicht. Andererseits wird bei dieser Abweichung ein Zielfeld von 2,56 mm 2 umschrieben.SchlussfolgerungenEin solches navigiert angesteuertes Zielfeld ist jedoch hinsichtlich Reproduzierbarkeit und Genauigkeit besser als ohne Einsatz der Navigation. Bei Weiterentwicklung der Technik ist eine navigierte Kochleostomie grundsätzlich möglich.
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