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Dastagirzada YM, Eremiev A, Wisoff JH, Kay-Rivest E, Shapiro WH, Unterberger A, Waltzman SB, Roland JT, Golfinos JG, Harter DH. Auditory brainstem implantation: surgical experience and audiometric outcomes in the pediatric population. J Neurosurg Pediatr 2024; 33:496-504. [PMID: 38427998 DOI: 10.3171/2023.12.peds23299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/26/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Pediatric data regarding treatment via an auditory brainstem implant (ABI) remains sparse. The authors aimed to describe their experience at their institution and to delineate associated demographic data, audiometric outcomes, and surgical parameters. METHODS An IRB-approved, retrospective chart review was conducted among the authors' pediatric patients who had undergone auditory brainstem implantation between 2012 and 2021. Demographic information including sex, age, race, coexisting syndrome(s), history of cochlear implant placement, average duration of implant use, and follow-up outcomes were collected. Surgical parameters collected included approach, intraoperative findings, number of electrodes activated, and complications. RESULTS A total of 19 pediatric patients had an ABI placed at the authors' institution, with a mean age at surgery of 4.7 years (range 1.5-17.8 years). A total of 17 patients (89.5%) had bilateral cochlear nerve aplasia/dysplasia, 1 (5.3%) had unilateral cochlear nerve aplasia/dysplasia, and 1 (5.3%) had a hypoplastic cochlea with ossification. A total of 11 patients (57.9%) had a history of cochlear implants that were ineffective and required removal. The mean length of implant use was 5.31 years (0.25-10 years). Two patients (10.5%) experienced CSF-related complications requiring further surgical intervention. The most recent audiometric outcomes demonstrated that 15 patients (78.9%) showed improvement in their hearing ability: 5 with sound/speech awareness, 5 able to discriminate among speech and environmental sounds, and 5 able to understand common phrases/conversation without lip reading. Nine patients (47.4%) are in a school for the deaf and 7 (36.8%) are in a mainstream school with support. CONCLUSIONS The authors' surgical experience with a multidisciplinary team demonstrates that the retrosigmoid approach for ABI placement in children with inner ear pathologies and severe sensorineural hearing loss is a safe and effective treatment modality. Audiometric outcome data showed that nearly 79% of these patients had an improvement in their environmental and speech awareness. Further multicenter collaborations are necessary to improve these outcomes and potentially standardize/enhance electrode placement.
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Affiliation(s)
| | | | | | - Emily Kay-Rivest
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - William H Shapiro
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - Ansley Unterberger
- 3Department of Neurosurgery, UCLA Medical Center, Los Angeles, California
| | - Susan B Waltzman
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - J Thomas Roland
- 2Otolaryngology, NYU Langone Medical Center, New York, New York; and
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Marinelli JP, Herberg HA, Moore LS, Yancey KL, Kay-Rivest E, Casale GG, Durham A, Khandalavala KR, Lund-Johansen M, Kosaraju N, Lohse CM, Patel NS, Gurgel RK, Babu SC, Golfinos JG, Roland JT, Hunter JB, Kutz JW, Santa Maria PL, Link MJ, Tveiten ØV, Carlson ML. Salvage Microsurgery Following Failed Primary Radiosurgery in Sporadic Vestibular Schwannoma. JAMA Otolaryngol Head Neck Surg 2024; 150:287-294. [PMID: 38358763 PMCID: PMC10870221 DOI: 10.1001/jamaoto.2023.4474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024]
Abstract
Importance Management of sporadic vestibular schwannoma with radiosurgery is becoming increasingly common globally; however, limited data currently characterize patient outcomes in the setting of microsurgical salvage for radiosurgical failure. Objective To describe the clinical outcomes of salvage microsurgery following failed primary stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) among patients with sporadic vestibular schwannoma. Design, Setting, and Participants This was a cohort study of adults (≥18 years old) with sporadic vestibular schwannoma who underwent salvage microsurgery following failed primary SRS/FSRT in 7 vestibular schwannoma treatment centers across the US and Norway. Data collection was performed between July 2022 and January 2023, with data analysis performed between January and July 2023. Exposure Salvage microsurgical tumor resection. Main Outcomes and Measures Composite outcome of undergoing less than gross total resection (GTR) or experiencing long-term facial paresis. Results Among 126 patients, the median (IQR) age at time of salvage microsurgery was 62 (53-70) years, 69 (55%) were female, and 113 of 117 (97%) had tumors that extended into the cerebellopontine angle at time of salvage. Of 125 patients, 96 (76%) underwent primary gamma knife SRS, while 24 (19%) underwent linear accelerator-based SRS; the remaining patients underwent FSRT using other modalities. Postoperative cerebrospinal fluid leak was seen in 15 of 126 patients (12%), hydrocephalus in 8 (6%), symptomatic stroke in 7 (6%), and meningitis in 2 (2%). Each 1-mm increase in cerebellopontine angle tumor size was associated with a 13% increased likelihood of foregoing GTR (64 of 102 patients [63%]) or long-term postoperative House-Brackmann grade higher than I (48 of 102 patients [47%]) (odds ratio, 1.13; 95% CI, 1.04-1.23). Following salvage microsurgery, tumor growth-free survival rates at 1, 3, and 5 years were 97% (95% CI, 94%-100%), 93% (95% CI, 87%-99%), and 91% (95% CI, 84%-98%), respectively. Conclusions In this cohort study, more than half of patients who received salvage microsurgery following primary SRS/FSRT underwent less than GTR or experienced some degree of facial paresis long term. These data suggest that the cumulative risk of developing facial paresis following primary SRS/FSRT by the end of the patient's journey with treatment approximates 2.5% to 7.5% when using published primary SRS/FSRT long-term tumor control rates.
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Affiliation(s)
- John P. Marinelli
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hans A. Herberg
- Department of Neurosurgery, Bergen University Hospital, Bergen, Norway
| | - Lindsay S. Moore
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Kristen L. Yancey
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Emily Kay-Rivest
- Department of Otolaryngology–Head and Neck Surgery, New York University Langone Health, New York, New York
| | | | - Allison Durham
- Department of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Karl R. Khandalavala
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Nikitha Kosaraju
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Christine M. Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Neil S. Patel
- Department of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Richard K. Gurgel
- Department of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Seilesh C. Babu
- Department of Neurotology, Michigan Ear Institute, Farmington Hills
| | - John G. Golfinos
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - J. Thomas Roland
- Department of Otolaryngology–Head and Neck Surgery, New York University Langone Health, New York, New York
| | - Jacob B. Hunter
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - J. Walter Kutz
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Peter L. Santa Maria
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California
| | - Michael J. Link
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Landsberger DM, Long CJ, Kirk JR, Stupak N, Roland JT. Effect of Return Electrode Placement at Apical Cochleostomy on Current Flow With a Cochlear Implant. Ear Hear 2024; 45:511-516. [PMID: 38047764 DOI: 10.1097/aud.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVES A method for stimulating the cochlear apex using perimodiolar electrode arrays is described. This method involves implanting an electrode (ECE1) into the helioctrema in addition to standard cochlear implant placement. One objective is to verify a suitable approach for implanting ECE1 in the helicotrema. Another is to determine how placement of ECE1 reshapes electric fields. DESIGN Two cadaveric half-heads were implanted, and electric voltage tomography was measured with ECE1 placed in many positions. RESULTS An approach for placing ECE1 was identified. Changes in electric fields were only observed when ECE1 was placed into the fluid in the helicotrema. When inside the helicotrema, electric voltage tomography modeling suggests an increased current flow toward the apex. CONCLUSIONS Placement of ECE1 into the cochlear apex is clinically feasible and has the potential to reshape electric fields to stimulate regions of the cochlea more apical than those represented by the electrode array.
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Affiliation(s)
- David M Landsberger
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, New York, USA
| | - Christopher J Long
- Advanced Innovation, Research and Technology Labs, Cochlear Ltd., Lone Tree, Colorado, USA
| | - Jonathon R Kirk
- Advanced Innovation, Research and Technology Labs, Cochlear Ltd., Lone Tree, Colorado, USA
| | - Natalia Stupak
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, New York, USA
| | - J Thomas Roland
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, New York, USA
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Cottrell J, Spitzer E, Friedmann D, Jethanamest D, McMenomey S, Thomas Roland J, Waltzman S. Cochlear Implantation in Children Under 9 Months of Age: Safety and Efficacy. Otol Neurotol 2024; 45:121-127. [PMID: 38082466 DOI: 10.1097/mao.0000000000004071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To assess the safety of cochlear implants (CIs) in children under 9 months of age to better understand expected postoperative complication rates, and to provide a preliminary look at efficacy. STUDY DESIGN Single-center retrospective review. SETTING Tertiary referral center. PATIENTS Children 5 to 8 months of age who received a CI between 2011 and 2021. INTERVENTIONS Therapeutic-CI. MAIN OUTCOME MEASURES The primary outcome was 6-month postoperative complication rate. Secondary outcomes included length of stay, device explantation/reimplantation, rehabilitation supports, and hearing and language outcomes. Complications of children implanted under than 9 months of age was compared with a cohort of children implanted 9 to 18 months of age between the years 2011 and 2016 using a chi-squared test ( p < 0.05). RESULTS One hundred six children under 9 months of age were implanted (204 CIs) at a mean age of 6.6 months (range: 5-8). Postoperative complications occurred in 28 patients (26%) and were often minor. There were no mortalities. There was no statistically significant difference in complications, including reimplantation rates, between patients implanted under 9 months of age and those implanted 9 to 18 months of age. Speech discrimination outcomes were excellent, and mean spoken language outcomes were near normative for typically developing children. CONCLUSIONS Cochlear implantation can be a safe and effective treatment option for children 5 to 8 months of age. Early hearing screening and referral for infants to receive appropriate intervention will continue to play a critical role in optimizing speech and language outcomes.
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Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, NY
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Spitzer ER, Attlassy Y, Roland JT, Waltzman SB. Early cochlear implantation for children with single sided deafness. Int J Pediatr Otorhinolaryngol 2024; 177:111857. [PMID: 38244481 DOI: 10.1016/j.ijporl.2024.111857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES Single-sided deafness (SSD) can have consequences for a child's language, educational, and social development. A cochlear implant (CI) is the only device which can restore true binaural hearing, yet they are only approved for children with (SSD) over the age of five in the United States. Reports on speech perception outcomes for children implanted at a younger age are limited. The present study aims to examine the effects of age at implantation, duration of deafness, hearing loss etiology, and presence of additional disabilities on device usage and speech perception outcomes. METHODS A retrospective chart review was used to examine demographics and speech perception outcomes for 18 children implanted at age five or younger. RESULTS Speech perception results were highly variable, with some children deriving significant benefit and others demonstrating no sound awareness through the implant alone. Age at implantation and duration of deafness did not have a clear impact on outcomes. Device usage was low in many children, often those with anatomical abnormalities such as a hypoplastic cochlear nerve. There are challenges to assessing speech perception in young children with SSD, leading to a lack of standardized outcome measures. CONCLUSIONS Early CI for children with SSD may improve speech perception, but benefit is not guaranteed. Candidacy evaluation should consider both medical and audiological factors, in addition to the degree of family support and realistic expectations. Caution is especially warranted in children with significant anatomical anomalies.
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Affiliation(s)
- Emily R Spitzer
- New York University Grossman School of Medicine, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA.
| | - Younes Attlassy
- New York University Grossman School of Medicine, New York, NY, USA
| | - J Thomas Roland
- New York University Grossman School of Medicine, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - Susan B Waltzman
- New York University Grossman School of Medicine, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
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Carlson ML, Lohse CM, Agazzi S, Babu SC, Barker FG, Barnett S, Bi WL, Biggs N, Boahene KD, Breen JT, Brown KD, Cayé-Thomasen P, Cosetti MK, Deep NL, Dey JK, Dornhoffer JR, Forner D, Gurgel RK, Hansen MR, Hunter JB, Kalamarides M, Kim IA, King AT, Kircher ML, Lassaletta L, Link MJ, Lloyd SKW, Lund-Johansen M, Marinelli JP, Matthies C, Mehta V, Moore EJ, Nassiri AM, Neff BA, Nelson RF, Olson JJ, Patel NS, Celda MP, Plitt AR, Price DL, Thomas Roland J, Sweeney AD, Tasche KK, Tatagiba M, Tveiten Ø, Van Gompel JJ, Vrabec JT, Wanna GB, Weisskopf PA. Rationale for the Development of a Novel Clinical Grading Scale for Postoperative Facial Nerve Function: Results of a Multidisciplinary International Working Group. Otol Neurotol 2023; 44:e747-e754. [PMID: 37875014 DOI: 10.1097/mao.0000000000004039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications. STUDY DESIGN Survey. SETTING A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery. RESULTS House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting. CONCLUSIONS Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.
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Affiliation(s)
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Siviero Agazzi
- Department of Neurosurgery, University of South Florida, Tampa, Florida
| | | | - Frederick G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Barnett
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nigel Biggs
- Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia
| | - Kofi D Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph T Breen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery
| | | | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Richard K Gurgel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michel Kalamarides
- Department of Neurosurgery, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Irene A Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK
| | - Matthew L Kircher
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Chicago, Illinois
| | - Luis Lassaletta
- Department of Otolaryngology, IdiPAZ Institute for Health Research, La Paz University Hospital; Biomedical Research Networking Centre on Rare Diseases (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain
| | | | - Simon K W Lloyd
- Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Cordula Matthies
- Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Neil S Patel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | | | | | | | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Øystein Tveiten
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | | | | | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Peter A Weisskopf
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
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Schlacter JA, Kay-Rivest E, McMenomey SO, Roland JT, Friedmann DR, Jethanamest D. Bilateral cochlear implantation after immunotherapy-related profound hearing loss: A case report. Cochlear Implants Int 2023; 24:268-272. [PMID: 36988037 DOI: 10.1080/14670100.2023.2193918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Immune-checkpoint inhibitors (ICI) are being utilized with increasing frequency and may be linked to neurologic and audiovestibular toxicities. This report aimed to describe a case of ICI-induced sensorineural hearing loss ultimately requiring bilateral cochlear implantation. METHODS A 42-year-old female with stage IV metastatic melanoma of the perianal skin was treated with ipilimumab (blocker of cytotoxic T-lymphocyte associated protein 4 [CTLA-4]) and nivolumab (anti-programmed cell death protein 1 [PD1]). After 21 weeks of therapy, she developed sudden vertigo and bilateral hearing loss. A full workup including MRI and lumbar puncture ruled out intracranial parenchymal metastases, leptomeningeal metastases, stroke and intracranial infection. ICI-associated aseptic meningoencephalitis was therefore diagnosed. The patient received systemic steroids as well as intratympanic steroids, which temporarily improved hearing, but eventually developed permanent, bilateral profound sensorineural hearing loss. RESULTS The patient received bilateral cochlear implants and has demonstrated good performance one year after implantation. DISCUSSION ICI are being increasingly used to treat a variety of advanced malignancies. This is the first report of bilateral cochlear implants in the context of profound hearing loss after an immunotherapy induced meningoencephalitis. CONCLUSION ICI carries the risk of potential ototoxicity, including profound SNHL as depicted in our case. Cochlear implantation proved to be beneficial and may be considered in patients with ICI-related hearing loss.
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Affiliation(s)
| | - Emily Kay-Rivest
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Sean O McMenomey
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - David R Friedmann
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Jethanamest
- Department of Otolaryngology-Head & Neck Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Marinelli JP, Schnurman Z, Killeen DE, Nassiri AM, Hunter JB, Lees KA, Lohse CM, Roland JT, Golfinos JG, Kondziolka D, Link MJ, Carlson ML. Stratifying Risk of Future Growth Among Sporadic Vestibular Schwannomas. Otol Neurotol 2023; Publish Ahead of Print:00129492-990000000-00318. [PMID: 37367632 DOI: 10.1097/mao.0000000000003934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE In certain cases, clinicians may consider continued observation of a vestibular schwannoma after initial growth is detected. The aim of the current work was to determine if patients with growing sporadic vestibular schwannomas could be stratified by the likelihood of subsequent growth based on initial growth behavior. STUDY DESIGN Slice-by-slice volumetric tumor measurements from 3,505 serial magnetic resonance imaging studies were analyzed from 952 consecutively treated patients. SETTING Three tertiary-referral centers. PATIENTS Adults with sporadic vestibular schwannoma. INTERVENTIONS Wait-and-scan. MAIN OUTCOME MEASURES Composite end point of subsequent growth- or treatment-free survival rates, where growth is defined as an additional increase of at least 20% in tumor volume from the volume at the time of initial growth. RESULTS Among 405 patients who elected continued observation despite documented growth, stratification, of volumetric growth rate into less than 25% (reference: n = 107), 25 to less than 50% (hazard ratio [HR], 1.39; p = 0.06; n = 96), 50 to less than 100% (HR, 1.71; p = 0.002; n = 112), and at least 100% (HR, 2.01; p < 0.001; n = 90) change per year predicted the likelihood of future growth or treatment. Subsequent growth- or treatment-free survival rates (95% confidence interval) at year 5 after detection of initial growth were 31% (21-44%) for those with less than 25% growth per year, 18% (10-32%) for those with 25 to less than 50%, 15% (9-26%) for those with 50 to less than 100%, and 6% (2-16%) for those with at least 100%. Neither patient age (p = 0.15) nor tumor volume at diagnosis (p = 0.95) significantly differed across stratification groups. CONCLUSIONS At the time of diagnosis, clinical features cannot consistently predict which tumors will ultimately display aggressive behavior. Stratification by volumetric growth rate at the time of initial growth results in a stepwise progression of increasing likelihood of subsequent growth. When considering continued observation after initial growth detection, almost 95% of patients who have tumors that double in volume between diagnosis and the first detection of growth demonstrate further tumor growth or undergo treatment if observed to 5 years.
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Affiliation(s)
- John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Zane Schnurman
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University Medical School, Cleveland, Ohio
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
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Spitzer ER, Kay-Rivest E, Waltzman SB, O'Brien-Russo CA, Santacatterina M, Roland JT, Landsberger DM, Friedmann DR. Acceptance and Benefit of Electroacoustic Stimulation in Children. Otol Neurotol 2023; 44:453-461. [PMID: 37167445 DOI: 10.1097/mao.0000000000003877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Children with high-frequency severe-to-profound hearing loss and low-frequency residual hearing who do not derive significant benefit from hearing aids are now being considered for cochlear implantation. Previous research shows that hearing preservation is possible and may be desirable for the use of electroacoustic stimulation (EAS) in adults, but this topic remains underexplored in children. The goal of this study was to explore factors relating to hearing preservation, acceptance, and benefits of EAS for children. STUDY DESIGN Retrospective review. SETTING Tertiary academic medical center. PATIENTS Forty children (48 ears) with preoperative low-frequency pure-tone averages of 75 dB HL or less at 250 and 500 Hz (n = 48). INTERVENTION All patients underwent cochlear implantation with a standard-length electrode. MAIN OUTCOME MEASURE Low-frequency audiometric thresholds, speech perception, and EAS usage were measured at initial stimulation, and 3 and 12 months postoperatively. Outcomes were compared between children with and without hearing preservation, and between EAS users and nonusers. RESULTS Hearing was preserved at similar rates as adults but worse for children with an enlarged vestibular aqueduct. Fewer than half of children who qualified to use EAS chose to do so, citing a variety of audiologic and nonaudiologic reasons. No differences were detected in speech perception scores across the groups for words, sentences, or sentences in noise tests. CONCLUSIONS Neither hearing preservation nor EAS use resulted in superior speech perception in children with preoperative residual hearing; rather, all children performed well after implantation.
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Affiliation(s)
- Emily R Spitzer
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY
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10
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Berger A, AlzateRamirez J, Bernstein K, Mullen R, McMenomey S, Jethanemest D, Friedmann DR, Smouha E, Sulman EP, Silverman JS, Roland JT, Golfinos JG, Kondziolka D. 509 Modern Hearing Preservation Outcomes After Vestibular Schwannoma Stereotactic Radiosurgery. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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11
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O'Leary S, Mylanus E, Venail F, Lenarz T, Birman C, Di Lella F, Roland JT, Gantz B, Beynon A, Sicard M, Buechner A, Lai WK, Boccio C, Choudhury B, Tejani VD, Plant K, English R, Arts R, Bester C. Monitoring Cochlear Health With Intracochlear Electrocochleography During Cochlear Implantation: Findings From an International Clinical Investigation. Ear Hear 2023; 44:358-370. [PMID: 36395515 PMCID: PMC9957964 DOI: 10.1097/aud.0000000000001288] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Electrocochleography (ECochG) is emerging as a tool for monitoring cochlear function during cochlear implant (CI) surgery. ECochG may be recorded directly from electrodes on the implant array intraoperatively. For low-frequency stimulation, its amplitude tends to rise or may plateau as the electrode is inserted. The aim of this study was to explore whether compromise of the ECochG signal, defined as a fall in its amplitude of 30% or more during insertion, whether transient or permanent, is associated with poorer postoperative acoustic hearing, and to examine how preoperative hearing levels may influence the ability to record ECochG. The specific hypotheses tested were threefold: (a) deterioration in the pure-tone average of low-frequency hearing at the first postoperative follow-up interval (follow-up visit 1 [FUV1], 4 to 6 weeks) will be associated with compromise of the cochlear microphonic (CM) amplitude during electrode insertion (primary hypothesis); (b) an association is observed at the second postoperative follow-up interval (FUV2, 3 months) (secondary hypothesis 1); and (c) the CM response will be recorded earlier during electrode array insertion when the preoperative high-frequency hearing is better (secondary hypothesis 2). DESIGN International, multi-site prospective, observational, between groups design, targeting 41 adult participants in each of two groups, (compromised CM versus preserved CM). Adult CI candidates who were scheduled to receive a Cochlear Nucleus CI with a Slim Straight or a Slim Modiolar electrode array and had a preoperative audiometric low-frequency average thresholds of ≤80 dB HL at 500, 750, and 1000 Hz in the ear to be implanted, were recruited from eight international implant sites. Pure tone audiometry was measured preoperatively and at postoperative visits (FUV1 and follow-up visit 2 [FUV2]). ECochG was measured during and immediately after the implantation of the array. RESULTS From a total of 78 enrolled individuals (80 ears), 77 participants (79 ears) underwent surgery. Due to protocol deviations, 18 ears (23%) were excluded. Of the 61 ears with ECochG responses, amplitudes were < 1 µV throughout implantation for 18 ears (23%) and deemed "unclear" for classification. EcochG responses >1 µV in 43 ears (55%) were stable throughout implantation for 8 ears and compromised in 35 ears. For the primary endpoint at FUV1, 7/41 ears (17%) with preserved CM had a median hearing loss of 12.6 dB versus 34/41 ears (83%) with compromised CM and a median hearing loss of 26.9 dB ( p < 0.014). In assessing the practicalities of measuring intraoperative ECochG, the presence of a measurable CM (>1 µV) during implantation was dependent on preoperative, low-frequency thresholds, particularly at the stimulus frequency (0.5 kHz). High-frequency, preoperative thresholds were also associated with a measurable CM > 1 µV during surgery. CONCLUSIONS Our data shows that CM drops occurring during electrode insertion were correlated with significantly poorer hearing preservation postoperatively compared to CMs that remained stable throughout the electrode insertion. The practicality of measuring ECochG in a large cohort is discussed, regarding the suggested optimal preoperative low-frequency hearing levels ( < 80 dB HL) considered necessary to obtain a CM signal >1 µV.
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Affiliation(s)
- S O'Leary
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
| | - E Mylanus
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - F Venail
- University Hospital of Montpellier & Institute of Neurosciences of Montpellier INSERM U1298, Montpellier, France
| | - T Lenarz
- Department Otolaryngology, Hannover Medical School, Hannover, Germany
| | - C Birman
- Cochlear Implant Program, NextSense, Sydney, Australia
| | - F Di Lella
- Hospital Italiano de Buenos Aires, Argentina
| | - J T Roland
- NYU Grossman School of Medicine, New York, USA
| | - B Gantz
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - A Beynon
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - M Sicard
- University Hospital of Montpellier & Institute of Neurosciences of Montpellier INSERM U1298, Montpellier, France
| | - A Buechner
- Department Otolaryngology, Hannover Medical School, Hannover, Germany
| | - W K Lai
- Cochlear Implant Program, NextSense, Sydney, Australia
| | - C Boccio
- Hospital Italiano de Buenos Aires, Argentina
| | - B Choudhury
- NYU Grossman School of Medicine, New York, USA
| | - V D Tejani
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - K Plant
- Cochlear Limited, Sydney, Australia
| | | | - R Arts
- Cochlear Benelux NV, Mechelen, Belgium
| | - C Bester
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
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Kay-Rivest E, Friedmann DR, McMenomey SO, Jethanamest D, Thomas Roland J, Waltzman SB. The Frailty Phenotype in Older Adults Undergoing Cochlear Implantation. Otol Neurotol 2022; 43:e1085-e1089. [PMID: 36190900 DOI: 10.1097/mao.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To prospectively evaluate the frailty phenotype in a population of older adults and determine its association with 1) perioperative complications, 2) need for vestibular rehabilitation after surgery, and 3) early speech perception outcomes. STUDY DESIGN Prospective cohort study. SETTING Tertiary care hospital. PATIENTS Adults older than 65 years undergoing cochlear implantation. INTERVENTIONS The Fried Frailty Index was used to classify patients as frail, prefrail, or not frail based on five criteria: 1) gait speed, 2) grip strength, 3) unintentional weight loss, 4) weekly physical activity, and 5) self-reported exhaustion. MAIN OUTCOMES MEASURES Rates of intraoperative and postoperative complications, postoperative falls, need for vestibular rehabilitation, and early speech perception outcomes. RESULTS Forty-six patients were enrolled in this study. Five patients (10.8%) were categorized as frail and 10 (21.7%) as prefrail. The mean ages of frail, prefrail, and not frail patients were 80.9, 78.8, and 77.5, respectively. There were no intraoperative complications among all groups. Three patients required postoperative vestibular rehabilitation; all were not frail. One postoperative fall occurred in a nonfrail individual. Mean (standard deviation) device use times at 3 months in frail, prefrail, and not frail patients were 7.6 (3.5), 11.1 (3.6), and 11.6 (2.9) hours per day, respectively. Consonant-nucleus-consonant word scores 3 months after surgery in frail, prefrail, and not frail patients were 13% (12.2), 44% (19.7), and 51% (22.4), respectively. The median (range) number of missed follow-up visits (surgeon, audiologist, speech language pathologist combined) was 7 (1-10) in frail patients, compared with a median of 3 (0-4) and 2 (0-5) in prefrail and not frail patients. CONCLUSIONS Frail patients did not have increased rates of surgical complications, need for vestibular rehabilitation, or postoperative falls. However, frail patients experienced challenges in accessing postoperative care, which may be addressed by using remote programming and rehabilitation.
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Affiliation(s)
- Emily Kay-Rivest
- Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York
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Khera Z, Kay-Rivest E, Friedmann DR, McMenomey SO, Thomas Roland J, Jethanamest D. The Natural History of Primary Inner Ear Schwannomas: Outcomes of Long-Term Follow-Up. Otol Neurotol 2022; 43:e1168-e1173. [PMID: 36136609 DOI: 10.1097/mao.0000000000003698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the natural history of primary inner ear schwannomas over a long follow-up period. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Patients with primary inner ear schwannomas with serial audiometric and radiologic follow-up. MAIN OUTCOME MEASURES Patterns of hearing loss, rate of hearing decline, presence of vestibular symptoms, and rate of tumor growth. RESULTS A total of 12 patients with 13 tumors were identified. The mean duration of follow-up was 7 years. Forty-six percent of tumors were intracochlear, 15% were intravestibular, 23% were transmodiolar, and 15% were intravestibular-cochlear. Hearing loss was the most common presenting symptom, occurring in all patients. Among patients with serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery Class A or B) at the time of presentation, the average time to decline to a nonserviceable hearing level was 57.3 months (range, 21-117 mo). Hearing loss was sudden in 31% of patients, progressive in 61% and fluctuating in 8%. No patients had intractable vertigo; however, two required vestibular physiotherapy. On initial magnetic resonance imaging, the mean largest tumor dimension was 3.1 mm (standard deviation, 1.2 mm), and the mean largest dimension on most recent magnetic resonance imaging was 4.4 mm (standard deviation, 1.1 mm). Two tumors exhibited no growth over a follow-up of 11.3 and 2.8 years, respectively. Overall, the mean growth was 0.25 mm per year followed. Two patients underwent cochlear implantation with simultaneous tumor resection and had favorable outcomes. CONCLUSION Long-term follow-up suggests a conservative approach, with possible hearing rehabilitation at the time of deterioration, is a safe management strategy for primary inner ear schwannomas.
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Affiliation(s)
- Zain Khera
- New York University Grossman School of Medicine
| | - Emily Kay-Rivest
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, New York, New York
| | - David R Friedmann
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, New York, New York
| | - Sean O McMenomey
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, New York, New York
| | - J Thomas Roland
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, New York, New York
| | - Daniel Jethanamest
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, New York, New York
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Berger A, Alzate JD, Bernstein K, Mullen R, McMenomey S, Jethanemest D, Friedmann DR, Smouha E, Sulman EP, Silverman JS, Roland JT, Golfinos JG, Kondziolka D. Modern Hearing Preservation Outcomes After Vestibular Schwannoma Stereotactic Radiosurgery. Neurosurgery 2022; 91:648-657. [PMID: 35973088 PMCID: PMC10553130 DOI: 10.1227/neu.0000000000002090] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND For patients with vestibular schwannoma (VS), stereotactic radiosurgery (SRS) has proven effective in controlling tumor growth while hearing preservation remains a key goal. OBJECTIVE To evaluate hearing outcomes in the modern era of cochlear dose restriction. METHODS During the years 2013 to 2018, 353 patients underwent Gamma knife surgery for VS at our institution. We followed 175 patients with pre-SRS serviceable hearing (Gardner-Robertson Score, GR 1 and 2). Volumetric and dosimetry data were collected, including biological effective dose, integral doses of total and intracanalicular tumor components, and hearing outcomes. RESULTS The mean age was 56 years, 74 patients (42%) had a baseline GR of 2, and the mean cochlear dose was 3.5 Gy. The time to serviceable hearing loss (GR 3-4) was 38 months (95% CI 26-46), with 77% and 62% hearing preservation in the first and second years, respectively. Patients optimal for best hearing outcomes were younger than 58 years with a baseline GR of 1, free canal space ≥0.041 cc (diameter of 4.5 mm), and mean cochlear dose <3.1 Gy. For such patients, hearing preservation rates were 92% by 12 months and 81% by 2 years, staying stable for >5 years post-SRS, significantly higher than the rest of the population. CONCLUSION Hearing preservation after SRS for patients with VS with serviceable hearing is correlated to the specific baseline GR score (1 or 2), age, cochlear dose, and biological effective dose. Increased tumor-free canal space correlates with better outcomes. The most durable hearing preservation correlates with factors commonly associated with smaller tumors away from the cochlea.
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Affiliation(s)
- Assaf Berger
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Juan Diego Alzate
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Reed Mullen
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Sean McMenomey
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Daniel Jethanemest
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - David R. Friedmann
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Eric Smouha
- Department of Otolaryngology, Mount Sinai Beth Israel, The Mount Sinai Hospital, New York, New York, USA
| | - Erik P. Sulman
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Joshua S. Silverman
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - J. Thomas Roland
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - John G. Golfinos
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
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15
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Schnurman Z, Gurewitz J, Smouha E, McMenomey SO, Roland JT, Golfinos JG, Kondziolka D. Matched Comparison of Hearing Outcomes in Patients With Vestibular Schwannoma Treated With Stereotactic Radiosurgery or Observation. Neurosurgery 2022; 91:641-647. [PMID: 36001782 DOI: 10.1227/neu.0000000000002089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Previous studies comparing hearing outcomes in patients managed with stereotactic radiosurgery (SRS) and a watch-and-wait strategy were limited by small sample sizes that prevented controlling for potential confounders, including initial hearing status, tumor size, and age. OBJECTIVE To compare hearing outcomes for patients with vestibular schwannomas (VS) managed with observation and SRS while controlling for confounders with propensity score matching. METHODS Propensity score matching was used to compare 198 patients with unilateral VS with initial serviceable hearing (99 treated with SRS and 99 managed with observation alone) and 116 with initial class A hearing (58 managed with SRS and 58 with observation), matched by initial hearing status, tumor volume, age, and sex. Kaplan-Meier survival methods were used to compare risk of losing class A and serviceable hearing. RESULTS Between patients with VS managed with SRS or observation alone, there was no significant difference in loss of class A hearing (median time 27.2 months, 95% CI 16.8-43.4, and 29.2 months, 95% CI 20.4-62.5, P = .88) or serviceable hearing (median time 37.7 months, 95% CI 25.7-58.4, and 48.8 months, 95% CI 38.4-86.3, P = .18). For SRS patients, increasing mean cochlear dose was not related to loss of class A hearing (hazard ratio 1.3, P = .17) but was associated with increasing risk of serviceable hearing loss (hazard ratio of 1.5 per increase in Gy, P = .017). CONCLUSION When controlling for potential confounders, there was no significant difference in loss of class A or serviceable hearing between patients managed with SRS or with observation alone.
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Affiliation(s)
- Zane Schnurman
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Jason Gurewitz
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Eric Smouha
- ENT and Allergy Associates, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean O McMenomey
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Landsberger DM, Stupak N, Spitzer ER, Entwisle L, Mahoney L, Waltzman SB, McMenomey S, Friedmann DR, Svirsky MA, Shapiro W, Roland JT. Stimulating the Cochlear Apex Without Longer Electrodes: Preliminary Results With a New Approach. Otol Neurotol 2022; 43:e578-e581. [PMID: 35283466 PMCID: PMC9149041 DOI: 10.1097/mao.0000000000003529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate a new surgical and signal processing technique that provides apical stimulation of the cochlea using a cochlear implant without extending the length of the electrode array. PATIENTS Three adult patients who underwent cochlear implantation using this new technique. INTERVENTIONS The patients received a cochlear implant. The surgery differed from the standard approach in that a ground electrode was placed in the cochlear helicotrema via an apical cochleostomy rather than in its typical location underneath the temporalis muscle. Clinical fitting was modified such that low frequencies were represented using the apically placed electrode as a ground. MAIN OUTCOME MEASURES Pitch scaling and speech recognition. RESULTS All surgeries were successful with no complications. Pitch scaling demonstrated that use of the apically placed electrode as a ground lowered the perceived pitch of electric stimulation relative to monopolar stimulation. Speech understanding was improved compared with preoperative scores. CONCLUSIONS The new surgical approach and clinical fitting are feasible. A lower pitch is perceived when using the apically placed electrode as a ground relative to stimulation using an extracochlear ground (i.e., monopolar mode), suggesting that stimulation can be provided more apically without the use of a longer electrode array. Further work is required to determine potential improvements in outcomes and optimal signal processing for the new approach.
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Affiliation(s)
- David M Landsberger
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, New York
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Dastagirzada Y, Klauberg O, Sheerin K, Lieberman S, Lebowitz R, McMenomey S, Sen C, Roland JT, Golfinos JG, Pacione D. Skull Base Aerosol Generating Cases Amidst the COVID-19 Pandemic: An Experience from the Epicenter. Skull Base Surg 2022; 83:e169-e172. [DOI: 10.1055/s-0041-1722936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
AbstractSoon after the World Health Organization declared the severe acute respiratory syndrome coronavirus 2 a global health emergency on January 30, 2020, New York City was plagued by the virus and its health system and economy pushed to their limits. The majority of the limited neurosurgical data in relation to COVID-19 is anecdotal and the higher theoretical risk of transmission of the virus among skull base aerosol generating (SBAG) cases has not been investigated or discussed in a neurosurgical population. We discuss a series of 13 patients who underwent 15 SBAG surgical procedures during the peak of COVID-19 in our hospital system and the protocols use perioperatively for their procedures. Our data support that with proper preoperative testing, a well-delineated surgical algorithm, and appropriate personal protective equipment, emergent/urgent cases can be done safely in hospitals that are currently experiencing high volumes of COVID-19 cases as we did in March to May of 2020.
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Affiliation(s)
- Yosef Dastagirzada
- Department of Neurosurgery, NYU Langone Health, New York City, New York, United States
| | - Olga Klauberg
- Department of Neurosurgery, NYU Langone Health, New York City, New York, United States
| | - Kathleen Sheerin
- Department of Neurosurgery, NYU Langone Health, New York City, New York, United States
| | - Seth Lieberman
- Department of Otolaryngology, NYU Langone Health, New York City, New York, United States
| | - Richard Lebowitz
- Department of Otolaryngology, NYU Langone Health, New York City, New York, United States
| | - Sean McMenomey
- Department of Otolaryngology, NYU Langone Health, New York City, New York, United States
| | - Chandranath Sen
- Department of Neurosurgery, NYU Langone Health, New York City, New York, United States
| | - J Thomas Roland
- Department of Otolaryngology, NYU Langone Health, New York City, New York, United States
| | - John G. Golfinos
- Department of Neurosurgery, NYU Langone Health, New York City, New York, United States
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York City, New York, United States
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Deep NL, Johnson BJ, Kay-Rivest E, Carlson ML, Friedmann DR, Driscoll CLW, Thomas Roland J, Jethanamest D. Modifications to Implanting the OSIA® 2 Bone Conduction Hearing Implant: How I Do it. Laryngoscope 2022; 132:1850-1854. [PMID: 35616210 DOI: 10.1002/lary.30153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/23/2022] [Accepted: 04/16/2022] [Indexed: 11/06/2022]
Abstract
This "How I Do It" report describes modifications made to the OSIA bone conduction hearing implant surgery in order to reduce wound complications. Laryngoscope, 2022.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Brian J Johnson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Emily Kay-Rivest
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David R Friedmann
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Daniel Jethanamest
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
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Asfour L, Smyth D, Whitchurch CB, Cavaliere R, Roland JT. Fluorescence in situ hybridization and microbial community profiling analysis of explanted cochlear implants. Acta Otolaryngol 2022; 142:395-401. [PMID: 35549817 DOI: 10.1080/00016489.2022.2070931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cochlear implant (CI) infections affect a small, but significant number of patients. Unremitting infections can lead to explantation. Fluorescence in situ hybridization (FISH) and microbial community profiling (MCP) are methods of studying microbial environments of explanted devices that can provide information to reduce morbidity and costs of infected CIs. AIMS/OBJECTIVES To describe the results and clinical significance of bacterial analyses conducted on explanted CIs. MATERIAL AND METHODS Between 2013 and 2017, 12 explanted devices underwent microbiological analysis in addition to the manufacturer's device failure analysis. Patients' clinical history, infection status and outcome were reviewed and correlated with microbial analysis results. RESULTS From 2013 to 2017, 12 Cochlear™ devices from 11 patients underwent additional MCP or FISH analysis. Five devices were explanted due to suspected implant associated infection, and seven were explanted for other reasons. FISH analysis revealed biofilm presence on all infected devices, only partial correlation of cultures with biofilm composition and confirmation that biofilm formation occurs preferentially at particular device interfaces and geometries. MCP analysis presented challenges in data analysis inherent to its technique but correlated with cultures of infected devices and suggested a diverse microbial composition of explanted devices. CONCLUSIONS AND SIGNIFICANCE Microbial analysis of explanted devices can aid in further elucidating treatment approaches to infected CIs.
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Affiliation(s)
- Leena Asfour
- Department of Otolaryngology—Head & Neck Surgery, New York University School of Medicine, New York City, NY, USA
| | - Daniel Smyth
- Cochlear Limited, 1 University Avenue, Macquarie University, Sydney, Australia
| | | | - Rosalia Cavaliere
- The ithree Institute, University of Technology Sydney, Ultimo, Australia
| | - J. Thomas Roland
- Department of Otolaryngology—Head & Neck Surgery, New York University School of Medicine, New York City, NY, USA
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Asfour L, Risi F, Miah H, Roland JT. Cochlear implant explantation: An in vitro model to evaluate electrode explant force and trauma. Cochlear Implants Int 2022; 23:189-194. [PMID: 35236258 DOI: 10.1080/14670100.2022.2045075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Removal of a cochlear implant and its intracochlear electrode array is sometimes necessary, potentially causing cochlear explant trauma. Explantation typically occurs years post-implantation by which time reactive tissue has formed around the electrode. We aimed to create an in-vitro electrode explant model to examine explant forces and intracochlear trauma across multiple electrode types and insertion depths. STUDY DESIGN An in-vitro model using gel to represent tissue surrounding the electrode was developed. Pre-curved electrodes and straight electrodes at different insertion depths (20mm, 25mm, 28mm) were explanted from the model. During explantation, explant force was measured, and high-definition videos were recorded to capture electrode exit path and gel disruption. RESULTS Explant force patterns varied based on electrode position in the scala tympani. Explant forces did not correlate with gel disruption, which represented explant trauma. The least gel disruption occurred with pre-curved electrodes and the under-inserted straight electrode. The greatest disruption occurred with the overly inserted straight electrode. CONCLUSION An in-vitro model using gel to mimic tissue surrounding the electrode may provide insights into potential electrode explant trauma. Explant force did not correlate with explant trauma in our model. Pre-curved electrodes and shallower insertion depth of a straight electrode resulted in the least amount of explant trauma.
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Affiliation(s)
- Leena Asfour
- Department of Otolaryngology - Head & Neck Surgery, New York University School of Medicine, New York City, NY, USA
| | - Frank Risi
- Cochlear Limited, Macquarie University, Sydney, Australia
| | - Hanif Miah
- Cochlear Limited, Macquarie University, Sydney, Australia
| | - J Thomas Roland
- Department of Otolaryngology - Head & Neck Surgery, New York University School of Medicine, New York City, NY, USA
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Marinelli JP, Schnurman Z, Killeen DE, Nassiri AM, Hunter JB, Lees KA, Lohse CM, Roland JT, Golfinos JG, Kondziolka D, Link MJ, Carlson ML. Long-term natural history and patterns of sporadic vestibular schwannoma growth: A multi-institutional volumetric analysis of 952 patients. Neuro Oncol 2021; 24:1298-1306. [PMID: 34964894 PMCID: PMC9340632 DOI: 10.1093/neuonc/noab303] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The current study aims to characterize the natural history of sporadic vestibular schwannoma volumetric tumor growth, including long-term growth patterns following initial detection of growth. METHODS Volumetric tumor measurements from 3505 serial MRI studies were analyzed from unselected consecutive patients undergoing wait-and-scan management at three tertiary referral centers between 1998 and 2018. Volumetric tumor growth was defined as a change in volume ≥20%. RESULTS Among 952 patients undergoing observation, 622 experienced tumor growth with initial growth-free survival rates (95% CI) at 1, 3, and 5 years following diagnosis of 66% (63-69), 30% (27-34), and 20% (17-24). Among 405 patients who continued to be observed despite demonstrating initial growth, 210 experienced subsequent tumor growth with subsequent growth-free survival rates at 1, 3, and 5 years following initial growth of 77% (72-81), 37% (31-43), and 24% (18-31). Larger tumor volume at initial growth (HR 1.13, P = .02) and increasing tumor growth rate (HR 1.31; P < .001) were significantly associated with an increased likelihood of subsequent growth, whereas a longer duration of time between diagnosis and detection of initial growth was protective (HR 0.69; P < .001). CONCLUSIONS While most vestibular schwannomas exhibit an overall propensity for volumetric growth following diagnosis, prior tumor growth does not perfectly predict future growth. Tumors can subsequently grow faster, slower, or demonstrate quiescence and stability. Larger tumor size and increasing tumor growth rate portend a higher likelihood of continued growth. These findings can inform timing of intervention: whether upfront at initial diagnosis, after detection of initial growth, or only after continued growth is observed.
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Affiliation(s)
- John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zane Schnurman
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Carlson
- Corresponding Author: Matthew L. Carlson, MD, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA ()
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Deep NL, Kay-Rivest E, Roland JT. Iatrogenic Third Window After Retrosigmoid Approach to a Vestibular Schwannoma Managed with Cochlear Implantation. Otol Neurotol 2021; 42:1355-1359. [PMID: 34267100 DOI: 10.1097/mao.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To present a case of an iatrogenic inner ear third window after vestibular schwannoma microsurgery. PATIENTS A 42-year-old male presented 9-months after left-sided retrosigmoid approach for an intracanalicular vestibular schwannoma with hearing-preservation attempt performed elsewhere. Immediately postoperatively, he developed the following disabling and persistent symptoms on the ipsilateral side: autophony, pulsatile tinnitus, high-pitched ringing tinnitus, and hearing his footsteps. He denied vertigo. Otoscopy was normal. Tuning fork (512-Hz) lateralized to the left and Rinne was negative on the left. Audiogram demonstrated a severe mixed hearing loss and 10% aided word-recognition score. High-resolution CT demonstrated violation of the common crus and dehiscence of bone along the medial vestibule suggestive of an iatrogenic inner ear third window. INTERVENTIONS Labyrinthectomy and concurrent cochlear implantation. MAIN OUTCOME MEASURES Resolution of third window symptoms, open-set speech recognition, tinnitus suppression. RESULTS Patient reported immediate resolution of third window symptoms after labyrinthectomy and cochlear implantation. He demonstrates open-set word recognition of 64% at 1-year postoperatively and tinnitus suppression with his cochlear implant on. CONCLUSIONS Iatrogenic third window symptoms can occur after hearing-preservation vestibular schwannoma microsurgery. Patients with sufficient hearing preservation who are disabled by third window symptoms yet lack sound clarity and useful hearing may be considered for labyrinthectomy and concurrent cochlear implantation. This intervention effectively extinguishes third window symptoms by destroying residual auditory function and simultaneously provides an opportunity to restore useful hearing and suppress tinnitus, thereby enhancing overall quality of life.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Emily Kay-Rivest
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York
| | - J Thomas Roland
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York
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Kay-Rivest E, Golfinos JG, McMenomey SO, Friedmann DR, Jethanamest D, Kondziolka D, Roland JT. Outcomes of Salvage Resection and Radiosurgery Following Failed Primary Treatment of Vestibular Schwannomas. Otolaryngol Head Neck Surg 2021; 166:957-963. [PMID: 34488519 DOI: 10.1177/01945998211039786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate outcomes following salvage microsurgery (MS) and salvage stereotactic radiosurgery (SRS) after failure of primary treatment for vestibular schwannomas (VS). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. METHODS Patients with more than 1 intervention for their VS were divided into 4 groups: MS followed by SRS (n = 61), MS followed by MS (n = 9), SRS followed by MS (n = 7), and SRS followed by SRS (n = 7), and outcomes were evaluated. RESULTS A total of 77 patients were included (84 procedures). In group 1 (MS then SRS), 3% developed a decline in facial function, 3% developed trigeminal sensory loss, and 13% patients had gradual improvement of facial nerve function following SRS. Group 2 (MS then MS) had the highest rates of facial nerve deterioration, although all but 1 patient achieved a House-Brackmann score of II or III. Gross-total resection (GTR) was achieved in 56% of patients. When a different approach was used for salvage resection, GTR occurred more commonly, and facial nerve outcomes were similar. In group 3 (SRS then MS), GTR occurred in 43% of cases, and 2 of 7 patients developed worsened facial function. In group 4 (SRS then SRS), no patient developed facial weakness after reirradiation, and 1 developed a trigeminal nerve deficit. CONCLUSIONS For MS recurrences/residuals, SRS is the mainstay of treatment and does not preclude facial function recovery. If salvage microsurgery is required, an alternate approach should be considered. For SRS failures, when MS is required, less-than GTR may be preferable, and reirradiation is a potential safe alternative.
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Affiliation(s)
- Emily Kay-Rivest
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, New York University, NYU Langone Medical Center, New York, USA
| | - John G Golfinos
- Deparment of Neurosurgery, New York University, NYU Langone Medical Center, New York, USA
| | - Sean O McMenomey
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, New York University, NYU Langone Medical Center, New York, USA
| | - David R Friedmann
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, New York University, NYU Langone Medical Center, New York, USA
| | - Daniel Jethanamest
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, New York University, NYU Langone Medical Center, New York, USA
| | - Douglas Kondziolka
- Deparment of Neurosurgery, New York University, NYU Langone Medical Center, New York, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, New York University, NYU Langone Medical Center, New York, USA
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Gurewitz J, Schnurman Z, Nakamura A, Navarro RE, Patel DN, McMenomey SO, Roland JT, Golfinos JG, Kondziolka D. Hearing loss and volumetric growth rate in untreated vestibular schwannoma. J Neurosurg 2021; 136:768-775. [PMID: 34416729 DOI: 10.3171/2021.2.jns203609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to clarify the relationship between hearing loss and tumor volumetric growth rates in patients with untreated vestibular schwannoma (VS). METHODS Records of 128 treatment-naive patients diagnosed with unilateral VS between 2012 and 2018 with serial audiometric assessment and MRI were reviewed. Tumor growth rates were determined from initial and final tumor volumes, with a median follow-up of 24.3 months (IQR 8.5-48.8 months). Hearing changes were based on pure tone averages, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class. Primary outcomes were the loss of class A hearing and loss of serviceable hearing, estimated using the Kaplan-Meier method and with associations estimated from Cox proportional hazards models and reported as hazard ratios. RESULTS Larger initial tumor size was associated with an increased risk of losing class A (HR 1.5 for a 1-cm3 increase; p = 0.047) and serviceable (HR 1.3; p < 0.001) hearing. Additionally, increasing volumetric tumor growth rate was associated with elevated risk of loss of class A hearing (HR 1.2 for increase of 100% per year; p = 0.031) and serviceable hearing (HR 1.2; p = 0.014). Hazard ratios increased linearly with increasing growth rates, without any evident threshold growth rate that resulted in a large, sudden increased risk of hearing loss. CONCLUSIONS Larger initial tumor size and faster tumor growth rates were associated with an elevated risk of loss of class A and serviceable hearing.
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Affiliation(s)
| | | | | | | | | | - Sean O McMenomey
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
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Abstract
INTRODUCTION Understanding the clinical manifestations of the coronavirus disease (COVID-19) has become an urgent objective in the research community. Amongst the emerging neurologic complications is sensorineural hearing loss. While several cases of hearing loss amongst COVID-19 patients have been reported, the management of these patients has yet to be discussed and determined. Herein we present cochlear implant outcomes for a patient who suffered from unilateral sensorineural hearing loss after a prolonged hospital course for COVID-19. METHODS A patient who was hospitalized for COVID-19 for one month and subsequently developed unilateral profound sensorineural hearing loss underwent cochlear implantation for single-sided deafness. His COVID-19 hospital course was reviewed in detail. Speech perception and audiometric assessments were used to evaluate cochlear implant outcomes. RESULTS After cochlear implantation, the patient demonstrated improved speech perception on the implanted side and decreased tinnitus within 1 month of activation. CONCLUSIONS Cochlear implantation may be an appropriate intervention for patients who suffer from severe sensorineural hearing loss following infection with COVID-19.
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Affiliation(s)
- Leena Asfour
- Department of Otolaryngology-Head & Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Emily Kay-Rivest
- Department of Otolaryngology-Head & Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head & Neck Surgery, New York University School of Medicine, New York, NY, USA
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26
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Karajannis MA, Mauguen A, Maloku E, Xu Q, Dunbar EM, Plotkin SR, Yaffee A, Wang S, Roland JT, Sen C, Placantonakis DG, Golfinos JG, Allen JC, Vitanza NA, Chiriboga LA, Schneider RJ, Deng J, Neubert TA, Goldberg JD, Zagzag D, Giancotti FG, Blakeley JO. Phase 0 Clinical Trial of Everolimus in Patients with Vestibular Schwannoma or Meningioma. Mol Cancer Ther 2021; 20:1584-1591. [PMID: 34224367 DOI: 10.1158/1535-7163.mct-21-0143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/18/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022]
Abstract
Inhibition of mTORC1 signaling has been shown to diminish growth of meningiomas and schwannomas in preclinical studies, and clinical data suggest that everolimus, an orally administered mTORC1 inhibitor, may slow tumor progression in a subset of patients with neurofibromatosis type 2 (NF2) with vestibular schwannoma. To assess the pharmacokinetics, pharmacodynamics, and potential mechanisms of treatment resistance, we performed a presurgical (phase 0) clinical trial of everolimus in patients undergoing elective surgery for vestibular schwannoma or meningiomas. Eligible patients with meningioma or vestibular schwannoma requiring tumor resection enrolled on study received everolimus 10 mg daily for 10 days immediately prior to surgery. Everolimus blood levels were determined immediately before and after surgery. Tumor samples were collected intraoperatively. Ten patients completed protocol therapy. Median pre- and postoperative blood levels of everolimus were found to be in a high therapeutic range (17.4 ng/mL and 9.4 ng/mL, respectively). Median tumor tissue drug concentration determined by mass spectrometry was 24.3 pg/mg (range, 9.2-169.2). We observed only partial inhibition of phospho-S6 in the treated tumors, indicating incomplete target inhibition compared with control tissues from untreated patients (P = 0.025). Everolimus led to incomplete inhibition of mTORC1 and downstream signaling. These data may explain the limited antitumor effect of everolimus observed in clinical studies for patients with NF2 and will inform the design of future preclinical and clinical studies targeting mTORC1 in meningiomas and schwannomas.
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Affiliation(s)
- Matthias A Karajannis
- Pediatric Neuro-Oncology Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Audrey Mauguen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ekrem Maloku
- Division of Neuropathology, Department of Pathology, NYU Langone Health, New York, New York
| | - Qingwen Xu
- Department of Cancer Biology, MD Anderson Cancer Center, Houston, Texas
| | - Erin M Dunbar
- Neuro-Oncology, Piedmont Brain Tumor Center, Atlanta, Georgia
| | - Scott R Plotkin
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna Yaffee
- Department of Pediatrics, NYU Langone Health, New York, New York
| | - Shiyang Wang
- Department of Pediatrics, NYU Langone Health, New York, New York
| | - J Thomas Roland
- Department of Otolaryngology, NYU Langone Health, New York, New York.,Department of Neurosurgery, NYU Langone Health, New York, New York
| | - Chandranath Sen
- Department of Neurosurgery, NYU Langone Health, New York, New York
| | | | - John G Golfinos
- Department of Neurosurgery, NYU Langone Health, New York, New York
| | - Jeffrey C Allen
- Department of Pediatrics, NYU Langone Health, New York, New York
| | | | | | | | - Jingjing Deng
- Department of Cell Biology and Skirball Institute, NYU Langone Health, New York, New York
| | - Thomas A Neubert
- Department of Cell Biology and Skirball Institute, NYU Langone Health, New York, New York
| | - Judith D Goldberg
- Department of Population Health, NYU Langone Health, New York, New York
| | - David Zagzag
- Division of Neuropathology, Department of Pathology, NYU Langone Health, New York, New York.,Department of Neurosurgery, NYU Langone Health, New York, New York
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Buchman CA, Gifford RH, Haynes DS, Lenarz T, O'Donoghue G, Adunka O, Biever A, Briggs RJ, Carlson ML, Dai P, Driscoll CL, Francis HW, Gantz BJ, Gurgel RK, Hansen MR, Holcomb M, Karltorp E, Kirtane M, Larky J, Mylanus EAM, Roland JT, Saeed SR, Skarzynski H, Skarzynski PH, Syms M, Teagle H, Van de Heyning PH, Vincent C, Wu H, Yamasoba T, Zwolan T. Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements. JAMA Otolaryngol Head Neck Surg 2021; 146:942-953. [PMID: 32857157 DOI: 10.1001/jamaoto.2020.0998] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Cochlear implants are a treatment option for individuals with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss (SNHL) who receive little or no benefit from hearing aids; however, cochlear implantation in adults is still not routine. Objective To develop consensus statements regarding the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral SNHL. Design, Setting, and Participants This study was a modified Delphi consensus process that was informed by a systematic review of the literature and clinical expertise. Searches were conducted in the following databases: (1) MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE, (2) Embase, and (3) the Cochrane Library. Consensus statements on cochlear implantation were developed using the evidence identified. This consensus process was relevant for the use of unilateral cochlear implantation in adults with severe, profound, or moderate sloping to profound bilateral SNHL. The literature searches were conducted on July 18, 2018, and the 3-step Delphi consensus method took place over the subsequent 9-month period up to March 30, 2019. Main Outcomes and Measures A Delphi consensus panel of 30 international specialists voted on consensus statements about cochlear implantation, informed by an SR of the literature and clinical expertise. This vote resulted in 20 evidence-based consensus statements that are in line with clinical experience. A modified 3-step Delphi consensus method was used to vote on and refine the consensus statements. This method consisted of 2 rounds of email questionnaires and a face-to-face meeting of panel members at the final round. All consensus statements were reviewed, discussed, and finalized at the face-to-face meeting. Results In total, 6492 articles were identified in the searches of the electronic databases. After removal of duplicate articles, 74 articles fulfilled all of the inclusion criteria and were used to create the 20 evidence-based consensus statements. These 20 consensus statements on the use of unilateral cochlear implantation in adults with SNHL were relevant to the following 7 key areas of interest: level of awareness of cochlear implantation (1 consensus statement); best practice clinical pathway from diagnosis to surgery (3 consensus statements); best practice guidelines for surgery (2 consensus statements); clinical effectiveness of cochlear implantation (4 consensus statements); factors associated with postimplantation outcomes (4 consensus statements); association between hearing loss and depression, cognition, and dementia (5 consensus statements); and cost implications of cochlear implantation (1 consensus statement). Conclusions and Relevance These consensus statements represent the first step toward the development of international guidelines on best practices for cochlear implantation in adults with SNHL. Further research to develop consensus statements for unilateral cochlear implantation in children, bilateral cochlear implantation, combined electric-acoustic stimulation, unilateral cochlear implantation for single-sided deafness, and asymmetrical hearing loss in children and adults may be beneficial for optimizing hearing and quality of life for these patients.
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Affiliation(s)
- Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Gerard O'Donoghue
- Department of Otology and Neurotology, University of Nottingham, Nottingham, United Kingdom.,Nottingham Biomedical Research Center, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, United Kingdom
| | - Oliver Adunka
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus
| | | | - Robert J Briggs
- Department of Otolaryngology, The University of Melbourne, Melbourne, Victoria, Australia.,Otology and Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Pu Dai
- Department of Otolaryngology, General Hospital of People's Liberation Army, Beijing, China
| | - Colin L Driscoll
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Howard W Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Bruce J Gantz
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
| | - Richard K Gurgel
- Division of Otolaryngology-Head & Neck Surgery, School of Medicine, University of Utah Hospital, Salt Lake City
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
| | - Meredith Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,now with Department of Otolaryngology, University of Miami, Miami, Florida
| | - Eva Karltorp
- Cochlear Implant Department, Karolinska University Hospital, Stockholm, Sweden
| | - Milind Kirtane
- Department of ENT and Head Neck Surgery, Seth Gordhandas Sunderdas Medical College, King Edward Memorial Hospital, Mumbai, India
| | - Jannine Larky
- Cochlear Implant Center, Stanford University School of Medicine, Stanford, California
| | - Emmanuel A M Mylanus
- Department of Ear Nose Throat, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Thomas Roland
- NYU Langone Health, New York University School of Medicine, New York
| | - Shakeel R Saeed
- Royal National Throat, Nose and Ear Hospital and University College London Ear Institute, London, United Kingdom
| | - Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Nadarzyn, Poland
| | - Piotr H Skarzynski
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Nadarzyn, Poland.,Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Institute of Sensory Organs, Kajetany, Nadarzyn, Poland
| | | | - Holly Teagle
- School of Population Health-Audiology, The University of Auckland, Auckland, New Zealand
| | - Paul H Van de Heyning
- Department NKO & Head-Neck Surgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Christophe Vincent
- Service d'Otologie et Oto-Neurologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Hao Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology and Auditory and Voice Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Terry Zwolan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
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Purcell PL, Deep NL, Waltzman SB, Roland JT, Cushing SL, Papsin BC, Gordon KA. Cochlear Implantation in Infants: Why and How. Trends Hear 2021; 25:23312165211031751. [PMID: 34281434 PMCID: PMC8295935 DOI: 10.1177/23312165211031751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/22/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
In children with congenital deafness, cochlear implantation (CI) prior to 12 months of age offers the opportunity to foster more typical auditory development during late infancy and early childhood. Recent studies have found a positive association between early implantation and expressive and receptive language outcomes, with some children able to achieve normal language skills by the time of school entry. Universal newborn hearing screening improved early detection and diagnosis of congenital hearing loss, allowing for earlier intervention, including decision-making regarding cochlear implant (CI) candidacy. It can be more challenging to confirm CI candidacy in infants; therefore, a multidisciplinary approach, including objective audiometric testing, is recommended to not only confirm the diagnosis but also to counsel families regarding expectations and long-term management. Surgeons performing CI surgery in young children should consider both the anesthetic risks of surgery in infancy and the ways in which mastoid anatomy may differ between infants and older children or adults. Multiple studies have found CI surgery in infants can be performed safely and effectively. This article reviews current evidence regarding indications for implantation in children younger than 12 months of age and discusses perioperative considerations and surgical technique.
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Affiliation(s)
- Patricia L. Purcell
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas L. Deep
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - Susan B. Waltzman
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - J. Thomas Roland
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - Sharon L. Cushing
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A. Gordon
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Shaul C, Roland JT, Sichel JY, Salem R, Perez R. Revision cochlear implantation using a double array device in the post-meningitis ossified cochlea. Int J Pediatr Otorhinolaryngol 2020; 139:110446. [PMID: 33091810 DOI: 10.1016/j.ijporl.2020.110446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the surgical technique and outcome in a series of patients who underwent revision cochlear implantation using a double array or split electrode device. All patients developed ossified cochleae due to meningitis and were functioning poorly with the previous implant. METHODS Four patients between the ages of 4-15 years underwent revision with five double-array cochlear implant devices. One patient underwent bilateral revision surgery. All patients had previous meningitis with CT and MRI imaging studies that demonstrated completely ossified cochleae. The time interval range between the disease and the initial cochlear implantation and was 4 months to 3 years. The patient's data were retrospectively analyzed with emphasis on the surgical technique, the number of electrodes inserted, and the number of active electrodes at follow-up. In addition, pre and post-revision surgery function was compared. RESULTS The revision surgery was carried out 2-11 years after the initial surgery. Two tunnels, basal and apical, were drilled in the ossified cochlea. In each of the tunnels, 5 to 11 electrodes were inserted. While the number of active electrodes before revision was 0-5, after revision with the double array, it was increased to 8-12, resulting in improved auditory and speech function. CONCLUSION Revision cochlear implantation with a double array implant using the two tunnel technique can increase the number of active electrodes. This leads to a better outcome in post-meningitis children with completely ossified cochleae and a poor functioning previous device.
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Affiliation(s)
- Chanan Shaul
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - J Thomas Roland
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, NY, USA
| | - Jean-Yves Sichel
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - Riki Salem
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - Ronen Perez
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center Affiliated with the Hebrew University Medical School, Jerusalem, Israel.
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Kay-Rivest E, Friedmann DR, Roland JT. Imaging for Menière Disease. AJNR Am J Neuroradiol 2020; 41:1964-1965. [PMID: 33033041 DOI: 10.3174/ajnr.a6818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Connors JR, Deep NL, Huncke TK, Roland JT. Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Cases. Laryngoscope 2020; 131:E946-E951. [PMID: 32663339 DOI: 10.1002/lary.28853] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To report the outcomes on a large series of elderly patients who underwent cochlear implantation (CI) surgery under local anesthesia with conscious sedation (LA-CS). METHODS Retrospective chart review on 100 consecutive elderly patients (> 65 years) who underwent CI with LA-CS at a tertiary care center between August 2013 and January 2020. An age-matched control group of 50 patients who underwent CI with general anesthesia (GA) are used for comparison. Outcomes measured included time in the operating room, time in the postanesthesia care unit (PACU), and rate of adverse events. RESULTS Cochlear implant surgery under LA-CS was successfully performed in 99 (99%) patients. One patient requiring conversion to GA intraoperatively. No patients in the LA-CS group experienced cardiopulmonary adverse events; however, three patients (6%) in the GA group experienced minor events including atrial fibrillation and/or demand ischemia. Overnight observation in the hospital due to postoperative medical concerns or prolonged wake-up from anesthesia was required in one patient (1%) from the LA-CS cohort and 12 patients (24%) from the GA cohort. Perioperative adverse events exclusive to the LA-CS group included severe intraoperative vertigo (8%), temporary facial nerve paresis (3%), and wound infection (1%). The average amount of time spent in the operating room was 37 minutes less for procedures performed under LA-CS compared to GA (P < .05). The average amount of time in recovery was similar for both groups (P > .05). CONCLUSION Cochlear implant surgery under LA-CS offers many benefits and is a safe, feasible, and cost-effective alternative to GA when performed by experienced CI surgeons. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E946-E951, 2021.
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Affiliation(s)
- Joseph R Connors
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, NY, USA
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, NY, USA
| | - T Kate Huncke
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, NY, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, NY, USA
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Friedmann DR, Tona KM, Roland JT, Spitzer ER, Waltzman SB. Cochlear implantation in children under 12 months: Prevalence and implications of 'hidden' disabilities. Cochlear Implants Int 2020; 21:307-312. [PMID: 32508288 DOI: 10.1080/14670100.2020.1773675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: While cochlear implants (CI) prior to 12 months of age have become common, the prevalence and impact of issues that either arise or were not evident prior to implantation is unknown. Methods: Retrospective chart review of children implanted under 12 months of age with minimum 3 years follow up. The children were divided into three groups: those with no identified additional disabilities, those with no known disabilities at time of implantation but diagnosed with additional disabilities following implantation, and those that had known anticipated additional disabilities at time of implantation. Results: 108 children under the age of 12 months were implanted at our Center between 2000 and 2013 with an average age of 9 months at time of implantation and n = 93 met inclusion criteria. In 79.6% (74/93) of children, there were no additional issues detected. In 11.8% (11/93), additional issues were known at the time of implantation while in 8.6% (8/93) of the children were diagnosed with additional issues that were not evident prior to implantation. The auditory and linguistic benefits vary commensurate with the severity of their disabilities. Those with anticipated issues preoperatively did not perform as well. Conclusions: Children implanted below one year of age but diagnosed with additional disabilities following implantation obtained substantial though varying degrees of benefit. In none of these cases would knowledge of the disability have altered the decision to offer early CI. It is important to address these potential issues when counseling families about outcomes.
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Affiliation(s)
- David R Friedmann
- Department of Otolaryngology-Head & Neck Surgery, NYU Cochlear Implant Center, New York, NY, USA
| | - Kaitlyn M Tona
- Department of Otolaryngology-Head & Neck Surgery, NYU Cochlear Implant Center, New York, NY, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head & Neck Surgery, NYU Cochlear Implant Center, New York, NY, USA
| | - Emily R Spitzer
- Department of Otolaryngology-Head & Neck Surgery, NYU Cochlear Implant Center, New York, NY, USA
| | - Susan B Waltzman
- Department of Otolaryngology-Head & Neck Surgery, NYU Cochlear Implant Center, New York, NY, USA
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Cambron NK, Hume CR, Roland JT. Cochlear Implant Access for Veterans. JAMA Otolaryngol Head Neck Surg 2020; 146:386-387. [PMID: 32077904 DOI: 10.1001/jamaoto.2019.4793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Deep NL, Gordon SA, Shapiro WH, Waltzman SB, Roland JT, Friedmann DR. Cochlear Implantation in Children with Single-Sided Deafness. Laryngoscope 2020; 131:E271-E277. [PMID: 32065422 DOI: 10.1002/lary.28561] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/01/2020] [Accepted: 01/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe our experience with children undergoing unilateral cochlear implantation (CI) for treatment of single-sided deafness (SSD). STUDY DESIGN Retrospective case series. METHODS A retrospective case review from a tertiary referral center involving 14 pediatric patients (<18 years) with SSD who underwent unilateral CI. Speech perception testing in quiet and noise in the CI-only and bimodal conditions with at least 1 year of device use and device usage from data logs represent the main outcome measures. RESULTS The mean age at CI was 5.0 years (median 4.4, range 1.0-11.8 years). The mean duration of deafness was 3.0 years (median 2.4, range 0.6-7.0 years). Mean follow-up was 3.4 years. Speech perception testing with a minimum of 1 year post-CI was available in eight patients. The mean word recognition scores (WRS) in the CI-only condition was 56%; a significant improvement from baseline. Testing in background noise with spatially separated speech and noise revealed that patients scored as well or better with the CI-on versus CI-off in all conditions and in no cases was interference from the CI noted. Data logs were reviewed for device usage which revealed an average use of 6.5 hr/d. CONCLUSION Cochlear implantation is a viable treatment option for pediatric SSD in this self-selected cohort. Open-set speech and improvement in background noise can be achieved. Careful patient selection and thorough counseling on expectations is paramount to achieving successful outcomes. LEVEL OF EVIDENCE IV Laryngoscope, 131:E271-E277, 2021.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - Steven A Gordon
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - William H Shapiro
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - Susan B Waltzman
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - J Thomas Roland
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
| | - David R Friedmann
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, U.S.A
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Gordon SA, Garber D, Taufique Z, Shao Q, Amin MR, Roland JT, Givi B. Improving On-time Discharge in Otolaryngology Admissions. Otolaryngol Head Neck Surg 2020; 163:188-193. [DOI: 10.1177/0194599819898910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We conducted a quality improvement project to increase the rate of discharges before noon (DBN) in the otolaryngology department at a tertiary care center. Methods Based on a Plan-Do-Study-Act framework, monthly discharge data and observed-to-expected (O:E) length of stay were collected and shared with the department members monthly. A target of 43% DBN was predetermined by the center (Plan). The following interventions were implemented (Do): discharge planning starting at the time of admission, focus on early attending-to-resident team communication, placement of discharge order prior to rounding, and weekly reminders to the entire department. Results Discharges were monitored for 3 years. For the year prior to this study, a minority of patients were discharged before noon (12 months: 75 of 190, 36%). During the first 6 months of monitoring (Study), no significant improvement was identified (34 of 95, 36%). After interventions, performance significantly improved (31 months: 250 of 548, 68%). The performance was consistently above the predetermined target of 43%. During the study time, O:E length of stay remained below the predetermined target (O:E ratio, 0.90; hospital target, 0.93). Discussion Comprehensive discharge planning beginning at the time of admission, weekly reminders, and improved communication (Act) can help to prioritize DBN and increase the percentage of discharges before noon. Implications for Practice By utilizing a quality improvement framework, significant improvements in timely discharge can be achieved and sustained with changes in workflow and departmental culture. These changes can be achieved without increases in resources or prolonging the length of stay.
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Affiliation(s)
- Steven A. Gordon
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - David Garber
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Zahrah Taufique
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Qianhui Shao
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Milan R. Amin
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - J. Thomas Roland
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Babak Givi
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
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Kocharyan AH, Briggs S, Cosetti MK, Heman-Ackah SM, Golfinos JG, Roland JT. Atypical Schwannoma: A 10-year experience. Am J Otolaryngol 2020; 41:102309. [PMID: 31727334 DOI: 10.1016/j.amjoto.2019.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this study was to describe the clinical presentation associated with atypical schwannoma of the cerebellopontine angle, characterize the pathologic findings and describe the long-term outcome. MATERIALS AND METHODS The study design was retrospective case review of patients with the histopathologic diagnosis of atypical and benign schwannoma of the cerebellopontine angle diagnosed at the study institution over a 10-year period. SETTING Tertiary referral center. MAIN OUTCOMES MEASURE Demographic data of the cohort were recorded. Findings on pathology were evaluated. Initial treatment and post-operative course was recorded. Main outcome measures were clinical presentation, including cranial nerve deficits at the time of presentation, complication and recurrence rates. RESULTS At presentation, a somewhat accelerated course of cranial nerve deficit was noted among patients with atypical schwannoma as compared to benign schwannoma. In the immediate post-operative period, there were no differences noted in the complication rate. Atypical schwannomas appear to have higher recurrence rate compared to benign schwannomas. CONCLUSIONS Atypical schwannoma is an intermediate disease process with an accelerated clinical course and higher recurrence rate as compared to vestibular schwannoma. Traditional operative approaches may be employed without increased concern for post-operative complications. Thorough counseling and close follow-up should be offered to these patients given the higher recurrence rate. Larger studies are required to determine if these patients need more frequent MRIs for long-term surveillance.
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Affiliation(s)
- Armine H Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Selena Briggs
- Department of Otolaryngology, MedStar Georgetown University Medical Center, Washington, DC, USA; Department of Otolaryngology, MedStar Washington Hospital Center, Washington, DC, USA; Department of Otolaryngology, New York University School of Medicine, New York, NY, USA.
| | - Maura K Cosetti
- Department of Otolaryngology, Eye and Ear Infirmary of Mount Sinai, The Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA
| | - Sabrina M Heman-Ackah
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - John G Golfinos
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - J Thomas Roland
- Department of Otolaryngology, New York University School of Medicine, New York, NY, USA; Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
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Karajannis M, Goldberg J, Thomas Roland J, Sen C, Placantonakis D, Golfinos J, Allen J, Dunbar E, Plotkin S, Akshintala S, Schneider R, Deng J, Neubert TA, Giancotti F, Zagzag D, O Blakeley J. ACTR-09. A PHASE 0 PHARMACODYNAMIC AND PHARMACOKINETIC STUDY OF EVEROLIMUS IN VESTIBULAR SCHWANNOMA (VS) AND MENINGIOMA PATIENTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Inhibition of mTORC1 signaling has been shown to diminish growth of NF2 deficient tumors in preclinical studies, and clinical data suggest that everolimus, an orally administered mTORC1 inhibitor, may slow tumor progression in a subset of adult and pediatric NF2 patients with VS. To assess the pharmacokinetics, pharmacodynamics and potential mechanisms of treatment resistance, we performed a pre-surgical (“phase 0”) clinical trial of everolimus in patients undergoing surgery for VS or meningiomas.
METHODS
Eligible patients with meningioma or VS requiring tumor resection received everolimus 10 mg daily for 10 days immediately prior to surgery. Everolimus blood levels were determined immediately prior to and after surgery. Tumor samples were collected intraoperatively.
RESULTS
Ten patients completed protocol therapy, including 5 patients with NF2-related meningioma, 3 patients with sporadic meningioma, and 2 patients with NF2-related VS. Median pre- and post-operative plasma levels of everolimus were found to be in a high therapeutic range (17.4 ng/ml and 9.4 ng/ml, respectively). Median tumor tissue drug concentration determined by mass spectrometry was 24.3 ng/g (range 9.2–169.2), and median tumor tissue to post-operative plasma drug concentration ratio was 0.39. We observed only partial inhibition of phospho-S6 in the treated tumors, indicating incomplete target inhibition compared to matched control tissues from untreated patients (p = 0.005). Consistent with prior observations that inhibition of mTORC1 may lead to MAPK pathway activation through a PI3K-dependent feedback loop, we observed a statistically significant increase of phospho-ERK (p < 0.03) versus untreated controls.
CONCLUSIONS
In patients with meningioma or VS, treatment with everolimus leads to incomplete inhibition of mTORC1 signaling and upregulation phospho-ERK. These data may explain the limited anti-tumor effect of everolimus observed in clinical studies for NF2 patients and identify upregulation of phospho-ERK as a likely resistance mechanism that could be addressed with combination therapies.
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Schnurman Z, Golfinos JG, Roland JT, Kondziolka D. Knowledge silos: assessing knowledge sharing between specialties through the vestibular schwannoma literature. J Neurosurg 2019; 129:1278-1285. [PMID: 29192857 DOI: 10.3171/2017.6.jns171182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIt is common for a medical disorder to be managed or researched by individuals who work within different specialties. It is known that both neurosurgeons and neurotologists manage vestibular schwannoma (VS) patients. While overlap in specialty focus has the potential to stimulate multidisciplinary collaboration and innovative thinking, there is a risk of specialties forming closed-communication loops, called knowledge silos, which may inhibit knowledge diffusion. This study quantitatively assessed knowledge sharing between neurosurgery and otolaryngology on the subject of VS.METHODSA broad Web of Science search was used to download details for 4439 articles related to VS through 2016. The publishing journal's specialty and the authors' specialties (based on author department) were determined for available articles. All 114,647 of the article references were categorized by journal specialty. The prevalence of several VS topics was assessed using keyword searches of titles.RESULTSFor articles written by neurosurgeons, 44.0% of citations were from neurosurgery journal articles and 23.4% were from otolaryngology journals. The citations of otolaryngology authors included 11.6% neurosurgery journals and 56.5% otolaryngology journals. Both author specialty and journal specialty led to more citations of the same specialty, though author specialty had the largest effect. Comparing the specialties' literature, several VS topics had significantly different levels of coverage, including radiosurgery and hearing topics. Despite the availability of the Internet, there has been no change in the proportions of references for either specialty since 1997 (the year PubMed became publicly available).CONCLUSIONSPartial knowledge silos are observed between neurosurgery and otolaryngology on the topic of VS, based on the peer-reviewed literature. The increase in access provided by the Internet and searchable online databases has not decreased specialty reference bias. These findings offer lessons to improve cross-specialty collaboration, physician learning, and consensus building.
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Affiliation(s)
| | | | - J Thomas Roland
- 2Otolaryngology Head and Neck Surgery, NYU Langone Medical Center, New York, New York
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Rozman PA, Benjamin CG, Kondziolka D, Sen C, Roland JT, Zagzag D, Snuderl M, Gordon D. Intraosseous Petrous Apex Schwannoma: Case Report and Review of Literature. World Neurosurg 2019; 132:182-187. [PMID: 31476472 DOI: 10.1016/j.wneu.2019.08.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraosseous petrous apex schwannomas are an exceedingly rare entity; little is known about their epidemiology, natural history, and postoperative outcomes. CASE DESCRIPTION Here, we present the fourth known case of a primary intraosseous schwannoma of the petrous apex: a 68-year-old woman presenting with diplopia, facial numbness, progressive intermittent vertigo, tinnitus, diminished hearing, and ataxia. She underwent a transtemporal approach for subtotal resection of the tumor with subsequent stereotactic radiosurgery. CONCLUSIONS Our 2-year follow-up demonstrates slow growth and success of multimodal management in the treatment of these tumors. We review the 3 prior reports of petrous apex schwannomas and identify unifying radiographic and clinical characteristics to aid future diagnostic considerations of lesions of the petrous apex.
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Affiliation(s)
- Peter A Rozman
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA; Department of Radiation Oncology, NYU Langone Health, New York, New York, USA
| | - Chandranath Sen
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - J Thomas Roland
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA; Department of Otolaryngology, NYU Langone Health, New York, New York, USA
| | - David Zagzag
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA; Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - David Gordon
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Schnurman Z, Nakamura A, McQuinn MW, Golfinos JG, Roland JT, Kondziolka D. Volumetric growth rates of untreated vestibular schwannomas. J Neurosurg 2019; 133:1-7. [PMID: 31374553 DOI: 10.3171/2019.5.jns1923] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There remains a large discrepancy among surgeons in expectations of vestibular schwannoma (VS) growth. The anticipated growth rate of a VS and its potential clinical impact are important factors when deciding whether to observe the lesion over time or to intervene. Previous studies of VS natural growth remain limited, mostly confined to linear measurements, often without high-resolution, thin-sequence imaging. The present study comprehensively assessed natural tumor growth rates using volumetric measurements. METHODS Between 2012 and 2018, 212 treatment-naïve patients diagnosed with a unilateral VS were evaluated. A total of 699 MR images were assessed, with a range of 2-11 MR images per patient. All MR images preceded any intervention, with patients subsequently being observed through completion of data analysis (36%) or treated with stereotactic radiosurgery (32%) or microsurgical resection (32%). To determine precise tumor volumes, the tumor area was outlined on every slice, and the products of the area and slice thickness were summed (99% of scans were ≤ 1-mm slice thickness). A multilevel model with random effects was used to assess the mean volume change over time. Each tumor was categorized as one of the following: growing (volume increase by more than 20% per year), fast growing (volume increase by more than 100% per year), stable (volume change between 20% decrease and 20% increase per year), and shrinking (volume decrease by more than 20% per year). RESULTS The mean VS volumetric growth rate was 33.5% per year (95% CI 26.9%-40.5%, p < 0.001). When assessing the frequencies of individual tumor annual growth rates, 66% demonstrated growth (30% fast growing), 33% were stable, and 1% exhibited shrinking over an average interval of 25 months. Larger tumors were associated with increased absolute growth, but there was no relationship between tumor size and proportional growth rate. There was also no relationship between patient age and tumor growth rate. CONCLUSIONS This study comprehensively assessed VS volumetric growth rates using high-resolution images and was conducted in a large and diverse patient sample. The majority of the tumors exhibited growth, with about one-third growing at a rate of 100% per year. These findings may contribute to a consensus understanding of tumor behavior and inform clinical decisions regarding whether to intervene or observe.
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Affiliation(s)
| | | | | | | | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
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Roland JT. In Memoriam: Noel Cohen. J Int Adv Otol 2019; 15:1. [PMID: 31058591 DOI: 10.5152/iao.2019.030418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Deep NL, Choudhury B, Roland JT. Auditory Brainstem Implantation: An Overview. J Neurol Surg B Skull Base 2019; 80:203-208. [PMID: 30931229 DOI: 10.1055/s-0039-1679891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 01/27/2023] Open
Abstract
An auditory brainstem implant (ABI) is a surgically implanted central neural auditory prosthesis for the treatment of profound sensorineural hearing loss in children and adults who are not cochlear implant candidates due to a lack of anatomically intact cochlear nerves or implantable cochleae. The device consists of a multielectrode surface array which is placed within the lateral recess of the fourth ventricle along the brainstem and directly stimulates the cochlear nucleus, thereby bypassing the peripheral auditory system. In the United States, candidacy criteria for ABI include deaf patients with neurofibromatosis type 2 (NF2) who are 12 years or older undergoing first- or second-side vestibular schwannoma resection. In recent years, several non-NF2 indications for ABI have been explored, including bilateral cochlear nerve avulsion from trauma, complete ossification of the cochlea due to meningitis, or a severe cochlear malformation not amenable to cochlear implantation. In addition, growing experience with ABI in infants and children has been documented with encouraging outcomes. While cochlear implantation generally remains the first-line option for hearing rehabilitation in NF2 patients with stable tumors or post hearing preservation surgery where hearing is lost but a cochlear nerve remains accessible for stimulation, an ABI is the next alternative in cases where the cochlear nerve is absent and/or if the cochlea cannot be implanted. Herein, we review ABI device design, clinical evaluation, indications, operative technique, and outcomes as it relates to lateral skull base pathology.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, United States
| | - Baishakhi Choudhury
- Department of Otolaryngology, Loma Linda University, Loma Linda, California, United States
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, United States
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Schnurman Z, Golfinos JG, Epstein D, Friedmann DR, Roland JT, Kondziolka D. Comparing costs of microsurgical resection and stereotactic radiosurgery for vestibular schwannoma. J Neurosurg 2018; 131:1-10. [PMID: 30497146 DOI: 10.3171/2018.5.jns18508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given rising scrutiny of healthcare expenditures, understanding intervention costs is increasingly important. This study aimed to compare and characterize costs for vestibular schwannoma (VS) management with microsurgery and radiosurgery to inform practice decisions and appraise cost reduction strategies. METHODS In conjunction with medical records, internal hospital financial data were used to evaluate costs. Total cost was divided into index costs (costs from arrival through discharge for initial intervention) and follow-up costs (through 36 months) for 317 patients with unilateral VSs undergoing initial management between June 2011 and December 2015. A retrospective matched cohort based on tumor size with 176 patients (88 undergoing each intervention) was created to objectively compare costs between microsurgery and radiosurgery. The full sample of 203 patients treated with resection and 114 patients who underwent radiosurgery was used to evaluate a broad range of outcomes and identify cost contributors within each intervention group. RESULTS Within the matched cohort, average index costs were significantly higher for microsurgery (100% by definition, because costs are presented as a percentage of the average index cost for the matched microsurgery group; 95% CI 93-107) compared to radiosurgery (38%, 95% CI 38-39). Microsurgery had higher average follow-up costs (1.6% per month, 95% CI 0.8%-2.4%) compared to radiosurgery (0.5% per month, 95% CI 0.4%-0.7%), largely due to costs incurred in the initial months after resection. A major contributor to total cost and cost variability for both resection and radiosurgery was the need for additional interventions in the follow-up period, which were necessary due to complications or persistent functional deficits. Although tumor size was not associated with increased total costs for radiosurgery, linear regression analysis demonstrated that, for patients who underwent microsurgery, each centimeter increase in tumor maximum diameter resulted in an estimated increase in total cost of 50.2% of the average index cost of microsurgery (95% CI 34.6%-65.7%) (p < 0.001, R2 = 0.17). There were no cost differences associated with the proportion of inpatient days in the ICU or with specific surgical approach for patients who underwent resection. CONCLUSIONS This study is the largest assessment to date based on internal cost data comparing VS management with microsurgery and radiosurgery. Both index and follow-up costs are significantly higher when tumors were managed with resection compared to radiosurgery. Larger tumors were associated with increased resection costs, highlighting the incremental costs associated with observation as the initial management.
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Affiliation(s)
| | | | | | - David R Friedmann
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Medical Center, New York, New York
| | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Medical Center, New York, New York
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Friedmann DR, Asfour L, Shapiro WH, Roland JT, Waltzman SB. Performance with an Auditory Brainstem Implant and Contralateral Cochlear Implant in Pediatric Patients. Audiol Neurootol 2018; 23:216-221. [PMID: 30391957 DOI: 10.1159/000493085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess bimodal auditory performance in children with a cochlear implant (CI) and contralateral auditory brainstem implant (ABI). METHODS This is a retrospective case review performed at a tertiary referral center. Four patients with cochlear nerve deficiency initially underwent cochlear implantation but were not benefiting from their devices and underwent ABI in the contralateral ear. The main outcome measures included age-appropriate speech perception and production assessments. RESULTS Three subjects performed better on their auditory perception assessments using both of their devices than with either device alone. One subject had only preliminary outcomes, but subjectively performed best with both devices. CONCLUSIONS We observed continued improvement in CI performance over time, even if no benefit was evident before the decision for ABI. This could suggest that ABI and CI have a synergistic effect, or it could simply be the adaptive ability of the developing brain to utilize the signals coming from these devices. There is preliminary evidence to support choosing the ear contralateral to the CI for an ABI in a pediatric patient with bilateral cochlear nerve deficiency.
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Affiliation(s)
- David R Friedmann
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA,
| | - Leena Asfour
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - William H Shapiro
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
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Benjamin CG, Sen RD, Golfinos JG, Sen C, Roland JT, McMenomey S, Pacione D. Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses. J Neurosurg 2018; 131:1-7. [PMID: 30497227 DOI: 10.3171/2018.4.jns18308] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/23/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVECerebral venous sinus thrombosis (CVST) is a known complication of surgeries near the major dural venous sinuses. While the majority of CVSTs are asymptomatic, severe sinus thromboses can have devastating consequences. The objective of this study was to prospectively evaluate the true incidence and risk factors associated with postoperative CVST and comment on management strategies.METHODSA prospective study of 74 patients who underwent a retrosigmoid, translabyrinthine, or suboccipital approach for posterior fossa tumors, or a supratentorial craniotomy for parasagittal/falcine tumors, was performed. All patients underwent pre- and postoperative imaging to evaluate sinus patency. Demographic, clinical, and operative data were collected. Statistical analysis was performed to identify incidence and risk factors.RESULTSTwenty-four (32.4%) of 74 patients had postoperative MR venograms confirming CVST, and all were asymptomatic. No risk factors, including age (p = 0.352), BMI (p = 0.454), sex (p = 0.955), surgical approach (p = 0.909), length of surgery (p = 0.785), fluid balance (p = 0.943), mannitol use (p = 0.136), tumor type (p = 0.46, p = 0.321), or extent of resection (p = 0.253), were statistically correlated with thrombosis. All patients were treated conservatively, with only 1 patient receiving intravenous fluids. There were no instances of venous infarctions, hemorrhages, or neurological deficits. The rate of CSF leakage was significantly higher in the thrombosis group than in the nonthrombosis group (p = 0.01).CONCLUSIONSThis prospective study shows that the radiographic incidence of postoperative CVST is higher than that previously reported in retrospective studies. In the absence of symptoms, these thromboses can be treated conservatively. While no risk factors were identified, there may be an association between postoperative CVST and CSF leak.
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Affiliation(s)
| | - Rajeev D Sen
- 2Department of Neurosurgery, University of Washington, Seattle, Washington
| | | | | | - J Thomas Roland
- 3Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - Sean McMenomey
- 3Otolaryngology, NYU Langone Medical Center, New York, New York; and
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Asfour L, Friedmann DR, Shapiro WH, Roland JT, Waltzman SB. Early experience and health related quality of life outcomes following auditory brainstem implantation in children. Int J Pediatr Otorhinolaryngol 2018; 113:140-149. [PMID: 30173973 DOI: 10.1016/j.ijporl.2018.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess auditory brainstem implant (ABI) outcomes in children with a prospective study. METHODS Twelve patients with cochlear nerve deficiency received an auditory brainstem implant. Patients were evaluated with age appropriate speech perception and production assessments, and health related quality of life (HRQoL) surveys for parents of subjects and for subjects if age appropriate. RESULTS Twelve patients received an ABI without major complications. Eleven out of twelve received some auditory benefit from their ABI. Parental HRQoL ratings were positive for all domains with the exception of communication. Self reported overall HRQoL metrics from two subjects were also positive. CONCLUSIONS ABI is a good option for patients who are not eligible for or fail CI. Our findings show that despite varying degrees of postoperative performance, HRQoL ratings were positive. The presence of additional disabilities and health problems resulted in less positive HRQoL outcomes. Our results emphasize the need to assess outcomes in these patients beyond speech perception and communication.
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Affiliation(s)
- Leena Asfour
- New York University School of Medicine, 550 1st Ave, NY, NY 10016, USA
| | - David R Friedmann
- New York University School of Medicine, 550 1st Ave, NY, NY 10016, USA.
| | - William H Shapiro
- New York University School of Medicine, 550 1st Ave, NY, NY 10016, USA
| | - J Thomas Roland
- New York University School of Medicine, 550 1st Ave, NY, NY 10016, USA
| | - Susan B Waltzman
- New York University School of Medicine, 550 1st Ave, NY, NY 10016, USA
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Prabhu V, Kondziolka D, Hill TC, Benjamin CG, Shinseki MS, Golfinos JG, Roland JT, Fatterpekar GM. Preserved Cochlear CISS Signal is a Predictor for Hearing Preservation in Patients Treated for Vestibular Schwannoma With Stereotactic Radiosurgery. Otol Neurotol 2018; 39:628-631. [PMID: 29561382 DOI: 10.1097/mao.0000000000001762] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hearing preservation is a goal for many patients with vestibular schwannoma. We examined pretreatment magnetic resonance imaging (MRI) and posttreatment hearing outcome after stereotactic radiosurgery. METHODS From 2004 to 2014, a cohort of 125 consecutive patients with vestibular schwannoma (VS) treated via stereotactic radiosurgery (SRS) were retrospectively reviewed. MRIs containing three-dimensional constructive interference in steady state or equivalent within 1 year before treatment were classified by two radiologists for pretreatment characteristics. "Good" hearing was defined as American Academy of Otolaryngology-Head and Neck Surgery class A. Poor hearing outcome was defined as loss of good pretreatment hearing after stereotactic radiosurgery. RESULTS Sixty-one patients met criteria for inclusion. Most had tumors in the distal internal auditory canal (55%), separated from the brainstem (63%), oval shape (64%) without cysts (86%), and median volume of 0.85 ± 0.55 cm. Pretreatment audiograms were performed a median of 108 ± 173 days before stereotactic radiosurgery; 38% had good pretreatment hearing. Smaller tumor volume (p < 0.005) was the only variable associated with good pretreatment hearing. 49 (80%) patients had posttreatment audiometry, with median follow-up of 197 ± 247 days. Asymmetrically decreased pretreatment cochlear CISS signal on the side of the VS was the only variable associated with poor hearing outcome (p = 0.001). Inter-rater agreement on cochlear three-dimensional constructive interference in steady state preservation was 91%. CONCLUSIONS Decreased cochlear CISS signal may indicate a tumor's association with the cochlear neurovascular bundle, influencing endolymph protein concentration and creating an inability to preserve hearing. This important MRI characteristic can influence planning, counseling, and patient selection for vestibular schwannoma treatment.
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Affiliation(s)
| | | | | | | | | | | | - J Thomas Roland
- Department of Otolaryngology, NYU School of Medicine, New York, New York
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Roland JT, Gantz BJ, Waltzman SB, Parkinson AJ. Long-term outcomes of cochlear implantation in patients with high-frequency hearing loss. Laryngoscope 2018; 128:1939-1945. [PMID: 29330858 DOI: 10.1002/lary.27073] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/11/2017] [Accepted: 11/29/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To demonstrate the long-term benefits of implantation in patients with high-frequency sensorineural hearing loss, this report provides 5-year follow-up on a group of implant recipients who were subjects of the Cochlear™ Nucleus® Hybrid™ L24 Implant System pivotal clinical study. METHODS The results of three related clinical studies were compiled to provide outcome data after 1, 3, and 5 years of implant use in a group of subjects who presented with preoperative high-frequency hearing loss and were implanted with a Nucleus Hybrid L24 (Cochlear Ltd., Sydney, Australia) cochlear implant. A subset of the 50 adult subjects (N = 32) who participated in the Hybrid L24 pivotal Investigational Device Exemption (IDE) completed comprehensive evaluations at 12 months postactivation, 3 years postactivation, and then as part of a postapproval study at 5 years postactivation. Testing included audiometric, speech perception, and subjective satisfaction measures. RESULTS Mean unilateral speech perception performance was significantly improved at all postoperative intervals compared to preoperative best-aided results and has remained stable to 5 years postactivation. Ninety-four percent of subjects had measurable hearing, and 72% continued to use electric-acoustic stimulation in the implanted ear after 5 years of implant use. Subjective satisfaction results support objective performance improvements. CONCLUSION Results demonstrate long-term success of patients with high-frequency hearing loss following Hybrid L24 (Cochlear) cochlear implantation. Benefits include speech perception abilities significantly better than those in the preoperative best-aided condition, with additional benefit in those using electric-acoustic stimulation in the implanted ear. LEVEL OF EVIDENCE 2b. Laryngoscope, 1939-1945, 2018.
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Affiliation(s)
- J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York
| | - Bruce J Gantz
- Department of Otolaryngology-Head and Neck Surgery, the University of Iowa, Iowa City, Iowa
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York
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Hoch MJ, Patel SH, Jethanamest D, Win W, Fatterpekar GM, Roland JT, Hagiwara M. Head and Neck MRI Findings in CHARGE Syndrome. AJNR Am J Neuroradiol 2017; 38:2357-2363. [PMID: 28705814 DOI: 10.3174/ajnr.a5297] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/13/2017] [Indexed: 11/07/2022]
Abstract
Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and deafness (CHARGE) syndrome is a disorder with multiple congenital anomalies seen on imaging. A retrospective review of 10 patients with CHARGE syndrome who underwent MR imaging of the brain as part of a preoperative evaluation for cochlear implantation was conducted. Structural abnormalities of the entire MR imaging of the head were evaluated, including the auditory system, olfactory system, face, skull base, and central nervous system. The most frequent MR imaging findings included dysplasias of the semicircular canals and hypoplasia of the frontal lobe olfactory sulci. Less frequent findings included cleft lip/palate and coloboma. Our study uncovered new findings of a J-shaped sella, dorsal angulation of the clivus, and absent/atrophic parotid glands, not previously described in patients with CHARGE. Our results emphasize the utility of MR imaging in the diagnosis and management of patients with CHARGE syndrome.
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Affiliation(s)
- M J Hoch
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - S H Patel
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - D Jethanamest
- Department of Otolaryngology (D.J., J.T.R.), New York University Langone Medical Center, New York, New York
| | - W Win
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - G M Fatterpekar
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
| | - J T Roland
- Department of Otolaryngology (D.J., J.T.R.), New York University Langone Medical Center, New York, New York
| | - M Hagiwara
- From the Department of Radiology (M.J.H., S.H.P., W.W., G.M.F., M.H.), Section of Neuroradiology
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Svrakic M, Golfinos JG, Zagzag D, Roland JT. Cochlear Implantation of a Patient with Definitive Neurosarcoidosis. OTO Open 2017; 1:2473974X17742633. [PMID: 30480198 PMCID: PMC6239151 DOI: 10.1177/2473974x17742633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 09/08/2017] [Accepted: 10/26/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Maja Svrakic
- Department of Otolaryngology, New York University Langone Medical Center, New York, New York, USA.,Department of Otolaryngology, Northwell Health, New Hyde Park, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA
| | - David Zagzag
- Department of Pathology, New York University Langone Medical Center, New York, New York, USA
| | - J Thomas Roland
- Department of Otolaryngology, New York University Langone Medical Center, New York, New York, USA
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