- Bangalore Skull Base Institute
#14, Kalpavriksha, 1st Cross, 17th A Main, 5th Block, Koramangala, Bangalore, India 560095 - (+91) 6366888881
- Dr. Sampath Chandra Prasad Rao is a Consultant Otolaryngology - Head & Neck Surgeon specialized in Skull Base Surgeri... moreDr. Sampath Chandra Prasad Rao is a Consultant Otolaryngology - Head & Neck Surgeon specialized in Skull Base Surgeries and Hearing Implantology.
Dr. Rao did his Masters in Otolaryngology-Head & Neck Surgery at Kasturba Medical College, Mangalore (India) affiliated to the Manipal University. He was awarded the best outgoing student during his Masters. He is also the Fellow of the European Academy of Otology & Neurotology and Fellow of the European Board of Examinations in Otolaryngology. He was awarded the British Annual Congress in Otolaryngology (BACO) fellowship twice, Birla Smarak Kosh Fellowship and the GSE fellowship of Rotary International. He is the recipient of the Ten Outstanding Indian award from Junior Chamber International (JCI).
He completed his two year fellowship in Skull Base Surgeries, Hearing Implantology and Advanced Otology at the Skull Base unit of Casa Di Cura Piacenza (Italy), the premier center in the world in the discipline and was awarded the Fellowship of the European Academy of Neurotology (EAONO). He continued to work at the Skull Base Surgery unit at Casa Di Cura Piacenza for a total of 6.5 years accumulating vast experience in Skull Base Surgery.
Dr. Rao has 95 peer reviewed scientific publications (h index of 19), 10 chapters and 1 text book on Cochlear and other Auditory Implants by Thieme. He has over 100 presentations in national and international conferences, courses and workshops. He is invited as a faculty routinely in most prestigious international and national congresses in his specialty. He has won prizes for paper presentations in many prestigious International Congresses including the Politzer Society Meeting in 2013. He is also the member of several national and international organisations including the AAO-HNS, EAONO, ERS, AOI, ISO and FHNO. He is the member of the Skull Base Committee of the AAO-HNS.
Dr. Rao was honored with a visiting Professorship to the Shanghai Jiao Tong University, one of Asia's largest Universities. He was also honored with the Dr. GS Grewal Oration at the Annual Congress of the Association of Otolaryngologists of India in 2018. He has been invited to the Skull Base Courses organised by the World Federation of Neurosurgical Societies (WFNS) and toss a key note speaker to the National Conferences of the Italian, Indian, Turkish, Saudi, Bangladeshi and UAE societies.
He has pioneered many skull base and Implant surgeries in India and also performed the 1st Cochlear Implantation in a Subtotal Petrosectomy in Bangladesh. He is the Founder of World Skull Base, an international skull base organisation. The WSB Fellowship Diplomas in Skull Base Surgery, held at Bangalore are the 1st curriculum based skull base courses in India that are awarded a University Diploma.edit
BACKGROUND Intrinsic tumors of the facial nerve are a rare entity. Dealing with this subset of tumors is challenging both in terms of decision making and surgical intervention. OBJECTIVE To review the outcomes of surgical management of... more
BACKGROUND Intrinsic tumors of the facial nerve are a rare entity. Dealing with this subset of tumors is challenging both in terms of decision making and surgical intervention. OBJECTIVE To review the outcomes of surgical management of facial nerve tumors and cable nerve graft interpositioning. METHODS A retrospective analysis was performed at a referral center for skull base pathology. One hundred fifteen patients who were surgically treated for facial nerve tumors were included. In case of nerve interruption during surgery, the cable nerve interpositioning technique was employed wherein the facial nerve palsy lasted for less than 1-yr duration. In cases of facial nerve palsy lasting for greater than 1 yr, the nerve was restituted by a hypoglossal facial coaptation. RESULTS Various degrees of progressive paralysis were seen in 84 (73%) cases. Sixty nine (60%) of the tumors involved multiple segments of the facial nerve. Sixty-two (53.9%) tumors involved the geniculate ganglion. Seventy four (64.3%) of the cases were schwannomas. Hearing preservation surgeries were performed in 60 (52.1%). Ninety one (79.1%) of the nerves that were sectioned in association with tumor removal were restituted primarily by interposition cable grafting. The mean preoperative House-Brackmann grading of the facial nerve was 3.6. The mean immediate postoperative grading was 5.4, which recovered to a mean of 3.4 at the end of 1 yr. CONCLUSION In patients with good facial nerve function (House-Brackmann grade I-II), a wait-and-scan approach is recommended. In cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve.
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1) To review the surgical and auditory outcomes and complications of cochlear implantation in cases with cochlear ossification. 2) To evaluate association between the extent and etiology of ossification to outcomes. Retrospective study.... more
1) To review the surgical and auditory outcomes and complications of cochlear implantation in cases with cochlear ossification. 2) To evaluate association between the extent and etiology of ossification to outcomes. Retrospective study. Otology and skull base surgery center. Charts of 40 patients (42 ears) with cochlear ossification undergoing cochlear implantation were reviewed. Demographic features, operative findings, auditory outcomes, and complications were analyzed. Operative findings included extent of cochlear ossification, extent of drilling required to obtain patent cochlear lumen, approach (posterior tympanotomy/subtotal petrosectomy), electrode insertion (partial/complete, scala tympani/vestibuli), and complications. Auditory outcomes were assessed over a 4-year follow-up period using vowel, word, sentence, and comprehension scores. Patients were divided into groups (otosclerotic/non-otosclerotic and round window/basal turn ossification) for comparison of auditory outcomes. Outcomes were compared with 60 randomly identified controls (adults with postlingual deafness) who underwent implantation with no cochlear ossification. The median age and duration of deafness of patients was 54.39 and 27.15 years, respectively. Etiology of cochlear ossification was otosclerosis in 23 of 42 ears and mixed in 19 of 42 ears (chronic otitis media, temporal bone fractures, idiopathic, meningitis, Cogan's syndrome) with exclusive round window involvement in 54.7% of cases and the rest having partial or complete basal turn ossification. 59.5% ears underwent subtotal petrosectomy for implantation. Three patients underwent scala vestibuli insertion and five had incomplete electrode insertion. Auditory outcomes were comparable in otosclerotic and non-otosclerotic cases and in round window and basal turn ossification cases. No significant differences were observed in auditory scores when compared with controls with no ossification. Cochlear implantation in cochlear ossification is feasible despite surgical challenges and modifications. Auditory outcomes in basal turn ossification appear to be comparable to cases with no ossification with extent of ossification having no significant association with outcomes.
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Research Interests: Adolescent, Medicine, Hearing, Population, Humans, and 15 moreChild, Female, Male, Pediatric Surgery, Infant, Hearing Loss, Clinical Sciences, Retrospective Studies, Cholesteatoma, Petrous bone, Postoperative Complications, Child preschool, Bone Diseases, Paediatrics and reproductive medicine, and Referral and consultation
To evaluate the role of lateral skull base approaches in the management of benign parapharyngeal space tumors and to propose an algorithm for their surgical approach. Retrospective study of patients with benign parapharyngeal space... more
To evaluate the role of lateral skull base approaches in the management of benign parapharyngeal space tumors and to propose an algorithm for their surgical approach. Retrospective study of patients with benign parapharyngeal space tumors. The clinical features, radiology and preoperative management of skull base neurovasculature, the surgical approaches and overall results were recorded. 46 patients presented with 48 tumors. 12 were prestyloid and 36 poststyloid. 19 (39.6%) tumors were paragangliomas, 15 (31.25%) were schwannomas and 11 (23%) were pleomorphic adenomas. Preoperative embolization was performed in 19, stenting of the internal carotid artery in 4 and permanent balloon occlusion in 2 patients. 19 tumors were approached by the transcervical, 13 by transcervical-transparotid, 5 by transcervical-transmastoid, 6, 1 and 2 tumors by the infratemporal fossa approach types A, B and D, respectively. Total radical tumor removal was achieved in 46 (96%) of the cases. Lateral skull base approaches have an advantage over other approaches in the management of benign tumors of the parapharyngeal space due to the fact that they provide excellent exposure with less morbidity. The use of microscope combined with bipolar cautery reduces morbidity. Stenting of internal carotid artery gives a chance for complete tumor removal with arterial preservation.
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Objective: To review the classification and management of petrous bone cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions. Methods: This was a retrospective study. The setting was a... more
Objective: To review the classification and management of petrous bone cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions. Methods: This was a retrospective study. The setting was a quaternary referral center for skull base pathology in Italy. A total of 200 patients with 201 PBCs were included in the study. All patients diagnosed radiologically with PBCs were classified according to the Sanna classification. All patients were surgically treated and followed up with radiology. The main outcome measures - classification of PBCs, the surgical approach used, disease control, and FN outcomes - were analyzed. Results: Supralabyrinthine PBCs were the most common type with 92 cases (45.8%) followed by the massive PBCs with 72 cases (35.8%). Preservation of preoperative FN function was highest in the infralabyrinthine (72.2%) and infralabyrinthine-apical (73.3%) types. The transotic approach was used in 66 cases (32.8%) in this series. The modified transcochlear approach type A was applied in 55 cases (27.3%). Active management of the nerve (rerouting, anastomosis, or grafting) was required in 53 cases (26.4%). Postoperatively, of the 116 cases with FN House-Brackmann grade I and II, 107 cases (92.2%) retained the same grade or improved. Recurrence was seen in 7 cases (3.5%). The mean duration of follow-up was 6.3 years. Conclusions: Radical disease clearance must take precedence over hearing and FN preservation in PBCs. Active FN management, including rerouting, end-to-end anastomosis, and cable nerve grafting, routinely come to play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.
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Research Interests: Surgery, Medicine, Humans, Chronic Disease, Female, and 15 moreMale, Cochlear Implants, Cochlear implant outcomes, Clinical Sciences, Otology Neurotology, Aged, Middle Aged, Adult, Retrospective Studies, Otitis Media, Cholesteatoma, Cochlear Implantation, Petrous bone, Craniotomy, and Device Removal
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The surgical management of skull base paragangliomas is particularly challenging as a result of their complex anatomical location, the local major neurovascular structures, and the proximity of intracranial structures. The internal... more
The surgical management of skull base paragangliomas is particularly challenging as a result of their complex anatomical location, the local major neurovascular structures, and the proximity of intracranial structures. The internal carotid artery (ICA) is often involved by tympanojugular paragangliomas (TJPs) in its upper cervical and petrous portions [1]. Similarly carotid body paraganglioma and the vagal paragangliomas are also intimately related to the ICA. Early attempts to resect tumors involving the ICA were associated with high rates of morbidity and mortality [2]. However, today, significant reduction in morbidity has been achieved in the surgical management of this subset of tumors due to advances in preoperative interventional neuroradiology and refinements in skull base microsurgery [3]. To avoid intraoperative morbidity and mortality from vascular compromise, various modalities of management of the cervical and intratemporal ICA have been described. These modalities include cervical-to-petrous ICA saphenous vein bypass grafting [4], permanent balloon occlusion (PBO) [5, 6], and intravascular reinforcement with stenting [7–12].
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Objective: Neurofibromatosis Type 2 (NF2) patients have multiple central nervous system tumors and, specifically, bilateral vestibular schwannomas (VSs) causing bilateral deafness. If the cochlear nerve is not preserved during tumor... more
Objective: Neurofibromatosis Type 2 (NF2) patients have multiple central nervous system tumors and, specifically, bilateral vestibular schwannomas (VSs) causing bilateral deafness. If the cochlear nerve is not preserved during tumor removal, the only hearing rehabilitation in these patients could be via an auditory brainstem implant (ABI). Study Design: Retrospective case study and literature review. Setting: Tertiary referral cranial base center. Patients: In 24 NF2 patients, 25 ABIs were placed in the lateral recess of the fourth ventricle after VS surgery via a translabyrinthine approach. Results: In this series, a large range of results are observed: from open speech and use of the telephone to no ABI use, because of the poor sound identification ability. Of the 24 patients, 19 use their ABI on a daily basis, 4 are nonusers, and 1 died of NF2 progression. A multivariate analysis did not reveal a good predictor for ABI outcome. In literature, the results of ABI in NF2 are difficult to compare, and the overall outcome was poor compared with cochlear implantation results. Conclusion: Auditory brainstem implantation in NF2 patients directly after tumor removal is a safe procedure and the best means of hearing rehabilitation if the cochlear nerve is not preserved. The results in NF2 cases in the literature and these series are poor compared with cochlear implantation. If a cochlear implant is possible, it has the preference over an ABI, also in NF2. Nevertheless, the majority of the patients have benefit of the ABI during daily life particularly in combination with lip reading. Key Words: BrainstemVHearing rehabilitationV ImplantationVNeurofibromatosisVReviewVVestibular schwannoma.
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Laryngeal hemangiomas are relatively rare. Laryngeal hemangiomas occur in two main forms--infantile and adult laryngeal hemangiomas. While infantile hemangiomas are usually found to occur in the subglottis, adult hemangiomas occur... more
Laryngeal hemangiomas are relatively rare. Laryngeal hemangiomas occur in two main forms--infantile and adult laryngeal hemangiomas. While infantile hemangiomas are usually found to occur in the subglottis, adult hemangiomas occur commonly in the supraglottic regions of the larynx. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present a case of hemangioma of the right vocal cord in an adult, which was managed successfully in our center.
Research Interests: Microsurgery, Medicine, Humans, Female, Pubmed, and 7 moreAdult, Subglottis, Larynx, Vocal cords, hemangioma, Cord, and Laryngeal neoplasms
The temporal bone houses the organ of hearing and balance. Trauma to the ear and the temporal bone can therefore lead to distressing symptoms, such as hearing loss, dizziness and tinnitus, in addition to facial paralysis. This chapter... more
The temporal bone houses the organ of hearing and balance. Trauma to the ear and the temporal bone can therefore lead to distressing symptoms, such as hearing loss, dizziness and tinnitus, in addition to facial paralysis. This chapter focuses on the clinical features of hearing loss and tinnitus and their management, with an emphasis on the role of cochlear implantation. Facial weakness is discussed elsewhere. Trauma to the temporal region sufficient to cause such symptoms can be both soft tissue and bony in nature. Common causes include an impact such as a slap to the side of the head, an object hitting the area or a fall on to the side of the face. Accidental insertion of objects into the ear, e.g. swabs, are also common causes. Trauma can also be iatrogenic, such as injury during an attempt to remove wax, irrigating or suctioning the ear canal, or during foreign body removal.
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External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized. 1) To elucidate etiology of EACC and cardinal features. 2) To suggest... more
External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized. 1) To elucidate etiology of EACC and cardinal features. 2) To suggest a practical staging of EACC. 3) To enumerate surgical management according to stage of EACC. Retrospective study in a quaternary referral center of 31 consecutive cases of EACC. Thirty-one patients with EACC were reviewed. Unilateral otorrhea 19 (61.2%), hearing loss 22 (70.9%), and otalgia 8 (25.8%) are cardinal symptoms. Sixteen primary and 15 secondary EACCs were treated. Bone erosion was observed in 20 cases. In the present series, stage III = 12 (38.7%), stage II = 8 (25.8%), stage I = 11 (35.4%) underwent definitive treatment by surgery. Canalplasty with reconstruction was done in 19 cases of stages I and II. Of 12 cases in stage III, 3 cases underwent canalplasty with reconstruction. Subtotal petrosectomy was done in five cases. Intact canal wall mastoidectomy with canalplasty in two cases and radical mastoidectomy in two cases. Fascia, cartilage, muscle, and bone dust were used for reconstruction. Median follow-up period was 6 years and no recurrence of cholesteatoma was observed. EACC is unique entity. Intraoperative and radiological findings assist in correct and practical staging of EACC. Late stage presentations of EACC are common. Definitive surgical treatment in our series avoided recurrence of cholesteatoma.
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Head and Neck paragangliomas (HNPs) are tumors of the skull base which pose a challenge to surgeons due to the fact that these tumors are vascular, locally aggressive and involve important neurovascular structures like the jugular bulb,... more
Head and Neck paragangliomas (HNPs) are tumors of the skull base which pose a challenge to surgeons due to the fact that these tumors are vascular, locally aggressive and involve important neurovascular structures like the jugular bulb, internal carotid artery, the facial and the lower cranial nerves. We have identified a set of HNPs that can be considered as complex cases based on certain clinical parameters. The identification of such highrisk complex cases is necessary for logical decision making, proper pre-operative planning and intraoperative management. Of a total of 284 HNPs, 66 were considered as complex cases. We did a retrospective review of these cases and analyzed the outcomes of these cases.
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<i>Objective:</i> To report the hearing results of cochlear implantation simultaneous to vestibular schwannoma (VS) resection by means of a translabyrinthine approach in patients with normal contralateral hearing.... more
<i>Objective:</i> To report the hearing results of cochlear implantation simultaneous to vestibular schwannoma (VS) resection by means of a translabyrinthine approach in patients with normal contralateral hearing. <i>Methods:</i> This was a prospective study including adults with sporadic VS. Tumors were resected by means of a modified translabyrinthine approach with preservation of the cochlear nerve. <i>Results:</i> A total of 13 patients underwent cochlear implantation. At 14 months, the mean pure-tone audiogram was 56 dB. The mean speech recognition was 80%. Cochlear implantation provides monaural and binaural benefits in all the conditions tested, including sound localization. <i>Conclusions:</i> Cochlear implantation can be safely performed simultaneously to VS resection with satisfactory hearing results provided that the cochlear nerve is anatomically intact.
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The given and family names of two co-authors were incorrect in the published article. The correct spelling should read as: Sampath Chandra Prasad and Vinagolu K Rajasekhar.
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Head and neck paragangliomas (HNPGLs) are rare tumors that may cause important morbidity, because of their tendency to infiltrate the skull base. At present, surgery is the only therapeutic option, but radical removal may be difficult or... more
Head and neck paragangliomas (HNPGLs) are rare tumors that may cause important morbidity, because of their tendency to infiltrate the skull base. At present, surgery is the only therapeutic option, but radical removal may be difficult or impossible. Thus, effective targets and molecules for HNPGL treatment need to be identified. However, the lack of cellular models for this rare tumor hampers this task. PPARα receptor activation was reported in several tumors and this receptor appears to be a promising therapeutic target in different malignancies. Considering that the role of PPARα in HNPGLs was never studied before, we analyzed the potential of modulating PPARα in a unique model of HNPGL cells. We observed an intense immunoreactivity for PPARα in HNPGL tumors, suggesting that this receptor has an important role in HNPGL. A pronounced nuclear expression of PPARα was also confirmed in HNPGL-derived cells. The specific PPARα agonist WY14643 had no effect on HNPGL cell viability, where...
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In this paper, we report the postoperative outcomes in canal wall up procedures with second stage surgery in 40 children undergoing intervention for cholesteatoma of the middle ear. The residuals, recurrences and the hearing results were... more
In this paper, we report the postoperative outcomes in canal wall up procedures with second stage surgery in 40 children undergoing intervention for cholesteatoma of the middle ear. The residuals, recurrences and the hearing results were analysed. All 40 patients had a follow-up of at least five years. Of the 39 patients who underwent two staged surgery, 18 (46.1%) had a residual lesion that was identified and excised during the second surgery. Over a five year follow-up period, there were five (12.5%) patients with recurrences, all belonging to the group in whom a residual cholesteatoma was identified during the second staged surgery. The rate of residual cholesteatoma tends to decrease as age increases. The type of cholesteatoma, acquired or congenital middle ear, were not statistically related to the incidence of residual cholesteatoma. Hearing analysis showed that hearing recovery was excellent with canal wall up procedures and remained stable over five years.
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With improvement in economic and social conditions and the use of effective anti-tuberculous therapy, the developed nations and most developing nations have enjoyed a decline in tuberculosis (TB) for several decades. However, over ten... more
With improvement in economic and social conditions and the use of effective anti-tuberculous therapy, the developed nations and most developing nations have enjoyed a decline in tuberculosis (TB) for several decades. However, over ten million cases of TB are reported annually and TB continues to kill nearly two million people each year. Extrapulmonary TB comprises 15–30% of new TB cases, and tuberculous lymphadenitis is an important manifestation. Tuberculous cervical lymphadenitis, or scrofula, accounts for at least 70% of TB cases involving the head and neck. The majority of cases occur without systemic symptoms or concurrent pulmonary TB. In addition to cervical lymphadenitis, tuberculosis can produce isolated disease in the oral cavity, ear, salivary glands, mandible, nose, and larynx. These infections can have various manifestations and it is important for the clinician to recognize and diagnose head and neck TB promptly. This chapter reviews the epidemiology, clinical manifestations, diagnosis, and treatment of various tuberculous infections in the head and neck.
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BackgroundTo review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra‐arterial stenting in their surgical management.MethodsRetrospective case series of 20 patients with 28 CBPs that were surgically... more
BackgroundTo review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra‐arterial stenting in their surgical management.MethodsRetrospective case series of 20 patients with 28 CBPs that were surgically resected at our center. Intra‐arterial stenting was performed in Shamblin II and II classes.ResultsThe mean follow‐up was 47.8 months. Five (17.9%) tumors were Shamblin class I, 15 (53.6%) were class II, and 8 (28.6%) were class III. Thirteen (68.4%) CBPs were associated with other paragangliomas. The internal carotid artery (ICA) was stented preoperatively in eight (28.6%) cases and occluded in four (14.3%) cases. The tumor extended to the jugular foramen in six cases (21.4%). Intraoperatively, there was an ICA injury in one case of Shamblin II CBP in the present era.ConclusionsThe proposed classification enables the clinician to plan the management of the ICA and the right approach. Stenting of the ICA gives a chance for complete tumor removal with...
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Objective: To study the early and late facial nerve (FN) outcomes in different tumor classes in addition to determining the predictive factors for the same. Study Design: A retrospective clinical study. Setting: A quaternary referral... more
Objective: To study the early and late facial nerve (FN) outcomes in different tumor classes in addition to determining the predictive factors for the same. Study Design: A retrospective clinical study. Setting: A quaternary referral otology and skull base center. Patients and Methods: A retrospective study of 1983 cases of vestibular schwannomas (VSs) with preoperative normal FN function, undergoing total excision with anatomical preservation of the nerve by enlarged translabyrinthine approach (ETLA) were included. FN status was recorded postoperatively at day 1, at discharge, and at 1-year follow-up and were analyzed in different tumor sizes. Results: At 1 year, 988 patients with House–Brackmann (H–B) grade I and II FN at day 1 after surgery, 958 (96.9%) maintained their status up-to 1 year. Of the 216 patients with H–B grade III at day 1 after surgery, 113 (52.3%) improved to H–B grade I and II. Similarly, of the 779 patients with H–B grade IV and VI FN function at day 1 after su...
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OBJECTIVE To study the clinical presentation, intraoperative findings and surgical management in meningo-encephalic-herniation (MEH) based on the etiology. STUDY DESIGN A retrospective clinical study and is a follow-up on the previously... more
OBJECTIVE To study the clinical presentation, intraoperative findings and surgical management in meningo-encephalic-herniation (MEH) based on the etiology. STUDY DESIGN A retrospective clinical study and is a follow-up on the previously published report in 2009. SETTING A quaternary referral otology and skull base center PATIENTS AND METHODS:: The inclusion criteria were intraoperatively verified MEH in patients with a minimum follow-up of 12 months, which yielded 262 operated ears. The data were extracted regarding demographics, laterality, clinical presentation, past surgeries, contralateral-ear condition, intraoperative findings, complications, recurrences, revision-surgeries, audiometric-data, and follow-up. RESULTS The mean age at surgery was 49.7 years with the involvement of right-ear in 53.8% of patients. Lesions were categorized based on the etiology as chronic-otitis-media with/without cholesteatoma-MEH (COM/CHOL-MEH)-47.7%, iatrogenic-MEHs -20.9%; traumatic-MEHs -8% and spontaneous-MEHs -23.3%. At presentation, hearing loss (100 and 98.2%) and otorrhea (65.6 and 49.1%) were predominant in COM/CHOL-MEHs and iatrogenic-MEHs, respectively. On the other hand, meningitis (23.9 and 14.3%) and cerebrospinal fluid-leak (52.4 and 42.8%) were more pronounced in spontaneous and traumatic MEHs, respectively. Surgical approaches included 1) transmastoid, 2) middle-cranial-fossa-approach, 3) combined, and 4) middle-ear-obliteration (MEO) techniques. A total of 52.8% of COM/CHOL-MEHs and 49.1% of iatrogenic-MEHs underwent MEO. Middle-cranial-fossa approach was predominantly used in spontaneous-MEHs (52.5%) and traumatic-MEHs (38.1%). The defect was mostly single (75.2%). Smaller, multiple, bilateral lesions were more common in spontaneous-MEHs with tegmen-tympani involvement (57.4%). CONCLUSION Incorporating etiology into MEHs is a key-step that can be used as a guidance in choosing the right surgery. MEO is a part of armamentarium, and should be used whenever needed, if the objective is performing a definitive surgery.
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The wait-and-scan modality has emerged as an important strategy in the management of vestibular schwannoma (VS) as it has been demonstrated that many tumors grow slowly or do not show any growth over long periods. To analyze long-term... more
The wait-and-scan modality has emerged as an important strategy in the management of vestibular schwannoma (VS) as it has been demonstrated that many tumors grow slowly or do not show any growth over long periods. To analyze long-term outcomes of wait-and-scan in the treatment of patients with VS, discuss the factors contributing to the decision making, determine the inherent risks of the policy, and compare our results with literature. In total, 576 patients with sporadic unilateral VS who were managed with wait-and-scan were reviewed retrospectively. Of these, a subset of 154 patients with 5-yr follow-up was separately analyzed. The tumor characteristics including patterns of growth, rate of growth, hearing outcomes, and likely factors affecting the above parameters were analyzed. The mean period of follow-up was 36.9 ± 30.2 mo. The mean age was 59.2 ± 11.6 yr. Thirteen different patterns of tumor growth were observed. Eighty-four (54.5%) of 154 tumors with 5-yr follow-up showed n...
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Tympanojugular paragangliomas (TJPs) have always presented a challenge to surgeons due to the fact that these tumors are vascular and locally aggressive and involve important neurovascular structures like the jugular bulb (JB), the... more
Tympanojugular paragangliomas (TJPs) have always presented a challenge to surgeons due to the fact that these tumors are vascular and locally aggressive and involve important neurovascular structures like the jugular bulb (JB), the internal carotid artery (ICA), and the facial and the lower cranial nerves (LCNs, CN IX, X, XI, XII). Owing to their indolent nature, they often present late with cranio-temporo-cervical extensions rendering them inoperable in the past. However, significant developments in the last couple of decades have changed this scenario. A thorough anatomical and surgical mapping of the skull base and descriptions of various rational approaches, in addition to technological improvements in neuromonitoring, neuroanesthesia, and neuroradiology, have made surgical removal of skull base tumors technically feasible and safer. Fisch originally classified TJPs into classes A, B, C, and D according to location and extension based on high-resolution computed tomography (HRCT) examination. This was subsequently modified by Sanna [1] to include subclassifications and an additional class V to include tumors that involve the vertebral artery (VA) (Table 8.1).
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To report the hearing results of cochlear implantation simultaneous to vestibular schwannoma (VS) resection by means of a translabyrinthine approach in patients with normal contralateral hearing. This was a prospective study including... more
To report the hearing results of cochlear implantation simultaneous to vestibular schwannoma (VS) resection by means of a translabyrinthine approach in patients with normal contralateral hearing. This was a prospective study including adults with sporadic VS. Tumors were resected by means of a modified translabyrinthine approach with preservation of the cochlear nerve. A total of 13 patients underwent cochlear implantation. At 14 months, the mean pure-tone audiogram was 56 dB. The mean speech recognition was 80%. Cochlear implantation provides monaural and binaural benefits in all the conditions tested, including sound localization. Cochlear implantation can be safely performed simultaneously to VS resection with satisfactory hearing results provided that the cochlear nerve is anatomically intact.