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The use of microscopically controlled laser surgery to treat tumors of the upper aerodigestive tract has as a function maintaining form of treatment gained significance. It is an alternative to conventional surgery, which often makes organ removal necessary. We report on our experience with 85 patients who underwent a laser surgical resection of malignomas of the upper aerodigestive tract. The aim of transoral laser surgery is a histologically confirmed radical tumor resection. Tumor resection can be individually adapted according to the tumor extent. An unnecessary resection of cartilage and muscles can be avoided. Provided the appropriate indication is given, laser surgery yields good oncologic and excellent functional results.

Megadolichobasilar anomaly, a dilatant arteriopathy of the basilar artery attributable to chronic arterial hypertension, can cause cranial nerve compression syndromes of the cerebellopontine angle or infarcts of the vertebrobasilar circulation. In this paper, we report on a patient with known megadolichobasilar anomaly and a partially thrombosed fusiform aneurysm of the basilar artery, who presented with acute-onset vertigo and subsequent deafness due to thromboembolic occlusion of the labyrinthine artery. Because of the vascular origin of the patient's symptoms, his vertigo disappeared over time while the deafness persisted.

The aim of the present paper is to evaluate the clinical parameters in patients implanted for combined, ipsilateral electric-acoustic stimulation of the auditory system.A total of 18 patients with residual deep frequency hearing were implanted with a Combi 40+cochlear implant (MED-EL, Austria). Insertion depths ranged from 18 to 22 mm (360 degrees ). A modified surgical technique should contribute to hearing preservation in low frequency regions of the cochlea. Pure-tone audiometric thresholds were measured pre- and postoperatively. A speech audiometric evaluation was performed on two subjects.Utilizing adapted surgical procedures, the preservation of low frequency hearing was accomplished in 16 of 18 subjects (88.9%). Seven (38.9%) patients had complete and nine (50.0%) partial preservation of residual hearing. The speech discrimination scores of two patients documented an increase in sentence intelligibility when compared with only the cochlear implant.Hearing preservation in cochlear implant surgery is possible. Insertions of 360 degrees provide a full functioning cochlear implant to stimulate sufficient neural structures for above average discrimination scores with the implant alone. A synergistic effect of the electric and the acoustic stimulation modes leads to high discrimination scores in background noise.

Treatment of anterior skull base tumours is still considered being a major challenge for all involved disciplines. Surgical management, complications, as well as the role of imaging for multimodality treatment options should be evaluated critically.57 patients underwent interdisciplinary one step trans-basal approaches for resection of benign and malignant anterior fossa tumours. Beside assessment of surgical results and perioperative morbidity, in 13 patients with malignant tumours perioperative imaging was evaluated with regard to further possible radio-oncological treatment options.Applying trans-basal approaches radical tumour resection could be achieved in all cases independent of tumor-size (diameter 12-114 mm). Permanent postoperative complications (until 6 months postoperatively) were found in 4 cases (7%), transient complications in 7 cases (12.3%). Evaluation of perioperative imaging showed a heterogen use of different imaging modalities and revealed lack of standardization, hampering further planning of radiation therapy.Treatment of anterior skull base tumours requires a maximum level of standardization of perioperative imaging, to grant a successful surgical and radio-oncological interdisciplinary patient management.

We present our clinical experiences regarding interdisciplinary surgical treatment of anterior skull base tumours and evaluate postoperative results.Fifty-seven patients (25 male, 32 female) with benign and malignant neoplasms involving the anterior skull base were retrospectively reviewed. In all cases tumour resection was carried out by an interdisciplinary rhino-neuro-surgical skull base operating team. Forty-three of 57 patients (75.4%) underwent common transbasal tumour resection and 11 (19.3%) were operated on from an extended transbasal approach. An extensive transbasal approach for tumour resection was used in 3 patients (5.3%). Postoperative mortality and morbidity were evaluated over a period of 6 months.In all 57 patients a good access to the frontal fossa and the sinuses was achieved. By means of the transbasal approaches, one-step tumour removal was possible in all cases. Tumor diameter ranged fom 12 mm to 114 mm. Even tumours extending as far as the hard palate required no additional transfacial procedures. Surgical mortality was 3.5%. Permanent postoperative complications were noted in 4 cases (7.02%) and transient postoperative complications in 7 (12.28%).In dealing with anterior skull base tumours, interdisciplinary surgical procedures using transbasal approaches provide a satisfactory outcome at a low rate of postoperative complications. When transbasal approaches are applied, no additional transfacial skull base exposure using midfacial incisions is required.

To assess the value of a three-dimensional (3D) T2-weighted turbo spin-echo sequence (3D T2-TSE) in comparison to conventional two-dimensional (2D) T2-weighted TSE and unenhanced and enhanced T1-weighted spin-echo sequences (SE) in imaging anatomic structures and pathologic changes of the inner ear and cerebellopontine angle.The inner ear and cerebellopontine angle were investigated by MRI in three healthy volunteers and 18 patients performing a 2D T2-weighted turbo spin-echo sequence and a 3D T2-TSE in the axial plane. In the patient study, 2D T1-weighted SE sequences both before and after the i.v. injection of gadopentetate dimeglumine in both the axial and coronal plane were performed in addition.Only the 3D T2-TSE enabled an accurate imaging of the anatomic structures. In cases of pathology, the 3D T2-TSE provided additional information to the performed 2D sequences. The combination of the 3D T2-TSE with unenhanced and enhanced 2D T1-weighted SE enabled the most accurate diagnosis in cases of pathology.Accurate depiction of anatomic structures of the inner ear and cerebellopontine angle could be obtained by 3D T2-TSE only. The most accurate diagnosis in cases of pathology was provided by the combination of the 3D T2-TSE with unenhanced and enhanced 2D T1-weighted spin-echo sequences.

To investigate the interrelation between number of channels and stimulation rate in the continuous interleaved sampling strategy (CIS).Three of the first recipients of the new COMBI 40+ cochlear implant participated in consonant, vowel, number, and sentence tests. Speech understanding was evaluated for different combinations of number of active channels from two to twelve and stimulation rate per channel between 1,515 and 9,090 pulses per second.The results indicate that the optimum number of active channels is not necessarily the maximum number of usable channels.