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Introduction Free anterolateral thigh (ALT) flap constitutes an alternative to latissimus dorsi and radial forearm flaps for head and neck reconstruction. The authors report a case of mastoid reconstruction in a patient with multi-operated cholesteatoma associated with tubal dysfunction. Case report This patient presented a fistula of the lateral semicircular canal and invagination of retroauricular soft tissues responsible for non-compensated almost complete areflexia with anacusis. She did not present any signs of cholesteatoma recurrence, but chronic inflammation of the mastoidectomy cavity. The head and neck procedure consisted of translabyrinthine labyrinthectomy: resection of the atrophic retroauricular skin, resection of the vestibular neurosensory tissue and obliteration of the mastoidectomy cavity. An ALT flap measuring 5 × 5 cm, anastomosed to the superior thyroid artery and facial vein, was used to cover the defect. Careful defatting of the flap allowed filling of the defect, while providing a sufficient quantity of appropriate tissue. The postoperative course was uneventful and the patient was considerably improved. The only donor site sequelae consisted of a thin linear scar. Conclusion The free anterolateral thigh flap, a reliable, polyvalent flap that can be shaped as needed and which is associated with minimal donor site morbidity, constitutes a good alternative for head and neck reconstruction.

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Objective: To summarise treatment outcomes compared to surgical and patient variables for a multicentre recipient cohort using a fully implantable active middle ear implant for hearing impairment. To describe the authors' preferred surgical technique to determine microphone placement. Study Design: Multicentre retrospective, observational survey. Setting: Five tertiary referral centres. Patients: Carina recipients (66 ears, 62 subjects) using the current Cochlear® Carina® System or the legacy device, the Otologics® Fully Implantable Middle Ear, with a T2 transducer. Methods: Patient file review and routine clinical review. Patient outcomes assessed were satisfaction, daily use and feedback reports at the first fitting and ≥12 months after implantation. Descriptive and statistical analysis of correlations of variables and their influence on outcomes was performed. Independently reported preferred methods for microphone placement are collectively summarised. Results: The average implant experience was 3.5 years. Satisfaction increased significantly over time (p < 0.05). No correlation with covariates examined was observed. Feedback significantly decreased over time, showing a significant correlation with microphone location, primary motivation, gender, age at implantation, and contralateral hearing aid use (p < 0.05). Patient satisfaction was inversely correlated with reports of system feedback (p < 0.05). The implantable microphone was most commonly on the posterior inferior mastoid line, in 42/66 (65%) cases, correlating with less likelihood for feedback and consistent with author surgical preference. Conclusion: Carina recipients in this study present as satisfied consistent daily users with very few reports of persistent feedback. As microphone location is an influencing factor, a careful surgical consideration of microphone placement is required. The authors prefer a posterior inferior mastoid line position whenever possible.

Objective The temporal bone shields sensorineural, nervous, and vascular structures explaining the potential severity and complications of trauma related to road and sport accidents. So far, no clear data are available on the exact mechanisms involved for fracture processes. Modelization of structures helps to answer these concerns. Our objective was to design a finite element model of the petrous bone structure to modelize temporal bone fracture propagation in a scenario of lateral impact. Materials and methods A finite element model of the petrous bone structure was designed based on computed tomography data. A 7-m/s lateral impact was simulated to reproduce a typical lateral trauma. Results of model analysis was based on force recorded, stress level on bone structure up to induce a solution of continuity of the bony structure. Results Model simulation showed that bone fractures follow the main axes of the petrous bone and occurred in a 2-step process: first, a crush, and second, a massive fissuration of the petrous bone. The lines of fracture obtained by simulation of a lateral impact converge toward the middle ear region. This longitudinal fracture is located at the mastoid-petrous pyramid junction. Discussion Using this model, it was possible to map petrous bone fractures including fracture chronology and areas of fusion of the middle ear region. This technique may represent a first step to investigate the pathophysiology of the petrous bone fractures, aiming to define prognostic criteria for patients' care.

International audience; The vestibular system contributes to a wide range of functions, from postural and oculomotor reflexes to spatial representation and cognition. Vestibular signals are important to maintain an internal, updated representation of the body position and movement in space. However, it is not clear to what extent they are also necessary to mentally simulate movement in situations that do not involve displacements of the body, as in mental imagery. The present study assessed how vestibular loss can affect object-based mental transformations (OMTs), i.e., imagined rotations or translations of objects relative to the environment. Participants performed one task of mental rotation of 3D-objects and two mental scanning tasks dealing with the ability to build and manipulate mental images that have metric properties. Meniere's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (1 week and 1 month). They were compared to healthy participants tested at similar time intervals and to bilateral vestibular-defective patients tested after the recovery period. Vestibular loss impaired all mental imagery tasks. Performance varied according to the extent of vestibular loss (bilateral patients were frequently the most impaired) and according to the time elapsed after unilateral vestibular neurotomy (deficits were stronger at the early stage after neurotomy and then gradually compensated). These findings indicate that vestibular signals are necessary to perform OMTs and provide the first demonstration of the critical role of vestibular signals in processing metric properties of mental representations. They suggest that vestibular loss disorganizes brain structures commonly involved in mental imagery, and more generally in mental representation. (C) 2011 Elsevier Ltd. All rights reserved.

Resume Objectif Etudier les procedes d’ossiculoplastie utilisant les protheses en titane de type Kurz et evaluer les facteurs pronostiques des resultats fonctionnels. Methodes Une etude retrospective a ete realisee pour les patients ayant eu une ossiculoplastie par des protheses en titane de type Kurz durant la periode allant de 2006 a 2009 au sein du service ORL et chirurgie cervicofaciale de l’hopital Nord de Marseille. Resultats La population etudiee est de 70 patients, correspondant a 37 reconstructions ossiculaires par prothese partielle (PORP) et 33 par prothese totale (TORP). Le suivi moyen etait de neuf mois. Une comparaison des resultats audiometriques pre- et postoperatoires a ete realisee en se basant sur les frequences (0,5, 1, 2, et 3 kHz) selon les recommandations de l’Academie americaine d’otolaryngologie et chirurgie cervicofaciale. Un rinne audiometrique postoperatoire (ABG) ≤ 20 dB a ete obtenu chez 71,43 % des patients (86,49 % en cas de PORP et 54,55 % en cas de TORP). L’amelioration moyenne du rinne audiometrique (ABG) etait de 12,45 dB dans les otites cholesteatomateuses versus 13,41 dB dans les otites non cholesteatomateuses. Conclusion L’augmentation de la longueur des protheses d’ossiculoplastie en titane, surtout pour les protheses totales (TORP), peut ameliorer les resultats fonctionnels postoperatoires.

Summary Objective To assess the efficiency of ossiculoplasty procedures with the Kurz titanium ossicular prosthesis and evaluate prognostic factors for the functional results. Methods Retrospective chart reviews were performed for ossiculoplasty involving Kurz titanium prostheses between 2006 and 2009 in the ENT Head and Neck Department of the hopital Nord, Marseille, France. Results The population studied was 70 patients, with 37 procedures using the partial (PORP) and 33 the total ossicular replacement prosthesis (TORP). Mean follow-up was 9 months. Pre- and postoperative audiological parameters on four frequency averages (0.5, 1, 2, and 3 kHz) were compared according to AAO-HNS guidelines. A postoperative air-bone gap (ABG) ≤ 20 dB was obtained in 71.43% of the patients (86.49% for PORP, and 54.55% for TORP). The mean change in ABG was 12.45 dB in cholesteatomatous otitis versus 13.41 dB in non-cholesteatomatous otitis. Conclusion Increasing the length of the ossicular prosthesis, especially TORP, may improve postoperative functional results.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 131 - N° 2 - p. 147-149

Summary Aims and methods The aim of this prospective study was to compare the diagnostic value of [18F]FDOPA-PET and [111In]pentetreotide-SPECT somatostatin receptor scintigraphy (SRS) in patients with nonmetastatic extra-adrenal paragangliomas (PGLs). Twenty-five consecutive unrelated patients who were known or suspected of having nonmetastatic extra-adrenal PGLs were prospectively evaluated with SRS and [18F]FDOPA-PET. 131I-MIBG and [18F]FDG-PET were added to the work-up in patients with a personal or familial history of PGL, predisposing mutations, abdominal PGLs, metanephrine hypersecretion and abdominal foci on SRS and/or [18F]FDOPA-PET. Results SRS correctly detected 23/45 lesions of which 20 were head or neck lesions (H&N) and 3 were abdominal lesions. [18F]FDOPA-PET detected significantly more lesions than SRS (39/45, P

Objective Open mastoid cavity rehabilitation should focus on both anatomical and functional aspects. We hereby report the technique and results of a combined strategy to reconstruct the external ear canal using a titanium wall implant and the middle ear using a fully implantable active middle ear device. Methods A fully implantable active middle ear implant was used to rehabilitate the mixed hearing loss of a 63-year-old woman, and a titanium posterior canal wall prosthesis was used to reconstruct the external ear canal during the same procedure. The middle ear implant was placed directly on the footplate. The auditory results were compared to the preoperative unaided thresholds and to the amplification of a conventional hearing aid. Results Following the procedure, there was an anatomically normal external ear canal with a healed tympanic membrane separating the external from the middle ear spaces. The postoperative auditory gains were on average 31.8 dB on pure-tone audiometry, and 20 dB on speech reception threshold. No complications occurred. Conclusion The rehabilitation of the external ear canal in an open mastoid cavity allows for clinical follow-up of the patient, and the implantation of an active middle ear implant provides appropriate auditory gains both in pure tones and in speech reception thresholds.

After initial contact of the active middle ear implant (AMEI) on the incus, significant increases in device performance can be achieved intraoperatively without affecting residual hearing by additional static loading of the incus with 62 μm (quarter turn) to 125 μm (half turn) increments via an adjustment screw.To assess the performance gains of driving the incus with an AMEI under increasing static loads in cadaveric temporal bones.Incus drive efficacy was assessed using laser Doppler velocimetry measurements of stapes velocities over a frequency range of 0.25 to 8 kHz. Results were compared to stapes velocities following acoustic stimulation via insert earphone. Maximum equivalent ear canal sound pressure level (L(Emax)) and residual hearing loss after initial loading of the AMEI (first contact) were compared in each temporal bone. Additional increases in incus load were induced by turning an adjustment screw in quarter turn steps, corresponding to 62 μm increments per step. L(Emax)and residual hearing loss were reassessed after each step. For each temporal bone, experiments were repeated for three different AMEIs.On average across bones, incus stimulation upon initial contact produced an L(Emax)of 125, 127, and 121 dB SPL and residual hearing losses of -2, -1, and -1 dB with respect to unloaded, unaided conditions for the three AMEIs, respectively. Across bones and transducers, increasing static transducer load by incrementing the AMEI up to 125 μm significantly improved performance without affecting residual hearing loss. Loading beyond 125 μm (half turn) did not improve performance but significantly increased residual hearing loss.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 127 - N° 4 - p. 198-201

Objective: To describe the rehabilitation of canal wall down mastoidectomy cavities using a custom-made titanium wall implant and to analyze the benefits and the long-term functional results. Study Design: Retrospective analysis. Setting: Tertiary care center. Patients and Methods: We have reviewed the data of 113 consecutive operated ears from 106 patients during a 9-year period (1993Y2002). The following preoperative and postoperative criteria were compared: the persistence or resolution of otorrhea, cholesteatoma, and vertigo; external auditory canal healing, position of the titanium prosthesis, and tympanic membrane findings. In addition, the hearing status was evaluated by comparing the preoperative data with the 6-month and last follow-up postoperative data to deduce the air-bone gap (ABG) and the auditory gains. Results: Operated ears (88.5%) were dry after the initial rehabilitation, and 97.3% were dry after a revision surgery for defective canal healing. Most patients (96.5%) were free of vertigo. The external auditory canal wall was in a good position in all cases and allowed for a primary skin healing process in 84% of cases; the remaining patients underwent revision surgery under local anesthesia to complete the healing. The reconstructed drum was stable and anatomic in 73% of the cases (n = 83) after the first surgery. Thirty-six patients (32%) underwent various revision procedures: aeration tube placement for 16 patients with mesotympanic retraction and/or serous effusion, revision surgery for 12 patients with attic retraction or evidence of cholesteatoma, and revision for 5 patients with perforation. At last follow-up, 100% of the ear canals were healed, and 85% of patients had a normal tympanic membrane. No residual cholesteatoma was found at last follow-up. Thirtysix percent of patients had an ABG within 20 dB at last followup, and 69% within 30 dB. Conclusion: The rehabilitation of canal wall down mastoidectomies improves the quality of life of patients regarding cholesteatoma recurrence, otorrhea, and vertigo in more than 95% of cases and stabilizes the hearing loss to less than 30 dB of ABG for more than two thirds of patients. The main unresolved problem is the persistent dysfunction of the middle ear cavity, with unsatisfactory auditory improvements. Middle ear implants represent in selected cases a new solution to rehabilitate the refractory hearing losses. Key Words: Canal wall downVMiddle ear implantVOssiculoplastyVPosterior ear canal wallVTitanium. Otol Neurotol 31:220Y224, 2010.

Las enfermedades del angulo pontocerebeloso y del conducto auditivo interno pueden estudiarse perfectamente mediante pruebas de imagen. Estas afecciones son sobre todo de tipo tumoral: aunque el schwannoma vestibular (el mas comun con gran diferencia) y despues el meningioma y el «quiste» epidermoide son los tres tumores mas frecuentes, el abanico de las otras etiologias es muy extenso. Las pruebas de imagen actuales suelen permitir establecer su diagnostico. La resonancia magnetica es la prueba de eleccion para precisar la naturaleza y el origen de un sindrome expansivo del angulo pontocerebeloso y del conducto auditivo interno: las tecnicas de alta resolucion permiten un estudio inframilimetrico y reconstrucciones en los tres planos del espacio. Su papel es fundamental para el diagnostico positivo de los conflictos vasculonerviosos que afectan a los nervios facial, cocleovestibular, trigemino y mixto, asi como para la cartografia vascular postoperatoria. En las enfermedades infecciosas e inflamatorias, la resonancia magnetica puede poner de manifiesto enfermedades de los nervios craneales. La tomografia computarizada se utiliza para el estudio de las enfermedades del hueso temporal y del oido interno, con cortes oseos inframilimetricos en los tres planos del espacio, en especial las malformaciones como los sindromes del acueducto dilatado o el gusher del oido y las osteopetrosis o las displasias fibrosas. El papel de la angiografia cerebral es preterapeutico, antes de la realizacion de un tratamiento quirurgico o endovascular.

Objectives: First, to assess for the performance of the Carina placed on the round window at various European centers; second, to study the follow-up after 2 years and discuss limitations and technical issues; and finally, to further develop our understanding of the principles of acoustic transfer through the round window. Materials and Methods: Eleven patients were included in this retrospective study (7 women and 4 men) from 7 European tertiary referral hospitals (4 centers in France, 2 in Belgium, 1 in Spain). The mean age was 50.8 years (35-71 yr). All patients have multiple previous surgeries (93 surgical procedures) for otosclerosis (3 patients) or chronic otitis media (8 patients), and in all cases, the stapes was not accessible due to obliteration by sclerotic tissue. Preoperative and postoperative air conduction, bone conduction, as well as aided and unaided thresholds and speech scores were measured. Results: No significant differences were observed between pre-operative and postoperative air-conduction and bone-conduction pure-tone averages. The average free field functional gain obtained with the implant ranged from 22 to 42 dB at each individual frequency, with a mean of 29 T 5 dB across all audiometric frequencies. Word recognition scores demonstrated significant differences between unaided and implant-aided conditions. Complications included 2 cases of postoperative infection (including 1 anacusis) that required explantation, and 1 case reduced initial benefit, followed by a nonfunctioning device. In 10 patients, postoperative hearing was unchanged. The 8 other patients are using their implant daily. Conclusion: These results show that this option is valid for patients with a fixed footplate and unsuccessful previous surgeries or patients who cannot benefit from a stapedotomy for anatomic reasons. In some cases, access to the round window membrane could represent a limitation. However, these promising initial results establish the need for further works with regard to 3 issues: 1) clinical data studies are needed, including a greater number of patients to confirm these preliminary results; 2) a long-term follow-up must be performed to detect any possible cochlear adverse effects, in particular, on the basilar membrane; 3) the effect of fascia interposition and tip size has to be evaluated in experimental studies.

The level of success of neurovascular decompression in ponto-cerebellar angle for hemifacial spasm and trigeminal neuralgia has already established the reality of the pathology to explain such symptoms. However, cochlear nerve compression syndrome by vascular loop is still a controversial topic. We have performed a retrospective cases review with long-term follow-up (5-7 years) concerning the results of microvascular decompression surgery of the cochlear nerve via an endoscopy assisted retrosigmoid approach on 15 patients suffering from unilateral incapacitating tinnitus with abnormal auditory brainstem response and an offending vessel on magnetic resonance imaging. During the surgery, a vascular compression was found on every patient. In a long-term follow-up, 53.3% (8 cases) of our tinnitus cases improved and 20% (3 cases) of them were completely cured. The ABR returned to normal in all patients who had good clinical results (diminished or disappeared tinnitus). When a vertebral artery loop (5 cases) was concerned we obtained 80% of good clinical results. No one showed amelioration or sudden aggravation of their hearing. Three cases required surgical correction of cerebrospinal fluid leak and one case developed spontaneously regressive swallowing problems. Such microvascular decompression surgery of the cochlear nerve appears to be successful in treating incapaciting tinnitus in particular when a vertebral artery loop is observed. Therefore, in such a case, one might recommend neurovascular decompression surgery, keeping in mind that the complications of this surgery should be minimized by a careful closure of the retrosigmoid approach. In order to ensure a better selection of patient more accurate cochlear nerve monitoring and functional MRI should be a promising assessment.

Objective To assess outcome following excision of meningiomas of the posterior aspect of the petrous bone through transpetrosal approaches. Material and method We carried out a retrospective case-series study in a multidisciplinary tertiary care center on all patients who underwent meningiomas removal from January 1989 to September 2005. Surgical approaches were transpetrosal: widened retrolabyrinthine, translabyrinthine, transotic and transcochlear, occasionally combined with a subtemporal transtentorial approach. Epidemiology, symptoms, preoperative evaluation, surgery, postoperative complications and facial and auditory results were analyzed using standardized grading systems. The Desgeorges and Sterkers classification was used to assess tumor size and location. Results Forty women and three men underwent surgery (mean age: 56.7). Medium-sized tumors stages 2 and 3 (84%) and AM and P localization (34% and 20.4%) predominated. In 65% of cases, the tumor extended beyond the CPA. Main presenting symptoms were balance disorders (72%) and sensorineural hearing loss (53.5%). Mortality was nil. A preoperative facial nerve paresis was present in 14% of patients. Tumor removal was complete in 79.1% of cases. At 1-year post-op, 73% of patients had a normal or subnormal facial function and 55% had serviceable hearing. A cerebrospinal fluid leakage occurred in 6.9%. Discussion Posteriorly attached meningiomas are less symptomatic and of better prognosis than medially inserted ones. Transpetrosal approaches are reliable for the removal for all types and sizes of such tumors, and can be easily combined in the same procedure with a subtemporal transtentorial approach to remove extensions to the clivus and tentorium. They offer low morbidity and a high proportion of facial nerve and hearing preservation.

International audience; Middle ear implantation is an efficient procedure to restore moderate to severe sensorineural hearing loss (HL) in selected patients. Implantation of such devices requires ossicular chain integrity. Patients suffering from otosclerosis with mixed HL should be eligible for this treatment after stapes surgery with air-bone gap closure. To address this issue, we report four cases of middle ear implantation after or during stapes surgery. Results and complications obtained with Vibrant SoundBridge, MedEl and Middle Ear Transducer, Otologics are reported. Audiologic results were similar to those obtained in cases of sensorineural HL. One case of postoperative labyrinthitis was observed.

International audience; Social interactions depend on mechanisms such as the ability to take another person's viewpoint, i.e. visuo-spatial perspective taking. However, little is known about the sensorimotor mechanisms underpinning perspective taking. Because vestibular signals play roles in mental rotation and spatial cognition tasks and because damage to the vestibular cortex can disturb egocentric perspective, vestibular signals stand as important candidates for the sensorimotor foundations of perspective taking. Yet, no study merged natural full-body vestibular stimulations and explicit visuo-spatial perspective taking tasks in virtual environments. In Experiment 1, we combined natural vestibular stimulation on a rotatory chair with virtual reality to test how vestibular signals are processed to simulate the viewpoint of a distant avatar. While they were rotated, participants tossed a ball to a virtual character from the viewpoint of a distant avatar. Our results showed that vestibular signals influence perspective taking in a direction-specific way: participants were faster when their physical body rotated in the same direction as the mental rotation needed to take the avatar's viewpoint. In Experiment 2, participants realized 3D object mental rotations, which did not involve perspective taking, during the same whole-body vestibular stimulation. Our results demonstrated that vestibular stimulation did not affect 3D object mental rotations. Altogether, these data indicate that vestibular signals have a direction-specific influence on visuo-spatial perspective taking (self-centered mental imagery), but not a general effect on mental imagery. Findings from this study suggest that vestibular signals contribute to one of the most crucial mechanisms of social cognition: understanding others' actions. (c) 2015 Elsevier Ltd. All rights reserved.

Due to improvement in medical cares and an increase in functional expectations, auditive rehabilitation has become a public health issue.Hearing rehabilitation can use either air conducted sound tr...

International audience; Objectives: Four studies assessing vestibular compensation in Meniere's disease patients undergoing unilateral vestibular neurotomy, using different analysis methods, are reviewed, with a focus on the different strategies used by patients according to their preoperative sensory preference. Material and methods: Four prospective studies performed in a university tertiary referral center were reviewed, measuring the pattern of vestibular compensation in Meniere's disease patients before and after unilateral vestibular neurotomy on various assessment protocols: postural syndrome assessed on static posturography and gait analysis; perceptual syndrome assessed on subjective visual vertical perception; and oculomotor syndrome assessed on ocular cyclotorsion. Results: Vestibular compensation occurred at variable intervals depending on the parameter investigated. Open-eye postural control and gait/walking returned to normal one month after neurotomy. Fine balance analysis found that visual perception of the vertical and ocular cyclotorsion impairment persisted at long-term follow-up. Clinical postural disturbance persisted only when visual afferents were cut off (eyes closed). These impairments were the expression of a postoperative change in postural strategy related to the new use of visual and non-visual references. Conclusions: Understanding pre-operative interindividual variation in balance strategy is critical to screening for postural instability and tailoring vestibular rehabilitation. (C) 2015 Elsevier Masson SAS. All rights reserved.

The effects of haptic supplementation on postural stability during upright standing with vision were investigated in 11 unilateral vestibular loss (UVL) patients and compared to 12 age-marched controls. All the participants were instructed to grip a fixed or mobile stick. In the mobile conditions, the lower extremity of the stick was in contact with a slippery or a rough surface. Postural stability was assessed by the root mean square (RMS) and the velocity of the center of foot pressure (CoP) displacements in both antero–posterior (AP) and medio-lateral (ML) directions. Results showed that RMS was larger in UVL patients than in aged-matched participants in AP direction. However, in the mobile stick conditions, only the rough surface improved postural stability. In addition, RMS was more sensitive to haptic supplementation than CoP velocity. The present study confirms the importance of haptic information in the multi-sensory (re) weighting process underlying postural control in UVL patients.

Background:Infratemporal fossa schwannomas are benign, encapsulated tumours of the trigeminal nerve limited to the infratemporal fossa. Because of the complications and significant morbidity associated with traditional surgical approaches to the infratemporal fossa, which include facial nerve dysfunction, hearing loss, dental malocclusion and cosmetic problems, less invasive alternatives have been sought.Methods:This paper reports two cases of infratemporal fossa schwannomas treated in 2012 using mini-invasive approaches. The literature regarding different infratemporal fossa approaches was reviewed.Results:The first schwannoma was 30 mm in size and was removed completely by a preauricular subtemporal approach. The second one was 25 mm in size and was removed completely using a purely transnasal endoscopic approach. In both cases, there were no intra-operative or post-operative complications.Conclusion:These two approaches allow non-invasive and wide exposure of the infratemporal fossa as compared to classical approaches. Surgical approach should be selected according to the tumour's anatomical location with respect to the maxillary sinus posterior wall. The preauricular subtemporal approach is recommended for tumours localised posterolaterally with respect to the maxillary sinus posterior wall. Medial and anterior tumours near the maxillary sinus posterior wall can be best removed using a transnasal endoscopic approach.

Objectif Evaluer l’interet de la tomographie par emission de positons au 18-fluoro-2-deoxy-D-glucose dans la surveillance post-therapeutique precoce des carcinomes ORL. Methodes Cette etude prospective incluait 61 patients presentant un carcinome epidermoide evolue des voies aerodigestives superieures traite de facon curative. Un bilan standard (clinique + TDM + panendoscopie) ainsi qu’une TEP couplee a une TDM par fusion d’images (TEP/TDM) ont ete realises trois mois apres la fin du traitement. Les patients ont ete suivis six mois apres ce bilan. La TEP/TDM a ete evaluee a plusieurs niveaux : tumeur primitive, statut ganglionnaire, metastases et patient pris dans sa globalite. Resultats Pour la tumeur primitive, la TEP/TDM a presente une sensibilite, une specificite, une valeur predictive positive, une valeur predictive negative, et une valeur globale respectivement de 86,7 %, 82,6 %, 62 %, 95 % et 83,6 %. Pour le statut ganglionnaire : 100 %, 98,2 %, 80 %, 100 % et 98,3 %. Pour les metastases : 100 %, 92,2 %, 66,7 %, 100 % et 93,2 %. Au niveau patient : 88,8 %, 78,1 %, 64 %, 94,1 % et 81,4 %. La TEP/TDM aura ete plus performante que le bilan standard chez 22 % des patients. Conclusion La TEP/TDM presente un interet dans cette indication, en particulier pour son excellente valeur predictive negative.

Objectives: The objective of this study was to describe and evaluate the efficacy of the endoscope assisted minimally invasive retrosigmoid approach. Study Design: Retrospective study and literature review. Methods: From December 1993 to December 2004, a total of 1,177 cases of endoscope assisted minimally invasive retrosigmoid approach were performed at the Otorhinolaryngology unit of Hopital Nord in Marseille. By using this approach, we performed microvascular decompression for hemifacial spasm and trigeminal neuralgia, vestibular neurotomy for refractory Meniere's disease with repeated attacks of dizziness, and tumor removal of acoustic neurinoma. We examined the results and postoperative complications. Results: All the results were positive, and we did not experience any mortal complications. The most common complication was cerebrospinal fluid leakage, encountered in 42 (3.6%) cases. Conclusions: We believe that the combination of an endoscope and microscope that provides accurate information with low invasion is becoming indispensable for these types of operations, which are in the category of functional surgery. We report the merits and significance of the approach of combining the endoscope and microscope and discuss the operational technique to perform a minimally invasive surgery as an oto-neurosurgeon.

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