Search

This article discusses a case of a cerebellar flocculus pseudomass, a lesser-known lesion that can occur in the cerebellopontine angle (CPA). The patient, a 73-year-old female, presented with gradual onset of right-sided low frequency hearing loss and was initially diagnosed with a vestibular schwannoma. However, further imaging revealed characteristics inconsistent with a vestibular schwannoma, leading to the diagnosis of a cerebellar flocculus pseudomass. The article emphasizes the importance of comprehensive MRI studies for CPA lesions to avoid misdiagnosis and inappropriate treatment. The presentation of a cerebellar flocculus pseudomass with unilateral hearing loss is considered novel, and more information about this condition is needed in the literature. [Extracted from the article]

This article explores the use of smartphone and wearable activity monitoring as a marker for recovery after skull base surgery. The study included 19 patients who underwent anterior or lateral skull base surgery at NYU Langone Health. The results showed that patients achieved a 75% return to preoperative mobility by the sixth week, although the rates varied depending on the type of surgery. Additionally, the study found that the weekly step count after surgery was significantly correlated with the length of hospital stay. The findings suggest that passive smartphone and wearable activity monitoring could be a reliable metric for assessing outcomes in skull base surgery. [Extracted from the article]

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. 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. The patient received bilateral cochlear implants and has demonstrated good performance one year after implantation. 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. 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. [ABSTRACT FROM AUTHOR]

Evaluate rates of Advanced Bionics Ultra 3D/Ultra cochlear implant failure in the setting of a worldwide device recall and report surgical and auditory outcomes after revision. Retrospective chart review was performed for adult and pediatric patients implanted with at risk devices at our center from 2016 to 2020. Device failure rates, surgical, and auditory outcomes were recorded and analyzed. Of 113 at-risk devices, 20 devices (17.7%) in 18 patients (two bilaterally implanted) were identified as failures. All devices were with mid-scala electrodes. Eleven patients (61.1%) were children and 7 (38.9%) adults. Twelve patients were found to have failing devices after reporting subjective performance decline; the remainder were prompted by manufacturer notification. All were revised, with the majority (83.3%) choosing the same manufacturer. All had uncomplicated original and revision insertions. Among adults, average word scores on the revised side were stable pre- to post-revision (P = 0.95). Patients with device failure due to this field action performed well after revision implantation. Patients with bilateral at-risk devices but evidence of unilateral failure may elect to undergo simultaneous empiric revision of the contralateral device. Three patients who elected to change device manufacturers on revision have variable results that require further investigation. Patients requiring revision for a device field action overall perform well. At-risk devices continue to require monitoring as a growing number are likely to fail over time. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

* The clinical and aspiration cytologic details of a case of temporomandibular joint pigmented villonodular synovitis are presented and correlated with imaging, surgical, histopathologic, and clinical follow-up findings; the origin of such lesions is discussed. The lesion originally presented in a 36-year-old, otherwise healthy, white man as a unilateral mass involving the temporal fossa and temporomandibular joint region. The tumor's extent was defined by magnetic resonance imaging and computed tomographic scan; there was destruction of the temporomandibular joint and erosion of the temporal cranial bones by a lesion whose maximum dimensions were estimated by imaging to be 2.75 x 3.25 cm. The lesion was initially sampled and classified by computed tomography--guided fine-needle aspiration biopsy. Following complete resection, the original diagnosis was confirmed with both hematoxylin-eosin--stained paraffin sections and immunohistochemical staining. The patient remains free of disease 7 years postoperatively., Pigmented villonodular synovitis (PVNS) is an uncommon inflammatory, reactive, and pseudoneoplastic condition of unknown etiology affecting synovial-lined joints. Pigmented villonodular synovitis was originally described by Jaffe et al (1) and [...]