Search

Objective  This study was aimed to evaluate the impact of a multidisciplinary perioperative pathway on length of stay (LOS) and postoperative outcomes after vestibular schwannoma surgery. Setting  This study was conducted in a tertiary skull base center. Main Outcome Measures  The impact of the pathway on intensive care unit (ICU) LOS was evaluated as the primary outcome measure of the study. Overall resource LOS, postoperative complications, and readmission rates were also evaluated as secondary outcome measures. Methods  Present study is a retrospective review. Results  A universally adopted perioperative pathway was developed to include standardization of preoperative education and expectations, intraoperative anesthetic delivery, postoperative nursing education, postoperative rehabilitation, and utilization of stepdown and surgical floor units after ICU stay. Outcomes were measured for 95 consecutive adult patients who underwent surgical resection for vestibular schwannoma (40 cases before implementation of the perioperative pathway and 55 cases after implementation). There were no significant differences in the two groups with regard to tumor size, operative time, or medical comorbidities. The mean ICU LOS decreased from 2.1 in the preimplementation group to 1.6 days in the postimplementation group (p  = 0.02). There were no significant differences in overall resource LOS postoperative complications or readmission rates between groups. Conclusion  Multidisciplinary, perioperative neurotologic pathways can be effective in lowering ICU LOS in patients undergoing vestibular schwannoma surgery without compromising quality of care. Further research is needed to continue to sustain and continuously improve these and other measures, while continuing to provide high-quality care to this patient population. [ABSTRACT FROM AUTHOR]

Objective  The main purpose of this article is to investigate the prevalence and features of posterior fossa defects (PFD) in spontaneous cerebrospinal fluid leaks (sCSFL). Design  This is a retrospective case series. Setting  Tertiary skull base center. Participants  Consecutive adults undergoing lateral skull base repair of sCSFL between 2003 and 2018. Main Outcome Measures  The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma, or chronic ear disease were excluded. Results  Seventy-one patients (74% female, mean age 56.39 ± 11.50 years) underwent repair of spontaneous lateral skull base leaks. Eight ears (7 patients, 11.1%) had leaks involving the posterior fossa plate in addition to defects of the tegmen mastoideum (50%), tegmen tympani (25%), or both (25%). Patients with PFDs more often had bilateral tegmen thinning on imaging (75%, odds ratio [OR]: 10.71, 95% confidence interval [CI]: 2.20–54.35, p =  0.005) and symptomatic bilateral leaks (OR: 9.67, 95% CI: 2.22–40.17, p  = 0.01. All PFD patients had arachnoid granulations adjacent to ipsilateral mastoid cell opacification. However, this finding was often subtle and rarely included on the radiology report. There was no significant difference in body mass index, age, presenting complaints, or operative success between the PFD and isolated tegmen defect sCSFL cohorts. Conclusion  The posterior fossa is an uncommon location for sCSFL. Careful review of preoperative imaging is often suggestive and can inform surgical approach. PFD patients are similar to those with isolated tegmen-based defects in presentation, comorbidities, and outcomes. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting  This study was done at the tertiary skull base center. Design  This is a retrospective case series. Main Outcome Measures  The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications. Results  Sixteen patients were identified with a median age of 45 years (range: 20–72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1–7.3) and the mean tumor volume was 28.5 cm 3 (SD: 18.8, range: 2.9–63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma (n  = 7) followed by chondrosarcoma (n  = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V (n  = 1), CN III (n  = 2), CN VI (n  = 1), and CN X (n  = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House–Brackmann grade 2). Conclusion  Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence and impact of obstructive sleep apnea (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of various etiologies.Methods: Retrospective case review at a tertiary skull base center was conducted of consecutive adults undergoing LSBR via transmastoid, middle cranial fossa, or combined approach between 2013-2018. The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma or chronic ear disease were excluded.Results: Ninety-four patients (67.4% female, mean age 53.5 ± 12.9 years) underwent repair for spontaneous (sCSFL, 44%) and other etiology (nsCSFL) leaks. nsCSFL served as a comparison group consisting of leaks status-post lateral skull base surgery, temporal bone fractures, and chronic ear disease. Class III obesity (P = .02), OSA (P = .03), and imaging findings of empty sella (OR = 3.32, P = .02), and skull base thinning including contralateral tegmen thinning (31%, OR = 4.3, P = .02), arachnoid granulations (26%, OR = 4.35, P = .02), and superior canal dehiscence (15.8%, OR = 8.57, P = .04) were more common in sCSFL. Four patients (4.2%) required surgical revision for recurrence, and another four (4.2%) resolved with shunting. Evidence of elevated intracranial hypertension was present in nine patients with sCSF leaks and was predictive of need for revision or shunt procedures (P < .01).Conclusion: Obesity, OSA, and imaging consistent with elevated intracranial pressures were more common among patients with sCSFL. Elevated intracranial pressure predicted outcomes following multilayer repair of spontaneous CSF leaks LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2234-2240, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To measure and report noise exposure at urban music venues and assess the risk of noise-induced hearing loss by comparing these measures to the National Institute of Occupations Safety and Health (NIOSH) guidelines.Study Design: Observational study.Methods: A commercially available smartphone and external calibrated microphone were used to measure sound levels at urban music venues. The maximum sound level, equivalent continuous sound level, and statistical noise levels (L10, L50, L75, L90) were recorded.Results: The average equivalent continuous sound level was 112.0 (±4.9) dBA, and the average maximum sound level was 127.0 (±3.2) dBA. The L90 average (sound levels at or above this loudness for 90% of measured exposure time) was 101.1 (±5.5) dBA, and the L10 average was 115.2 (±5.0) dBA. Based off of NIOSH guidelines, noise exposure duration at the L10 average should not exceed 28 seconds, and those at the L90 average should not exceed 12 minutes.Conclusions: Smartphone applications using external calibrated microphones can provide useful sound measurements. Data show that randomly sampled music venues may have noise levels that place patrons without hearing protection at risk for noise-induced hearing loss with prolonged exposure.Level Of Evidence: NA Laryngoscope, 131:25-27, 2021. [ABSTRACT FROM AUTHOR]