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Despite the increasing incidence rate of vestibular schwannomas (VS), controversies in their management are still present.A 35-item multiple-choice survey investigating the current practice patterns of VS care was sent to the members of the Italian Society of Otolaryngology, Head and Neck Surgery (SIO) and of the Italian Society of Neurosurgery (SINCH).Among 66 respondents, 37 (56.0%) claimed to be actively involved in VS management. Most interviewees (35.1%) declared20 years of experience and 59.5% claimed to work in an academic practice. The number of cases evaluated in each centre per year varied widely, with 54.0% evaluating25 cases/year and only 13.6%100 cases/year. Multidisciplinary care for VS evaluation was confirmed by 50.0% of respondents, and multidisciplinary surgical care by 62.2%. Observation and surgery were the most common management options proposed. Further details regarding VS care are presented.The present study provides the first overview on the current practice patterns of VS care in Italy. Although integrated in most centres, a multidisciplinary model of care needs to be encouraged. Wide heterogeneity in experience and practices is mostly influenced by the surgeon's different specialties and by the lack of shared guidelines.L’attuale gestione dello schwannoma vestibolare in Italia: risultati di una survey nazionale.Nonostante il costante incremento di incidenza dello schwannoma vestibolare (VS), non vi è ancora uniformità nella gestione di tale patologia.Un questionario di 35 domande sulle strategie di trattamento del VS è stato sottoposto ai membri della SIO e della SINCH.Tra i 66 intervistati che hanno risposto al questionario, il 56,0% ha confermato di prendere parte attivamente nel trattamento dello VS. La maggioranza dei partecipanti (35,1%) dichiarava20 anni di esperienza nel settore, e il 59,5% di lavorare in un contesto accademico. Il 54,0% degli intervistati ha affermato di valutare25 casi/anno, mentre solo il 13,6%100 casi/anno. Il 50,0% ha dichiarato di valutare lo VS nell’ambito di un gruppo multidisciplinare, mentre il 62,2% di operare in un contesto multidisciplinare. L’approccio conservativo e la chirurgia si confermavano le strategie terapeutiche più frequentemente proposte.Lo studio presenta una prima panoramica sulle strategie di trattamento dello VS in Italia. Nonostante un modello multidisciplinare di gestione dello VS sia già diffuso in molti centri, è necessario incrementarne ulteriormente lo sviluppo. Le diverse specializzazioni del chirurgo e la mancanza di linee guida condivise contribuiscono a determinare la vasta eterogeneità osservata nella gestione del VS nel nostro Paese.

The interest in surgical routes to the internal auditory canal (IAC) through the external auditory canal for vestibular schwannoma removal has been recently raised by the endoscopic approaches to the lateral skull base. The aim of the study was to reappraise the transmeatal microsurgical approach (TMMa) to the labyrinth and IAC, first described 50 years ago.A retrospective series of 8 consecutive patients treated for intralabyrinthine and intrameatal schwannomas through TMMa is presented. Main outcome measures consisted of surgical indications, postoperative complications, facial nerve status, bed mobilisation time, hospitalisation time and tumour recurrence rate.Surgical indications for TMMa were tumour growth (62.5%) and disabling vertigo (37.5%) in the present series. Complete tumour removal with no complications and postoperative normal facial nerve function was obtained in all cases. Bed mobilisation occurred after a median of 3 postoperative days (IQR 2.2-3.0) and discharge after a median of 5.6 days (IQR 4.7-7.0). After a median follow-up of 13 months (IQR 7.5-27.5), no tumour recurrence was observed.TMMa indications are limited to schwannomas of the labyrinth and IAC, which dropped out from observation protocols due to unmanageable symptoms or growth. Despite the narrow mini-invasive surgical corridor, the TMMa was a safe an effective microsurgical technique in terms of tumour removal and postoperative course.Approccio transmeatale microchirurgico nei neurinomi intralabirintici e intrameatali: rivalutazione di una tecnica.L’interesse per i corridoi chirurgici dal condotto uditivo esterno al condotto uditivo interno (CUI) nel trattamento del neurinoma è incrementato negli ultimi anni grazie alla divulgazione di approcci endoscopici al basecranio laterale. Lo studio si prefigge di rivalutare l’approccio microscopico transmeatale (TMMa) al labirinto e al CUI, descritto in origine circa 50 anni fa.Otto pazienti sottoposti a TMMa per exeresi di neurinomi intralabirintici o intrameatali sono stati inclusi nello studio. Indicazione chirurgica a TMMa, complicanze postoperatorie, funzionalità del nervo facciale, tempo di mobilizzazione dal letto e di degenza, tasso di recidiva sono state le principali misure di outcome analizzate.Crescita tumorale (62,5%) e vertigini incoercibili (37,5%) hanno rappresentato l’indicazione chirurgica più frequente. In tutti i pazienti il tumore è stato rimosso in toto, in assenza di complicanze postoperatorie. La mobilizzazione dal letto è avvenuta dopo 3 giorni (IQR 2,2-3,0), la dimissione dopo 5,6 giorni (IQR 4,7-7,0). All’ultimo follow-up (mediana 13 mesi, IQR 7,5-27,5) non sono state registrate recidive.L’indicazione al TMMa è limitata agli schwannomi intralabirintici e/o estesi al CUI, che escono dal protocollo di osservazione a causa di sintomi invalidanti o crescita. Nonostante l’accesso chirurgico mini-invasivo offra uno spazio limitato di manovra, il TMMa si è dimostrato una opzione di trattamento microchirurgico sicura ed efficace in termini di rimozione tumorale e decorso postoperatorio.

Lettera in risposta a: “Approccio transmeatale microchirurgico nei neurinomi intralabirintici e intrameatali: revisione della letteratura”.

BACKGROUND Research efforts are been directed in the last few years on tissue- engineering and the possibility of tissue creation by laboratory device. In fact biochemistry, immunology and experimental surgery has been provided new solutions for organs transplant or anatomical structure replacement. Variously method were described to obtain decelullarized matrix from organ or part of them, and how that bioengineered scaffolds can be integrated into recipient organism. The aim of the studies is to provide a source, from animal or cadaver, of engineered organs or tissue flaps available from transplant or reconstructive surgery, free from infective disease, completely functional and without rejection phenomenon. AIM OF THE STUDY The aim of this study is to investigate the bio integration potential of a tissue engineered abdominal wall obtained from a donor, even after a protocol of decellularization than after recellularization with stem cell of recipient, obtained from adipose tissue, in vitro and microsurgical transfer in vivo, in order to create a biocompatible free flap without rejection phenomenon (omo-autologous flap). Similarly a sample of decellularized muscle are transferred to a recipient and histological and sonographic result were evaluated. MATERIAL AND METHODS Samples of the abdominal wall were collected with iliac arterial and vein pedicle as a free flap from rabbits, before sacrifice (donor). At the same time a sample of adipose tissue was collected from a different rabbit (recipient). The abdominal wall samples underwent a 7 days decellularization protocol. Small samples of the tissues were collected before and after that procedure for histological evaluation of the process. The adipose tissue sample of the recipient were treated to obtain a full rich stem cells tissue. Similar sample of muscle without vessel are collected and underwent a decellularization protocol and so on for major vessel sample with a specific one for vascular tissue. A decellularized muscle patch are implanted in vivo and rejection phenomenon, survival of the patch and herniation presence were observed after three weeks even by sonography than by histological evaluation after sacrifice. RESULTS The histological evaluations shown a progressive degeneration and loss of cellular content of the rabbit abdominal wall samples. In parallel, the general ECM structure maintain their staining properties. Particularly relevant is the preservation of vascular channels. Muscle decellularized sample implanted in vivo demonstrated good biointegration at sonography exam and no herniation was observed; histologic evaluation demonstrated presence of limitated granulomatosis reaction , numerously vessels and conservation of original muscle architecture, substituted by fibrosis,without evident rejection. Histological and moreover evaluation of free flap transplant, stem cells seeding and vessel decellularization are in process. CONCLUSION Decellularized muscle patch provide the evidence of a new bioingeneered tissue that could be useful for abdominal wall repair or reconstruction. Biointegration could be improve by use of stem cells and growth factor seeding. Similarly the demonstration of the preservation of the vascular network and extra cellular matrix of abdominal wall sample provide the possibilities of being bio integrated after vascular anastomoses that is the aim of the studies actually on going

Scopo di questo studio clinico controllato randomizzato è l'analisi dei risultati dopo impiego di lenti di magnificazione in pazienti sottoposti a tiroidectomia totale. L'approccio microchirurgico con l'ausilio di magnificazione riduce il tempo operatorio e migliora i risultati della tiroidectomia totale