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Here is an amazing collection of rare photos that shows the life in Jamaica from between 1860s to 1890s. We used MEG to evaluate the reactivity of the auditory cortex in 26 hemifacial spasm patients. There was a significant difference in the pure tone audiogram on the spasm side compared with the non-spasm side.
Our results indicate that MEG can detect differences in cortical activity between hemifacial spasm patients with and without tinnitus. Endovascular treatment of two concomitant causes of pulsatile tinnitus: sigmoid sinus stenosis and ipsilateral jugular bulb diverticulum. We describe a rare case of highly invalidating pulsatile tinnitus associated with both stenosis of the sigmoid sinus and ipsilateral jugular bulb diverticulum. Chronic microvascular compressions of the eighth nerve induce a slowing down of signal transmission in the auditory nerve, electrophysiologically characterized by IPL I-III prolongation. The authors hypothesize this is compensated by an active slowing down of signal transmission of the contralateral input at the level of the brainstem, characterized by contralateral IPL III-V prolongation.
Differences between ipsilateral and contralateral IPL I-III and IPL III-V are analyzed before and after microvascular decompression. Preoperatively, there is a marginal significant difference between the ipsi- and contralateral IPL III-V, which disappears postoperatively. The aim of this study was to evaluate gross and microscopic anatomical features of the vestibulocochlear nerve or eighth cranial nerve (CNVIII) from fresh cadavers, especially the nerve’s central myelin portion (CMP) and transitional zone (TZ), and to consider any pathological implications. Sporadic vestibular schwannoma (VS) causes unilateral hearing loss, tinnitus, vertigo and unsteadiness. A case with severe pulsatile tinnitus of the left side caused by occlusion of the right common carotid artery was reported.
The aim of this study was to evaluate the anatomy of the central myelin portion and the central myelin-peripheral myelin transitional zone of the trigeminal, facial, glossopharyngeal and vagus nerves from fresh cadavers.
The trigeminal, facial, glossopharyngeal and vagus nerves from six fresh cadavers were examined. At present it is rather well-established that primary trigeminal neuralgia, hemifacial spasm and vago-glossopharyngeal neuralgia have as one of the main causes a vascular compression. Intracranial lipomas are extremely rare tumors, with certain clinical and radiological characteristics. We considered the diagnostic evaluation and treatment options of seven patients presenting with lipoma in the cerebellopontine angle or internal acoustic meatus in our department.
The role of endovascular interventions in managing dural arteriovenous fistulas (DAVFs) is increasing.
In general, intracranial DAVFs can be successfully surgically managed by simple venous disconnection in many cases. Pre-operative and postoperative auditory function was reviewed retrospectively in 98 patients with vestibular schwannomas.
An unusual case of dural arteriovenous malformation (DAVM) harboring a parallel transverse-sigmoid sinus (TSS) is presented. The authors report an underestimated symptom and sign arising in pineal region tumours: tinnitus and hearing loss. The inferior colliculi, the structure more dense in fibres than any other auditory brain stem site and at which majority of the acoustic pathways relay, is closely adjacent to the pineal body.
Papaverine hydrochloride is a direct-acting vasodilator used to manage vasospasm during various neurosurgical operations. We conducted a retrospective review of 70 consecutive microvascular decompression operations and studied those patients who received topical papaverine for vasospasm. A temporal relationship was found between topical papaverine and BAEP changes leading to complete waveform loss.
Topical papaverine for the treatment of vasospasm was associated with the onset of a transient disturbance in neurophysiological function of the ascending auditory brainstem pathway.
We divided patients into a subjective tinnitus group (n?=?10) and a non-tinnitus group (n?=?16).
After stimulation on the spasm side, the amplitude of the N100m peak in the contralateral hemisphere was lower in the subjective tinnitus group than in the non-tinnitus group. This suggests that MEG can identify changes in cortical activity associated with non-motor symptoms. Both conditions were successfully treated by positioning a stent across the sigmoid sinus and jugular bulb. Methods: However, only a fraction of patients appear to benefit from surgery if the combination of findings such as paroxysmal vertigo, ABR changes and tinnitus is used to select patients for microvascular decompression. ABR diagnostic criteria for microvascular compression are ipsilateral IPL I-III prolongation or ipsilateral peak II decrease + ipsilateral IPL I-III prolongation. The implication of this length in the dysfunctional syndromes of this nerve, its propensity to harbor schwannomas, which most frequently arise at the porus of the auditory meatus, and the vulnerability to damages are discussed.
In many cases, the tumour size may remain unchanged for many years following diagnosis, which is typically made by MRI.

Surgical manipulation of the fifth cranial nerve in its intra- or extracranial course may lead to bradycardia or even asystole as well as arterial hypotension, a phenomenon described as the trigemino-cardiac reflex (TCR), first described by the authors previonsly [11]. Thirty six patients scheduled for vestibular schwannoma surgery were studied retrospectively for parameters influencing the post-operative ipsilateral tinnitus function. The TCR occured in 17% of the patients during vestibular schwannoma surgery and influenced the occurrence of post-operative ipsilateral tinnitus: the overall incidence of post-operative ipsilateral tinnitus was 22%. Hypotension after intra-operative TCR is not only a negative prognostic factor for hearing preservation but also for ipsilateral tinnitus in patients undergoing vestibular schwannoma surgery.
Tinnitus in this case was supposed to be due to the rich blood flow of the external carotid systems developed as collateral routes resulting from the occlusion of the right common carotid artery. Many NVC syndromes were mistakenly diagnosed as Meniere's disease or benign paroxysmal positional vertigo. The aim was also to investigate the relationship between the length and volume of the central myelin portion of these nerves with the incidences of the corresponding cranial dysfunctional syndromes caused by their compression to provide some more insights for a better understanding of mechanisms. The strong correlations found between the lengths and volumes of the central myelin portions of the nerves and the incidences of the corresponding diseases is a plea for the role played by this anatomical region in the mechanism of these diseases.
Balance disorders (vertigo, dizziness) were the predominant symptoms (in six out of seven patients), followed by hearing loss. As the complete resection of such lipomas is a risky choice and taking into account the benign course of such tumors, the only absolute surgical indication should be uncontrolled tumor growth. Furthermore, in patients with aggressive DAVFs, different surgical interventions are required for complete obliteration or disconnection. We then conducted a systematic telephone interview to obtain long-term follow-up information. Nineteen (35%) patients presented with intracranial bleeding, 84% of patients scored between 0 and 2 using a modified Rankin Scale at the last follow-up visit. According to their hormonal status, women were categorized as “premenopausal” and “postmenopausal”.
The patient had a 2-year history of left-sided pulsatile tinnitus in the left ear refractory to medical management.
Displacement of this structure may be responsible for acoustic symptoms together with common visual symptoms.
Transient cranial nerve dysfunction has been described in a few cases with topical papaverine.
Topical papaverine was used as a direct therapeutic action to manage vasospasm in a total of 11 patients.
The average temporal delay between papaverine and the onset of an adverse BAEP change was 5 min. The complete disappearance of BAEP waveforms with a consistent temporal delay suggests a possible adverse effect on the proximal eighth nerve. These pictures have been collected from different public sources including different websites, considering to be in public domain.If any one has any objection of displaying any picture here, just send us an email and we will remove it immediately, after verification of the claim.
The latency and amplitude of the most prominent deflection, N100m, was compared between the two groups.
To our knowledge, the present clinical case represents the first report of such an approach. Results: Instead, a more specific syndrome of staccato or “typewriter” tinnitus, which is highly responsive to carbamazepine, was suggested to be caused by a neurovascular conflict.
With IPL I-III as diagnostic criterion, unlike preoperatively the difference between the ipsi- and contralateral IPL I-III is significant postoperatively. Longitudinal sections were stained to make following measurements: the diameter where the nerve enters the brainstem, the diameter where the TZ begins, the distance to the most distal part of TZ from the brainstem, and the depth of the TZ. In the majority of cases the tumour is small, leaving the clinician and patient with the options of either serial scanning or active treatment by gamma knife radiosurgery (GKR) or microneurosurgery. The authors report here the impact of this reflex on post-operative ipsilateral tinnitus in patients undergoing vestibular schwannoma surgery. According to the occurrence of intra- operative TCR the patients were divided into a TCR-subgroup and a non-TCR subgroup.
Sixty (60) percent of the patients in the TCR subgroup and 17% of those in the non-TCR subgroup expierenced ipsilateral tinnitus postoperatively. In combination with worse hearing function after intra-operative TCR, the present finding underlines the importance of the TCR during skull base surgery in relation to improved functional outcome. It subsided with the establishment of a bypass using a vein graft between the ascending aorta and the residual patent portion of the right common carotid artery.
The diagnosis of intracranial lipomas was based on the results of imaging studies, especially on magnetic resonance imaging.
Our objective was to evaluate the management of patients with intracranial DAVFs treated in our institution to identify the parameters that may help guide the long-term management of these lesions. Age and the occurrence of perioperative complication were the most important determinants of outcome. Before surgery, 48% of the women (65% premenopausal) and 16% of the men presented with sudden hearing loss.

This study supports previous reports and provides neurophysiological evidence of an adverse effect on the auditory nerve. The timing of papaverine application and ongoing operative events was reviewed relative to changes in neurophysiological recordings. To determine the usefulness of MEG in assessing changes in cortical activity associated with non-motor hearing symptoms in hemifacial spasm patients. The therapeutic decision-making is discussed in relation to the etiopathologic hypothesis put forward. Conclusion: We present the first case of typewriter tinnitus with complete long-term symptom relief following microvascular decompression of the vestibulocochlear nerve. When using the stricter diagnostic criterion of IPL I-III + peak II, there is a preoperative significant difference between ipsi- and contralateral IPL I-III, but postoperatively the difference between the ipsi- and contralateral IPL I-III is not significant. Despite the vast number of published treatment reports, comparative studies are few, and evidence is no better than class III (May, 2006). Neurovascular decompression (NVD) resulted in complete recovery or marked improvement of subjective symptoms in all 19 cases with vertigo (100%), and in 19 of 29 patients with tinnitus (65.5%).
The management of lipomas of the CPA and of the IAM should initially be conservative, including close follow-up of the patient and evaluation of a potential change in tumor size. Overall postoperative complications occurred in seven (29%) surgically treated patients, but only two patients permanently worsened.
Super-selective transvenous dural sinus occlusion of the DAVM situated at the pathological compartment of the TSS provided cure. Brainstem auditory evoked potentials (BAEPs) were routinely used to monitor cochlear nerve function during these operations. We suggest that this specific syndrome is caused by a neurovascular conflict and treatable by microvascular decompression. The predominant clinical endpoints of VS treatment include tumour control, facial nerve function and hearing preservation. Multiple factor analysis revealed that abnormal caloric responses have high diagnostic value for vertigo due to NVC. Surgical management of CPA lipomas should be reserved for patients with intractable clinical symptoms due to tumor overgrowth. For patients with Borden type II and III fistulas, the annual incidence of hemorrhage was 30%. Preservation of preoperative hearing was possible for 41% of the women (21% premenopausal) and 59% of the men.
We were able to spare the normal compartment providing anatomical venous drainage from this system. One patient showed no recovery of later waves and a delayed profound sensorineural hearing loss. Vertigo due to NVC is of short duration (a few sec to a few min.) in the early phase of the disease, which becomes longer and hearing becomes impaired as the history of NVC lengthens. Correlation between length and volume of the central myelin portion of these nerves and the incidences of the corresponding hyperactive dysfunctional syndromes as reported in the literature were studied. Further details of the surgery and the results of histopathological examination were also compared for women and men. It is uncertain if treating a small tumour leaves the patient with a better chance of obtaining relief from future hearing loss, vertigo or tinnitus than by observing it without treatment. Low pitch pulsatile and high pitch continuous tinnitus are probably due to NVC and are cured by NVD if hearing is still preserved. Long-term follow-up showed that compared with spinal DAVFs, only 50% of intracranial DAVFs showed complete remission of symptoms, 41% partial remission, 6% no remission and 4% deterioration of symptoms that led to treatment of the DAVF.
Our results support substantial evidence that hearing preservation after surgery of vestibular schwannoma is easier to accomplish for men than for women. Recent data indicate that QOL is reduced in untreated VS patients, and may differ between patients who have been operated and patients treated with GKR.
The finding of significantly more sudden hearing loss in premenopausal women may suggest a hormonal influence on tumour growth, which may also be partially responsible for the difference in hearing prognosis between women and men. In the present paper we review the natural course and complaints of untreated VS patients, and the treatment alternatives and results. Decompression of the 8th N should be performed in the early phase of disease, since cochlear and vestibular functions are irreversibly impaired if NVC continues for a long period of time. Finally, we present our experience with a management strategy applied to more than 300 cases since 2001.

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13.12.2014 admin

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