Benjamin M. McGrew

Pretreatment, Preoperative Swallowing Exercises May Improve Dysphagia Quality of Life

Objectives: Dysphagia is commonly associated with head and neck cancer treatment. Traditional dysphagia management strategies focus on post‐treatment therapy. This study evaluated the utility of pretreatment swallowing exercises in improving post‐treatment swallowing quality of life (QOL).

Lateral skull base surgery for glomus tumors: long-term control.

Objective The age of modern microsurgery has made resection of glomus tumors with extensive skull base involvement possible. Resection of extensive lesions is not without risk of major complication or new cranial nerve deficit. Because glomus tumors are rare and slow growing, data reflecting recurrence risk after resection using modern skull base techniques are lacking. These factors complicate the accurate definition of efficacy of surgical resection and its functional cost. The object of this review is to determine the current incidence of major complications, the surgical cranial nerve deficit, the long-term control rate, and the recurrence risk in patients undergoing surgical resection of glomus jugulare tumors. Study Design Retrospective case review. Setting Private practice tertiary referral center. Patients and Interventions One hundred seventy-six patients with glomus tumors underwent 182 lateral skull base resections between 1972 and 1998. Main Outcome Measures Major complications, tumor recurrence, postoperative functional capacity, and factors affecting the incidence of each were assessed. Results Complete surgical control was achieved in 85% of cases. There were nine cases of recurrence, for a recurrent rate of 5.5% (9/164). Cerebrospinal fluid leakage occurred in 4.5% of cases with intracranial extension. New deficits for cranial nerves IX, X, XI, and XII occurred in 39%, 25%, 26%, and 21% of cases, respectively. Satisfactory functional recovery was achieved in an overwhelming majority of cases. The mortality rate was 2.7% (5/182). Conclusions Surgical resection of glomus tumors is established as an effective technique with good functional outcomes and long-term control.

Impact of Mastoidectomy on Simple Tympanic Membrane Perforation Repair

Objectives/Hypothesis Mastoidectomy has long been identified as an effective method of treatment for chronic ear infection. The effect of mastoidectomy on patients without evidence of active infectious disease remains highly debated and unproven. The objective in the study was to examine the impact of mastoidectomy on the repair of uncomplicated tympanic membrane perforations.

Long-term Control of Surgically Treated Glomus Tympanicum Tumors

Objective The glomus tumor is an enigmatic middle ear neoplasm commonly delayed in diagnosis. Frequently grouped with its skull base counterpart, surgery and radiation are often recommended as therapy. The objective of this report is to highlight the diagnosis and surgical treatment of this neoplasm in a large series. Tumor control in the long term is defined. Study Design Retrospective case review. Setting Private practice–tertiary referral center. Patients All patients surgically treated for glomus tympanicum tumors from May 25, 1972 to July 3, 1998 (N = 80). Interventions Surgical excision of glomus tympanicum tumors. Main Outcome Measure Total tumor control in the long term. Results Surgical treatment resulted in long-term tumor control for the vast majority of the patients studied. Conclusions Surgery provides excellent control of glomus tympanicum tumors. It is safe and well tolerated, with minimal morbidity.

Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects.

Tumors of the lateral skull base are best treated with surgery plus or minus radiation thereapy. Surgical ablation may involve cutaneous structures, the auricle, the parotid, and the lateral temporal bone. These composite soft tissue defects are best reconstructed with composite tissue. Multiple pedicled flaps have been used to reconstruct these defects. Free flaps have been shown to provide the best tissue for these reconstructions. We review our experience and present an algorithm for their reconstruction.

Use of negative pressure dressings in head and neck reconstruction

Head and neck microvascular surgery commonly requires management of complex wounds of the upper aerodigestive tract and donor sites. Negative pressure dressings have been reported to promote healing in compromised wounds.

Outcomes Following Temporal Bone Resection

To evaluate survival outcomes in patients undergoing temporal bone resection.

Current practices in vestibular schwannoma management: A survey of American and Canadian neurosurgeons

OBJECTIVES Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions. METHODS A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach. RESULTS Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance. CONCLUSIONS The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada.

Reconstruction of the entire ossicular conduction mechanism

Objectives/Hypothesis Stapes fixation combined with fixation, absence, or malformation of the malleus‐incus complex requires an uncommon surgical reconstruction and offers a unique combination of challenges and hazards. This situation may occur in the presence of severe tympanosclerosis, otosclerosis, congenital ossicular malformations, and revision surgery for either stapedectomy or chronic ear disease. In previous reports, this procedure has been grouped with total ossicular reconstruction without much distinction. However, the challenges unique to this problem deserve special consideration. The present report offers a treatment plan for a group of patients requiring reconstruction of the entire ossicular conduction mechanism including removal of the stapes footplate.

Skull base surgery for glomus tumors

Abstract The complete resection of advanced glomus tumors involving the skull base has become feasible in the modern age of microsurgery. Despite the advance of microsurgical technique, resection of glomus tumors with extensive skull base involvement is not without risk of major complication. Even with these risks, surgical resection remains the standard and most successful therapeutic modality for these tumors. This review examines standard microsurgical approaches and techniques for the treatment of paragangliomas involving the temporal bone and lateral skull base. Results: Outcomes are separated between glomus tympanicum cases and skull base glomus tumor cases. In the glomus tympanicum group, complete surgical control approaches 93%. In the skull base group, complete surgical control approaches 85% of cases with a 5% recurrent rate. Cerebrospinal fluid (CSF) leakage has been reduced to less than 5% of cases with intracranial extension. New lower cranial nerve deficits range from 39% to 21%. Despite new cranial nerve deficits, satisfactory functional recovery is achieved in an overwhelming majority of cases. Mortality rate has been reduced to less than 3%. Conclusions: Surgical resection of glomus tumors remains an effective technique with good functional outcomes and long-term control. Results have been improving as skull base surgery techniques advance. To date, alternative therapies have not proven more effective.