Objective To evaluate the incidence and treatment of CSF leaks after resection of vestibular schwannomas and to propose a treatment algorithm for their management. Study Design Retrospective chart review. Setting Tertiary referral center. Patients Review of 1,922 subjects who underwent resection of vestibular schwannomas from 1970 through 2010. Intervention Surgical resection of vestibular schwannoma. Main Outcome Measures Patient demographics, surgical approach used, CSF leak incidence, meningitis, treatment and success in the management of CSF leaks. Results Postoperative CSF leaks were observed in 12.9% of our patients. There was no significant difference between the type of approach and the presence of CSF leak with translabyrinthine, suboccipital and middle fossa CSF leak rates of 12%, 12%, and 13% respectively (p=0.07). Patients presented with a wound leak or rhinorrhea almost equally. Ultimately, 92% of patients with rhinorrhea underwent surgical intervention. The probability of a patient with rhinorrhea requiring a second intervention was higher when the initial intervention was conservative rather than surgical. However, the probability of a patient with a wound leak requiring a second intervention was essentially the same when initially treated conservatively or surgically. Conclusion Our data suggests that there is no difference in CSF leak rates between the different surgical approaches. The appropriate treatment strategy is dependent on the presentation of the CSF. While conservative treatment is effective for managing wound leaks, it is less effective in managing patients with rhinorrhea. Therefore, surgical treatments should play an early role in the treatment algorithm of patients with CSF rhinorrhea.

We have identified multiple characteristics of FNS as well as multiple factors associated with increased statistical risk of poor FN outcomes.

Basic fibroblast growth factor induced the up-regulation of HAS-2, HAS-3, MMP-2, and procollagen type I. Histologically, aged vocal folds treated with bFGF revealed increased deposition of HA as compared to sham-treated vocal folds.

Dysplasia is common in RRP. Progression of dysplasia, especially with an initial dysplastic grading of benign or mild disease, is rare.

Objectives/Hypothesis-We investigated acute changes in extracellular matrix gene expression and histologic changes in the deposition of collagen and hyaluronan (HA) from hepatocyte growth factor (HGF) treatment of the aged rat vocal fold. We hypothesized that: 1) HGF induces matrix metalloproteinase gene expression, which may contribute to the downregulation of collagen; and 2) HGF induces hyaluronan synthase (HAS) gene expression, which may play a role in the upregulation of ECM HA.Study Design-prospective animal study.Methods-Fifteen, 18-month old, Sprague-Dawley rats were involved in this study. For gene expression analyses, ten rats were divided into two groups and received serial injections of sham (saline) or HGF (2ng/µL) and sacrificed 2 weeks after the initial injection to investigate acute changes in extracellular matrix gene expression. A separate group of five animals received the above treatment and were sacrificed 4 weeks after the initial injection to investigate histologic changes in the deposition of collagen and HA.Results-Real-time polymerase chain reaction revealed significantly upregulated MMP-2, -9, and HAS-3 messenger RNA (mRNA) expression and significantly downregulated procollagen type I mRNA expression in the HGF-treatment group, compared to the sham-treatment group. Histologic staining revealed significantly reduced collagen deposition and increased deposition of HA in the HGF-treated vocal fold, compared to the sham-treated vocal fold.Conclusions-HGF induced the upregulation of MMP-2, -9, and HAS-3, and downregulated the expression of procollagen type I. Histologically, aged vocal folds treated with HGF revealed decreased collagen deposition, and increased deposition of HA, compared to sham-treated vocal folds.

Total intravenous anesthesia is an attractive alternative to traditional endotracheal tube intubation, jet ventilation, or intermittent apneic ventilation for adult SML. During episodes of hypoventilation or desaturation, endotracheal ventilation, mask ventilation, or jet ventilation can effectively recover oxygenation.

Eagle syndrome is caused by an elongated styloid process or calcified stylohyoid ligament. The stylocarotid variant with neurologic symptoms is rare and presents a diagnostic challenge. Patients may present with transient ischemic attacks, syncope, or less well defined symptoms like episodic dizziness. We report use of vascular laboratory testing in the management of Eagle syndrome. In one patient, on Doppler ultrasound examination of the ipsilateral temporal artery, the signal was lost with provocative neck flexion. In another patient, transcranial Doppler ultrasound showed blunting of the middle cerebral artery with provocative maneuvers. We used perioperative transcranial Doppler ultrasound to assess the effectiveness of styloid resection.

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