Objective: This communication is the first assessment of outcomes after surgical repair of cochlea-facial nerve dehiscence (CFD) in a series of patients. Pre-and post-operative quantitative measurement of validated survey instruments, symptoms, diagnostic findings and anonymous video descriptions of symptoms in a cohort of 16 patients with CFD and third window syndrome (TWS) symptoms were systematically studied. Study design:Observational analytic case-control study.Setting: Quaternary referral center.Patients: Group 1 had 8 patients (5 children and 3 adults) with CFD and TWS who underwent surgical management using a previously described round window reinforcement technique. Group 2 had 8 patients (2 children and 6 adults) with CFD who did not have surgical intervention.Interventions: The Dizziness Handicap Inventory (DHI) and Headache Impact Test (HIT-6) were administered pre-operatively and post-operatively. In addition, diagnostic findings of comprehensive audiometry, cervical vestibular evoked myogenic potential (cVEMP) thresholds and electrocochleography (ECoG) were studied. Symptoms before and after surgical intervention were compared.Main outcome measures: Pre-vs. post-operative DHI, HIT-6, and audiometric data were compared statistically. The thresholds and amplitudes for cVEMP in symptomatic ears, ears with cochlea-facial nerve dehiscence and ears without CFD were compared statistically.Results: There was a highly significant improvement in DHI and HIT-6 at pre-vs. post-operative (p < 0.0001 and p < 0.001, respectively). The age range was 12.8-52.9 years at the time of surgery (mean = 24.7 years). There were 6 females and 2 males. All 8 had a history of trauma before the onset of their symptoms. The mean cVEMP threshold was 75 dB nHL (SD 3.8) for the operated ear and 85.7 dB (SD 10.6) for the unoperated ear. In contrast to superior semicircular canal dehiscence, where most ears have abnormal ECoG findings suggestive of endolymphatic hydrops, only 1 of 8 operated CFD ears (1 of 16 ears) had an abnormal ECoG study. Wackym et al. Surgery for Cochlea-Facial Nerve DehiscenceConclusions: Overall there was a marked improvement in DHI, HIT-6 and symptoms post-operatively. Statistically significant reduction in cVEMP thresholds was observed in patients with radiographic evidence of CFD. Surgical management with round window reinforcement in patients with CFD was associated with improved symptoms and outcomes measures.

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Background: Non-headache literature inevitably influences headache research, but the way this interdisciplinary interaction occurs has seldom been evaluated. Objective: Utilizing network analysis techniques within the PubMed Central (PMC) database, we illustrate a novel method by which to identify and characterize the important non-headache literature with significant impact within the headache world. Methods: Using the National Center for Biotechnology Information E-utilities application programing interface and custom backend software, all PMC articles containing the words "headache(s)" and/or "migraine(s)" in the title were identified. This generated a list of "seed articles" to represent the body of primary headache literature. Articles referenced by the seeds were then found, generating the list of articles with one degree of separation from the seeds (first-degree neighbors). This was iterated twice more to find the second-and third-degree neighbors. A directed network graph was generated for each level of separation using these articles and their referential connections. The hyperlink-induced topic search (HITS) and PageRank algorithms were used on these graphs to find the top 50 articles in the network (hub and authority rank via HITS, general rank via PageRank). Removing seed articles from the ranked lists left the influential non-headache articles at each level of separation. Results: We extracted 6890 seed articles. The first-, second-, and third-degree models contained 16,451, 105,496, and 431,748 articles, respectively. As expected, most first-degree neighbors were part of the seed group (headache literature). Using HITS, at the second degree, only two seed articles were found in the top 50 hubs (none in the authorities); the majority of non-seed articles were basic neuroscience, involving ion channel function or cell signaling. At the third degree, there were no seeds and all articles involved imaging/structure of brain connectivity networks. PageRank gave more varied results, with 35/50 second-degree articles being seeds, and the remainder a mixture of articles describing rating scales (3), epidemiology/disease burden (3), basic statistical/trial methods (3), and mixed basic science (6). At the third degree, five were seeds; non-seed articles were represented heavily by genomic mapping studies, brain connectivity networks, and ion channel/neurotransmitter studies. Conclusion: This work demonstrates the value of network citation analysis in the identification of interdisciplinary influences on headache medicine. Articles found with