Surgery of the ear and deafness
CSOM: Chronic Suppurative Otitis Media
This disease is manifested by a perforation of the tympanic membrane of various sizes, with chronic secretion of mucopus especially in the early stages of exacerbation.
CSOM may also involve damage to the ossicular chain, especially in cases of long lasting disease and consequent deafness.
The disease affects both ichildren and adults. The perforation of the tympanic membrane maintains the state of “chronicity” of the disease over time and leads to progressively higher stages of functional impairment, in addition to the fact that it represents in itself an outbreak of chronic infection never off permanently.
The surgical therapy is the first line treatment and consists in closing the perforation with autologous material, ie from the same patient (fascia, cartilage).
The surgery at our Unit runs in a Day Surgery (an overnight stay) under local anesthesia for adults (unless contraindicated) and general for children.
The patient is discharged the day after surgery and performs the first postoperative control after about a month.
The results of surgery are brilliant both in childhood (operations are performed on children as young as 3 years) than in adults with a success rate of more than 90%.
Chronic otitis with cholesteatoma is an insidious disease that must necessarily be treated with microsurgery.
The definition of “skin in the wrong place” is the simplest as the colestetaoma behaves as an epidermic cystic formation that progressively erodes the bony structures of the middle ear and mastoid, with destruction of one or more elements of the ossicular chain, purulent discharge from the external auditory meatus and conductive hearing loss.
Surgery is the treatment suggested and Tympanoplasty in one or two stages the golden standard. The Tympanoplasty is performed under general anesthesia in a Day Surgery regimen. I our series the recurrence rate of the disease at 10 yers follw-up is 9%.
TPL Aperta Obliterativa – Timpanoplastica
TPL Aperta – Timpanoplastica
TPL Aperta – Timpanoplastica
Otosclerosis is a familial hereditary genetic disease which manifests with progressive conductive hearing loss and tinnitus. In the majority of cases the disease affects both ears. In 5% of cases otosclerosis is an unilateral disease.
The disease is characterized by conductive hearing loss and tinnitus. The diagnosis is basically instrumental and achieved by tonal and vocal audiogram and study of the stapedial reflex.
The otosclerosis has 4 stages going from stage 1 disease with moderate deafness and normal cochlear function up to stage 4 with profound deafness and severe cochlear function compromised. Surgery is the treatment of choice because, despite it is not curing the disease, is the only one able to allow an almost complete recovery of hearing loss.
Stapedotomy is performed under local anesthesia, with microdrill or diode laser depending on the cases.
The patient is treated in a Day Surgery regimen. The first postoperative control is after 8 days. The first audiometric test to verify the hearing recovery is performed one month after surgery.
In the personal series of more than 1500 cases the success rate is about 90%. Revision surgery was performed in approximately 5 cases / year.
Prof.Dott.Giovanni Danesi ospite a “Sabato e Domenica” rai1
Stapedotomia Laser – Otosclerosi
Stapedotomia dx con facciale procidente
Stapedotomia sx con arteria stapediale persistente
Stapedotomia in otosclerosi obliterativa
Ossicular chain reconstruction
The cochlear implant or bionic ear is a state-of-the-art solution to restore hearing to those affected by profound deafness.
Profound deafness is not treatable with conventional hearing aids, which are unable to give satisfying auditory perception to the subject.
Therefore it is necessary to face the problem with advanced technology which by-passes the diseased auditory organ (choclea) and allows a direct stimulation of the acoustic nerve and transmitting digitally elaborated sounds to the auditory areas of the brain.
The Cochlear Implant Centre of Bergamo is a Terziary centre for the chomprensive management of the profound deafness.
We are able to face the problem of profound deafness from neonatal screening, to the diagnosis and genetic profiling up to surgical therapy with cochlear implant. Furthermore we have a Speech Rehabilitation Unit for the postoperative rehab training.
Our Centre implants 25 Choclear Implants a year at a highest standard of efficiency.
Surgery is carried out under general anesthesia and takes around 30 minutes. The patient is discharged the next day and the implant is activated after one month. 200 implants were made to date.
Skull base surgery
The VIII cranial nerve acoustic schwannoma or neuroma i s a benign tumor that arises from the vestibular component of the eighth nerve or auditory nerve.
The incidence of acoustic neuroma is 1 case/200.000 inhabitants. The classic symptoms are unilateral tinnitus and a persistent unilateral sensorineural hearing loss. There are also cases in which the hearing, despite the presence of a small neuroma, is perfectly efficient and preserved.
About 2% of acoustic schwannomas may occur at the onset with a sudden deafness.
This kind of sporadic or unilateral neuroma can be treated with different approaches: wait and see with serial MRIs , microsurgery or stereotactic radiotherapy. The Counseling provides the patient to be informed exaustively about the options available in the management of this benign tumor.
At our center, Giovanni Danesi, specialist of acoustic schwannoma treatment, performs the surgery by the translabyrinthine approach in most of the cases, except for those who wish to attempt an hearing preservation surgery. In this case the pathology is approached by a retrosigmoid route with direct monitoring of the acoustic nerve. The postoperative hospital stay varies from 5 to 7 days. To date 450 cases were operated personally. Contact us for more information about the most innovative techniques to practice the acoustic schwannoma surgery.
Neurinoma Via translabirintica 1
Neurinoma Via translabirintica 2
Via retrosigmoidea Neurinoma Acustico Conservazione dell’udito
Il meningioma della fossa cranica posteriore e la sua estensione sopratentoriale, è una lesione benigna nella maggioranza dei casi.
I meningiomi hanno la caratteristica di coinvolgere vasi e nervi cranici con atteggiamento invasivo, avvolgendoli e rendendone complessa a volte la loro dissezione in modo da preservarne la struttura.
L’intervento per meningioma prevede una notevole variabilità negli approcci e nelle strategie terapeutiche. Noi previlegiamo le vie di accesso Transpetrose, variamente combinate tra loro.
I principali vantaggi di esse stanno nella possibilità di: 1. avere una ampia via di accesso con agevole corridoio chirurgico;
2. consentire al chirurgo di effettuare un lavoro con posizione laterale ai nervi cranici e non tra essi;
3. avere uno spazio adeguato ottenuto a spese dell’osso e non creato a spese di pesanti e prolungate retrazioni di cervello e cervelletto;
4. notevole diminuzione delle complicanze e quindi possibilità di raggiungere una asportazione radicale senza lasciare residui della patologia.
In caso di estensione della lesione del meningioma a livello sopratentoriale, la sezione del tentorio per via laterale consente l’accesso alle zone della cisterna interpenducolare e al mesencefalo senza retrazioni del lobo temporale e un controllo adeguato dei vasi della circolazione cerebrale posteriore. Inoltre la combinazione di queste vie di accesso permette una varietà di soluzioni atte a controllare queste lesioni in modo ottimale.
La strategie terapeutica nel trattamento dei meningiomi viene condivisa con il paziente nella fase di informazione e counseling, ove vengono descritte tutte le possibili alternative atte a preservare le principali funzioni neurologiche.
Meningioma Petroclivale via Transcocleare
Meningioma fossa cranica posteriore.
Meningioma fossa cranica posteriore.
Right temporal meningioma.
Middle cranial fossa approach.
Combined Retrolabyrinthine Sub temporal Transtentorial approach.
Posterior fossa meningioma.
Translabyrinthine transapical approach.
Paragangliomas of the temporal bone are vascular benign tumours that arise from the paraganglia dislocated in differentpartsof the body.
Temporal bone Paragangliomas are classifiedaccording to Fisch in 3 classes:
CLASS A: Tympanic paragangliomas, located in the tympanic cavity;
CLASS B: Located in the tympanic cavity with secondary invasion of the attic and the mastoid;
CLASS C: is the most important for diagnostic and therapeutic implications and is divided into the sub-groups C1-C2-C3-C4 according to the degree of invasion of the neurovascular structures of the temporal bone and, in particular, the internal carotid artery.
CLASS D: is generally associated to class C and identifies the tumour component with intracranial extradural (De) or intradural (Di) localization. While for type A and B paragangliomas the therapy is surgery, for those of class C the therapeutical implications must be evaluated attentively with the patient in order to carry out the best therapy with the lowest incidence of complications.
In the Operative Unit ORL a special protocol is implemented for type C paragangliomas which is shared with the patient in the Counselling phase in order to identify the specific treatment most suited for the best maintenance of life quality. Our treatment protocol is shown next in the presentation.
Video Paraganglioma Tipo A
Chordoma and Chondrosarcoma
Round Table: Cordomi
Temporal bone Squamous cell. Carcinoma
Temporal bone Cholesteatoma
Colesteatoma della rocca sovralabirintico. Via Transpetrosa.
Colesteatoma della Rocca. Via Translabirintica.
Epidermoide apice petroso. Via Infratemporale tipo B.
Lower cranial nerves Schwannoma
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Neurinoma nervo facciale dx ricostruzione con innesto neurale.
Granuloma colesterinico apice petroso.
Fossa cranica media.
Petrous apex Cholesterol Granuloma.
Combined Retrolabyrinthine Subtemporal approach.