Introduction
: The cochlear implant is the first-choice solution for severe and profound hearing loss. Skull base surgery procedures often require sacrificing the hearing function. An interesting and ...innovative application field for cochlear implants is to restore hearing function after this skull base surgery procedure.
Patients and Methods
: In our department from March, 2009 to January, 2013 16 patients affected by different pathology involving skull base was surgically treated plus cochlear implant insertion (in one single step or in the two stages modalities).
Results
: Overall 16 patients with 6 acoustic cochlear schwannoma, 3 Meniere syndrome, 2 petrous-apex giant cholesteatoma, 2 colesterinic granuloma, 1 facial schwannoma, 1 CPA vascular conflict, 1 glomus jugular tumor. Total 14 of them have hearing benefits from CI, even those cases with controlateral normal hearing or mild hearing loss. One (giant petrous apex cholesteatoma with partial erosion of cochlea apex) and one giant schwannoma had no hearing benefits.
Conclusion
: Those skull-base procedures, where the sacrifice of the auditory function is required represent, in our experience, an interesting application field for cochlear implants.
Intracranial dural arteriovenous fistulas (AVFs) have been recognized as acquired lesions that can behave aggressively depending on the pattern of venous drainage. Based on the type of venous ...drainage, they can be classified as fistulas drained only by venous sinuses, those drained by venous sinuses with retrograde flow in arterialized leptomeningeal veins, and fistulas drained solely by arterialized leptomeningeal veins. Serious symptoms, including hemorrhage and focal deficit, are related to the presence of arterialized leptomeningeal veins. In this paper, the authors report a consecutive series treated between 1988 and 1993 of 20 cases of intracranial dural AVFs with "pure leptomeningeal drainage." All patients underwent surgical interruption of the leptomeningeal draining veins. Based on the arterial supply, nine patients were managed by direct surgery, whereas 11 patients were prepared for surgery by means of preoperative arterial embolization. Radioanatomical cure of the fistula and good neurological recovery were achieved in 18 cases. Complete obliteration of the fistula was documented angiographically in two cases, but fatal hemorrhage occurred, probably due to partial thrombosis of the venous drainage. Based on this experience, the authors believe that surgical interruption of the draining veins is the best treatment option for intracranial dural AVFs. However, surgical results may be affected by the extension of postoperative thrombosis, which in turn may be related to the degree of preoperative venous engorgement.
This paper describes a framework used to develop and run automotive applications both on board of vehicles and in laboratory. It includes the recording system designed and implemented in the GOLD ...framework. The system can record data from different sensors, such as cameras, laserscanners, radars, GPS, IMU, IO boards. The system can easily be expanded adding new device drivers. An in-RAM prerecording functionality is available to let the user record events started in the past. An index file collects essential information on each recorded event, such as timestamp, source identifier, and other sourcespecific data. Different file formats can be used to store data on disks; standard file formats are available for images and audio, small data such as CAN messages or GPS data are recorded directly into the index file. In order to have a faster lookup of a particular scene, the system is also equipped with a user interface that allows to insert tags during the recording. This system has been under development and successfully employed in the last 15 years to acquiring data for several VisLab projects. The description of two case studies is included in this paper. BRAiVE is an advanced prototype used as mobile laboratory to acquire data for different purposes. VIAC is a trip from Parma, Italy, to Shanghai, China, performed to test the robustness of VisLab driving assistance systems; the autonomous driving sessions have been recorded generating a unique database suitable to study and possibly improve the algorithm performance.
The outcome of treatment for a spinal dural arteriovenous fistula is unpredictable. In this study, we reviewed the outcome of patients treated for this condition, in relation to pretreatment ...indicators.
We reviewed the records of 37 consecutive patients treated either surgically or endovascularly in our department between 1989 and 2002.
At follow-up, 78% of the patients reported improvement. Those with motor symptoms had the best outcome: improvement was achieved in more than 60% of the patients, amounting to 1 or 2 points on the Aminoff scale. Sensory disorders improved in 43% of cases, pain in 61%, and sphincter impairment in only 37%. Patients with a fistula in the lower thoracic region did better than those with fistulae in other locations.
The clinical state before treatment is certainly relevant in predicting outcome. Age and duration of the symptoms before treatment have no direct relation to the chances of improvement with treatment, particularly when motor improvement is considered. The modality of onset of symptoms and location of the fistula play significant roles, also: a fistula in the lower thoracic segment was associated with more severe symptoms but tended to improve more (83%, P = 0.04) after treatment. Midthoracic and lumbar fistulae showed a lower incidence of improvement (<50%).
The GDC endovascular approach represent an effective alternative to surgery for treatment of intracranial aneurysms. Anyway no data are available about the impact of endovascular embolization with ...GDC on overall outcome of patients with subarachnoid hemorrhage. We analyse retrospectively a series of 234 patients admitted for ruptured intracranial aneurysm. Results were then compared with results of three surgical series from the literature. The 95.7% of patients underwent aneurysm treatment; 56.4% of patients were classified as good recovery, 12.8% presented moderate disability, 10.3% were severely disabled, 3% were in persistent vegetative state and 17.5% were dead. Patients older than 60 years accounted for 37% of all cases and good outcome in this group accounted for 54.7%. Good results were obtained in 90.1%, 61.7% and 22.8% of patients with Hunt-Hess grade I-II, III and IV-V respectively. Finally good outcome was observed in 82.8% of patients with aneurysms of the posterior circulation. Introduction of GDC embolization in clinical practice contributed to the extension of indication for aneurysm treatment leading to a reduction of overall mortality. GDC utilisation does not affect the overall percentage of patients with good outcome reflecting an increase of severely disabled patients. Endovascular treatment seems an effective theraputic choice in selected grade I-II patients. Results in grade III patients suggest that surgery may be advantageous because of washing and decompression of the basal cisterns while results in grade IV and V patients are unsatisfactory. GDC embolization clearly improves the prognosis of patients with posterior circulation aneurysms and probably is an advantageous theraputic choice in elderly patients.
Aneurysms of the vertebro-basilar junction area have been considered the most difficult to be surgically treated because of their deep location, the proximity of the brain stem and the cranial ...nerves. However, at present, new endovascular techniques and new transbasal surgical approaches offer valuable management strategies. This paper concerns six consecutive patients whom we managed either endovascularly or surgically during a period of eighteen months. Direct surgical treatment was offered to two young patients with relatively small aneurysms in good neurological condition, whereas the other four patients initially underwent an endovascular attempt at aneurysm obliteration using the Guglielmi detachable coil system. Unfortunately, interventional neuroradiology failed in three cases, and surgery had to be re-considered. Accordingly, a total of five patients underwent surgical clipping through the combination of a transmastoid retrolabyrinthine approach with the suboccipital lateral approach. This combination of approaches provided a good control of both vertebral arteries and basilar artery, and allowed the aneurysm to be correctly clipped in all cases. Good long-term results were achieved in all cases but one. Based on this preliminary experience, we would stress the importance of multidisciplinary approach with a treatment calibrated for each single case. Furthermore, if surgery is to be performed, the combination of transmastoid-retrolabyrinthine and suboccipital lateral approaches provides a wide exposure of the whole vertebro-basilar junction area and allows good access to the lesion.
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