Objective. The vestibular schwannoma incidence rate is approximately 4.2 per 100,000/year. Thus far, about 700,000 cochlear implantations have been performed worldwide; therefore, the occurrence of vestibular schwannoma postcochlear implantations can be assumed to be infrequent. Recent developments allow safe observation and surveillance of the implanted-side internal auditory canal (IAC) and cochlea by magnetic resonance imaging (MRI), even after cochlear implantation. Patients. A 71-year-old woman with sudden hearing loss and a contralateral vestibular schwannoma without clinical and genetic signs of neurofibromatosis type II. Intervention(s). Ipsilateral cochlear implantation and contralateral vestibular schwannoma extirpation with regular tumor follow-up. Main Outcome Measure(s). Comparison of ipsilateral pre and postcochlear implantation 3T MRI T1 GAD. Results. We observed a tumor growing at the fundus of the internal auditory canal 1 year after cochlear implantation on the ipsilateral side. Although first detected after cochlear implantation beside a known vestibular schwannoma on the contralateral side, a scan slice thickness of 2 mm cannot fully exclude the preoperative persistence of a small tumor. Based on the clinical findings and after genetic exclusion of NFII, the patient was classified as a NFII mosaic type. Conclusion. Even after cochlear implantation, tumors in the IAC causing vertigo, facial palsy, and affecting the audiologic outcome can be detected by MRI. The MRI slice thickness used before cochlear implantation should be under 2 mm.

Introduction: Intracranial aneurysm can be treated by coil emobilsation.This is an effectiv and safe procedure.It is known to produce good clinical outcomes and provide sufficient protection against recurrent bleeding.During coil embolisation complications like rupture of aneurysm, arterial dissection,bleeding and microembolic complications can occur.The dislocation of a coil is a rare complication which occur in 2- 6 % oft he procedures.The dislocated coil can carefully be removed from the aneursym or can be fixed by place the coil back in the aneursym.Case:We present a case of a 61-year-old man with an recurrent undifferentiated epipharynx-carinoma who was represented through the emercency room with unclear nosebleeding.Bleeding was first successfully controlled by insert tamponade.But under sustained bleeding the patient was transfered to a neuroradiolocial departement.An intracranial ruptured aneurysm was detected by magnetic resonance imaging(MRI)and Computed tomography(CT)in the internal carotid artery at the junction of the petrous part to the cavernous part.Endovascular intervention as coiling and endovascular plug embolisation was planned for treatment of this aneurysm.Ten months later the patient described thread material removing of his left nose. It was material of the used coil. A new magnetic resonance imaging(MRI)showed the still correct emobilsation of the internal carotid artery via vascular plug. No intervention was needed.

Content The occurrence rate of vestibular schwannomas is described as 1 per 100.000/y. With at present about 500.000 cochlear implantees the probability of newly occurring vestibular schwannoma after cochlear implantation is low, but not negligible. Usually an MRI is performed as part of the regular preoperativ evaluation setup to exclude this kind of tumor.

Content We investigated the effectiveness of a soft-tissue bulking agent comparing novel approaches of Eustachian tube (ET) augmentation procedures: transpalatinatal Eustachian tube augmentation in local and general anesthesia versus an augmentation with velotraction under general anesthesia. Group (A) transpalatinatal soft-tissue bulking agent with infltration/augmentation under local anesthesia in a sitting position, group (B) transpalatinatal soft-tissue bulking agent infltration/augmentation under general anesthesia in the fat position or group (C) infltration/transoral augmentation of the ET with velotraction under general anesthesia in a fat position. A total of 50 procedures were executed in 50 patients with unilateral PETD. The necessity to perform a second procedure has analyzed a mean of 6 months postoperatively (range: 6–17 months). Compared to the transpalatinatal augmentation in local anesthesia (group A) (100 % success rate (SR)), the 6-month failure rate was significantly higher for transpalatinatal augmentation under general anesthesia (group B) (80 % SR) and velotraction augmentation under general anesthesia (group C) (67 % SR). Patient cohort with transpalatinatal augmentation under general anesthesia required 20 % and augmentation with velotraction under general anesthesia in 33 % revision augmentation procedures reviewed at 6 months follow-up (mean follow-up 11.2 months). The transpalatinatal ET augmentation in local anesthesia achieved a statistically significantly superior results. This improvement may be related to the intraoperative “feedback” by the patients in local anesthesia in the sitting position eliminating the necessity for repeated procedures.

Purpose A new generation of cochlear implant (CI) magnets and specific surgical techniques (e.g., implant positioning) has changed the relationship between a CI and magnet resonance imaging (MRI). MRI allows a pain free in vivo evaluation of the inner ear fluid state and internal auditory canal after the insertion of an electrode. The aim of this study is to evaluate how the patient's head position in the MRI scanner influences the CI magnet-related artefact. Methods We performed in vivo measurement of MRI artefacts at 3 T with a CI system containing a bipolar diametrical magnet. The implant magnet was positioned with a head bandage at different positions from the nasion and external auditory canal in three volunteers. We used a turbo spin echo (TSE) T2w sequence on the axial and coronal planes and observed three positions: (1) regular position, (2) chin to chest (anteflexion), and (3) hyperextension (retroflexion). Results By comparing the positions, anteflexion of the cervical spine in a chin-to-chest position allowed us to place the artefact in a more apical position from the IAC in the coronal plane. The hyperextension of the cervical spine position shifts the artefact father towards the cochlea's direction. Conclusion The head's position can influence the location of MRI artefacts. In cases where the artefact diminished the IAC or cochlea, anteflexion of the cervical spine in the chin-to-chest position of the head in the MRI scanner should be attempted to allow a visualization of the IAC.

Die Wirksamkeit eines Weichgewebe-Füllstoffs wurde im Vergleich eines transnasal-transpalatinatalen chirurgischen Eingriffs mit einem transnasal-transoralen endoskopischen chirurgischen Eingriff in Vollnarkose zur Beseitigung der Symptome einer einseitigen patulösen Eustachischen Tubus-Dysfunktion (PETD) untersucht. Patienten, die an einer PETD litten, wurden einem der folgenden Verfahren unterzogen: i) transnasal-transpalatinatales Weichteilbauschmittel in Lokalanästhesie ii) transnasal-transpalatinatales Weichteilbauschmittel in Vollnarkose oder iii) transnasal-transorales Weichteilbauschmittel in Vollnarkose. Die Notwendigkeit, das Verfahren aufgrund eines erneuten Auftretens von PETD-bezogenen Symptomen zu wiederholen, wurde aufgezeichnet. Eine Erweiterung des proportionalen Cox-Gefährdungsmodells, wurde für die Überlebensanalyse verwendet. Obwohl alle Verfahren mit unterschiedlichen Ansätzen zu einer Verbesserung der Auflösung von PETD-Symptomen führten, war es wahrscheinlicher, dass die transnasal-transpalatinatale ET-Augmentation eine vollständige Auflösung von PETD-bezogenen Symptomen erreichte.

Patienten nach einer AN-Resektion müssen postoperativ über Jahre mittels MRT untersucht werden. Untersuchungsbedingte Artefakte im MRT sind am häufigsten vorzufinden. Da die Cochlea-Implantation ein wichtiger Bestandteil der audiologischen Rehabilitation von Patienten mit AN sein kann, spielt die postoperative Kontrolle mittels MRT eine große Rolle. Neue Studien haben gezeigt, dass die richtige Position des CI eine postoperative artefaktfreie Untersuchung des Inneren Gehörgangs (IGG) und der Cochlea ermöglicht. Das Ziel dieser Studie ist es zu bewerten, ob die Lage der MRT Artefakte vom CI-Magneten abhängig von der Kopfposition des Patienten im MRT ist. Wir haben eine in vivo-Messung von MRT-Artefakten im 3 Tesla durchgeführt. Das Implantat wurde 7,0 cm und 120 ° vom äußeren Gehörgang zum Mittelpunkt des Magneten positioniert. Wir verwenden eine hochauflösende MRT-Sequenz in axialer und koronarer Übersicht und haben 3 Positionen beobachtet: 1 Neutral-Null-Position 2 Kinn auf die Brust und 3 Hyperextension (HE) der Halswirbelsäule.

Patients after An-resection need to be followed-up postoperatively over years by an MRI. MRI scanning in patient with CI is associated with side effects. Scan- related artifacts are known prolems. Since cochlear implantation can be an important part of the audiological rehabilitation of acoustic neuroma patients MRI scanning is of high interest. New studies showed that the right position of the CI receiver allows an postoperative artifact-free examination of the internal auditory canal (IAC) and the cochlea. The aim of this study is to evaluate how the CI magnet related artifact depends on the head position of the patient within the 3T MRI scanner.

Wir berichten über einen 24 Jahre alten Patienten der mit initial sonografisch nicht malignitätsverdächtigem Tumor der Gl. Parotidea rechts vorstellig wurde und mit histologisch gesichertem low grade sekretorischem Karzinom (Synonym: Mamma-analoges sekretorisches Karzinom, MASC) der Parotis entlassen wurde. Es wurde lediglich eine seit 4 Monaten mäßig größenprogrediente unklare Raumforderung bemerkt, welche auf eine orale antibiotische Therapie nicht ansprach. Nach zweimaligem operativem Eingriff konnte der Tumor R0 reseziert werden. In der interdisziplinären Tumorkonferenz wurde bei unklaren Hiliären und mesenterialen Lymphknoten eine Biopsie dieser empfohlen. Hierbei ergaben sich keine pathologischen Befunde. Aufgrund des Tumorstadiums und knapper R0-Resektion ist eine postoperative lokale Radiatio für den Patienten letztendlich vorgesehen worden

We report about a 24-year-old male patient who was diagnosed with an initially sonographically non-malignant tumor of the right Parotid Gland and with histologically confirmed low grade secretory carcinoma (synonym: mammary analogous secretory carcinoma, MASC) of the Parotid Gland. The patient had no pre-existing conditions or a positive history of noxa. The patient did not complain of B-symptoms, facial paralysis or pain. Only an unclear lesion moderately sized for 4 months was noted, which did not respond to oral antibiotic therapy. After two surgical procedures the tumor could be resected R0. In the interdisciplinary tumor conference a biopsy of unclear hilar and mesenteric lymph nodes showed no malignant. There were no pathological findings. Due to the tumor stage and the tight R0-resection, a postoperative local radiotherapy for the patient has finally been provided.