BACKGROUND AND OBJECTIVES: Complete removal of large vestibular schwannomas (VS) poses a significant risk of facial nerve [cranial nerve VII (CNVII)] paralysis. However, less-than-total removal may be associated with an increased risk of regrowth, which could require further treatment with additional risks. The objective was to assess long-term outcomes of postoperative CNVII function in relation to the extent of resection in patients who underwent removal of large VS. METHODS: A multicenter, prospective, nonrandomized cohort study of patients with large VS (≥2.5 cm) who underwent gross total resection (GTR), near-total resection (NTR), or subtotal resection (STR). GTR was defined as no visible remnant, NTR as a remnant <0.5 cm 3 on postoperative MRI, and STR as any larger remnant. CNVII function was evaluated using binary variables: House-Brackmann grades I-II represented excellent-to-good function, whereas House-Brackmann grades III-VI represented fair-to-poor function. RESULTS: A total of 126 patients were included with a mean (SD) follow-up of 60 (±31) months. The mean preoperative tumor diameter was 3.3 ± 0.7 cm. Thirty-five received GTR, 39 received NTR, and 52 received STR based on postoperative MRI. Smaller preoperative tumor size ( P = .03) and volume ( P = .03) were associated with good immediate CNVII function. Neither immediate nor late facial nerve function was related to the extent of resection. STR was associated with a 3-fold higher surgical failure rate compared with GTR ( P = .02), and patients who experienced surgical failure requiring stereotactic radiosurgery or revision surgery had increased odds of fair-to-poor long-term CNVII function (odds ratio 4.6, 95% CI, 1.7-12.5, P = .002). CONCLUSION: The degree of resection did not predict immediate or late good CNVII function. Surgical failure was associated with worse long-term function. GTR or NTR should be attempted whenever feasible to reduce the likelihood of repeat surgery and poor facial nerve outcomes.

BACKGROUND AND OBJECTIVES: Subtotal resection (STR) of large vestibular schwannomas (VS) may achieve better facial nerve outcomes. However, this approach, involving less-than-total tumor removal, may also increase the risk of regrowth. The objective was to examine differences in the regrowth rate based on the extent of resection in patients with large VS. METHODS: A multicenter, prospective, nonrandomized cohort study was conducted on patients with large VS (≥2.5 cm) who underwent gross total resection (GTR), near-total resection (NTR), or STR. GTR was defined as no visible remnant, NTR as a remnant <0.5 cm 3 on postoperative MRI or 5 × 5 × 2 mm during surgery, and STR as any larger remnant. A Cox proportional hazard model assessed the risk of tumor regrowth. RESULTS: Among 126 patients (mean follow-up: 60 ± 31 months; mean tumor diameter: 3.3 ± 0.7 cm), 35 underwent GTR, 39 NTR, and 52 STR. Tumor regrowth occurred in 22 cases (17%). STR patients (27%) had a 3-fold higher regrowth risk compared with GTR patients (8%) ( P = .02). The median regrowth time for STR (24 months) was significantly shorter than for NTR or GTR (48 months, P = .03). A greater residual tumor volume percentage (TV%) was associated with regrowth (hazard ratio 1.73, 95% CI, 1.07-2.81, P = .02). A residual tumor volume of 0.7 cm 3 and a TV% of 12% were identified as optimal cutoff points for predicting regrowth in NTR. CONCLUSION: STR is associated with a significantly higher likelihood of tumor regrowth. The percentage of the residual tumor remnant is positively correlated with the risk of regrowth. A residual tumor volume of 0.7 cm 3 and a TV% of 12% were identified as optimal cutoffs for NTR. When feasible, GTR or NTR should be attempted to minimize the chances of tumor regrowth.

BACKGROUND:Philip Morris International's (PMI) heated tobacco brand IQOS has long been advertised as a fashionable lifestyle product and as a supposedly safer alternative to cigarettes. PMI's new campaign for IQOS, focused on 'Curiosity', was launched in 2024 and is ongoing in 2026. METHODS:The IQOS Curiosity advertising campaign sources included 20 company-controlled, country-specific Instagram accounts, 2 Facebook accounts and 10 'X' (formerly Twitter) accounts and videos from YouTube (14), Vimeo (7), and TikTok (4). RESULTS:The principal brand descriptors were all variations on the central theme of curiosity: Stay Curious, Forever Curious, Curious? and Curious X. Key advertising words included: Discover, innovation, explorations, creativity, inspires and trailblazing. Key campaign slogans included: New experience, new possibilities, open your mind, next adventure, unexpected adventures, your passion, drives confidence and let life surprise you. Social media advertising was supplemented by sponsored events, partnerships with popular media such as Rolling Stone and Vogue, and use of influencers. The campaign consistently portrays IQOS as a highly desirable, novel experience that stimulates adventure seeking, enhances self-confidence, promotes romantic success and helps users unwind. These messages are disseminated primarily through social media platforms that are heavily frequented by youth. CONCLUSIONS:Marketers know that curiosity is at its peak during youth. The IQOS Curiosity campaign appears designed to appeal to impulsive and sensation-seeking youth who are drawn to novel experiences. In its new 'Curiosity' campaign PMI has transitioned its IQOS advertising strategy from one focused on recruiting adults who smoke to differentially targeting youth and young adults.

BACKGROUND AND OBJECTIVES: Management of large vestibular schwannomas (VS) increasingly includes partial resection strategies, yet the impact of extent of resection on perioperative and long-term symptom outcomes remains unclear. This study evaluates how the extent of resection influences perioperative measures, complications, and balance performance. METHODS: A prospective, multicenter cohort study was conducted from 2004 to 2019. A total of 126 patients with VS measuring at least 2.5 cm were enrolled. Perioperative outcomes included operation duration, length of stay, and complications such as cerebrospinal fluid leak, wound infection, and meningitis. Long-term outcomes included headache severity, Dizziness Handicap Inventory scores, and standardized balance testing. Analyses accounted for demographic variables, tumor characteristics, and surgical approach. RESULTS: The mean patient age was 48 ± 14 years, and the mean cerebellopontine angle tumor diameter was 3.3 ± 0.7 cm. Based on postoperative MRI, 35 patients underwent gross total resection, 39 underwent near-total resection, and 52 underwent subtotal resection (STR). Operation duration, length of stay, and overall complication rates did not differ by extent of resection. Younger age was associated with cerebrospinal fluid leak ( P = .024), and meningitis was more frequent after translabyrinthine approach ( P = .03). At 1 year, patients who underwent gross total resection or near-total resection exhibited significant improvement in headache severity ( P = .015 and P = .012), whereas STR patients did not. Residual tumor volume showed a significant positive association with Dizziness Handicap Inventory score at 1 year (r = 0.55, P = .03). STR was also associated with poorer postoperative balance performance. CONCLUSION: The extent of resection did not influence perioperative measures or early complication rates in large VS surgery. However, subtotal resection was associated with persistent headaches, greater dizziness handicap, and worse balance outcomes at 1 year. These findings indicate that partial resection does not confer perioperative benefit and may compromise long-term symptom recovery compared with more complete resection.

Objective To assess magnetic resonance imaging (MRI) safety of stapes prostheses. Data Sources Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched from inception to November 2021 following PRISMA guidelines. Review Methods Studies reporting evidence of stapes prosthesis displacement or interaction in adult or pediatric implant recipients undergoing MRI. Cadaveric, animal, and basic studies with nonhuman data were also included. Results From an initial search of 123 articles, 42 full-text studies were evaluated for eligibility and 19 studies that met the inclusion criteria were included. Motion artifact was reported in a few stainless steel prosthesis types in vitro; however, such displacement was not observed in human cadaver temporal bone studies and had no adverse reported outcomes. A small subgroup of patients in the 1980s received a ferromagnetic stainless steel stapes implant that was recalled and has not been used since 1987. Patients with implants performed in the 1980s should be directed to 1.5T scanners from an abundance of caution. Conclusion Modern (post-1987) stapes prostheses do not pose a risk in vivo when exposed to the magnetic fields of MRI scanners.

Aaron, Ksenia A.; Eltawil, Yasmin; Fernandez-Miranda, Juan Carlos; Jackler, Robert K. Author Information

An article by Moshtaghi et al. appeared in the July 2023 issue of Otology & Neurotology titled "The Effect of Immediate Microsurgical Resection of Vestibular Schwannoma on Hearing Preservation" (1). The authors concluded, "Patients who underwent microsurgical resection within 3 months of diagnosis demonstrated a hearing preservation advantage compared to those who did not," among a group of patients with small vestibular schwannoma (VS) and good hearing. The authors reach the conclusion that immediate surgery (up to 3 months post-initial magnetic resonance imaging) offers a significantly better chance of hearing preservation compared with those who underwent operation an average of 10 months post-diagnosis. The difference in timing of surgery between their comparison groups was a mere 8 months (62 days immediate vs 301 days delayed—a 239 day difference). Given the slow growth kinetic of VS, such a substantial difference in surgical outcome over such a short time frame would not be anticipated. My interest piqued; I decided to examine the study. In so doing, a number of questions arose concerning the study's methods, data analysis, and conclusions. One factor that led to such an unexpected result was that the comparison cohorts might not have been equivalent. As the 70 patients in the immediate treatment group never had an observation period, their tumor growth behavior was unknown. Patients in the delayed surgery group initially chose a period of observation. When they changed their management strategy and decided to undergo surgery, a fraction of study patients were reported to have had interval scans, which showed tumor growth. Evolution of symptoms was also likely to have played a role in patients' decisions to abandon observation in favor of surgery. Hence, the study compared outcomes of small VS of unknown biological behavior with a dissimilar group in which many had proven growth and/or worsening symptoms. In addition, the study did not compare important risk criteria for worse hearing outcomes between the two cohorts, such as internal auditory canal (IAC) fundal involvement, which is an adverse hearing outcome predictor in both surgery and observation (2). The authors opined in their discussion that "We suspect those proceeding with immediate intervention avoid this rapid growth occurring early in the observation period after diagnosis." To the contrary, rapid growth in the initial 8 months postdiagnosis is rare for small VS. Even among growing tumors, it often takes several years of interval scans to discern growth. In their introduction, the authors characterize VS as a progressive disease with a high rate of growth and hearing deterioration. To support this assertion, the authors quote a 2012 article: "During observation, tumors are likely to grow: 70% of patients demonstrate growth within 5 years and 95% with measurable growth within 10 years." (3) However, the article they cite for this uncharacteristically high growth rate offered only an anecdotal opinion, unsupported by data or even reference. By contrast, a 2016 systematic review that compiled data from many studies of VS growth behavior found that 50.1% of followed tumors demonstrated growth at 5 years (4). Numerous studies have identified a lower rate of growth for small tumors compared with larger tumors (5). This implies that reviews encompassing all tumor sizes may overestimate the growth for small tumors. In longer-term follow-up, a 2021 study of 243 followed VSs demonstrated a 5-year growth rate of only 33%, which rose to 42% at 10 years (6). The priority in small VS is not preservation of life but rather optimizing functional outcome. In terms of hearing, after immediate surgery, 40% of operated ears in the study deteriorated from hearing class A/B to class C/D (35% to class D)—effectively converting useful ears into nonuseful in patients with good contralateral hearing. In Table 2, preoperative class A hearing was achieved in 22% of immediate surgery and 20% in delayed surgery. The p value is cited as 0.003, which seems mathematically impossible given their small sample size and minimal difference between the groups. Because only early postoperative audiograms were included, the durability of the early postoperative hearing of the 60% who retained class A/B is uncertain. Although those with preserved A/B hearing after tumor removal may achieve lasting hearing stability, which might have otherwise deteriorated, that surgery entails a sizable risk of immediate hearing loss needs to be an important factor in patient decision-making. The authors' contention that immediate surgery is needed to maximize hearing conservation is debatable. The apt comparison is not immediate surgery versus surgery after a <1 year delay but rather hearing function over time comparing immediate surgery with observation. Among observed VS ears, serviceable hearing is maintained in 94 to 95% after 1 year (7). In a 2022 systematic review of 26 studies on observed VS with initially serviceable hearing, 75% retain it at 3 years, 60% at 5 years, and 40% at 10 years (8). This review included tumors of all sizes, not just small ones as in this study, suggesting that the hearing stability among the study cohort may have been better than the aggregate percentages. The two study groups had maximal diameters of 12.0 and 9.3 mm, respectively. Given that the IAC length is 10 mm, it is clear that all of these tumors were indeed small and most had little or no cerebellopontine angle component. This puts them in the best possible category for hearing preservation surgery. The authors chose to use "maximum linear measurement" rather than more informative criteria such as separately measuring the IAC and cerebellopontine angle components. The Otology & Neurotology instructions for authors have long required inclusion of the American Academy of Otolayrngology-Head & Neck Surgery scattergram as a minimal standard for reporting hearing loss in clinical studies (9). This is needed both to provide a comprehensive data set and to facilitate interstudy comparison. The authors chose to include data only in the 1995 A/B/C/D classification of outcomes in VS. It would be helpful if the authors addended scattergrams characterizing the two cohorts hearing levels before and after surgery and also provided a pre- versus post- comparison. A survey of the contemporary trends in VS management shows that a period of observation is most often recommended for smaller tumors, especially those with good hearing (10). Indeed, in their article, the authors agree that most practitioners today recommend an initial "wait and scan" approach for small tumors. The authors make a valid point that a subset of observed small tumors will show progressive growth and/or hearing deterioration over time, and delayed intervention will have a lower probability of hearing preservation. Nevertheless, their study data fall well short of making a convincing argument that immediate surgery is a more suitable management strategy for patients with small VS and good hearing. Centers managing patients with VS have become increasingly aware that a sizable fraction of patients with small tumors and good hearing never require treatment. Published data support encouraging patients with newly diagnosed small VS and good hearing to consider an initial period of observation, under most circumstances, and only undertake treatment with progressive growth and/or worsening symptoms. Those who eventually come to surgery or radiation may enjoy a considerable period, often years, benefiting from functional hearing in the tumor ear, whereas immediate surgery carries a high risk of immediate loss of function. In their summative comments, the authors opine, "The conclusions that can be drawn from this study and its utility in clinical practice and patient counseling remain unknown at this time." I wholeheartedly agree. Robert K. JacklerStanford University School of MedicineStanford, CA[email protected]

Mammalian inner ear hair cell loss leads to permanent hearing and balance dysfunction. In contrast to the cochlea, vestibular hair cells of the murine utricle have some regenerative capacity. Whether human utricular hair cells regenerate in vivo remains unknown. Here we procured live, mature utricles from organ donors and vestibular schwannoma patients, and present a validated single-cell transcriptomic atlas at unprecedented resolution. We describe markers of 13 sensory and non-sensory cell types, with partial overlap and correlation between transcriptomes of human and mouse hair cells and supporting cells. We further uncover transcriptomes unique to hair cell precursors, which are unexpectedly 14-fold more abundant in vestibular schwannoma utricles, demonstrating the existence of ongoing regeneration in humans. Lastly, supporting cell-to-hair cell trajectory analysis revealed 5 distinct patterns of dynamic gene expression and associated pathways, including Wnt and IGF-1 signaling. Our dataset constitutes a foundational resource, accessible via a web-based interface, serving to advance knowledge of the normal and diseased human inner ear.

This Viewpoint explores tobacco industry–funded continuing medical education and concerns regarding the precedents this funding sets in relation to commercial bias and influence and conflicts of interest.

BACKGROUND:In January 2020, the US Food and Drug Administration prohibited the sale of flavours (except for menthol and tobacco) in prefilled pod devices such as JUUL to decrease youth vaping. Excluded from the prohibition were disposable devices.OBJECTIVES:To determine the scope and scale of flavours marketed by Puff Bar, a leading disposable brand, and related products.METHODS:Disposable e-cigarette flavours were identified via online searches encompassing vendor websites, wholesale distributors, manufacturers (eg, made-in-china.com), and social media channel, Instagram, between June and August 2020.RESULTS:The 'Puff' brand name and iconic cloud logo appear on a variety of products of differing sizes and nicotine e-liquid volumes. Among Puff Bar and its copycats (Puff-a-Likes), 139 flavours were identified. Fruit flavours predominated comprising 82.2% of the flavour varieties (fruit 50%, fruit and menthol/mint 23.6%, and fruity drinks 8.6%). A prevalent new flavour category which combines fruit with menthol/mint (Ice) was offered in 33 varieties such as Lychee Ice, Lush Ice and Banana Ice. Disposable e-cigarette brands are undertaking measures to escape tobacco regulation (eg, non-tobacco-sourced nicotine) and flavour limitations via post-market flavour additions to unflavoured nicotine e-liquid.CONCLUSIONS:The proliferation of flavoured disposable e-cigarette products, many of which are designed to emulate popular pod devices, illustrates that narrowly limited flavour regulations covering only a single category are destined to fail. To be effective in youth protection, flavour regulations need to apply to all recreational nicotine-containing products and need to include measures to counter post-market flavour addition.

Introduction: A recent paper in Annals of Anatomy (The human masseter muscle revisited: First description of its coronoid part) claimed to have discovered a previously unrecognized anatomical component of the deep layer of the masseter muscle. The goal of this study is to emphasize the importance of undertaking comprehensive exploration of the historical literature before asserting primacy of an anatomical discovery.Methods: A search was conducted of historical texts describing the anatomical structure of the masseter muscle, spanning the 18th, 19th, and early 20th centuries. Historical sources were obtained via Google Books, the Internet Archive, and the digital collections of Stanford Lane Library Medical History Center, Paris University Numerical library Medica (France), and the State Library of Bavaria (Germany). Contemporary anatomical studies were identified via PUBMED searchResults: Rather than a "first description" of newly discovered anatomical feature, the paper we comment upon has added important anatomical details of the length, width, thickness, and fiber orientation of coronoid portion of the deep layer of the masseter. As early as the 18th century, anatomists had described the masseter as possessing a three rather than two-layer structure with a deep layer which inserts on the coronoid process.Discussion: Assertions of primacy (ie. "first description") of an anatomical structure in the 21st century necessitates a diligent search of literature, including sources which were published during the era when anatomical studies reigned supreme at the forefront of medical science. Systematic scanning of historical medical material has made older texts widely and freely available and digital translation tools have helped to remove language barriers. It is important to study original articles as secondary citations of historical material are less reliable. Without rigorous historical investigation, assertions of primacy cannot be made with confidence. (c) 2022 Published by Elsevier GmbH.

Otolaryngology–Head and Neck SurgeryVolume 166, Issue 4 p. 652-656 Ethics in Practice When Should Patients Receive Mask Exemptions During the COVID-19 Pandemic? Ethics in Practice: Point-Counterpoint Michael J. Brenner MD, Corresponding Author Michael J. Brenner MD [email protected] Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USAMichael J. Brenner, MD, University of Michigan Medical School, 1500 East Medical Center Drive / 1903 Taubman Center SPC 5312, Ann Arbor, MI 48104, USA Email: [email protected]Search for more papers by this authorIna Roy-Faderman MD, PhD, Ina Roy-Faderman MD, PhD School of History, Philosophy and Religion, Oregon State University, Corvallis, Oregon, USASearch for more papers by this authorSoham Roy MD, Soham Roy MD Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical School at Houston, Children's Memorial Hermann Hospital, Houston, Texas, USASearch for more papers by this authorNosayaba Osazuwa-Peters PhD, MPH, Nosayaba Osazuwa-Peters PhD, MPH Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USASearch for more papers by this authorRobert K. Jackler MD, Robert K. Jackler MD Departments of Otolaryngology–Head and Neck Surgery and Neurosurgery, School of Medicine, Stanford University, Stanford, California, USASearch for more papers by this authorG. Richard Holt MD, MSE, MPH, G. Richard Holt MD, MSE, MPH Department of Otolaryngology–Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USASearch for more papers by this author Michael J. Brenner MD, Corresponding Author Michael J. Brenner MD [email protected] Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USAMichael J. Brenner, MD, University of Michigan Medical School, 1500 East Medical Center Drive / 1903 Taubman Center SPC 5312, Ann Arbor, MI 48104, USA Email: [email protected]Search for more papers by this authorIna Roy-Faderman MD, PhD, Ina Roy-Faderman MD, PhD School of History, Philosophy and Religion, Oregon State University, Corvallis, Oregon, USASearch for more papers by this authorSoham Roy MD, Soham Roy MD Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical School at Houston, Children's Memorial Hermann Hospital, Houston, Texas, USASearch for more papers by this authorNosayaba Osazuwa-Peters PhD, MPH, Nosayaba Osazuwa-Peters PhD, MPH Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USASearch for more papers by this authorRobert K. Jackler MD, Robert K. Jackler MD Departments of Otolaryngology–Head and Neck Surgery and Neurosurgery, School of Medicine, Stanford University, Stanford, California, USASearch for more papers by this authorG. Richard Holt MD, MSE, MPH, G. Richard Holt MD, MSE, MPH Department of Otolaryngology–Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USASearch for more papers by this author First published: 06 July 2021 https://doi.org/10.1177/01945998211031447Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Prather KA, Wang CC, Schooley RT. Reducing transmission of SARS-CoV-2. Science. 2020; 368(6498): 1422–1424. 10.1126/science.abc6197 CASPubMedWeb of Science®Google Scholar 2Chan NC, Li K, Hirsh J. Peripheral oxygen saturation in older persons wearing nonmedical face masks in community settings. JAMA. 2020; 324(22): 2323–2324. 10.1001/jama.2020.21905 CASPubMedWeb of Science®Google Scholar 3Asimakopoulou K, Hoorens V, Speed E, et al. Comparative optimism about infection and recovery from COVID-19: implications for adherence with lockdown advice. Health Expect. 2020; 23(6): 1502–1511. 10.1111/hex.13134 PubMedWeb of Science®Google Scholar 4Rubin R. As their numbers grow, COVID-19 "long haulers" stump experts. JAMA. 2020; 324(14): 1381–1383. 10.1001/jama.2020.17709 CASPubMedWeb of Science®Google Scholar 5Pizzo PA, Spiegel D, Mello MM. When physicians engage in practices that threaten the nation's health. JAMA. 2021; 325(8): 723–724. 10.1001/jama.2021.0122 PubMedWeb of Science®Google Scholar 6 Editors. Dying in a leadership vacuum. N Engl J Med. 2020; 383(15): 1479–1480. 10.1056/NEJMe2029812 Google Scholar 7Arnold C. Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History. St Martin's Publishing Group; 2020. Google Scholar 8Kal EC, Young WR, Ellmers TJ. Face masks, vision, and risk of falls. BMJ. 2020; 371: m4133. 10.1136/bmj.m4133 PubMedGoogle Scholar 9Pfattheicher S, Nockur L, Bohm R, Sassenrath C, Petersen MB. The emotional path to action: empathy promotes physical distancing and wearing of face masks during the COVID-19 pandemic. Psychol Sci. 2020; 31(11): 1363–1373. 10.1177/0956797620964422 PubMedWeb of Science®Google Scholar 10Dorfman D, Raz M. Mask exemptions during the COVID-19 pandemic—a new frontier for clinicians. 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Petroclival meningiomas are extremally challenging lesions due to their deep location and close relation to critical neurovascular structures. Several approaches have been described to achieve gross-total resection with low morbidity and mortality. In this 2-dimensional operative video, the authors show a simultaneous combined transpetrosal approach. The patient is a 44-year-old woman with an 8-month history of gait imbalance with evidence of a giant petroclival meningioma on neuroimaging. She underwent a combined middle fossa approach with anterior petrosectomy and retrosigmoid/retrolabyrinthine approach to achieve gross-total tumor resection. The postoperative course was characterized by trigeminal neuralgia, and neuroimaging showed gross-total resection of the tumor. The video can be found here: https://stream.cadmore.media/r10.3171/2022.1.FOCVID21248.

Background: To better counsel vestibular schwannoma patients, it is necessary to understand the tumor control rates of stereotactic radiosurgery (SRS). Objectives: To determine tumor control rates, factors determining control and complication rates following SRS. Methods: Tertiary hospital retrospective cohort. Results: 579 tumors (576 patients) were treated with SRS. 477 tumors (474 patients, 82%) had ≥1 year follow up and 60% (344) ≥3 years follow up. 88% of tumors had primary SRS and 6.7% salvage SRS. Median follow up time was 4.6 years. At 3 years, the tumor control rate of primary SRS was 89% (258 of 290) in sporadic tumors compared to 43% in Neurofibromatosis type II (3 of 17) (p < 0.01). Our bivariable survival data analysis showed that Neurofibromatosis type II, documented pre-SRS growth, tumor measured by maximum dimension, SRS given as nonprimary treatment increased hazard of failure to control. There was one case of malignancy and another of rapid change following intra-tumoral hemorrhage. For tumors undergoing surgical salvage (25 of 59), 56% had a total or near-total resection, 16% had postoperative CSF leak, with 12% new facial paralysis (House-Brackmann grade VI) and worsening of facial nerve outcomes (House-Brackmann grade worse in 59% at 12 mo). Conclusions: Control of vestibular schwannoma after primary SRS occurs in the large majority. Salvage surgical treatment was notable for higher rates of postoperative complications compared to primary surgery reported in the literature.

Objectives/Hypothesis From the 1970s–1990s the U.S. Smokeless Tobacco Company (USST) conducted aggressive campaigns to solicit college students to buy their smokeless tobacco (ST) products. The scope, scale, methods, and impact of this youth marketing campaign have yet to be analyzed in the academic literature. Study Design Historical research study. Methods Internal industry documents describing the USST campaigns were obtained via the University of California, San Francisco's repository of tobacco company records. Marketing materials were obtained from Stanford University's Research Into the Impact of Tobacco Advertising (SRITA) collection of 657 USST advertisements. Results USST's College Marketing Program (1978–mid 1980s) sponsored events in some 350 campuses and hired student representatives in at least 175 colleges and universities across America. College representatives were trained to provide free samples to fellow students. Over a typical school year approximately a quarter million Happy Days, Skoal, and Skoal Bandits samples were handed out to undergraduates. USST paid their student representatives well and offered them a variety of incentives based upon sales growth. During the 1990s, USST's Skoal Music program engaged students on campuses and at “spring break” venues such as Daytona Beach. Conclusions Targeting of college students on campus was a common tobacco industry practice between the 1940s and early 1960s. From the 1970s through 1990s USST resurrected the method and pursued it with vigor including: distribution of free samples; sponsored events and concerts, branded intramural teams; visits by sports celebrities; logo wearables and merchandise; contests and incentives; and displays and promotions in stores on and surrounding campuses. Laryngoscope , 131:E1860–E1872, 2021

We read with interest the recent paper by Valstar and colleagues, “The tubarial salivary glands: A potential new organ at risk for radiotherapy,” describing what they characterize as a newly discovered salivary gland structure [1]. The paper makes numerous statements of primacy such as: “Previously unnoticed salivary gland structures in the posterior nasopharynx;” and “to our knowledge, this structure did not fit prior anatomical descriptions;”

AbstractObjectivesTwo pilot studies of AR‐42, a pan‐histone deacetylase inhibitor, in human neurofibromatosis type 2 (NF2), vestibular schwannomas (VS), and meningiomas are presented. Primary endpoints included safety, and intra‐tumoral pharmacokinetics (PK) and pharmacodynamics (PD).MethodsPilot 1 is a subset analysis of a phase 1 study of AR‐42 in solid tumors, which included NF2 or sporadic meningiomas. Tumor volumes and treatment‐related adverse events (TRAEs) are reported (NCT01129193).Pilot 2 is a phase 0 surgical study of AR‐42 assessing intra‐tumoral PK and PD. AR‐42 was administered for 3 weeks pre‐operatively. Plasma and tumor drug concentrations and p‐AKT expression were measured (NCT02282917).ResultsPilot 1: Five patients with NF2 and two with sporadic meningiomas experienced a similar incidence of TRAEs to the overall phase I trial. The six evaluable patients had 15 tumors (8 VS, 7 meningiomas). On AR‐42, tumor volume increased in six, remained stable in eight, and decreased in one tumor. The annual percent growth rate decreased in eight, remained stable in three, and increased in four tumors. Pilot 2: Four patients with sporadic VS and one patient with meningioma experienced no grade 3/4 toxicities. Expression of p‐AKT decreased in three of four VS. All tumors had higher AR‐42 concentrations than plasma.ConclusionsAR‐42 is safe. Tumor volumes showed a mixed response, but most slowed growth. On a 40‐mg regimen, drug concentrated in tumors and growth pathways were suppressed in most tumors, suggesting this may be a well‐tolerated and effective dose. A phase 2 study of AR‐42 for NF2‐associated tumors appears warranted.Level of Evidence1b, 4.

Lack of ergonomic training and poor ergonomic habits during the operation leads to musculoskeletal pain and affects the surgeon's life outside of work. The objective of the study was to evaluate the severity of ergonomic hazards in the surgical profession across a wide range of surgical subspecialties. We conducted intraoperative observations using Rapid Entire Body Assessment (REBA) score system to identify ergonomic hazards. Additionally, each of the ten surgical subspecialty departments were sent an optional 14 question survey which evaluated ergonomic practice, environmental infrastructure, and prior ergonomic training or education. A total of 91 surgeons received intraoperative observation and were evaluated on the REBA scale with a minimum score of 0 (low ergonomic risk <3) and a maximum score of 10 (high ergonomic risk 8-10). And a total of 389 surgeons received the survey and 167 (43%) surgeons responded. Of the respondents, 69.7% reported suffering from musculoskeletal pain. Furthermore, 54.9% of the surgeons reported suffering from the highest level of pain when standing during surgery, while only 14.4% experienced pain when sitting. Importantly, 47.7% stated the pain impacted their work, while 59.5% reported pain affecting quality of life outside of work. Only 23.8% of surgeons had any prior ergonomic education. Both our subjective and objective data suggest that pain and disability induced by poor ergonomics are widespread among the surgical community and confirm that surgeons rarely receive ergonomic training. Intraoperative observational findings identified that the majority of observed surgeons displayed poor posture, particularly a poor cervical angle and use of ergonomic setups, both of which increase ergonomic risk hazards. This data supports the need for a comprehensive ergonomic interventional program for the surgical team and offers potential targets for future intervention.