The detection of sound by the inner ear requires a sensitivity to mechanical stimulation on a nanometer scale. To prevent inner ear damage from mechanical overstimulation, the goal of this study is to develop a non-mechanical approach to stapedotomy as treatment for otosclerosis.
As an established middle ear model, lamb temporal bones were acquired from a butcher and the stapes were harvested. A dental decalcifying gel containing phosphoric acid was applied to the stapes suprastructure in order to decalcify and dissolve the stapedial bone. The decalcification capability was modified by addition of phosphoric acid or hydrochloric acid and stapes crura decalcification time was measured to define a dose-response-curve. To stop decalcification, the blue-colored decalcifying gel was rinsed off with normal saline solution. Then, decalcification and damage to the remaining bone was quantified by means of a micro-CT-scan.
The decalcification of the stapes crura and thus, stapedotomy was possible within 3 to 6 minutes. Micro-CT scans demonstrated a localized decalcification at the site of application with a distinct and sharp margin to unexposed sites of the stapes.
As a proof of principle, this study demonstrates that a chemical stapedotomy is possible within minutes. Erroneous application can be salvaged by normal saline irrigation. Micro-CT scans confirmed precise decalcification within distinct margins. Given the accurate and localized decalcification, a future step will be risk assessment of hearing loss from chemical inner ear damage in an in-vivo model.

Introduction: Postoperative outcome for monosyllabic word perception after cochlear implantation (CI) in adult patients with sensorineural hearing loss is known to vary. Aim of this study is to optimize the prediction of the postoperative outcome for patients eligible for cochlear implantation.

Methods: Retrospective analysis of an existing data set of adult CI patients of the ORL department, University Hospital Zurich (N = 660) from 1977 until 2016 were performed. The influence of age, duration of hearing loss, preoperative residual hearing and etiology of hearing loss (congenital vs acute) were investigated to point out differences in postoperative speech comprehension. Speech understanding was examined by monosyllabic word perception scores, preoperative existing residual hearing through pure tone audiogram.

Results: Age did not have a significant influence on postoperative speech understanding in the population studied (p = 0.59). Patients with preoperative residual hearing showed a significantly better performance in the postoperative performed word perception scores (* p = 0.025). A longer duration of hearing loss correlates with a worse postoperative outcome (* p <0.0001). The congenitally deafened patients scores significantly worse in terms of postoperative speech understanding than the acute deafened group (* p <0.0001).

Conclusion: Preoperative residual hearing, shorter duration of deafness and the etiology of hearing loss have a significant positive impact on postoperative speech understanding in CI patients. On the other hand, the results suggest that age in CI implantation has no impact on future speech understanding.

Purpose: Long-term evaluation of the vestibular function of CI-patients implanted during the childhood. Methods: 49 patients aged from 7-34 years (mean=15.89) were included into our retrospective study. CI Implantation was performed on both sides (n=31), right (n=10), left (n=8); in children between the ages of 0.7 to 15.5 years (mean=5). Deafness was congenital (n=37), due to meningitis (n=2), skull fracture (n=1), perinatal CMV infection (n=1), ototoxic drugs (n=1) and unknown etiology (n=7). Vestibular function was measured with a time delay of 3 to 22 years (mean=11) after CI, and including VNG, v-HIT, c-VEMPS. Results: Nine out of patients (18%) were symptomatic. Three patients complained of recurrent transient vertigo episodes at the adult age with either normal vestibular function (n=1), bilateral hyporeflexia (n=1) or unilateral areflexia to the side of delayed endolymphatic hydrops (n=1). Three patients complained of dizziness in darkness with bilateral areflexia (confirmed by calorics/vHT/cVEMP) before CI (meningitis n=1; perinatal CMV n=1; unknown etiology n=1). Dizziness was central in origin after medulloblastoma excision (n=1). Vestibular neuritis with hyporeflexia, contralateral to CI was diagnosed within two patients. Among the 40 asymptomatic patients (82%), vestibular function was normal (n=16), decreased bilaterally (n=4), or unilaterally (n=18), not interpretable results (n=2). Conclusion: This first long-term evaluation in children with CI pointed out that 82% have no vestibular symptoms 3-22 years after CI. Vestibular function depends first of the etiology of the inner ear disease: it is particularly true in case of bilateral vestibular loss.

Object: A functioning vestibular system is important for a child’s development. Vestibular disorders continue to be an overlooked entity in children. This is in part due to the fact that children often cannot describe their symptoms well and in part that doctors are unfamiliar with the diagnostic spectrum and uncomfortable with the examination. An interdisciplinary clinic including Paediatric ENT and Paediatric Neurology, was established in 2014 at our clinic to better evaluate children with vestibular disorders. The aim of this study is to demonstrate the range of paediatric vestibular disorders and the feasibility of the various examinations.

Material and methods: Retrospective Data analysis of children less than 16 years of age examined in the Paediatric ENT department of the Basel university paediatric hospital during 2014-2018. Vestibular exams performed included clinical testing, Video Head Impulse Test, Video Oculography and Caloric Testing.
Results: the main causes of Vertigo in childhood in our clinic are presented and compared to the literature as well as the number and results of the specific vestibular tests. Constraints are discussed.
Conclusions: The most common cause of vertigo in children was vestibular migraine, although several peripheral vestibular disorders were also diagnosed. Testing and diagnosing paediatric vestibular disorders is reliable and will contribute to optimize a child’s motor and cognitive development.

Ziele
Vergleich der Cholesteatom-Klassifikationen ChOLE und EAONO-JOS bezüglich der Praktikabilität im klinischen Alltag sowie deren prognostischen Wert für Rezidive und Hörgewinn.

Material und Methoden
100 konsekutive, am Luzerner Kantonsspital vom selben Operateur operierte Primärfälle von Cholesteatomen im Zeitraum 2010 bis 2015 wurden retrospektiv sowohl nach ChOLE wie auch nach EAONO-JOS klassifiziert. Das Operationsspektrum umfasste reine Kanalplastiken sowie geschlossene und offene Techniken. Unterschiede der zwei Klassifikationssysteme wurden analysiert. Die unterschiedlichen Stadien sowie weitere spezifische, in den jeweiligen Klassifikationen implementierte Faktoren wurden mit verschiedenen Endpunkten (Rezidiv und Gehörverbesserung) korreliert.

Resultate
41% zeigten unterschiedliche Stadieneinteilungen, 95% davon ein höheres Stadium in der EAONO-JOS- verglichen mit der ChOLE-Klassifikation. Bei geringer Rezidivrate von 5% konnte kein Zusammenhang mit den Cholesteatom-Stadien oder weiteren Faktoren berechnet werden. Während bei Stadium I für beide Einteilungen ein postoperativer ABG < 20dB in 73%, bei Stadium II in 38% (ChOLE) und 53% (EAONO-JOS) resultierte, kann der wirkliche Erfolg einer Ossikuloplastik nur in der ChOLE Einteilung analysiert werden. Bei 13 Patienten mit intakter Ossikelkette war der durchschnittliche postoperative ABG 11dB, bei 35 Patienten nach Inkusinterposition 20dB mit 65% innerhalb 0-20 dB.

Schlussfolgerungen
Die ChOLE-Klassifikation ist in ihrer Anwendung aufwändiger als die EAONO-JOS-Klassifikation, erbringt jedoch für spezifische Fragestellungen, insbesondere für die Gehörrehabilitation, einen relevanten Mehrwert.

Ziele

This Multi Centre study is performed in order to evaluate foreign language acquisition at school in cochlear implant patients in the German speaking part of Switzerland.

Material und Methoden

In October 2016, 125 CI patients (10-18 years) were registered in the national CI Database. CI non-users and mentally retarded patients were excluded. Additional data (type of schooling, for-eign language learning and bilingualism) were obtained with questionnaires: 100 returned ques-tionnaires were available for analysis: 48 CI users were in mainstream. German-speaking children with foreign language tuition (English and/or French) in mainstream were enrolled for further test-ing (n=31). The normal-hearing control group consisted of matched-pairs.

Resultate

Based on the returned questionnaires, 88 CI users (88%) had foreign language tuition. The others were all in special schools. CI users with foreign language education had better German speech comprehension (89% vs. 51%; p < 0.05). In 6th grade, all 10 CI students had reached the school norms in English reading and listening. For French, 3 out of 7 CI students (44%) reached the school norm for French reading and one (14%) in French listening. The normal hearing group had higher scores (83.6 vs. 76.4%) which was statistical significant for English reading.

Schlussfolgerungen

Almost 90% of our CI children attain foreign language tuition. Overall, most of the tested patients reached the current school norm for English reading and listening, whereas the French school norms appeared to be more difficult to reach.

Aim: In a prospective, randomized and single blinded study, application of tomographic neurofeedback in treatment of chronic tinnitus in comparison to standard neurofeedback protocols were analyzed.

Methods and Material: A total of 52 patients suffering from chronic tinnitus were included in the study and randomly assigned to the two different study groups. Before and after (1, 3 and 6 months) neurofeedback treatment, EEG-measurements and questionnaire scores were assessed. Each patient received 15 neurofeedback trainings with either tomographic, sLORETA based, or standard protocols to increase alpha activity and decrease delta power.

Results: Preliminary results indicate that tomographic neurofeedback approaches resulted in improvements of subjective tinnitus symptoms measured by standard tinnitus questionnaires for the majority of patients. However, not all participants equally benefited from neurofeedback training. Resting-state EEG analysis will be analyzed regarding individual behavioral and neurophysiological pattern changes to identify responders and non-responders.

Conclusions: Tomographic neurofeedback protocols as a treatment of chronic tinnitus showed improvements in subjective tinnitus symptoms as well as changes in neurophysiological patterns in EEG-recordings.

Konventionelle zentralvenöse Hämodialysekatheter sind infektanfällig (1.65–5.5/1000 Kathetertage). Ausgehend von der bekannten Komplikationsarmut perkutaner Knochenleitungshörgeräte wurde in Bern ein neuartiger Gefässzugang für die Hämodialyse entwickelt, der knochenverankert hinter dem Ohr implantiert wird (bone anchored port = BAP). Ziel ist die Infektvermeidung durch komplett subkutane Katheterführung und Immobilisierung des Anschlusses. Bisher wurde in Rahmen einer klinischen Studie bei 4 dialysepflichtigen Patienten ein BAP implantiert. Einschlusskriterium ist die Kontraindikation für eine arteriovenöse (A/V) Fistel und einen konventionellen Hämodialysekatheter. Beobachtet werden Komplikationen, Katheterinfektionen, Verträglichkeit und Funktion. Die bisherigen Implantationen waren komplikationslos. Postoperativ hatten 2 Patienten kutane Wundheilungsstörungen, welche in einem Fall konservativ, im anderen Fall mit einmaliger Wundrevision beherrscht wurden. Die Patienten tolerieren das Implantat sehr gut, Manipulationen sind schmerzfrei. Eine Dialyse ist früh postoperativ möglich. Anschluss und Durchführung der Dialyse erfolgen reibungslos. Beim ersten Implantat musste bei Undichtigkeit das Innenventil gewechselt werden, was komplikationslos ohne Anästhesie möglich war. Bisher trat keine Katheterinfektion auf. Mit dem neu entwickelten BAP scheint es möglich, Katheterinfektionen zu vermeiden. Der BAP kann somit Patienten, welche nicht über eine A/V-Fistel dialysiert werden können, eine sichere Alternative zu cervicalen oder subclaviculären Kathetern bieten. Das System könnte dank seiner einfachen Handhabung neue Perspektiven für die dezentrale oder Heim-Dialyse eröffnen.

Objectif: Explorer la possibilité d’évoquer des réponses posturales contrôlées en utilisant la stimulation électrique chez un patient porteur d’un implant vestibulaire (IV) prototype.
Méthode: Une patiente de 69 ans avec déficit vestibulaire bilatéral équipée d’un IV comprenant 3 électrodes implantées dans chaque ampoule (oreille gauche). Les réponses posturales ont été évaluées à l’aide du test d’Unterberger, d’une durée de 20 secondes, effectué : 1) sans stimulation électrique et 2) avec stimulation électrique (série d’impulsions balancées en charge, biphasiques, 200µs/phase, 400 impulsions-par-seconde) à différentes intensités de courant modulées autour d’une stimulations électrique de base constante. Les réponses posturales ont été enregistrées avec un système de capture de mouvement (Caméra : Oqus7+, Qualisys AB, Göteborg, Sweden).
Résultats: Sans stimulation électrique, la rotation du tronc était de 3.6±3.6° (sens horaire) à la fin du test d’Unterberger. Une corrélation négative significative a été mise en évidence entre l’amplitude du courant électrique et l’amplitude de rotation du tronc (Pearson product-moment correlation r=-0.92, n=14, p < 0.0001). Avec l’intensité de stimulation maximale, l’amplitude de rotation était de -8.33±10.8°. Avec l’intensité de stimulation minimale, l’amplitude de rotation était de 31.6±5.8°. La déviation linéaire du tronc (distance et direction) était peu significative et variable, sans corrélation avec la stimulation électrique.
Conclusions: Le contrôle postural peut être modulé avec une stimulation électrique délivrée aux branches ampullaires du nerf vestibulaire. L’IV pourrait permettre d’améliorer le contrôle postural.

INTRODUCTION
Vertigo and dizziness are amongst the most frequent reasons for patients to seek medical advice, but many of these patients still remain undiagnosed. We investigated the spectrum of vertigo and dizziness in a tertiary ENT emergency department (ED).

METHODS
We screened all ED reports from 2013 for adult patients and included all patients with vertigo or dizziness referred to the ENT department. Frequency of diagnoses, symptoms and clinical findings have been assessed.

RESULTS
In total, we found 2885 cases with reported vertigo or dizziness in the ED as a chief complaint. 286 of 2885 cases were referred to the ENT-specialist. Benign paroxysmal positional vertigo (BPPV) was the most frequent diagnosis in our study (n=46, 16.1%), followed by vestibular neuritis (n=44, 15.4%), otitis media (n= 20, 7%) and 9 patients (3.1%) with a stroke or a TIA. 70 (24.5%) cases had dizziness not further specified. Considering all ED patients with BPPV (101 from 2885), 31 reported headache as a secondary symptom. Only 14 out of 101 patients had a positional nystagmus.

CONCLUSIONS
BPPV is the most frequent diagnosis seen in the ED, however, ED physicians need to document nystagmus accurately and to perform diagnostic maneuvers systematically in order to make an accurate diagnosis. BPPV was frequently associated with headache. Stroke or TIA was diagnosed in 9 patients, who were initially referred to the ENT. ED physicians and ENT specialists need to look out for central signs in patients with an acute vestibular syndrome, in order to avoid any misdiagnosis. Every 4th patient did not receive a final diagnosis. Diagnostic ED work-up for dizzy patients needs further improvement.

Objective: Thyroplasty Type I (TP I) is a standard procedure for unilateral vocal fold paralysis (UVFP). In some cases, the paralysed VF is lowered due to an anteromedially rocked arytenoid cartilage. Aim of the study was to analyse the functional effect of the Montgomery implant on the arytenoid cartilage during TP I.
Methods/design: 15 patients with a UVFP as a result of a deep vagus lesion underwent TP I surgery. Pre- and postoperatively, laryngoscopy and a HRCT scan of the larynx were performed. After rendering the DICOM data from HRCT scans, a 3D-Visualisation of the laryngeal cartilage was possible by MIMICS®. The length of the vocal fold (anterior commissure – vocal process) was calculated pre- and postoperatively.
Results: All laryngeal cartilages could be visualised three dimensionally. Depending on the size of the implant, two movements of the arytenoid could be observed: (1) a push back movement on the shoulder of the cricoidal joint facet; (2) a medial rotation of the vocal process. As a result, the vocal fold got elongated and elevated. The paralysed vocal fold could be elongated from 17.6mm (range: 11.8mm – 23.0mm) to 21.1mm (range: 15.1mm – 27.0mm). That corresponds to a significant elongation of 20.6%. Interestingly, also the non-paralysed contralateral vocal fold showed a significant elongation by an average of 0.2mm.
Conclusions: Depending on the Montgomery implant size, it is possible to reach (1) a medialisation and (2) a significant elongation of the vocal fold. Therefore, a preoperative CT-Scan may help in order to evaluate the correct implant size

Aim:
After cochlear implant (CI) surgery some patients experience vertigo, dizziness and/or deficits in vestibulo-ocular reflexes. Therefore we analysed balance control before and after cochlear implant surgery in order to provide recommendations for preoperative counselling.

Methods:
We measured the balance control of 30 CI patients (mean age 59 SD 15.4 years), prior to and 2 months after CI surgery. Trunk sway was measured during 14 different stance and gait tests.

Results:
Across all 30 patients the difference of in balance control was not significant. However significant changes were observed, when we defined sub-groups. Patients younger than 60 years of age had a significant worsening of a so called “balance control index” (BCI) after CI surgery (p=0.008). Also patients with a normal BCI preoperatively (p=0.005) showed a significant worse BCI after CI surgery. Further analysis showed that the differences occured during gait tasks but not during stance tasks. Patients over 60 years or with a pathological BCI pre-operatively showed improved tandem walking post-operatively (p=0.0235).

Conclusion:
Across all patients CI surgery has a minor effect on balance control 2 months postoperatively. In contrast to our study hypothesis, we recommend to focussing preoperative counselling concerning worsening of balance control due to CI surgery on candidates younger than 60 years and candidates who have normal balance control preoperatively. This study underlines the importance of measuring balance control prior to CI surgery.

Aim:
Smell loss due to chronic rhinosinusitis with (CRS+P) or without polyps (CRS-P) is the most frequent type of smell disorder. This is due to congestion preventing odorants from reaching the olfactory cleft and inflammation damaging the olfactory neuroepithelium. Medical management is the preferred treatment option. However, endoscopic sinus surgery is considered when medication treatments fail. Previous studies evaluated olfactory function before and after surgery but without distinguishing between CRS+P and CRS-P, although the two conditions may behave differently. We decided to evaluate olfactory function in CRS+P and CRS-P before and after surgery independently.
Method:
We included 212 patients suffering from CRS+P (n=92) or CRS-P (n=120) who underwent endoscopic sinus surgery. Olfactory thresholds for n-butanol were measured before and 3 months after surgery with the Sniffin’Sticks test battery.
Results:
Mean olfactory threshold was 7.45±0.24 points for CRS-P and 5.32±0.36 points for CRS+P (P < 0.001) preoperatively. There was significant improvement in both groups postoperatively (8.02+0.23; P=0.003 for CRS-P and 6.64+0.35; P < 0.0001 for CRS+P). The improvement rate was 58% and 52% in CRS-P and CRS+P patients, respectively.
Conclusion:
These results suggest that CRS+P has a more detrimental effect on olfactory thresholds than CRS-P. In over 50% of the patients in both groups, surgery does improve olfactory thresholds. However, olfactory threshold remains unchanged or becomes even worsen in more than one third of the patients. This confirms previous work that it is difficult to predict and guarantee olfactory improvement after endoscopic sinus surgery.

Objective: Olfactory deficits precede neurodegenerative diseases such as M. Alzheimer and M. Parkinson. It is still unclear whether there is a correlation between hearing loss, olfactory dysfunction and impaired cognitive abilities, which was the subject of this study. Methods: One hundred subjects (age: 18 to 55 years) participated in this study. Fifty subjects (mean age: 37.9 y ± 1.6 y) had a normal symmetric hearing threshold (HT) tested by pure tone audiogram using pure tone average (PTA). Fifty subjects (mean age: 39.6 y ± 1.7 y) had an uni- or bilateral hearing loss (mean pure tone threshold right: 51.7 dB PTA5, left 55.7 dB PTA5). Olfactory function and cognitive function were tested by using a lateralized Sniffin´ Sticks test examining threshold (T), discrimination (D) and identification (I) and DemTect (dementia detection test, score: 0-18). Results: Subjects with hearing loss exhibited a composite TDI score on both sides being significantly worse than subjects with normal hearing (TDI right: 26.2 vs 30.8, p= < 0.001; left: 28.6 vs. 31.5, p= 0.005). Hearing impaired subjects also scored significantly worse in DemTect (14.9 vs 16.9, p= < 0.001). HT on the right side correlated significantly with discrimination (D) tests results, on the left side with discrimination on the left side only. These correlations remained significant when controlling for DemTect test results. Conclusion: We were able to show a correlation between sensorineural hearing loss, olfactory impairment and mild cognitive deficit. Thus, olfactory dysfunction and cognitive impairment in hearing impaired subjects might express a general sensorineural decline.

Aim: The aim of the present study was to investigate whether repetitive aversive odor conditioning induces changes at the level of the peripheral olfactory system in humans.
Material and Methods: A total of 51 volunteers participated. A pair of indistinguishable odor enantiomers [(+)-rose oxide and (−)-rose oxide] were used as stimuli. During pre and post conditioning, participants’ ability to discriminate between the two odors was assessed using a discrimination task. Further, electro-olfactograms (EOG) from the olfactory epithelium were recorded. Participants underwent three conditioning sessions on consecutive days. The experimental group received an electrical stimulus to the forearm only following (+)-rose oxide presentation, but not after (−)-rose oxide exposition.
Results: After conditioning, the experimental group was able to discriminate the odor enantiomers [(+)-rose oxide and (−)-rose oxide]. Further, a significant difference in the peripheral electrophysiological responses between the conditioned and the unconditioned stimulus demonstrated contextually-induced changes at the level of the first neuron in the olfactory system.
Conclusions: For the first time in humans, we were able to demonstrate peripheral plasticity in the human olfactory system in response to repetitive olfactory conditioning.

Objective: We have previously shown the impact of nasal obstruction is associated with depressed mood in patients with chronic rhinosinusitis (CRS). Here, we sought to validate this finding by determining whether improvement in nasal obstruction would translate to improvement in depressed mood. Materials and methods: This was a prospective observational study of 150 patients undergoing medical management for CRS. Data were collected at two time points: enrollment and a subsequent follow up visit 3 to 12 months later. Impact of nasal obstruction was measured using the Nasal Obstruction Symptom Evaluation (NOSE) instrument and depressed mood was measured using the 2-item Patient Health Questionnaire (PHQ-2). Sinonasal symptoms associated with CRS were also measured using the 22-item Sinonasal Outcomes Test.Clinical and demographic characteristics were collected. The relationship between changes in PHQ-2 and NOSE scores were determined with correlation and linear regression. Results: Change in PHQ-2 score was significantly correlated with change in NOSE score (ρ = 0.30, 95%CI: 0.15 – 0.44, p < 0.001).After controlling for covariates, change in PHQ-2 score was associated with change in NOSE score (adjusted linear regression coefficient [β]=0.01, 95%CI: 0.01 – 0.02, p < 0.001). We confirmed these relationships, finding that change in PHQ-2 was correlated (ρ = 0.20, 95%CI: 0.04 – 0.35, p=0.015) and associated (adjusted β=0.04, 95%CI: 0.01 – 0.06, p=0.004) with change in the nasal subdomain score of the SNOT-22. Conclusion: These results provide evidence that changes in nasal manifestations/symptoms of CRS directly translate to significant improvements in mood

Ziele: Die chronische Rhinosinusitis mit Polypen wird mittels Glukokortikoidtherapie behandelt. Aus vorhergehenden Arbeiten konnte eine Dysfunktion der Tight junctions in dieser Erkrankung gezeigt werden, wodurch es zu einer Erhöhung der Permeabilität des Epithels kommt. Primäres Ziel war es, den Einfluss von gängigen Glukokortikoiden und eines Antihistaminikums auf die Dichtigkeit des nasalen Epithels in vitro zu messen.

Material und Methoden: Polypoide Schleimhaut wurde 11 Patienten entnommen, in einem Zellkultur-Labor kultiviert und folgend für die Messungen in Air-liquid-interfaces transferiert. Die Dichtigkeit des Epithels wurde vor und nach Zugabe von Fluticason propionat, Mometason furoat und Azelastin hydrochlorid gemessen. Die Ergebnisse wurden mit einer unbehandelten Kontrollgruppe verglichen.

Resultate: In allen Zellkulturen, aus welchen sich 53 Air-liquid-interfaces ergaben, konnten nach Zugabe der Substanzen verwertbare Resultate ermittelt werden. Die Messungen ergaben eine signifikante Erhöhung der Dichtigkeit innerhalb von 24 und 48 Stunden nach Zugabe von Fluticason propionat. Ebenso konnte 24h nach Zugabe von Mometason furoat eine signifikante Erhöhung gezeigt werden. Azelastin hydrochlorid zeigte eine Tendenz zur Erhöhung ohne Signifikanz. Die Kontrollgruppe repräsentierte einen Durchschnittswert, der lediglich 1.9% vom Ausgangswert abwich.

Schlussfolgerungen: Unsere Resultate zeigen erstmalig, dass die geschädigte epitheliale Barriere in chronischer Rhinosinusitis mit Polypen mittels gängigen Glukokortikoiden verbessert und die Permeabilität gemindert werden kann. So scheint deren Wirkung über eine reine Entzündungshemmung hinauszugehen.

Ziel:
Verletzungen der Arteria carotis interna sind häufig fatale Komplikationen in der Hypophysenchirurgie (TSS). Bei Entfernung von Hypophysenadenomen ändert sich der inter-carotidale (ICD) Abstand im chirurgischen Korridor, was untersucht werden soll.
Methodik:
Bei 85 Hypophysenpatienten wurden die MRI-Bilder von prä-, intra- und 3 Monate postoperativ auf ihre ICD im C4- Segment horizontal und vertical (ICDC4h, ICDC4v) im C6-Segment (ICDC6) gemessen und verglichen, wozu jeweils immer das gleiche 3-T-MRI, auch intraoperativ (iMRI), verwendet wurde.
Resultate:
Die ICD reduzierte sich in allen 3 Messungen der ACI um -3% (median: ICDC4h: -0.5 mm, ICDC4v: -0.7 mm ICDC6: -0.4 mm). Im MRI 3 Monate postop. reduzierte sich die ICD nochmals um -4%, -2% bzw. -4% (median ICDC4h: -0.7, ICDC4v: -0.4 mm, ICDC6: -0.5 mm). Die postoperative Verkleinerung des ICD war unabhängig davon, ob nach dem 3T-iMRI nachreseziert wurde. Die ICD-Änderung korrelierte in den verschiedenen Ebenen der ACI was auf einen uniformen perioperativen shift hinweist. Die präoperative ICD ist statistisch signifikant grösser als die intraoperative in den Segmenten ICD4v und ICD6.
Konklusion:
Mit dieser Untersuchung können wir eine uniforme Verengung des ICD in verschiedenen Ebenen während und nach TSS beweisen, weswegen sich der Chirurge dieser Verschmälerung des chirurgischen Korridors bei der Operation bewusst sein muss