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D.A. Moffat, S.E.M. Jones, S. Mahendran, R. Humphriss, D.M. Baguley. Referral patterns in vestibular schwannomas-10 years on. Clin Otolaryngol 2005; 29: 515-517 Diagnostic imaging techniques, symptom awareness and education of local sources of referral in vestibular schwannomas, including general practitioners, have all improved in the last 10 years. The referral patterns in vestibular schwannomas in Cambridgeshire in the period 1981-1993 has been reported. A direct comparison was made with regard to referral patterns seen in the last 10 years paying particular emphasis to source of referral, diagnosis at referral and symptoms/size at presentation. The incidence of vestibular schwannomas in the region is compared and discussed. Patients' managed by the ‘watch and wait’ policy were particularly scrutinized, as they were not discussed previously. Retrospective analysis of computerized database was used. We have demonstrated an increase in the proportion of referrals with known vestibular schwannoma to 90% of all referrals. No significant change in length of history prior to referral, source of referral or principal presenting symptom were found. An overall decrease in tumour size was found but an increase in the percentage with larger tumours (>4.5 cm). We attribute the significant findings to an increase in availability of magnetic resonance (MR) scanners in the country during the past 10 years. It appears that some tumours would still present with no symptoms until late and therefore will elude identification until large in spite of a low threshold for MR scanning. D. Sandooram, E.A. Grunfeld, C. Mckinney, M.J. Gleeson. Quality of life following microsurgery, radiosurgery, and conservative management for unilateral vestibular schwannoma. Clin Otolaryngol 2004; 29: 621-627 The best way to manage small and medium-sized vestibular schwannomas is currently a matter of heated debate. As these tumours are not immediately life-threatening, patients are invariably concerned about how management would affect their quality of life. Until now, no study has compared the three treatment modalities in terms of physical, psychological and social well being. This study is based on a retrospective database analysis and postal questionnaire survey of unilateral vestibular schwannoma patients who had either been managed conservatively, or treated with microsurgery or radiosurgery. The results showed that: quality of life (measured by the Glasgow Benefit Inventory) deteriorated after microsurgery, particularly for small tumours; conservative management did not lead to a change in quality of life, and there was a trend towards poorer quality of life following radiosurgery. The findings suggest that a conservative management approach may be more appropriate for small tumours, and that patients who are due to undergo microsurgery or radiosurgery may benefit from counselling about the potential impact of treatment on quality of life. Seth J. Kanowitz, William H. Shapiro, John G. Golfinos, Noel L. Cohen, J. Thomas Roland, Jr. Auditory brainstem implantation in patients with neurofibromatosis type 2. Laryngoscope 2004; 114: 2135-2146 Objectives: Multichannel auditory brainstem implants (ABI) are currently indicated for patients with neurofibromatosis type II (NF2) and schwannomas involving the internal auditory canal (IAC) or cerebellopontine angle (CPA), regard-less of hearing loss (HL). The implant is usually placed in the lateral recess of the fourth ventricle at the time of tumor resection to stimulate the cochlear nucleus. This study aims to review the surgical and audiologic outcomes in 18 patients implanted by our Skull Base Surgery Team from 1994 through 2003. Study Design: A retrospective chart review of 18 patients with ABIs. Methods: We evaluated demographic data including age at implantation, number of tumor resections before implantation, tumor size, surgical approach, and postoperative surgical complications. The ABI auditory results at 1 year were then evaluated for number of functioning electrodes and channels, hours per day of use, nonauditory side effect profile and hearing results. Audiologic data including Monosyllable, Spondee, Trochee test (MTS) Word and Stress scores, Northwestern University Children's Perception of Speech (NU-CHIPS), and auditory sensitivity are reported. Results: No surgical complications caused by ABI implantation were revealed. A probe for lateral recess and cochlear nucleus localization was helpful in several patients. A range of auditory performance is reported, and two patients had no auditory perceptions. Electrode paddle migration occurred in two patients. Patient education and encouragement is very important to obtain maximum benefit. Conclusions: ABIs are safe, do not increase surgical morbidity, and allow most patients to experience improved communication as well as access to environmental sounds. Nonauditory side effects can be minimized by selecting proper stimulation patterns. The ABI continues to be an emerging field for hearing rehabilitation in patients who are deafened by NF2. David R. White, Robert E. Sonnenburg, Matthew G. Ewend, Brent A. Senior. Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach. Laryngoscope 2004; 114: 1945-1948 Introduction: Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic,...

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