Sequential computerized tomography (CT) allows us to determine the growth rate of acoustic neuromas. Prior to CT scanning, a variability in tumor growth rates was recognized on the basis of clinical signs. After incomplete tumor removal, some patients experienced rapid recurrence, whereas others lived many years without recurrence. We used CT scanning to study tumor growth rates in a heterogeneous group of 21patients. Thirteen elderly patients were given annual scans after incomplete tumor removal, while eight patients who had not had surgery are likewise being followed up. Early detection and complete tumor removal with preservation of hearing and facial function remain the goal in vigorous and healthy patients. However, a large number of older, infirm patients with acoustic neuromas may not require surgery or be candidates for incomplete tumor removal. Because rapid tumor growth may necessitate total tumor removal even in older patients, a better understanding of the growth rates may permit us to take a more scientific approach in planning these patient's management.

OSTIOMEATAL COMPLEX RISK FACTORS FOR SUNUSITIS: CT EVALUATION

Abstract: The ostiomeatal complex was prospectively evaluated in 100 consecutive patients referred for CT scanning. The degree of nasal septal angulation, uncinate process deviation (U-VS angle), infundibular and middle meatus opacification were correlated with maxillary and ethmoid sinus opacification. Patients with more severe nasal septal deviation and more horizontally-oriented uncinate processes had a higher frequency of sinus opacification. However, the differences between patients with and without CT evidence of sinus disease were very small (1.7^o to 3.4^o). Infundibular opacificaion most accurately predicted maxillary (76%) and middle meatus opacification most accurately predicted ethmoid sinus disease (78%). There is a small but statistically significant decrease in U-VS angulation and increase in nasal septal deviation in patients with sinusitus. However, the value of performing these measurements is limited. The evaluation of the degree of nasal septal deviation and unicate process angulation will be most useful in preoperative planning.

THE RETROLABRYINTHINE TRANSSIGMOID APPROACH TO MIDBASILAR ARTERY ANEURYSMS

One of the more challenging problems in surgery of the petroclival area are aneurysms of the midbasilar trunk and vertebrobasilar artery junction. Aneurysms in this area are difficult to access. Most approaches result in a deep and narrow surgical field which includes retraction of the cerebellum for the temporal lobe. Aneurysm surgery not only requires access to the aneurysm but also requires a wide enough exposure to manipulate and place a clip on the the neck of the aneurysm.

POSTERIOR FOSSA VESTIBULAR NEURECTOMY: 14 YEARS EXPERIENCE

When medical management of patients with Meniere's disease fails, selective vestibular nerve section is the procedure of choice if hearing is to be preserved. The operation is effective in relieving vertigo attacks caused by Meniere's disease while preserving hearing in 90% of the patients. A recent review of the literature suggests that increasing emphasis is being placed on hearing preservation in surgery for vertigo and that more neurotologic surgeons are using the vestibular nerve section through the posterior fossa as their procedure of choice to cure vertigo caused by inner ear diseases. In this paper we review 191 of posterior fossa vestibular neurectomies performed at the Florida Ear and Sinus Center. We analyze the advantages and disadvantages of each technique with emphasis on vertigo occur rates and postoperative hearing results.