Pogodzinski, Matthew S.

A decrease in cerebrospinal fluid pressure may result in an endolymphatic hydrops through a patent cochlear aqueduct or through the fundus of the internal auditory canal. This hydrops typically leads to low-frequency sensorineural hearing loss. We describe the case of a man who presented with a subjective and objective hearing loss in addition to a headache 4 days after he had undergone a dural puncture. We treated him with a standard epidural blood patch. Immediately after treatment, his hearing improved and his headache resolved.

OBJECTIVESThere are options available to patients newly diagnosed with vestibular schwannoma. Our institution employs stereotactic radiosurgery, microsurgical removal, and watchful waiting. There are no studies in the literature examining which of these treatment options patients are choosing.STUDY DESIGN AND SETTINGUsing retrospective chart review from January 2000 through December 2001, we noted several variables and patients’ initial treatment choices.RESULTSDuring the 24‐month study period, 139 patients were seen at our institution with a new diagnosis of vestibular schwannoma and made a clear initial treatment choice. Of these, 32 (23%) patients elected watchful waiting; 51 (36%) underwent stereotactic radiosurgery, and 56 (40%) underwent surgical removal. Surgical excision correlated with younger age and larger tumor size.CONCLUSIONSOur initial hypothesis, that patients choosing treatment would choose stereotactic radiosurgery more than 50% of the time, was untrue for the time course studied.SIGNIFICANCEThis is the first study to examine patient choice in treatment of vestibular schwannoma.