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Chapter 24. Tumors of the Temporal Bone

A 54-year-old woman presents with a 3-year history of progressive facial paralysis which has been complete for 18 months. A preoperative CT demonstrates a partially calcified 13-mm lesion centered in the geniculate ganglion abutting the descending basal cochlear turn. Preoperative audiometry shows normal hearing bilaterally. What is the preferred treatment modality for this patient?

A. Continued observation with yearly MRI

B. Subtotal excision with facial nerve preservation as intraoperative supramaximal labyrinthine facial nerve stimulation was absent

C. Middle fossa approach with gross total excision with nerve grafting from labyrinthine to tympanic segment

D. Mastoid approach with gross total excision with nerve grafting from intracanalicular to tympanic facial nerve

Which of the following is correct regarding SDHA related head and neck paragangliomas?

A. Higher incidence in vagal paraganglioma

B. Low risk of pheochromocytoma

C. High risk for multiple head and neck paraganglioma

D. Maternal imprinting

A 50-year-old woman presents with right profound hearing loss and episodic vertigo. MRI demonstrates a heterogeneously enhancing mass centered on the mid portion of the posterior fossa dura adjacent to the posterior semicircular canal. A CT shows irregular bone erosion that involves both the posterior and lateral semicircular canal. What is the best approach for obtaining a gross total excision of the tumor?

A. Retrolabyrinthine transdural approach

B. Middle fossa approach

C. Infratemporal fossa approach with posterior re-routing of the facial nerve and overclosure of the ear canal

D. Translabyrinthine approach

What lesion in the IAC is hyperintense on a T1-weighted MRI without gadolinium contrast?

A. Vestibular schwannoma

B. Lipoma

C. Meningioma

D. Metastasis

What is an audiologic characteristic of a retrocochlear lesion?

A. Rollover

B. Carhart notch

C. Mixed hearing loss

D. Preservation of speech discrimination scores

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