Perinatal toxicology of Ruta chalepensis (Rutaceae) in mice

Dried leaf infusions of Ruta chalepensis L. (Rutaceae), 'rue', 'ruda', were found to cause perinatal changes in mice, at daily doses of 0.16, 0.80 and 1.60 g/kg, administered p.o. from 1 to 14 days post coitum. Significant decreases in the appearance time of physical signs, righting reflex and cliff avoidance together with minus scores in string test and swimming ability were observed. Moreover, histological studies showed progressive angiogenic development on placenta blood supply and weakness at blood barrier in brain, thymus and pery-lymph vestibule. We found out that the results tend to confirm the embryotoxic effect of the plant and its harmful use.

[Surgical management of cerebral metastases]

Surgical treatment of metastatic brain tumors had been controversial until two prospective randomized trials demonstrated that surgery followed by radiation is superior to radiation alone in patients with single metastasis. In this report, we reviewed current perspectives on the neurosurgical treatment of brain metastasis. The goals of surgery is to establish a histologic diagnosis, relieve symptoms and provide local cure through gross total resection. The results which established surgery as the preferred treatment for single brain metastasis were largely a result of advances in neurosurgical techniques of localization and neuroimaging, microdissection, and functional mapping. These modern methods have reduced the operative mortality to 3% and the morbidity to less than 10%. The indications of surgical treatment should be related to clinical and radiological criteria. Surgical treatment is best indicated for single and accessible metastasis and is also accepted for patients with multiple lesions especially when there is a life-threatening lesion or when two lesions are accessible through the same craniotomy or for recurrent brain metastasis. Surgery can also be a good option for recurrent metastasis. Altogether, surgery improves quality of life and the median survival time, all the more as pronostic factors are present such as age>60 years, long interval between diagnosis of the primary tumor and the metastasis, the absence of systemic disease and a Karnofsky score> 70.

Ca(2+)-independent phospholipase A2 is required for alpha2-adrenergic-induced preadipocyte spreading

In the present study, we studied the involvement of A2 phospholipases (PLA2) in alpha2-adrenergic receptor-control of preadipocyte actin cytoskeleton. For that, various PLA2 inhibitors were tested on the ability of the selective alpha2-adrenergic agonist UK14304 to induce the spreading in alpha2AF2 preadipocytes. We observed that, whereas several Ca(2+)-dependent PLA2 blockers were ineffective, the Ca(2+)-independent phospholipase A2 (iPLA2) inhibitor, broenolactone (BEL), specifically blocked alpha2-adrenergic-dependent preadipocyte spreading without affecting the spreading activity of lysophosphatidic acid (LPA) or serum. BEL inhibition was completely restored by lysophosphatidic acid, but not by arachidonic acid or other fatty acids. The presence of the lysophospholipase (phospholipase B) suppressed the effect of LPA on preadipocyte spreading, but had no influence on alpha2-adrenergic-induced spreading. Thus, the extracellular production of LPA or fatty acids is not involved in iPLA2-dependent preadipocyte spreading. iPLA2 protein was found in preadipocytes but, conversely to cPLA2, did not exhibit any modification of its electrophoretic mobility after alpha2-adrenergic stimulation. We concluded that iPLA2 is involved in alpha2-adrenergic control of preadipocyte actin cytoskeleton.

[Radiotherapy using a combination of photons and protons for locally aggressive intracranial tumors. Preliminary results of protocol CPO 94-C1]

PURPOSE

From October 1993 through July 1998, 48 assessable adult patients with non-resectable aggressive intracranial tumors were treated by a combination of high dose photon + proton therapy at the Centre de Protonthérapie d'Orsay.

PATIENTS AND METHODS

Grade 1 and 4 gliomas were excluded. Patients benefited from a 3D dose calculation based on high-definition CT and MRI, a stereotactic positioning using implanted fiducial markers and a thermoplastic mask. Mean tumor dose ranged between 63 and 67 Gy delivered in five weekly sessions of 1.8 Gy in most patients, according to the histological types (doses in Co Gy Equivalent, with a mean proton-RBE of 1.1).

RESULTS

With a median 18-month follow-up (range: four-58 months), local control in tumors located in the envelopes and in the skull base was 97% (33/34), and in parenchymal tumors, 43% (6/14) only. Two patients (5%) presented with a clinically severe radiation-induced necrosis (temporal lobe and chiasm).

CONCLUSION

In our experience, high-dose radiation combining photons and protons is a safe and highly efficient procedure in selected malignancies of the skull base and envelopes.

IL-13 induces serine phosphorylation of cPLA2 in mouse peritoneal macrophages leading to arachidonic acid and PGE2 production and blocks the zymosan-induced serine phosphorylation of cPLA2 and eicosanoid production

In a recent investigation, we demonstrated that long-term treatment of macrophages with IL-13 enhances cPLA2 expression and modulates zymosan-stimulated AA mobilization. In the present study, we examine the ability of IL-13 to modify the cPLA2 activity and the AA mobilization of macrophages after a short-period of treatment. We demonstrate that in resting macrophages, IL-13 induces, through a MAP kinase-dependent process, (1) an increase of free AA release within 15 min, followed by increased PGE2 production and (2) a time-dependent serine phosphorylation of cPLA2. Conversely, in macrophages stimulated by zymosan, IL-13 added 30 min before zymosan inhibited the AA release and the serine phosphorylation of cPLA2 induced by the phagocytic agonist. In conclusion, these findings show for the first time that a Th2-type cytokine can upregulate cPLA2 activity and downregulate zymosan-induced AA metabolism. Thus, establishment of the connection between these two events may help to understand the complex regulatory role of IL-13 on the macrophage AA metabolism.

Occupational asthma in a grain worker due to Lepidoglyphus destructor, assessed by bronchial provocation test and induced sputum

BACKGROUND

Occupational asthma (OA) can be a debilitating disease even when removal from the workplace is achieved. Today, the "gold standard" in the assessment of OA is the bronchial provocation test (BPT). Induced sputum is a non-invasive method of exploring airway inflammation which can provide additional information about such challenges and thus could be applied in OA diagnosis and monitoring.

METHODS

We report the study carried out in a grain worker sensitized to Lepidoglyphus destructor (Ld), who suffered from mild asthma at the workplace. Skin prick test and specific serum IgE were measured. Ld-BPT was performed, and the changes in eosinophil rates, and ECP and tryptase levels in induced sputum were studied 30 min and 18 h after Ld-BPT. We also determined the changes in nonspecific bronchial hyperresponsiveness (NSBH), given as PD20 values. To assess the specificity of the changes, we also carried out sputum induction and methacholine challenge after barley-BPT.

RESULTS

An isolated immediate response was obtained with Ld-BPT, while barley-BPT was negative. Induced sputum showed higher tryptase levels 30 min after Ld-BPT, and higher eosinophil and epithelial cell percentages and ECP levels 18 h after Ld-BPT. There was also a decrease in methacholine PD20 values after Ld-BPT. Those changes were not observed after barley-BPT.

CONCLUSIONS

The study of eosinophilic and mast-cell markers in induced sputum provides additional knowledge about the inflammatory process occurring in the airways, suggesting that the study of induced sputum should be considered in the assessment of OA.

Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils

PURPOSE

To evaluate the stability of aneurysm occlusion at follow-up angiography after endovascular treatment (EVT) with detachable coils in intracranial berry aneurysms.

MATERIALS AND METHODS

A total of 203 berry aneurysms (< 1.5 cm) were treated with EVT. Follow-up angiography at least 3 months later was performed in 169 cases.

RESULTS

Complete occlusion of the aneurysm sac and neck was achieved in 148 aneurysms, subtotal occlusion in 18, and incomplete occlusion in three. Recurrence occurred between 3 and 40 months in 20 (14%) of the 148 totally occluded aneurysms. A second treatment was performed in five cases, was scheduled in one, and failed in one. The small neck remnant increased in size but did not require any retreatment in three cases, and the size of the neck remnant remained stable in 10 cases. Remnant regrowth occurred in six of the 18 subtotally occluded aneurysms. A second treatment was performed in three. Of the 169 cases, last follow-up angiography showed total occlusion in 133 cases, subtotal in 30, and incomplete in six. No rebleeding occurred.

CONCLUSION

A very small recurrence may be observed at the level of the neck of the aneurysm at long-term follow-up angiography despite achieving total occlusion initially with detachable coils.

Conservative treatment for girls with nonmetastatic rhabdomyosarcoma of the genital tract: A report from the Study Committee of the International Society of Pediatric Oncology

PURPOSE

To report the results of a conservative multimodal approach in girls with nonmetastatic rhabdomyosarcoma (RMS) of the genital tract, treated in International Society of Pediatric Oncology (SIOP) Malignant Mesenchymal Tumors 84 and 89 protocols.

PATIENTS AND METHODS

From 1984 to 1994, 38 girls with RMS of the genital tract (vulva, vagina, uterus) were treated in SIOP protocols. With the exception of patients with rare small tumors, which were resected at the start of the studies, all patients received initial chemotherapy (CHT) (ifosfamide, vincristine, and actinomycin D). Local treatment including surgery, brachytherapy (BT), and external-beam radiotherapy (ERT) was given only to girls who did not achieve complete remission (CR) with CHT or who subsequently relapsed.

RESULTS

The primary tumor originated in the vulva or vagina in 27 girls and in the uterus in 11. The overall survival rate (+/- SE) was 91% +/- 6% at 5 years, and the event-free survival rate was 78% +/- 7%. At a median follow-up of 5 years, 30 girls were alive and in first CR and five were alive and in second CR. Four patients treated with complete resection of the tumor at diagnosis received less CHT. Thirteen patients were treated with CHT alone. In 17 patients, local treatment was necessary to achieve complete local control, for a residual mass after initial CHT (10 patients), for viable tumor on biopsy (three patients), or for local relapse (four patients). The local treatment used was radiotherapy (RT) (ERT in three patients, BT in seven), radical surgery with uterine ablation (three patients), RT and radical surgery (three patients), and conservative surgery with RT (one patient).

CONCLUSION

Girls with nonmetastatic RMS of the genital tract have an excellent prognosis. We found no difference in outcome between uterine and vulvovaginal RMS. Local treatment does not seem necessary in patients who have a complete response to CHT. When a local treatment is needed, BT may be an alternative to radical surgery or ERT.

[Intracranial abscess and empyema: neurosurgical management]

Brain abscesses and empyemas are severe infections with lethal outcomes in the case of inappropriate treatment. The files of 34 patients with brain abscesses, and nine with intracranial empyemas treated over eight years (1990-1997) were analyzed retrospectively. Cases were evaluated for treatment and compared with data from the literature. Patients with brain abscess underwent either aspiration of the lesion through a burr hole (79.5% of the cases), or craniotomy and excision (8.8% of the cases); 11.7% were treated only with antibiotics. The operative mortality was 2.9% and the outcome was satisfactory in 85% of patients. These results are in agreement with data from the literature. Prognosis is strongly related to the initial clinical status. Current methods of treatment include surgical aspiration of large abscesses with a mass effect, and are usually associated with a poor clinical status. Excision is suggested whenever aspiration procedures have failed, or in the presence of foreign material or fungal abscess. Medical treatment is indicated for small and deeply located abscesses in patients with satisfactory clinical states. Empyemas in our series were treated with burr hole and pus aspiration. The mortality rate was 11%, and 62.5% of the patients made a good recovery. In agreement with other reported studies, the method of treating subdural empyema is much less significant than an aggressive early drainage of the infection. Although brain abscesses and empyema remain a significant neurosurgical concern, aggressive treatment can result in an excellent outcome in the majority of patients.

Treatment of distal aneurysms of the cerebellar arteries by intraaneurysmal injection of glue

Distal aneurysms of the cerebellar arteries are associated with a poor prognosis, as surgery or embolization with GDCs is very difficult. We report our experience with a new therapeutic method involving intraaneurysmal injection of glue. Three aneurysms were catheterized with a flow-guided microcatheter, and glue was slowly injected into the aneurysms. In two cases, treatment resulted in total occlusion of the aneurysm with preservation of the parent artery. In one case, the aim was to occlude both the aneurysm and parent artery.

Interest of pelvic and paraaortic lymphadenectomy in patients with stage IB and II cervical carcinoma

OBJECTIVES

The objectives of this study were to evaluate the interest and the potential therapeutic value of systematic pelvic and paraaortic lymphadenectomy in patients with stage Ib and II cervical carcinoma.

METHODS

This was a prospective study including 421 patients with cervical cancer treated, from 1985 to 1994, by combined radiation therapy and surgery with systematic pelvic and paraaortic lymphadenectomy.

RESULTS

The overall rate of pelvic lymph-node involvement was 26% (106 patients), and the rate of paraaortic metastases was 8% (32 patients). Pelvic nodal involvement was unilateral in 14% (59 patients) and bilateral in 11% (47 patients). Macroscopic positive nodes were found in 12% (52 patients). In a univariate analysis, a young age (<30 years), a tumor size >/=4 cm, stage II disease, and nodal involvement were associated with significantly decreased survival. The nodal status and the characteristics of positive nodes (number and location) were the most significant prognostic factors. In the multivariate analysis, age, the tumor size, and the site of nodal involvement (pelvic or paraaortic) were prognostic factors. Three-year survival was 94% for patients with negative nodes compared to 64% for patients with positive pelvic nodes and 35% for patients with positive paraaortic nodes (P < 0.0001).

CONCLUSION

These results confirm the diagnostic and prognostic value of systematic complete lymphadenectomy when planning adjuvant treatment and the therapeutic value of complete removal of bulky positive nodes.

Apoptosis in carcinoma of the bladder: relation with radiation treatment results

PURPOSE

Radiotherapy is widely used in the treatment of bladder cancer. The search for biological parameters that could select patients who will respond to radiation treatment has become essential. The aim of this study is to assess whether the pretreatment apoptotic index is useful in predicting local control and survival in a group of bladder cancer patients treated by radiotherapy.

METHODS AND MATERIALS

Fifty-five patients with invasive bladder carcinoma treated between 1983 and 1996 were included in this study. Radiotherapy was given to a median dose of 66 Gy, mean 63.28 Gy, in 1.8-2 Gy daily fractions. Apoptotic cells were studied in hematoxylin-eosin slides. Clinicopathological tumor characteristics were studied in relation to the apoptotic index, and as prognostic factors for local control and survival in both univariate and multivariate analysis.

RESULTS

Pretreatment apoptotic indexes were related to tumor stage, mitotic index, and Ki67 proliferation index. Five-year actuarial local control for the whole group was 45%. Patients with tumors showing low pretreatment apoptotic indexes had better local control (p < 0.037) and survival (p < 0.01) than highly apoptotic tumors. Tumor stage (T2 vs. T3-4) and the pretreatment apoptotic index were significant predictive factors for local control and survival in multivariate analysis.

CONCLUSIONS

The pretreatment apoptotic index is useful in predicting the clinical outcome of bladder cancer patients treated by radiotherapy. Assessment of biological tumor characteristics could allow the selection of patients for different treatment strategies.

[Assessment of risks associated with multiple events]

Our aim, when evaluating many events, is to assess overall survival S(t) but also event free survival EFS(t). In addition, we often wish to estimate the respective contribution of each event involved in event free survival and to describe the distribution of the time of occurrence of each event by breaking down EFS into its different components. However, these different events are often dependent and/or exclusive. Appropriate statistic tools, named competing risk analyses are then required. The aim of this article is to define situations necessitating competing risk analyses as opposed to more simple alternatives which, although often used, are not always appropriate. First two examples are presented to illustrate the problems we face when studying many events. Statistical methods used to compute competing risks are then developed, as is the type of interpretation that can be given to these results.

Serum cholecystokinin and neurotensin during follow-up of pancreas, prostate and medullary thyroid tumors

BACKGROUND

Growth of pancreatic carcinoma cells is stimulated by cholecystokinin (CCK) and neurotensin (NT). Prostatic carcinoma cells can secrete neurotensin. The CCK gene has been described in thyroid medullary carcinomas (MCT).

METHODS

Serum CCK and NT were measured by RIAs during monitoring of 19 pancreas tumours, 10 prostate adenocarcinomas and 10 thyroid medullary cancers (MCT).

RESULTS

No correlations were found between CCK and NT in the three tumour types, nor with CA 19.9, PSA, CEA or calcitonin. In pancreas adenocarcinomas (n = 12), initial median CCK was > 8pg/ml (non significant differences between stages T, N or M). Median NT was > 80 pg/ml in all but M0 and stage I-II cases, and significantly higher in M1 and stages IV (P = 0.002). Non significant differences were found for CCK and NT according to clinical stages. In prostate cancers, median CCK was significantly more elevated after relapse (P = 0.040). Median NT was significantly more elevated in disease-free patients (P = 0.04). In MCT, CCK and NT were not related to clinical stages.

CONCLUSION

In pancreas and prostate cancers serum CCK may follow tumour load and disease progression. NT was lower in progressive disease. The contribution of these peptides in human tumour growth, since they may have therapeutic implication, warrants further investigation.

Prognostic factors for survival in patients with brain metastases from renal cell carcinoma

BACKGROUND

Patients presenting with brain metastases from renal cell carcinoma portend a poor prognosis, with a reported median survival of 4-6 months. Given their short life expectancy, these patients generally have been excluded from clinical trials that assess the efficacy of medical treatments. However, clinical impression suggests that some patients may achieve long term palliation.

METHODS

The clinical features of 68 patients who were treated at the Institut Gustave Roussy for brain metastases from renal cell carcinoma were collected retrospectively. Using univariate and multivariate analyses, a prognostic model based on independent prognostic factors was established. An external data set of 57 patients was used to validate the model.

RESULTS

The median survival was 7 months. On univariate analysis survival was related significantly to the following adverse prognostic factors: no initial nephrectomy, left side and temporal location of brain metastases, presence of fever or weight loss, erythrocyte sedimentation rate > 50 mm/h, and time from initial diagnosis to brain metastases < or = 18 months. Multivariate analyses identified the previous variable as well as the presence of other visceral metastases as independent prognostic factors. Forty-four patients (65%) with no or 1 adverse prognostic factor (average risk group) had a median survival of 8 months and a 26% 1-year survival rate. Twenty-four patients (35%) with 2 adverse prognostic factors (poor risk group) had a median survival of 3 months and a 1-year survival rate of 9%. This model proved to be discriminant in an external data set; the median survival of patients assigned to the average risk group was 11 months (46% 1-year survival rate) compared with 4 months (9% 1-year survival rate) for patients assigned to the poor risk group.

CONCLUSIONS

Patients presenting with brain metastases from renal cell carcinoma and poor risk prognostic factors are highly unlikely to benefit from medical treatments except symptomatic procedures. Conversely, the enrollment of patients with average risk prognostic factors into clinical trials dealing with chemotherapy or immunotherapy may be considered.

[Management of intracanalicular acoustic neurinoma]

Between 1991 and 1996, 35 patients had an intracanalicular tumor: 26 patients were operated via middle cranial fossa approach (MFA: 23 cases) or translabyrinthine approach (TL: 3 cases), 9 cases were supervised by audiovestibular testing and MRI. For the operated patients through MFA the functional hearing (pure tone loss < 50 dB and 100% vocal discrimination) was preserved in 47.8% of cases, facial function was grade I and II in 83% of cases and grade III in 17% of cases. One recurrence was noted and reoperated by TL. For the TL operated patients, the postoperative facial function was normal (grade I) in all cases. Among the 9 supervised cases for reasons of age (more than 60 years), or the tumoral size (< than 5 mm): the tumor in 3 cases did not increase in size, 5 cases increased by 1 mm/year and 1 case increased 1 cm/year (and must be operated). These results show the importance of the middle cranial fossa approach for excision of intracanalicular neuromas and supervising patients with the same tumor according to age, and tumoral size.

The role of Ki67 proliferation assessment in predicting local control in bladder cancer patients treated by radical radiation therapy

PURPOSE

To assess whether tumour proliferation as measured by Ki67 immunostaining has any predictive value for local control in bladder cancer patients treated by radiotherapy.

PATIENTS AND METHODS

Fifty-five patients suffering from infiltrating bladder carcinoma recommended for radical radiotherapy (66 Gy/6-7 weeks) were included in this study. Paraffin-embedded pre-treatment tumour sections were stained with the Ki67 antibody. The percentage of Ki67-positive nuclei was correlated with established prognostic factors, local control and survival.

RESULTS

The Ki67 index was not related to local control in our patients when the median was selected as the cut-off value. Patients with tumours with a very low (<27%) Ki67 index had better local control at 5 years (69%) than patients with tumours with greater (>27%) Ki67 expression indices (31.5%) (P<0.05; log-rank test).

CONCLUSIONS

Ki67 immunostaining was a feasible method to estimate tumour proliferation. Patients with very low proliferating tumours seemed to achieve better local control after fractionated radiotherapy compared to other patients. Further studies are needed with a greater number of patients to accurately define the role of Ki67 expression in predicting tumour repopulation during fractionated radiotherapy.

A phoneme effect in visual word recognition

In alphabetic writing systems like English or French, many words are composed of more letters than phonemes (e.g. BEACH is composed of five letters and three phonemes, i.e./biJ/). This is due to the presence of higher order graphemes, that is, groups of letters that map into a single phoneme (e.g. EA and CH in BEACH map into the single phonemes /i/ and /J/, respectively). The present study investigated the potential role of these subsyllabic components for the visual recognition of words in a perceptual identification task. In Experiment 1, we manipulated the number of phonemes in monosyllabic, low frequency, five-letter, English words, and found that identification times were longer for words with a small number of phonemes than for words with a large number of phonemes. In Experiment 2, this 'phoneme effect' was replicated in French for low frequency, but not for high frequency, monosyllabic words. These results suggest that subsyllabic components, also referred to as functional orthographic units, play a crucial role as elementary building blocks of visual word recognition.

Hearing restoration in posterior fossa tumors

OBJECTIVE

This study aimed to assess the results of hearing restoration with a cochlear or a brainstem implant in posterior fossa tumors.

PATIENTS

Six patients were selected. Two patients with an acoustic neuroma in the only-hearing ear (cases 1 and 2), one patient with a posterior fossa meningioma (case 3), one patient with bilateral facial neuroma (case 4), and two patients with bilateral acoustic neuroma (cases 5 and 6) participated.

INTERVENTION

In cases 1 and 2, the patients had a cochlear implant inserted on the only-hearing ear opposite the acoustic neuroma. In case 3, the patient presented with total deafness on the left side and a 10-mm meningioma on the right side. A cochlear implantation was performed after removal of the meningioma on the right side. In case 4, the patient was operated on on both sides with bilateral postoperative deafness. A cochlear implantation was performed on the better hearing ear. In cases 5 and 6, patients underwent an auditory brainstem implantation after the exeresis of the second tumor.

RESULTS

Promontory test results were positive for patients 1, 2, 3, and 4. After implantation, patients 1, 2, 3, and 4 scored 98%, 13%, 70%, and 30%, respectively, in open-set sentence recognition tests, whereas patients 5 and 6 scored 0% and 20%, respectively.

CONCLUSIONS

In case of nonfunctional cochlear nerve, in acoustic neuroma, either bilateral and in the only-hearing ear, promontory test should be performed. If positive results, a cochlear implantation should be performed, because successful results could be expected. Overall results of cochlear implantation on speech discrimination are better than those obtained with a brainstem implant.

IL-13 increases the cPLA2 gene and protein expression and the mobilization of arachidonic acid during an inflammatory process in mouse peritoneal macrophages

Pretreatment of mouse peritoneal macrophages with interleukin-13 (IL-13) potentiates the mobilization of arachidonic acid (AA) and the production of HETEs but does not affect the production of cyclooxygenase metabolites triggered by the suboptimal concentration of an inflammatory agonist (opsonized-zymosan). Cycloheximide suppresses these effects of IL-13 suggesting that de novo protein synthesis is involved. Indeed, IL-13 induces a time-dependent increase in the levels of cytosolic PLA2 (cPLA2) protein and mRNA. This study demonstrates a new pathway for IL-13 to modulate the inflammatory process in macrophages via modifications of cPLA2 expression and subsequent AA mobilization.

[Trans-petrous surgery in acoustic neuroma. Value of preoperative audiovestibular and facial investigation in the risk evaluation of facial nerve function]

Between 1987 and february 1994, 162 consecutive patients with acoustic neuroma were operated on by an otoneurosurgery team, using transpetrous approaches (89% translabyrinthine, 8% middle fossa and 3% retrosigmoid). The relationship between the clinical, audiometric and vestibulographic characteristics and the post-operative facial nerve function were evaluated. In acoustic neuromas with cerebello-pontine component inferior to 3 cm without central neurologic signs (ic: central controlateral auditory and/or ipsilateral vestibular pathway alteration), good post-operative facial nerve function was achieved in 80% of cases. In acoustic neuromas superior to 3 cm with alteration of the central vestibular and auditory pathways, a good result was obtained in only 30% of cases which correlated negatively with preoperative facial dysfunction. These results underline the value of preoperative facial and audiovestibular examinations in predicting the postoperative facial nerve function following surgery for acoustic neuroma.