Lateral skull base procedures, such as translabyrinthine approach (TLA), are challenging. An autonomous surgical robot might be a solution to these challenges. Our aim is to explore in an early phase the economic consequences of an autonomous surgical robot compared with conventional TLA.

An early decision analytic model was constructed in order to perform a step-wise threshold analyses and a sensitivity analysis to analyze the impact of the several factors on the incremental costs.

Using surgical robot results in incremental costs – EUR 5,562 per procedure – compared to conventional TLA. These costs are most reduced by higher number of procedures, followed by lower price of the robot, saved operation time, and reduced risk of complication, respectively.

The incremental costs of using an autonomous surgical robot can be decreased by choosing applications with a high turnover rate, a long operation time, and a high complication rate.

Socioeconomic risk factors may contribute to geographic variation in diseases, but studies are limited due to lack of large available cohorts.

A geographic analysis was performed of the association between socioeconomic risk factors and the distribution of vestibular schwannomas in adults diagnosed with sporadic vestibular schwannomas through the National Health Services in the West of Scotland from 2000 to 2015.

A total of 511 sporadic vestibular schwannomas were identified in a population of over 3.1 million. Prevalence of vestibular schwannomas were lowest in cases with good health (–0.64, 95 per cent confidence interval: –0.93,–0.38; p = 0.002) and level 1 qualifications (–0.562, 95 per cent confidence interval: –0.882 to –0.26; p = 0.01). However, these risk factors did not demonstrate consistent linearity of correlations. Prevalence was lower in people originating from European Union accession countries from April 2001 to March 2011 (–0.63, 95 per cent confidence interval: –0.84 to –0.43; p = 0.002). No correlation between distribution of vestibular schwannomas and socioeconomic risk factors met our threshold criteria (± 0.7).

This study demonstrated that there is little variation in distribution of vestibular schwannomas by socioeconomic risk factors.

To present a conservative surgical approach, via the transorbital route, for selected cases of infratemporal fossa involvement or inferolateral orbital tumours extending to the infratemporal fossa.

Case series report.

Department of ENT, CSM Medical University (King George Medical College), Lucknow, India.

One patient.

Operative feasibility, intra-operative access, post-operative morbidity and cosmesis.

This novel and relatively conservative technique provides excellent exposure in selected cases of infratemporal fossa involvement and has minimal post-operative morbidity. Cosmesis is excellent, as osteotomy is not required and scarring is minimal. There is no risk of trismus, Vth or VIIth cranial nerve injury, or cerebrospinal fluid leakage, and haemostasis is easily achieved.

Classical, open approaches to the infratemporal fossa involve considerable morbidity, while conservative approaches have their limitations. Diagnostic uncertainty over a small infratemporal fossa mass (perhaps an extension from an inferolateral orbital tumour) is an uncommon clinical challenge. The transorbital approach described is suited to benign and early malignant tumours, and has excellent results when combined with orbital exenteration (if needed). This paper discusses this approach's technical details and feasibility in different clinical situations, and compares it with other infratemporal fossa approaches.

Jugular foramen schwannomas are rare skull base tumours which typically have a variable clinical presentation. Glossopharyngeal syncope syndrome is an unusual clinical presentation; in the following case report, it was the sole presentation of an extracranial jugular foramen tumour.

The presentation of a patient with glossopharyngeal neuralgia syncope syndrome is reviewed and the pathophysiology, clinical features and treatment discussed.

A 45-year-old woman presented with unilateral throat pain, bradycardia and hypotension leading to episodes of impaired consciousness when lying on her left side or turning her head to the left. Imaging detected a left-sided extracranial jugular foramen schwannoma. The tumour was excised, and the patient had no more syncopal attacks.

Glossopharyngeal neuralgia syncope syndrome can be the sole presentation of a jugular foramen schwannoma. Although this syndrome may be treated with anti-dysrhythmic drugs, cardiac pacing or nerve section, in the presented patient excision of the jugular foramen schwannoma was successful in preventing further episodes of syncope.

To evaluate the clinical presentation and outcomes of treatment for patients with chondrosarcomas involving the skull base and temporal bone.

Retrospective review.

Tertiary medical centre.

Cases of histologically confirmed chondrosarcoma involving the skull base and temporal bones.

Surgery.

Demographic features of presenting patients; presenting symptoms and signs; surgical approach employed; use of post-operative radiation therapy; histological grade of tumour; and interval of post-operative follow up.

Results: Twelve patients were identified with chondrosarcomas involving the skull base, with post-operative follow up ranging from three to 33 years. The average age at presentation was 42 years. The most common presenting symptoms were diplopia, decreased visual acuity and headaches. Five of the 12 patients required multiple surgical procedures.

Patients with chondrosarcoma involving the skull base and temporal bone may present in a variety of ways. Surgical resection, even subtotal, in combination with radiation therapy, can often provide good tumour control over many years for these rare tumours.